Why don't CRNA's like AA's

  1. i've noticed a sense of hostility on this forum towards aa's by nurse anesthetist or student nurses of anesthesia. why so hasty? i always read on this forum about the shortage of anesthesia providers, yet some people want to block aa's from being able to do just that. i don't understand. if aa's have proven to be successful at administering safe anesthesia, why is it such an issue that they be allowed the same privileges as a crna (other than supervision). i recently read an article in another thread on this forum that seemed to be rallying for support so that they can ban the use of aa's in louisiana. i don't understand the hell-bent attitude. if there's a shortage, and there's a solution, what's the problem? if crna's are so concerned with the health of their patients, why won't they allow the shortage problem to be solved. it definitely doesn't seem to be helping the patient by having a shortage of anesthesia providers.
    Last edit by ep71 on May 18, '04
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  2. 52 Comments

  3. by   Busy20yo
    I think some people are afraid to lose their jobs to AA's.


    BTW. What is the average salary of an AA?
  4. by   mato_tom
    all about the benjamins and there is nothing wrong with various healthcare providers protecting or expanding their turf thru legal channels....its the nature of the bizness and its all about money and if you hear the association heads and lawyers that throw crap out like pt safety and access and this and that just remember to read b/w the lines and look for the dollar signs.....
  5. by   nilepoc
    Let me equate this to something you should be able to relate to if you are an RN.

    there is currently a shortage of RN's. To fix this shortage, I am going to allow anyone who is interested to become an RN. I am going to require them to have no experience and i am going to only give them positions in the ICU upon completion of their program. At the same time, i am going to cut the pay of current ICU RNs and additionally I am going to place restrictions on the practice of ICU RNs, so that I do not have to administrate more than one kind of provider.

    This is what is happening to CRNAs in some markets. AAs move in, the MDAs don't want to supervise two types of providers, so they limit the practice of CRNAs to equal the practice of AAs in that facility. Later taht year, administration asks the question why are we paying CRNAs more if they are doing the same limitted job of the AA? CRNA salaries fall, and CRNA practice deteriorates. Over time, this has the potential to become the norm in big hospital practice. It would not take many AAs in a hospital to bring about a change like this.

    IMHO this is one of the reasons CRNAs are less than friendly in supporting the practice of AAs.
  6. by   K38s
    ep71,
    Keep in mind that CRNA's have fought long and hard to maintain their level of practice. They have been attacked on just about every conceivable angle to have their practice restricted. So when AA's enter the picture under the guise of "anesthesia shortage relief" it is no wonder that this is met with some sceptisism by the CRNA community.

    Ask yourself this question. How do AA's help the anesthesia shortage in rural America (where the shortage really exsists) if no MDA is going to go there to supervise them?

    If they don't help the shortage what purpose do they serve?
  7. by   mato_tom
    Quote from K38s
    ep71,
    Keep in mind that CRNA's have fought long and hard to maintain their level of practice. They have been attacked on just about every conceivable angle to have their practice restricted. So when AA's enter the picture under the guise of "anesthesia shortage relief" it is no wonder that this is met with some sceptisism by the CRNA community.

    Ask yourself this question. How do AA's help the anesthesia shortage in rural America (where the shortage really exsists) if no MDA is going to go there to supervise them?

    If they don't help the shortage what purpose do they serve?
    AAs will take a MDA supervised job in the big city to replace a CRNA.... then the CRNA can go the the rural area to work unsupervised.

    the key question is...what % of jobs are MDA supervised....we all know CRNA do not require supervision, but how many work under supervision. let me rephrase that..........what % of crna jobs could be replaced by AAs.
  8. by   Trauma Tom
    Nilepoc

    Excellent post. I have never really looked at it the way you presented the argument in your post. It makes me want to re-examine my own feelings toward the practice of AA's. If their primary motives are indeed to decrease the shortage of anesthesia providers I am less inclined to be against their practice. However, if they are part of a organized plan by anesthesiologists to limit the practice of CRNA's then I too, as a soon to be SRNA will be less than supportive of the practice of AA's. I do not want to see anything that is going to erode the practice of CRNA's. This profession has provided a vital service to patient's everywhere and to limit the scope of practice of CRNA's would be a tremendous step backwards in thr delivery of safe and competent care to patients in need of anesthesia care.
  9. by   gaspassah
    they are part of a organized plan by anesthesiologists to limit the practice of CRNA's
    this is the deal. no 2 ways about it. control of the money. bill the same dollar to patient, pay less money to aa who does the case = more money in mda pocket. mda has no fear of aa they MUST be supervised by law. less work for mda, more money for mda. hmm......plus cut competition of alternate provider (crna) = whole or most of the market.
  10. by   user69
    Quote from k38s
    ep71,
    keep in mind that crna's have fought long and hard to maintain their level of practice. they have been attacked on just about every conceivable angle to have their practice restricted.
    i thought that the push was for expanded practice, not to stay at the status quo. that is why so much lobby power has been thrown behind the opt out options for states.
  11. by   Sheri257
    Quote from nilepoc
    Let me equate this to something you should be able to relate to if you are an RN.

    there is currently a shortage of RN's. To fix this shortage, I am going to allow anyone who is interested to become an RN. I am going to require them to have no experience and i am going to only give them positions in the ICU upon completion of their program. At the same time, i am going to cut the pay of current ICU RNs and additionally I am going to place restrictions on the practice of ICU RNs, so that I do not have to administrate more than one kind of provider.

    This is what is happening to CRNAs in some markets. AAs move in, the MDAs don't want to supervise two types of providers, so they limit the practice of CRNAs to equal the practice of AAs in that facility. Later taht year, administration asks the question why are we paying CRNAs more if they are doing the same limitted job of the AA? CRNA salaries fall, and CRNA practice deteriorates. Over time, this has the potential to become the norm in big hospital practice. It would not take many AAs in a hospital to bring about a change like this.

    IMHO this is one of the reasons CRNAs are less than friendly in supporting the practice of AAs.
    What if the states required more AA training and experience, more along the lines of what CRNA programs require? Would the same thing happen in that scenario?

    Last edit by Sheri257 on May 19, '04
  12. by   athomas91
    What if the states required more AA training and experience, more along the lines of what CRNA programs require? Would the same thing happen in that scenario?
    this is what CRNAs want to see IF AA practice is going to be....but - why - if you are going to train AA's more like CRNA's don't you just train more CRNA's.....why isn't the ASA throwing their money behind more CRNA's.....THAT IS YOUR ANSWER....


    Nipeloc - excellent post and very vivid example. thank you.
  13. by   Sheri257
    Quote from athomas91
    this is what CRNAs want to see IF AA practice is going to be....but - why - if you are going to train AA's more like CRNA's don't you just train more CRNA's.....why isn't the ASA throwing their money behind more CRNA's.....THAT IS YOUR ANSWER....
    Of course they're going to promote their own self interests, just as CRNA's do. Do you really expect MDA's to spend more money on CRNA's when they can't profit from it? Of course not. Just as CRNA's don't spend their money on the MDA agenda because they don't profit from it.

    I really wonder if CRNA's should be lobbying for more AA training instead. This all or nothing approach could really bite if AA's win more legislative battles.

    Think about it: As it stands now, CRNA's are trying to stop the whole thing. If they fail, like they did in Florida, you have more AA competition since only two years of school is required.

    Instead: If you say, sure, let them in, but we need to require more training, there's all kinds of advantages to that:

    * You don't look like you're trying to wipe out the competition which, IMHO, hurts the CRNA position, especially since there's a shortage.
    * Legislators could be more inclined to require more training since that's usually viewed as a positive thing, and they can still help out their MDA friends who want AA's.
    * More training would limit the competitive effects of AA's since, as we all know, more educational requirements tend to impose more limits on the labor pool.
    * And, it would add more credibility to the CRNA arguments about training, since you would be lobbying for that, rather than trying to eliminate AA's all together.

    Yes, it's a compromise, but five to ten years down the road, you might be in a much better situation than AA's practicing with just the two year requirement. And it might be easier to accomplish this now rather than trying to convince legislatures to revisit the issue and impose more requirements down the road. It could become especially difficult if AA's are established in more states.

    Just an idea which, as I've mentioned previously, is what the D.C. CRNA's are trying to do.

    :wink2:
    Last edit by Sheri257 on May 20, '04
  14. by   user69
    I wonder if this argument would have ever come up if they had made it where AAs were supervised by MDA or CRNA?

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