Anyone have any experience with anesthesia assistants compared to CRNAs ?

jwk · Jul 11, 2005

If AA's get the same education why don't they get their own license ? They should be able to pass the same board exam since they think they have the
same education as CRNA's . Why do you think MD like AA's, because they are not a threat!

Actually, we offered to challenge the CRNA boards many years ago. Our request was denied.

sandman1 · Jul 11, 2005

I will have to look up that study evaluate it. Not saying it's bogus but one thing you'll learn when doing the research aspect of your education is that one can make research say anything you want and you have to read the details VERY carefully as to methodology. I'm particularly interested to see how they dealt with the fact that there are 32000 CRNA's and I don't know how many AA's but my guess is very SIGNIFICANTLY less. (Someone help me out here.....how many?). I'm also interested in their sampling methods.

I currently have no research (not that I've looked) to back up what I say.....I'm just stating what seems obvious. With the two different backgrounds of AA's and CRNA's, they cannot be on TRUE equal footing coming out. Maybe the difference is too subtle to quantify. Maybe it's a difference in critical thinking and ability to evaluate the big picture. You can train a monkey to do almost anything but that doesn't mean they fully understand what's going on.

I'm also just really surprised that pompous MDA's would even consider backing a profession that does the same thing as them with no med school, no med background and only two years or so of education. It seems almost insulting to them.......(not that i'm concerned). The only reason they do is because of their complete control of them and the money it helps them to make. THAT is where the post you quoted earlier from SDN comes into play. If they did not govern everything about the profession of AA's, I can guarantee you all the sudden MDA's would consider them unsafe to practice.

Sandman, I agree that with all things being equal, the experience gives the nurse the edge. I just don't agree that AA's can't possibly learn hemodynamics and drips etc. while going to anesthesia school and practice at a level of a CRNA upon graduation.
You state "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". This is just speculation unless you have studies to back up your claim. In fact, I checked the AA website www.anesthetist.org and found this:
"AAs have long been recognized for their impeccable safety records. A recently-concluded four year data review at the University Hospitals in Cleveland, Ohio, comparing the safety records of AAs and Certified Registered Nurse Anesthestists (CRNAs) concluded that the two are on equal footing, saying, "Complication rates were no higher for AAs than CRNAs." The Medical Center conducted the research over four years (1999 - 2003) and measured more than 46 thousand cases involving AAs and CRNAs (23,000 cases each). This was an unbiased comparison because the medical center trains both AAs and CRNAs."
Sandman, I do appologize for comparing your post with that moron on SDN. You obviously do not have the same view of AA's as he does of CRNAs. Laughing Gas, really not sure what your problem is unless it's an ego thing. You can call me a "troll" and a "nobody" if it makes you feel better about yourself.
Jetman

Sheri257 · Jul 11, 2005

I'm particularly interested to see how they dealt with the fact that there are 32000 CRNA's and I don't know how many AA's but my guess is very SIGNIFICANTLY less. (Someone help me out here.....how many?).

According to this link there are about 800 AA's.

http://www.outpatientsurgery.net/2003/os09/anesthesia_provider_shortage.php?pg=2

:coollook:

gotosleepnow · Jul 11, 2005

I really wonder when people say that they are VERY interested in becoming a CRNA, then don't know hardly anything about the profession. The funny thing is that EVERYONE can state the starting pay??????? Sorry, I know I shouldnt write anything b/c I am not a CRNA or SRNA, but since being exposed to the profession in 2001, I've been preparing for that special day when I might be able to apply. The last 4 years in nursing school was very challenging, (even if not true) hoping never to get a B just so I might have a chance when I apply to CRNA school. Now that that hells over with, here comes GRE, more Chem. classes, and the hope to transfer into an ICU once I complete my 1st year as a new grad in cardio.. All this to become a CRNA. As you can see, there is so much preparation needed in becoming a CRNA, so maybe just doing basic research would help you. I know I'll probley get blasted for writing this, but as a hopefully SRNA one day, I know how hard I've worked and will have to work if I ever want to accomplish this goal and it really urks me when people "act" interested, but can't state the very basics as the differences b/t AA's and CRNA.
I'm done, blast away

best of luck with CRNA school.......you sound well versed and an adequate amount of

respect for the realities of CRNA profession. I am a crna and wish more persons would feel the way you do.........so many just go into it for the $ and don't realize the stress or the responsibility that goes with it.........kinda like quick sand.......once in hard to get out........so go in with both feet and make the best of it.It is worth it.@!! I am biased of course.........again good luck.

deepz · Jul 11, 2005

.....You can train a monkey to do almost anything but that doesn't mean they fully understand what's going on........

Please, Sandman, when you compare AAs and trained monkeys could you perhaps show a tad bit more kindness? Monkeys have tender feelings too, you know.

deepz

jwk · Jul 11, 2005

Please, Sandman, when you compare AAs and monkeys could you perhaps show a tad bit more kindness? Monkeys have tender feelings too, you know.
deepz

Laughing Gas · Jul 12, 2005

Sorry, I think that's total "phooey". Feel free to PM me the specifics - I'll be glad to check it out and report back.
It would be pretty stupid for an AA to work for 1/2 of what a CRNA makes. It makes no sense to me for an AA to work for any less than a CRNA in the same group, although admittedly, I know a FEW that do, usually because they really want to be in a specific town, regardless of their compensation. I assure you, it's not typical. Same work, same job description, same $$$.
Hope that was the typical response you were looking for.

You didn't disappoint me. :)

I can only go by what this anesthesia director told me about his OR. While this may seem somewhat anecdotal, consider that they employ roughly a dozen AA's. That is a pretty significant number considering there are less than 1000 AA's. I doubt he'd lie considering that this conversation took place in front of about two dozen RN doctorates who promptly took him to task.

It also wouldn't be stupid for an AA to take 1/2 the salary of a CRNA due to the fact that only a small number of states have deemed them legal to practice. I'd say that seriously narrows down an AA's job prospects, hence making it a buyer's market.

I am honestly not trying to be a smart orifice with the following question; If AA's truly make roughly what a CRNA makes, then why hire AA's at all? I was always lead to believe that the attraction of hiring AA's was for cost cutting and increased physician control. So, AA's must work under direct physician mandate/supervision (or whatever today's buzz word is) and start at a salary that makes most MDA's eyes water similar to a CRNA's. So they cost the same but are unlicensed requiring increased "involvement". Are they safer? Is there increased patient satisfaction?

Feel free to PM me the specifics - I'll be glad to check it out and report back.

Flame suit's on.

jwk · Jul 12, 2005

You didn't disappoint me. :)
I can only go by what this anesthesia director told me about his OR. While this may seem somewhat anecdotal, consider that they employ roughly a dozen AA's. That is a pretty significant number considering there are less than 1000 AA's. I doubt he'd lie considering that this conversation took place in front of about two dozen RN doctorates who promptly took him to task.
It also wouldn't be stupid for an AA to take 1/2 the salary of a CRNA due to the fact that only a small number of states have deemed them legal to practice. I'd say that seriously narrows down an AA's job prospects, hence making it a buyer's market.
I am honestly not trying to be a smart orifice with the following question; If AA's truly make roughly what a CRNA makes, then why hire AA's at all? I was always lead to believe that the attraction of hiring AA's was for cost cutting and increased physician control. So, AA's must work under direct physician mandate/supervision (or whatever today's buzz word is) and start at a salary that makes most MDA's eyes water similar to a CRNA's. So they cost the same but are unlicensed requiring increased "involvement". Are they safer? Is there increased patient satisfaction?
Feel free to PM me the specifics - I'll be glad to check it out and report back.
Flame suit's on.

Nah, no flames.

In most places, it's not a "buyer's market". Every graduating AA pretty much has their choice of jobs. I can hire 10 AA's or CRNA's right now. Look at Gaswork in the states that have AA's. No lack of job opportunities that I see.

In an ACT practice, AA's and CRNA's are no different. I know you don't agree with the ACT concept. No surprises there, but there are plenty of those practices out there. AA's fit in quite nicely. We cost the same (usually) because we do the same work in that practice.

Are we "safer" ? Not that I'm aware of. Are we AS SAFE? Of course we are. You don't need an incredibly controlled double-blind randomized study to show that. Look back at the records from several years running and look back at malpractice claims for several years running. No difference in "incidents", no difference in claims made.

Laughing Gas · Jul 13, 2005

JWK,

Do you have any links to sites that list current numbers of AA's in active practice?

In your group AA's and CRNA's do equal work. In a lot of groups like mine, CRNA's have major independence. Every form of regional, PA caths, lines etc are performed by the CRNA. We basically run our own show and OB. Don't get me wrong, there is MDA involvement, but they tend to let the show go on. How do you feel an AA would function in a group like this? There are places where AA's are not an option, specifically if the MD's are forced to pay CRNA salary. I will ask one of the head honchos in what capacity he could envision an AA in our group, also as pertains to salary.

What do you see as the seperating factor of AA and CRNA practice, and what exactly facilitates the need for groups to have AA's? :)

jwk · Jul 13, 2005

JWK,
Do you have any links to sites that list current numbers of AA's in active practice?
In your group AA's and CRNA's do equal work. In a lot of groups like mine, CRNA's have major independence. Every form of regional, PA caths, lines etc are performed by the CRNA. We basically run our own show and OB. Don't get me wrong, there is MDA involvement, but they tend to let the show go on. How do you feel an AA would function in a group like this? There are places where AA's are not an option, specifically if the MD's are forced to pay CRNA salary. I will ask one of the head honchos in what capacity he could envision an AA in our group, also as pertains to salary.
What do you see as the seperating factor of AA and CRNA practice, and what exactly facilitates the need for groups to have AA's? :)

AA's would function fine in your group. Although I don't do them in my current group, I have plenty of experience placing regionals, as well as CVP's and swans, so if I wanted to change to a group that allowed anesthetists to do these procdures, I could step right in. As far as procedures, anything you can I can do. I do or have done all surgical subspecialties including hearts, neuro, thoracic, OB, and peds.

I function much more independently than you might think. Is there a doc around that meets the 7 TEFRA requirements for medical direction? Yep. Do they hold my hand? Nope. With rare exceptions, I do my cases the way I want to - I pick the drugs, I manage the airway, I manage the case. If I have a problem, I deal with it. If I have a big problem, the same as you, I'll call the doc for help.

Interesting choice of words you had - "...forced to pay CRNA salary...". That makes paying you sound like a negative. I'm sure you earn every penny that you make. So do I.

I think the main thing that differentiates AA's from CRNA's is that CRNA's have the ability to work in a group or facility without anesthesiologists. AA's will always be working with anesthesiologists. We see that as a positive, many CRNA's see that as a negative. We make our choices and live with them, as do you.

As far as why a group would "need" an AA - why does a group need a CRNA? To take care of patients. Simple.

Laughing Gas · Jul 14, 2005

I think the main thing that differentiates AA's from CRNA's is that CRNA's have the ability to work in a group or facility without anesthesiologists. AA's will always be working with anesthesiologists. We see that as a positive, many CRNA's see that as a negative. We make our choices and live with them, as do you.

I may get covered in tar and feathers for this one but... I don't think MD supervision is always such a bad thing. Now keep in mind that supervision implies nothing more than a risk sharing contract, not medical direction. There is someone with deeper pockets than yours with their name on the chart. I will continue to fight with others for CRNA independence, but for myself, I can see its positives.

deepz · Jul 14, 2005

......any links to sites that list current numbers of AA's in active practice?...
Haven't seen that answered yet.
??