AA question

[manowar88]

Hello, I have recently been accepted into CRNA school and will start this fall. I have been involved in a discussion in a nursing synthesis class this semester and I want to pose some of the discussion to the forum and get some feedback. The discussion goes as follows: Some of the issues facing CRNA's are the same as for the entire nursing

profession. The shortage of CRNA's is a current issue as many of the

CRNA's reach retirement age and school admission is limited. To combat

the problem, there are more CRNA schools opening to accomodate the

shortage and some schools are admitting more students each year.

Another solution found here in Georgia, or atleast the Atlanta area is

that the CRNA positions are being filled by AA's. For CRNA's in the

Atlanta area, this competition translates into having Ga CRNA salaries

being one of the lowest in the nation when compared to other states.

From what I understand, there is great animosity between CRNA's/AA's/and

physicians in this area. The doctors seem to like the use of AA's

because they have more control over them as they cannot practice alone

and are limited as to where they can practice. However, this may not

always be the case as the AA's lobby to gain rights in many other

states, the CRNAs may see greater competition for employment and

salaries. However, I do not think employment will be an issue for

quite some time given the shortage, but something to think about for the

future. Salaries on the other hand are already becoming an issue.The

hospitals I have had the opportunity to visit carry a ratio of 80-85%

AA's over CRNA's and the majority of the CRNA's are 45+ years old. ------------------I am primarily interested in the forum's thoughts on AA's and their possible threat to CRNA's. Is their a rivalry? Do you think they will affect CRNA hiring and salaries? How many work in the OR at your place of work? Thanks for the feedback and I will pass it on to my classmates....

[loisane]

I thought we had discussed this recently, but when I went back to find the threads, it has been longer than I thought. Here they are, for you reference

https://allnurses.com/forums/showthread.php?t=38006

https://allnurses.com/forums/showthread.php?t=35911

At that time, I was quite surprised at the near apathetic tone many of the posters took. AANA is quite motivated about the AA issue, as are many individual CRNAs.

You seem to have a very good grasp of the realities of the situation right now. It is a non- issue many places outside of Georgia or Ohio, RIGHT NOW. But that could change at any time, it has been discussed in many states. So we need to stay on top of it.

loisane crna

[Jedav]

Is it true that Florida just approved the "use" of AA's also? Thought I heard this in class the other day-must confess I haven't had time to confirm this.

Loisane, from your posts my impression is that you are very proactive-so I'm looking for some advice...What "specifically" ( I need action statements :) ) can we as students, soon-to-be CRNAs, do to voice our opinions to support the position of CRNAs in the face of AAs?

Thanks!

Jedav

[user69]

Here we go on another AA train. I wonder if the AA boards have the same number of resuring questions about CRNAs?

[mato_tom]

Here we go on another AA train. I wonder if the AA boards have the same number of resuring questions about CRNAs?

the AA boards dont because there is not enough of them,,but the MDA boards sure do......in florida there is a fast track bill to license AAs just like there has been every year for along time.....more than likely it will pass eventually. The anesthesia pie is a big one that the MDAs want more of......its not about safety

or access or anything is about money and politics and the battleground is in state and fedral governement and the bullets are dollars and time given to your association.........

two questions I have:

i know the CRNAs have more autonomy but when i look at gasworks under job descriptions it seems the majority of positions say they will be under the direction of an MDA 100% of the time............how would the role of an AA and CRNA differ in this scenario? Honest question that i dont know the answer to

How hard wold it be to make AA a specialization of PA or intergrate AA into PA schools.... i would assume that all that is missing is facilites and educators, big stuff i know, i would guess the MDAs and AMA would be willing to foot some of the bill for this stuff.

I have not gone back to read the various threads on AA's but i would hope that the prevailing opinion of CRNAs is that the "threat" is real.

[Sheri257]

Another solution found here in Georgia, or at least the Atlanta area is that the CRNA positions are being filled by AA's. For CRNA's in the Atlanta area, this competition translates into having Ga CRNA salaries being one of the lowest in the nation when compared to other states.

Thank you. This is the kind of information I've been looking for. I need to know where this trend is going before I invest in a CRNA education. When you say some of the lowest salaries in the nation, exactly how low? If it's similar to PA's driving down NP salaries into the $80,000 range, that's important info.

I personally don't underestimate the power of the physicians lobby on this issue. An attorney friend of mine, who represents CRNAs, is dealing with a similar issue in Washington D.C., where there's a big push for AA's there as well.

[loisane]

Yes, this is a topic of much discussion among CRNAs. I believe it to be one of the important issues of our time.At the federal level, this is one of many issues that our national association tracks.

But state law is really more important to the issue of AA practice. All state CRNA associations should be keeping an eye on the issue in their particular state. It is a hotter issue in some states than others. This has been an issue under heavy discussion in Florida for some time, and other states as well.

Jedav, the best action you can take is to get involved in your state organization. Even if you are a student, it is not too early. Many states are reaching out to students, to foster relationships that will continue past graduation. And I mean real involvement. Go to meetings, and not just the parties, or even the education components. I mean the business meetings, and the board meetings. Work on committees. Get involved in PR projects. Get educated to the issues and the most effective way to respond to opposition views.

Think global and act local. It really does make a difference.

loisane crna

[loisane]

i know the CRNAs have more autonomy but when i look at gasworks under job descriptions it seems the majority of positions say they will be under the direction of an MDA 100% of the time............how would the role of an AA and CRNA differ in this scenario? Honest question that i dont know the answer to[/quote=mato_tom]

By education and state regulations, CRNAs may work independently of MDAs. The types of practice arrangements you see will be influenced by reimbursement patterns, market forces, local needs, individual's philosophy, etc.

Isn't gasworks on a MDA sponsored site? I wouldn't expect independent CRNA positions to be advertised there. Gasworks is not the only place to find a job.

How hard wold it be to make AA a specialization of PA or intergrate AA into PA schools.... i would assume that all that is missing is facilites and educators, big stuff i know, i would guess the MDAs and AMA would be willing to foot some of the bill for this stuff.[/quote=mato_tom]

It is my understanding that what you propose WOULD be a big deal. PAs and AAs are two entirely different sorts of providers. (This distinction has been blurred some by the fact that one of the AA programs is titled with terminology that makes it SOUND like a PA program, and the fact that there are a very few individuals who carry dual certification as an AA AND a PA). PAs programs are accredited in a separate way. PAs are certified in a different way. It is program accreditation, and provider certification that determines what type of provider a person is.

loisane crna

[deepz]

......i know the CRNAs have more autonomy but when i look at gasworks under job descriptions it seems the majority of positions say they will be under the direction of an MDA 100% of the time............how would the role of an AA and CRNA differ in this scenario? .........

Two points: the majority of open positions on gasworks advertizing may mean that those 100% directed positions are revolving doors, i.e. 'dumbed-down' subjugated CRNAs are what those MDAs demand. High turnover, therefore the need to advertize. Really good positions often are filled by word-of-mouth networking. Chronic continuing ads may signal a bad shop.

Second, though state laws generally require a higher standard of in-house supervision for AAs, since AAs do lack the background and independent provider credentials of CRNAs, in fact, in most of the (admittedly few) AA practice situations out there, the MDAs stretch the rules and ignore the laws, using AAs and CRNAs interchangeably.

deepz

[Sheri257]

The MDAs stretch the rules and ignore the laws, using AAs and CRNAs interchangeably.

deepz

This is what my D.C. friend is fighting: Illegal use of AA's and physicians pushing to make it legal. Maybe illegal use of AA's is more common than people think?

[gaspassah]

it's my humble opinion that a few high profile AA screw ups with some dire patient outcomes would bring a little light to the subject (heaven forbid). please dont think this is what i'm looking for, but the fact remains that if AA's are being used interchangably with crna's, screw ups are bound to happen. unfortunately these types of situations have to occur before ppl of power wake up to see the light.

d

[athomas91]

in the long run - AA's will cost more than a CRNA - you basically need a doc to oversee/authorize/give all orders...and (i may be wrong) - but i had read that there was a bill/law that one MDA could only oversee 2 AA's at a time - or that one was trying to be passed... how in the world can they think that this will be monetarily beneficial - or even more important how will it benefit pt care. the only motivation i can rationalize is power- which in the long run WILL endanger a pt.

I am sad to hear that this is being looked at in Florida...i am looking to move there upon graduation.