Anyone have any experience with anesthesia assistants compared to CRNAs ?

jwk · Jun 25, 2005

The main difference I have seen is that an AA is an assistant, they can assist MD's and even do procedures if there is a doctor in the house to fall back on. In some hospitals this is how it is with CRNA's, they assist the MD's, watch easy cases for doc's, etc. The hospital I'm doing clinicals in right now for nursing school is like this. MD's do all the inductions, spinals, edidurals, etc. and the CRNA's come in and maintain once the MD gets things the way he wants it. The DIFFERENCE is this, a CRNA who doesn't like this arrangement can go elsewhere and as a licensed practitioner he may work in a hospital where there are no MD's doing anesthesia. A CRNA can do it all and can even start his own group practice. Now this is usually done in rural area's mind you but a CRNA has the CHOICE. My opinion is that having more choices in life is always the way to go. You may not mind assisting an MD but after doing it for 10 years you might like the opportunity to strike out on your own and not always have an MD running your cases. By the way JYK, this is just my opinion and I respect ALL anethesia providers AA's included. I just find the CRNA route more appealing the me personally because I like autonomy and being my own boss and I love the country I hope this is usefull, good luck in all your endeavors!:)

The anesthetist actually comes in after the case is started? That would suck.

I think the biggest misconception about AA's is that there is always an MD standing over us holding our hands. It simply doesn't work like that. Are they around? Yes. Does my group do the 7-requirement TEFRA thing? Yes. But I pick the agents/drugs I want to use, push my own drugs, intubate, and manage the case. My current group does not have any anesthetists doing regionals and central lines, but my former group had us doing both, and many groups still do.

Every practice has it's quirks and policies - they're all different. I certainly don't begrudge the small-town independent CRNA. I know some that cover several small hospitals in south Georgia, but they're on call 24/7 for several places. To each his own - that would drive me nuts.

Except in smaller towns and cities, AA's and CRNA's often have their choice of places to work. Some choose to work in a heavily medically directed practice and others choose to work independently, or anywhere in between the two extremes.

sandman1 · Jun 25, 2005

Not trying to make a point here, just clarifying some issues that have come up on this blog and trying to inform the uninformed. This information came off of the Case Western Reserve AA school website.........

The main difference that I see is that an AA is required to work under the supervision of an MD who knows(or thinks they know) more than them about anesthesia(ie an anesthesiologist), while an anesthetist has to work under the supervision of someone with MD behind their name even if they don't know diddly squat about anesthesia.

"What is the average salary for a new graduate?Salaries vary depending on the experience of the individual and the regional cost of living. The average starting salary for a newly graduated Anesthesiologist Assistant is approximately $90,000 for a 40-hour work week plus benefits and consideration of on-call activity. An increase of approximately 5 to 15% should be expected after the first 1 to 2 years post graduation. Salaries are comparable to compensation paid to Certified Registered Nurse Anesthetists (CRNA) nationally.

Is the job description for the Anesthesiologist Assistant (AA) profession equivalent to that for a Certified Registered Nurse Anesthetist (CRNA)?Yes. When AAs are employed within the same organizations as CRNAs, the job description is usually identical. One fundamental difference is that AAs must work under the medical supervision of a licensed anesthesiologist. Conversely, in some unique clinical settings (usually not at tertiary care centers), a CRNA can practice under the medical supervision of any physician (not necessarily an anesthesiologist)."

Laughing Gas · Jun 26, 2005

We're not the same. Thank god.

Indeed! I would hate to throw away my years of experience needed to qualify for CRNA. If we were all AA's, that time spent would have been wasted on silly ICU patient care. Too bad I didn't know about this AA stuff before. I could have saved years of education and experience. I am just glad someone invented NURSE anesthesia for those of us who were unaware of the AA fast track. :rolleyes:

rn29306 · Jun 26, 2005

Not trying to make a point here, just clarifying some issues that have come up on this blog and trying to inform the uninformed. This information came off of the Case Western Reserve AA school website.........
The main difference that I see is that an AA is required to work under the supervision of an MD who knows(or thinks they know) more than them about anesthesia(ie an anesthesiologist), while an anesthetist has to work under the supervision of someone with MD behind their name even if they don't know diddly squat about anesthesia.

whats up GSU?

jwk · Jun 26, 2005

Indeed! I would hate to throw away my years of experience needed to qualify for CRNA. If we were all AA's, that time spent would have been wasted on silly ICU patient care. Too bad I didn't know about this AA stuff before. I could have saved years of education and experience. I am just glad someone invented NURSE anesthesia for those of us who were unaware of the AA fast track.

Gee, I thought your requirement was just one year. I know two SRNA's right now who had just 6 months of ICU experience when they were accepted into their programs, although they had a year by the time they started.

AA programs aren't fast-track. Same time as most CRNA programs. Many of the students have clinical experience in other fields, some don't. Maybe we use the time we have in school better, I dont' know.

The OP's initial comment was that "...if AA's are the same..." We're not. Never claimed to be, never will. Similar? Obviously. Identical? No. Why do you have such a problem with that?

sandman1 · Jun 26, 2005

The problem is...and I'm sure you've been through this 1000 times, CRNA's already have at least 4 years of healthcare education and at least 1 year of critical care experience (but the average is 5) while some AA's have none. Most people would not have such a problem with it if AA's were required to be PA's first, or EMS or something. Again, I've seen good and crappy providers in both fields BUT.... CRNA's already have experience titrating drips, interpreting hemodynamics, conscious sedation, coding people, understanding of pathophysiology, knowledge of medical equipment, pharmacology, ........and the list goes on........ and AA's have to learn all of that PLUS anesthesia.......and the length of education is the same???? You have to admit that is SCARY. I'm not saying AA's suck or they don't know what their doing or anything of the sort........I'm just saying that is the problem that people have with it. I mean how can you not know what normal blood pressure is and 2.5 years later be safely administering anesthesia? There is NO WAY that AA's, on average, coming out of school are at the same level as CRNA's. Sorry, but IMPOSSIBLE. There are many excellent AA's but the slack healthcare background admission standards are an insult to the complexity of anesthesia and make the AA profession as a whole questionable as far as safety is concerned .

Gee, I thought your requirement was just one year. I know two SRNA's right now who had just 6 months of ICU experience when they were accepted into their programs, although they had a year by the time they started.
AA programs aren't fast-track. Same time as most CRNA programs. Many of the students have clinical experience in other fields, some don't. Maybe we use the time we have in school better, I dont' know.
The OP's initial comment was that "...if AA's are the same..." We're not. Never claimed to be, never will. Similar? Obviously. Identical? No. Why do you have such a problem with that?

Laughing Gas · Jun 26, 2005

Gee, I thought your requirement was just one year. I know two SRNA's right now who had just 6 months of ICU experience when they were accepted into their programs, although they had a year by the time they started.
AA programs aren't fast-track. Same time as most CRNA programs. Many of the students have clinical experience in other fields, some don't. Maybe we use the time we have in school better, I dont' know.
The OP's initial comment was that "...if AA's are the same..." We're not. Never claimed to be, never will. Similar? Obviously. Identical? No. Why do you have such a problem with that?

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ALL CRNA's have patient care experience. Yes a small minority have less than a year. But that is still a year more than is necessary for AA. Not to mention the four years that they spent in school was based on health care academia, not art appreciation. I have a total of 12 years with 8 as an RN. Can you tell me that my time spent in OR, ER, MICU, SICU and ICCU can be rivaled by a 2 year AA program? Are we similar? Yes. Kias and Mercedes are both cars with alot of similarities. The details make the difference. Do I resent the fact that someone wants to circumvent the tried and true system to become an anesthetist? Yes. AA is a fast track. Anything that cuts years off a professional training is a fast track. It is the path of least resisitance. That is why I have a problem with this compact fast track. I will continue to fight in any venue to protect CRNA's practice. If you want to become an anesthetist, go to CRNA school. It is the standard for a reason.

NeuroNP · Jun 26, 2005

OK, I have a question. This is not meant to add fuel to the fire that already exists, so if you can't give me a straight and honest answer to a serious question, don't bother replying.

I've been reading a bit on AAs and I've seen (I don't know if this iss true or not) that AAs are required to do almost 2x the number of cases during training as CRNAs. I understand that "most" CRNAs do much more than just 450 cases (so why don't we up the requirements?) but their training is roughly the same length. How does this work? Less didactics? Seriously, because I think that CRNAs should have to do MORE cases during training if they're going to get more respect. I think that possibly we could adapt CRNA training to (in SOME ways) be more like AA training in order to get more clinical training in. Not at the expense of important classwork or course. That's why I'd like to know the difference in training.

gaspassah · Jun 26, 2005

well to try and avoid this firestorm again i needed to make a couple of comments.

1. "supervision is a term defined in medicare part A billing. the word "supervision" is not a term that is meant to imply that the surgeon, podiatrist, opthomologist etc has anything to do with the anesthetic. the physician does NOT in any way have an involvement in preoperative evaluation, perioperative management or postoperative evaluation/discharge. the supervision requirement just means that a physician must "request" the anesthetic. as a crna we cant just go around giving anesthesia, but i dont see where this is an issue unless you were opening a pain clinic. even in this environment patients are usually refered by a physician for pain management anyway. "supervision" again does not mean that the requesting physician be the "captain of the ship". if a crna is doing a case without "mda supervision" independantly, that crna is the sole provider responsible for the anesthetic. the surgeon is in no way responsible for the actions of the crna. this has been proven in several key lawsuits.

2. TEFRA rules stipulate that an mda must do the preop eval, be present at induction, any crisis period / issue during the case, check on the case at intervals, be present at extubation and evaluate the patient for postop discharge. i cant think of the last one there are 7 steps. this is for medicare part B billing. if these 7 specific steps are not met, then the group is practicing medicare fraud. so for jwk who i would think is a very safe and qualified practitioner, if at any time during the case where a patient became unstable, started or ended a case or if the mda didnt make a visit during the case then there is medicare fraud. as a student i have circulated through several different hospitals and i can tell you that if all cases were medicare patients / cases then most everyone of them is commiting fraud. but i have yet to see a mda ask or evaluate a patients billing status (medicare vs non-medicare).

3. It is already becoming apparent that medicare and hmos are becoming aware that crnas and mdas are doing the same job and that medicare is paying 2 ppl to do one case. ie mda "supervising" crna. my personal opinion is that crnas will soon be in direct competition with mdas/ and if these companies dont want to pay for 2 ppl doing one case i dont see them paying mdas/aas to do one case. CRNA's are the most cost efficient use of anesthesia time. we have shown a history of quality safe anesthesia practice outside of the Anesthesia care team model.

of course these are just my opinions/ jwk i aint bashing you my friend. but again we have to agree to disagree.

d

sandman1 · Jun 26, 2005

The CRNA case minimum requirement is 550. Most do end up over 800 but you have to set it low for the one's that get more long cases and end up with many hours of anesthesia but less cases. I can't find anything about the number of cases required for AA's. They seem to go by hours. But if they truly do THAT much more clinical during the same length program (leaving that much less time for didactic which they TRULY NEED) then that's even more frightening than I originally thought. As far as the basic differences in training, I truly don't know.

OK, I have a question. This is not meant to add fuel to the fire that already exists, so if you can't give me a straight and honest answer to a serious question, don't bother replying.
I've been reading a bit on AAs and I've seen (I don't know if this iss true or not) that AAs are required to do almost 2x the number of cases during training as CRNAs. I understand that "most" CRNAs do much more than just 450 cases (so why don't we up the requirements?) but their training is roughly the same length. How does this work? Less didactics? Seriously, because I think that CRNAs should have to do MORE cases during training if they're going to get more respect. I think that possibly we could adapt CRNA training to (in SOME ways) be more like AA training in order to get more clinical training in. Not at the expense of important classwork or course. That's why I'd like to know the difference in training.

heartICU · Jun 27, 2005

The CRNA case minimum requirement is 550. Most do end up over 800 but you have to set it low for the one's that get more long cases and end up with many hours of anesthesia but less cases. I can't find anything about the number of cases required for AA's. They seem to go by hours. But if they truly do THAT much more clinical during the same length program (leaving that much less time for didactic which they TRULY NEED) then that's even more frightening than I originally thought. As far as the basic differences in training, I truly don't know.

I would like to know how they calculate their hours. For example, I remember jwk stating some time ago that AAs need 2000 hours or something like that. However, are these hours spent at the hospital, or hours doing anesthesia? You can't count lunch, breaks, time between cases as actual anesthesia hours. I know that when SRNAs calculate their hours (at least in my program, I have to assume it is the same at others), we have to use the start time and end time. Basically, I cant go in at 6am and leave at 5pm and claim 11 hours for the day. You have to go by the case times.

edited to correct 200 to 2000 - mistyped:-)

sandman1 · Jun 27, 2005

It's probably more like 2000 hours. 200 is not very much......

I would like to know how they calculate their hours. For example, I remember jwk stating some time ago that AAs need 200 hours or something like that. However, are these hours spent at the hospital, or hours doing anesthesia? You can't count lunch, breaks, time between cases as actual anesthesia hours. I know that when SRNAs calculate their hours (at least in my program, I have to assume it is the same at others), we have to use the start time and end time. Basically, I cant go in at 6am and leave at 5pm and claim 11 hours for the day. You have to go by the case times.