AA vs. CRNA - Let's Discuss.

[warzone]

Let's have a discussion/debate (although it will probably be one sided) about AA vs. CRNA. These are just some topics I thought of off the top of my head. Any input or 'playing devil's advocate' would be appreciated.

- What is the difference in schooling/certification/academics?

- What is the difference in their scope of practice or autonomy?

- What economic factors are behind the push of AAs, if any?

- Can we relate this situation to another in Healthcare? Possibly LPN vs. RN?

- What are the best and worst case scenarios for CRNAs in the future, as it pertains to AAs vs. CRNAs?

- Why should one become a CRNA, rather than an AA?

- How does the MDA benefit from the increased use of AAs vs CRNAs?

- How does all this factor into the level of care a patient receives?

We need some AAs or MDAs to log on here to stir up the pot.

This is probably an emotional subject for some, but let's keep it civil. Ultimately we are all on the same team...I guess everyone just wants to be the MVP.

Who wants to cast the first stone?

[keermie]

loisane,

In reply to your post when AA legislation is introduced in my state . . .

Part of being a professional is being an active member in your organization. There is nothing wrong with debate, just how it is done ie misinfo, generalizations, paranoia . . .. ASA/AANA do well to their respective professions, so to ignore it is not an option as a participating member. I plan to participate.

Now to support or oppose . . . ? I would oppose because:

1) the shortage can be averted by increasing enrollment in est. SRNA/residency programs by a number of different options.

2) although MDA's believe that CRNA's believe that AA's do not justify their practice with their educational backgrounds; the AA as I understand it has little health care experience at all. I have tremendous respect for those who complete medical school. I also respect nursing school and the tough critical care arenas where CRNA's gain exposure, experience, critical thinking, as well as encompassing all the aspects of health care.

3) it adds a third providor that if there were not a shortage, would be a nonfactor

4) AA is a valid alternative, albeit it were not more than a strategic lobbying effort which evades the real issue which is clear and defined roles for both providors implored in a variety of clinical settings.

There is a middle ground, but I do not think it is AA's. If you allow AA's, it increases the rift between MDA's and CRNA's. AANA continues to push harder for expanded roles to offset shadowed roles by AA's. ASA cont to push harder to limit CRNA and promote AA's until the point where they are strong enough to establish their own professional organization: AAAEE (anesthesia assistants against everyone else). The misfocus of the debate will perpetuate and cloud the issue, until the only people who suffer are the ones like me who try to make sense of it all!

Just my $0.02.

[CRNA, DNSc]

I would highly recommend that you buy or borrow a copy of "Watchful Care: A History of America's Nurse Anesthetists by Marianne Bankert and read it. You will see a century of physician attempts to control anesthesia practice by a number of different methods, legal, legislative, regulatory, accreditation, slander, etc. Then ask why CRNAs are leary of of the ASA's push of AAs!!!!!

[warzone]

A special thanks to Tenesma for the differing view point. I think it's very beneficial to have an MDAs persepective in this discussion...however unpopular it may be.

[keermie]

Thank you for the advice. I really hope to gain a better understanding of the issue, and the book seems like a great place to start.

[meandragonbrett]

Originally posted by keermie

I do not look forward to animosity in the clinical arena.

From what I have seen myself, there doesn't seem to be noticeable animosity on the clinical field. It seems to be more on the political playing field. Has anybody else seen otherwise? Just wondering!

Brett

[KSCRNA]

Tenesma,

Where do you get your statistic that anesthesiologists are involved in 90% of all anesthetics. In Kansas, mostly rural, CRNAs do 65% of all anesthetics WITHOUT an anesthesiologist, primarily because they do not want to go to the rural areas.

I work with and for MDAs and we have a good collegial and trusting relationship. I don't think many of them buy into the radical rhetoric and misinformation of Dr. Lema with the ASA.

[smiling_ru]

Just to add to the Kansas info, this link takes you to a map that shows anesthesia care by county and provider. It may well be that 90% of anesthetics provided to Medicare patients had anesthesiologist involvment, and the reasons would be two fold.

1. Higher number of patients in the urban facilities.

2. The Medicare requirements for reimbursement, while those requirements only applied to hospital employeed CRNA's most hospitals wrote policies which included the medicare language...hence the 90% number. ( this is what the states are opting out of). But, as you know anesthesiologist involvment could mean a little or could mean a lot, there is no way to tell. That statistic was applied only to medicare/medicade patients.

At any rate this is the link to the kansas provider map.

http://www.kana.org/pdf/AnesthCovMap03.pdf

[no-pain]

Found this in the Denver Post 5/22/03. Not totally related to this thread but found it to be of some significants.

Title = Doctor shortage stalling surgeries

http://www.denverpost.com/Stories/0,1413,36~33~1407024,00.html