AA vs. CRNA - Let's Discuss.

New CCU RN · Apr 30, 2003

Originally posted by warzone
Well then AAs are dead in the water, if it can't be marketed as a viable option. Would the AA profession have been 'created' if there was no viable way to market it? I highly doubt that the role of AAs, if given the right amount of time, will stay stagnant. If they are directly supervised by MDAs, and proven reliable, why would they not be afforded more autonomy?

There is a shortage of all different health care positions, so I am sure that the AA will fall into place in some ways. Will the AA become anywhere equivalent to the scope of practice of a CRNA...I highly doubt it. Will the AA's be inserting Swan Ganz and A-lines, also highly doubtful. Will AA's be code blue responders like CRNA's often are... quite doubtful. Will they have an independant practice... as long as they have the title "assistant", they will be just that.... an assistant to the MDA.

Are AA's a threat to CRNA's... also highly doubtful. CRNA;s administer over 65 % of the anethesia in the US. There are a growing number of anethesia positions that are becoming open for both CRNA's and MDA's. AA's can be an assistance... but no where near that of a CRNA. Do remember that AA's will always in every circumstance be practicing under the MDA's license....they will be limited and unable to make many decisions.. ie) type of anethesia, etc.

Will AA's gain more autonomy. CRNA's like Louisane said are practicing nursing. They have their own organizations ie) the AANA that have been lobbying and advocating for the autonomy of CRNA's. AA's are still a part of the AMA thus controlled under doctors. Their autonomy will be limited as they have no voice. They are assistants and I honestly see their position staying that way... a handmaiden to the MDA.

EmeraldNYL, BSN, RN · Apr 30, 2003

Here's an interesting article from the ASA newsletter that is worth reading:

http://www.asahq.org/Newsletters/2003/04_03/ventilations04_03.html

I highly recommend that you guys check out the anesthesiology forum on studentdoctor.net, they are saying the exact thing about CRNA's as we are all saying about AA's.

Bottom line: How can we all work together as a team to provide safe patient care while still preserving the uniqueness and importance of the CRNA profession?

EmeraldNYL, BSN, RN · Apr 30, 2003

oops, double post, my bad!

warzone · Apr 30, 2003

Thanks Emerald!

From that Forum:

"Check out http://orlando.bizjournals.com/orla.../17/story6.html .

I think it's hilarious that CRNA's, having been made almost totally independent in some states, have failed to actually deliver on anaesthesia care in underserviced areas (surprise! they like to work in cities too)...but are more than willing to fight tooth and nail against other practitioners such as AA's.

They have the audacity to argue is that AA's will threaten public safety, and that they don't have rigorous enough training and experience! But they are silent on who's going to provide the care in low-renumeration areas.

Give me a break!

I'm actually a soon-to-be rads resident in Canada so I don't pretend to know all the issues. (We don't have CRNA legislation here, but resp therapists seem poised to fill the void). However, I think organized anaesthesiology will have to consider carefully which type of non-physician provider to support (not whether ). It seems that AA's want to work with BC'd anesthesiologists -- I think it will be easy to sell this concept to the public and in the long run beneficial for the profession.

Thoughts?"

New CCU RN · Apr 30, 2003

Except that the practice of nurse anethesia has been tried and proven true. There are so many studies out there indicating that CRNA and MDA patient outcomes are the same.

In addition: an AA's education requires a 4 year degree in whatever..could be philosophy, the med school requirements such as physics, bio, orgo, and chem, subpar mcat scores (20-22), then two years getting a masters.

CRNA education requires a four year nursing degree, at least a year of critical care experience, and then 2-3 years of masters programs.

MDA education requires four year degree, four years med school, 3-7 years of post graduate education (residency).

Just thought I should clarify the requirements...

As far as "getting along with the MDAs", while a positive workplace environment is a good thing, there should be no hostility, what is wrong with standing up for your profession and pushing for autonomy. Please don't tell me you'd like to go back to the days when a holier than thou MD walked in the room and we all jumped to our feet holding out the chart for them, when orders werent questioned...please.

All I have to say about the posted article is that you need to CONSIDER THE SOURCE. Many of those stats that are mentioned and many of his arguments are not even valid. And ya know what let the "studentdoctorforum" say whatever they would like, I am not sure you really can even have a valid argument about position in healthcare until you've worked in it. I am sure the elated egos of the student doctors will change once they are thrown into their residencies and realize what little they really do know.

New CCU RN · Apr 30, 2003

Anesthesia

Wisconsin Medicaid-covered services provided by a certified registered nurse anesthetist (CRNA) or an anesthesiologist assistant (AA) include those anesthesia services prescribed by a physician within the scope of practice permitted CRNAs and AAs by their professional standards of practice.

Supervision Requirements

Nurse anesthetist and anesthesiologist assistant services must be provided in the presence of a supervising anesthesiologist or a performing physician, according to HFS 107.065, Wis. Admin. Code.

For billing purposes, CRNA and AA services are considered either medically directed or medically supervised. Anesthesiologist assistants must work under the medical direction of an anesthesiologist who is physically present during the provision of services. Nurse anesthetists may be either medically directed by an anesthesiologist or medically supervised by the attending physician.

Medically Directed Anesthesia Services

Medically directed anesthesia services are those services performed by a CRNA or an AA and directed by an anesthesiologist. When a CRNA or AA is medically directed, the anesthesiologist must do all of the following:

Perform pre-anesthesia examination and evaluation.

Prescribe the anesthesia plan.

Personally participate in the most demanding procedures of the anesthesia plan, including induction and emergence, if applicable.

Monitor at frequent intervals the course of anesthesia administered.

Remain physically present and available for immediate diagnosis and treatment of emergencies.

Indicate post-anesthesia care.

Medically Supervised Anesthesia Services

Medically supervised anesthesia services are those services performed by a CRNA and supervised by the attending physician. When a CRNA is medically supervised, the attending physician:

Reviews and verifies the pre-anesthesia evaluation performed by the CRNA.

Reviews the anesthesia plan, including medication.

Reviews and comments during pre-anesthesia care.

Reviews and comments during post-anesthesia care.

Medically Directed vs. Medically Supervised Anesthesia Services

For medically directed anesthesia services, an anesthesiologist is present during critical points in the procedure and is immediately available for diagnosis and treatment of emergencies. However, when a CRNA is medically supervised by the attending physician, an anesthesiologist does not have to be present during critical points in the procedure or immediately available for diagnosis and treatment of an emergency.

Anesthesiologist assistants must perform services under the medical direction of an anesthesiologist. Therefore, they cannot perform medically supervised anesthesia services

http://www.dhfs.state.wi.us/Medicaid2/handbooks/nurse-anes/services.htm

meandragonbrett · Apr 30, 2003

I don't visit studentdoctor.net anymore....I blocked the website! Like New CCU said, there's no sense in talking to them about it!

Brett

CRNA, DNSc · May 1, 2003

WarZone- I suggest you get your figures straight on where CRNAs work. Yes many of them work in the cities but over 2/3 of rural hospitals in America have CRNA as the only anesthesia providers delivering anesthesia services. CRNA participate in over 65% of the MILLIONS of anesthetics given in the US each year. AA will not improve access to anesthesia services since they will not be working in those 2/3 of rural hospitals where there is no anesthesiologist. As for working in those cities-take a good look at who is working in those urban hospitals with high percentages of uncompensated care- usually CRNAs under the team model but not the anesthesiologist doing his own case since the reimbursement is not sufficent because of the uncompensated care.

New CCU RN · May 1, 2003

Originally posted by CRNA, DNSc
WarZone- I suggest you get your figures straight on where CRNAs work. Yes many of them work in the cities but over 2/3 of rural hospitals in America have CRNA as the only anesthesia providers delivering anesthesia services. CRNA participate in over 65% of the MILLIONS of anesthetics given in the US each year. AA will not improve access to anesthesia services since they will not be working in those 2/3 of rural hospitals where there is no anesthesiologist. As for working in those cities-take a good look at who is working in those urban hospitals with high percentages of uncompensated care- usually CRNAs under the team model but not the anesthesiologist doing his own case since the reimbursement is not sufficent because of the uncompensated care.

Thank you CRNA, DNSc! You are absolutely correct.

EmeraldNYL, BSN, RN · May 1, 2003

Originally posted by New CCU RN
As far as "getting along with the MDAs", while a positive workplace environment is a good thing, there should be no hostility, what is wrong with standing up for your profession and pushing for autonomy. Please don't tell me you'd like to go back to the days when a holier than thou MD walked in the room and we all jumped to our feet holding out the chart for them, when orders werent questioned...please.

I certainly never implied that there was anything wrong with standing up for your profession or pushing for greater autonomy. However, if we want to make a valid argument against AA's, we really need to consider the argument FROM ALL SIDES. Simply arguing that we don't want AA's taking CRNA's jobs isn't going to fly. So, we need to carefully consider the opposing argument and determine if they have any valid points in order to remain competitive. What can CRNA's do in order to remain competitive? Why aren't there more CRNA's with phD's doing anesthetia research? How can we prove that CRNA's are better providers than AA's? Just trying to play devil's advocate a little.... :)

New CCU RN · May 1, 2003

I never said that my argument is based upon not wanting AA's to take CRNA's jobs. Nor is there a problem with seeing the argument from all sides. AA's bring another anethesia provider to a shortage, which is a postive thing. However, there are some major things that seperate CRNA's from AA's and that is what I have been reiterating on this post: These are the same things that thus make CRNA's more competitive:

1) CRNA's are practicing nursing, with a nursing license while AA's are practicing medicine under the direction of a MDA

2) More clinical background

3) CRNAs can independantly establish a plan of care and implement it, AA's need the MDA to decide what anethestic to use and also need the MDA to frequently update on the process as well as assess the patient's status. Any intervention must be done under the direct supervision of the MDA

4) Haven been proven to have equal patient outcomes as the docs as well as a long history--- look into the history of CRNA's they were actually around before there was a physician specialty of anesthesia!!

5) CRNA are in the rural areas, assisting with a great needed area

6) As it stands now CRNAs administer 65 % of anethesia in the US---- they are doing this without having to ok every move with the MDA---can you imagine if CRNA's were replaced with AA's and the docs were thus taking on all of that responsibility which had been taken off their shoulders

What can CRNA's do to remain competitive:

Well the number one thing is to continue with such efforts as the AANA has made for CRNA's. We need a voice and the AANA is a powerful one.

Advancing education is definitely important and there are phD programs out there. You don't need your doctorate to support and participate in research though... check out some of the work that the AANA is currently doing.

As far as proving CRNA's care to be better than AA's---well, I don;t know that any MDA;s would recommend a AA over an MDA. Thus MDA's conclude their care to be superior than that of an AA. Studies have already shown that MDA's and CRNA's outcomes are equal with the same patient outcomes, so in a sense it isn't even an argument, it is a given. A direct study actually stating this would be beneficial, however, AA's haven't quite been around long enough to have much of an opportunity to examine patient outcome. However, I am sure that it will be a topic that CRNA's will be eagerly researching and debating.

loisane · May 1, 2003

I think warzone was quoting "the oposition" and their view on where CRNAs work. I don't think he was saying he agreed with this view, only pointing out the one of the arguments made against us.

I think it is great that so many on this forum can list the favorable attributes of CRNAs vs AA. But when making a persuasive case, remember your audience. Some of the things you list, only matter to us and nursing. The people we have to convice are the public, and elected officials. And they are heavily influenced by organized medicine's point of view.

Not to pick on New CCU RN, but just to use that list as an example:

1) CRNA's are practicing nursing, with a nursing license while AA's are practicing medicine under the direction of a MDA

So what? ASA says that it is better if a physician is in complete control.

2) More clinical background

But the MDA has lots of clinical background, and he is in charge.

3) CRNAs can independantly establish a plan of care and implement it, AA's need the MDA to decide what anethestic to use and also need the MDA to frequently update on the process as well as assess the patient's status. Any intervention must be done under the direct supervision of the MDA

Hey, that is a GOOD thing from their point of view. They WANT the MDA to be involved in every aspect of the case.

4) Haven been proven to have equal patient outcomes as the docs as well as a long history--- look into the history of CRNA's they were actually around before there was a physician specialty of anesthesia!!

You are right that our long history helps, but does this really convince a state legislator that he should vote against letting AAs practice in his state?

5) CRNA are in the rural areas, assisting with a great needed area

Now this is a good one that we can use. There are hospiatals where anesthesia is provided completely by CRNAs. AAs won't help the provider shortage there.

6) As it stands now CRNAs administer 65 % of anethesia in the US---- they are doing this without having to ok every move with the MDA---can you imagine if CRNA's were replaced with AA's and the docs were thus taking on all of that responsibility which had been taken off their shoulders

Yes, they can image it. THIS IS EXACTLY WHAT ASA WANTS!!!!

Great discussion here. Keep it up. Keep learning the issues. This is complex. DO NOT make the mistake of thinking this is no big deal, we can safely ignore it. The more and more you learn, the better you will be able to see the big picture.

loisane crna