Is the AA profession gaining ground?

core0 · Feb 15, 2007

Actually it is all about money. This is a direct result of the AANA drive for independence. From the Anesthesiology point of view AA's are preferable since they can only work under an anesthesiologist. No question of independence, no question of working under dentist's. What they would like is to put the genie back in the bottle.

paindoc · Feb 15, 2007

Given the CRNA penchant to proclaim they are just as good as MDs and want to make just as much money as MDs because they claim to be as good as MDs, it is just a matter of time until AAs become a common competitor for CRNA positions. MDs would much rather support AAs that work for them than CRNAs that work against them.

jackson74 · Feb 15, 2007

I've been a critical care nurse for 7 years I'm starting anesthesia school (CRNA) this aug. If you have ever precepted a new graduate RN into the ICU you understand the huge difference between individuals who have ICU experience and those that don't. 1st year AA students aren't even the functional equivalant of a new grad RN because the new graduate RN's have nursing school clinical experience to prepare them. AA's are required to have NO clinical experience! Personally, if I were going to AA school I would be terrified going in to the OR having no hemodynamic experience, experience with vents, vasoactive drips, IV's, and just monitoring patients. I guess if you don't know what you don't know it really wouldn't bother you then. :uhoh21:

paindoc · Feb 15, 2007

Perhaps it just goes to show one really doesn't need a year of critical care to learn how to use ephedrine, labetolol, NTG, or phenylephrine boluses. Drips are used during less than 2% of all surgeries in the US. For those 2% of cases, CRNAs would definitely have an advantage. But for the other 98% of cases, I wonder if one could really tell the difference in outcome.

jwk · Feb 16, 2007

Perhaps it just goes to show one really doesn't need a year of critical care to learn how to use ephedrine, labetolol, NTG, or phenylephrine boluses. Drips are used during less than 2% of all surgeries in the US. For those 2% of cases, CRNAs would definitely have an advantage. But for the other 98% of cases, I wonder if one could really tell the difference in outcome.

You can't tell the difference anyway. Places that have both AA's and CRNA's use them interchangeably.

platon20 · Feb 16, 2007

SHOW ME THE EVIDENCE THAT CRNAS HAVE BETTER OUTCOMES THAN AAS

You cant, because that evidence doesnt exist. However, there is ample evidence in peer reviewed pulbications like JAMA, NEJM, etc that outcomes are the SAME regardless of whether you are an MDA, AA, or CRNA.

Until then, all this talk about ICU experience, training period is worthless. MDAs go to school a lot longer than CRNAs, so using your logic MDAs must be better than CRNAs. The evidence shows clearly that is NOT the case. Therefore, all that "extra" training doesnt mean jack.

Again, it is extremely hypocritical for the CRNAs to attack AAs based on training. MDAs have been pushing for years trying to cut out CRNAs, and what was the AANA response? That CRNAs have equivalent outcomes to MDAs. The MDAs didnt have a leg to stand on, and the CRNAs likewise dont have a leg to stand on regarding attacking AAs for lack of training.

Until you prove that CRNAs have better outcomes, then this is all just posturing based on politics and money that hurts patient care. It hurts patient care when MDAs try to force out CRNAs, and it also hurts patient care when CRNAs try to force out AAs. Patients need all of us for their anesthesia care. For CRNAs to fight against AAs when they dont have any evidence of superiority means that those CRNAs are just as greedy/hypocritical/politically motivated as the MDAs were who tried to keep CRNAs out of the OR

paindoc · Feb 16, 2007

Excellent analysis!!

rodvigcrna · Feb 16, 2007

I say CRNA's and AA's UNITE !!!!

Here is my view:

First of all, I want to make a point.

I feel CRNA's and AA's all went into their perspective careers for the same reasons. More opportunity and a better life for them and their families. I'm sure no one chooses to enter anesthesia so they can fight with another group of people. For that matter, anesthesiologists do not enter anesthesia residency thinking of how fun it is going to be to crush CRNA's.

I am not going to attempt to predict the future. However I want to point something out. In the sate I live in, Doctors prefer to hire physician assistants rather than nurse practitioners. This has resulted in substantially higher salaries for PA's than NP's. However, a new trend is emerging. Some surgeons are trading their higher paid PA's for RN first assistants. Paying them less money than PA's but more money than RN's. So prominent is the trend that RN's are entering this field in droves.

Similarly, the anesthesiologists are protecting their best interest. No one can blame them for doing this. It is not wrong. It is just the capitalist way. They want to make sure they retain control, so they always maintain their field as lucrative.

So here is my point. If AA's feel safe because they are protected by the umbrella of the ASA, they are terribly mistaken. And, if CRNA's feel that AA's are a threat to us, we are terribly mistaken.

Stop and think before everyone starts bashing each other.

:roll

surgpa · Feb 20, 2007

I say CRNA's and AA's UNITE !!!!
Here is my view:
Some surgeons are trading their higher paid PA's for RN first assistants. Paying them less money than PA's but more money than RN's. So prominent is the trend that RN's are entering this field in droves.
Stop and think before everyone starts bashing each other.
:roll

OK, how does that make any sense? RNFAs are not reimbursed by Medicare or Medicaid, plus they aren't making rounds and writing orders. If they are doing this on their own (I know some who have TRIED) they might be in hot soup with the BNE.

I'm a PA and an RN.

Mike

SigmaSRNA · Feb 21, 2007

SHOW ME THE EVIDENCE THAT CRNAS HAVE BETTER OUTCOMES THAN AAS
You cant, because that evidence doesnt exist. However, there is ample evidence in peer reviewed pulbications like JAMA, NEJM, etc that outcomes are the SAME regardless of whether you are an MDA, AA, or CRNA.
Until then, all this talk about ICU experience, training period is worthless. MDAs go to school a lot longer than CRNAs, so using your logic MDAs must be better than CRNAs. The evidence shows clearly that is NOT the case. Therefore, all that "extra" training doesnt mean jack.
Again, it is extremely hypocritical for the CRNAs to attack AAs based on training. MDAs have been pushing for years trying to cut out CRNAs, and what was the AANA response? That CRNAs have equivalent outcomes to MDAs. The MDAs didnt have a leg to stand on, and the CRNAs likewise dont have a leg to stand on regarding attacking AAs for lack of training.
Until you prove that CRNAs have better outcomes, then this is all just posturing based on politics and money that hurts patient care. It hurts patient care when MDAs try to force out CRNAs, and it also hurts patient care when CRNAs try to force out AAs. Patients need all of us for their anesthesia care. For CRNAs to fight against AAs when they dont have any evidence of superiority means that those CRNAs are just as greedy/hypocritical/politically motivated as the MDAs were who tried to keep CRNAs out of the OR

Interesting point and I can see that perspective. I'll say this; Lets try to do a study comparing the outcomes of CRNAs and AAs in rural settings or settings outside of an anesthesia care team model. OH Wait!! That can't happen because AAs can't work outside of an ACT model and the supervision rules and lack of MDAs in the rural setting prevents them to work in such. That's the problem with healthcare. ACCESS!!!. 80 to 85% of the counties in Texas don't have an MDA working in them. So how the hell is an AA going to help??

Another way to think about it. In the setting of a big city, big anesthesia group, shrinking healthcare dollars. AAs/CRNAs cheaper alternative and in an ACT, same results of an MDA. AAs won't just take up CRNA jobs; MDAs won't exactly be sitting pretty either (especially those coming out of residency). Its already happening in big hospitals in Dallas. 6 years ago you couldn't find a job in Dallas. Now they are all over the place. At least for CRNAs :lol2:

jwk · Feb 21, 2007

Interesting point and I can see that perspective. I'll say this; Lets try to do a study comparing the outcomes of CRNAs and AAs in rural settings or settings outside of an anesthesia care team model. OH Wait!! That can't happen because AAs can't work outside of an ACT model and the supervision rules and lack of MDAs in the rural setting prevents them to work in such. That's the problem with healthcare. ACCESS!!!. 80 to 85% of the counties in Texas don't have an MDA working in them. So how the hell is an AA going to help??
Another way to think about it. In the setting of a big city, big anesthesia group, shrinking healthcare dollars. AAs/CRNAs cheaper alternative and in an ACT, same results of an MDA. AAs won't just take up CRNA jobs; MDAs won't exactly be sitting pretty either (especially those coming out of residency). Its already happening in big hospitals in Dallas. 6 years ago you couldn't find a job in Dallas. Now they are all over the place. At least for CRNAs

What percentage of surgery is done in small rural hospitals around the country? 10%? 15% If you CHOOSE to live in a rural county, you have to accept the fact that medical care is farther away. You can't support an open heart surgery program in a one-OR hospital in a county with 1500 residents in rural Montana. Don't expect to have a Level III NICU or a Level 1 Trauma Center in the middle of a Kansas wheat field.

And I've heard the Texas argument numerous times - the problem is that many of those 80-85% of those Texas counties DON'T HAVE A HOSPITAL EITHER!!!

If CRNA's are so gung ho to practice independently in small-town rural America, why aren't they flocking there? The same reason many people don't. Poor schools, lack of cultural activities, POOR HEALTHCARE, etc. Using your logic, AA's are in fact the solution to anesthesia access in rural areas - we're more than happy to take your position in the hospitals and medical centers with anesthesiologists that many of you are loathe to work with, which frees you up to offer your services independently to small town USA. Put your money where your mouth is!

SigmaSRNA · Feb 22, 2007

What percentage of surgery is done in small rural hospitals around the country? 10%? 15% If you CHOOSE to live in a rural county, you have to accept the fact that medical care is farther away. You can't support an open heart surgery program in a one-OR hospital in a county with 1500 residents in rural Montana. Don't expect to have a Level III NICU or a Level 1 Trauma Center in the middle of a Kansas wheat field.
And I've heard the Texas argument numerous times - the problem is that many of those 80-85% of those Texas counties DON'T HAVE A HOSPITAL EITHER!!!
If CRNA's are so gung ho to practice independently in small-town rural America, why aren't they flocking there? The same reason many people don't. Poor schools, lack of cultural activities, POOR HEALTHCARE, etc. Using your logic, AA's are in fact the solution to anesthesia access in rural areas - we're more than happy to take your position in the hospitals and medical centers with anesthesiologists that many of you are loathe to work with, which frees you up to offer your services independently to small town USA. Put your money where your mouth is!

80 - 85% of Texas Counties don't have hospitals? Ignorance in its highest form. You must be refering to Georgia counties with that number man. CRNAs are flocking to rural america alot faster than MDAs are and that is the basis of the argument. Basically, its not about being gung ho to do anything. Its about our committment to providing that access that is needed (and will be needed in greater numbers as the years goes on) And who is talking about a damn Open Heart or NICU anyway? I'm talking about the emergent appy, The MVAs, the meth explosion 100 miles outside of Dallas, the "damn, my wife caught me with my best friend and stabbed the s*** out of me". That's what I'm talking about. If you want to talk about money, I'll be able to work in all 50 states and the U.S. territories. Play your role ..........assistant.