Here's what AAs really think of CRNAs - page 3

And this comes from the PRESIDENT of the American Society of Anesthesiologist Assistants Again, assertions that AAs and CRNAs function at the same level -absolutely misleading. And, what's... Read More

  1. by   deepz
    Quote from LBHOTGIRL99
    ..... AA's vs. CRNA's. I am wondering, what is the REAL difference?? When I say REAL difference I am only meaning in terms of job outlook......

    Hot, there are no more than a few hundred AAs in practice after 30 years. And 31,000 CRNAs with a history stretching back to the 1880s. CRNAs working solo, independent of any anesthesiologist, serve half the hospitals in our nation; CRNAs deliver two-thirds of the 20-plus million anesthetics given each year. AAs are assistants to doctors only. See for further comparisons and contrasts.

    Atlanta is an anomolous situation, almost unique, wherein Emory University and only one other program actually train AAs, and it's reasonable to expect AAs to be clustered nearby, since they cannot practice solo in rural areas, as CRNAs can.

    The A$A line is that anesthesia is strictly, solely, and no less than The Practice of Medicine. AAs accept that line and they assist the doctors. They also (see above) use the term 'anesthesia nurse' to confuse the public into thinking that CRNAs are not full-fledged ANESTHETISTS in their own right but merely assistants to the doctors, as they are.

    CRNAs OTOH (and American courts, in legal precedents dating back to the early 20th century) view anesthesia as the practice of medicine when delivered by MDs, and yet also the practice of nursing when delivered by CRNAs. It is both, and not strictly the purview of either MDs or CRNAs.

    Refusing to be subjugated is where CRNAs rub the A$A wrong, and the main reason the A$A would wish to replace CRNAs with AAs. Wishful thinking.

    There are few job for AAs because the A$A wishful thinking hasn't borne much fruit after 30 years. Many AAs move on to med school, or to other pursuits, greener pastures.

    If you want to stand on your own two feet, I wouldn't think twice about AA school. I'd sooner pick cotton.

    Just MHO

  2. by   NCgirl
    You don't see job advertisements for AA's in NC because they still do not have the legal right to practice here.
  3. by   alansmith52
    I am with you. I ve read your past posts and I ver read your personal web site so I know you are knowlegable about this stuff.
    I like the way write.
    p.s. just so you know you have some support.
  4. by   Spoiled1
    Thanks for all they replies, keep 'em coming!
  5. by   user69
    Quote from deepz
    they also (see above) use the term 'anesthesia nurse' to confuse the public into thinking that crnas are not full-fledged anesthetists in their own right but merely assistants to the doctors, as they are.

    deepz, are you dealing with some kind of complex about the title? are you not an 'anesthesia nurse'? what part of the title do you not fit into? the nurse part or the anesthesia part? i think that is a silly point to get so angered over.

    i hope that georgia aa does come back and respond to the questions and that have been posted. this thread has grown so quickly that we need to remember that just because it is on the third page; it has only been 1 day since his first post and the comment

    Quote from deepz
    how convenient.

    all hat, no cattle.
    referring to the fact that he did not jump up and reschedule his life to reply to our questions is not very inviting to opening a dialog.

    Quote from athlein1

    i'm not familiar with these articles or editorials that call you a "bunch of incompetents". in fact, the aana is often silent in response to rhetoric from the aaaa or the asa. i am not an idiot. i understand that there is a great deal of intra-profession grousing from both sides. to take that grousing to a public level in the media is something else entirely. i would be very interested in seeing these articles and editorials. can you please provide more information? .

    i have not seen the article with the term "bunch of incompetents" either, but i do remember the add that was taken out in the "stars and stripes" that said that aas were under qualified to administer anesthesia. see attached link

    i am curious what crnas make in atlanta if an aa is pulling 160k/yr. if my salary is brought down to this level once i get my crna cart i am not sure how many tears i will be shedding

    and for the record. i would never want a mda to give me an iv or prep me for surgery. but once i was ready to go under anyone with the proper training and a couple of years of experience will be fine for me. aa, crna, or mda, as long as they are not students.
    Last edit by user69 on May 4, '04
  6. by   alansmith52
    what is going on here
  7. by   georgia_aa
    OK, most of you seem genuinely interested (DEEPZ notwithstanding) so I will attempt to address as many of the issues you have raised as I can.

    There were several questions relating to my scope of practice vs that of a CRNA. Keep in mind that I can only speak of those practices where there are MDA's supervising a group of anesthetists consisting of both CRNAs and AA's. In this type of practice, AA's and CRNAs are 100% equivalent. I can do anything that the CRNAs are permitted to do and vice versa.

    I am licensed as a PA in the state of Georgia. I hold the same physical license as a surgical PA, cardiac PA and so forth. The difference is that I am delineated as a subclass of PA with a job description on file with the state licensing board. In that description are most of the duties commonly performed by anesthetists. Anything not covered in that description can be delegated to me by my sponsoring physician. In my practice, I do not perform regional blocks, but neither do our CRNAs. I do, however, know many AA's that routinely perform spinals and epidurals everyday. I am primarily a cardiac anesthetist. I place all of my own lines including PA catheters. I can perform femoral cannulation and IJ cannulation but am not permitted to perform a subclavian stick (neither are the CRNAs). Again we are totally interchangable.

    As a senior anesthetist I am given free reign to manage my cases as I see fit. Very rarely does my attending dictate what the anesthetic should be. They may make a suggestion here or there like "work in a little Morphine towards the end" but I am not required to check with them about most decisions that come up during a case. New grads on the other hand (AA and CRNA) really are expected to communicate with their attendings a little more often. I commonly do extremely complicated cases from beginning to end with little to no involvement from my supervising MD.

    There was a question asking me how long it took to get comfortable with critically ill patients. This is a great question as it cuts straight to the heart of the whole "not a nurse first" issue. I will not say that I was as comfortable right out of school as a nurse with 10 years of ICU experience probably would be, but I did feel prepared to handle most situations. Nobody would be ready to do a thoracoabdominal aneurysm their first week out, I don't care how much nursing experience you had. I do feel that my training was first rate. Emory's department of Anesthesiology is one of the best in the country and I had access to Grady Memorial which is one of the nations busiest trauma centers. Egleston Children's hospital performs cutting edge procedures every day and is a major referral center in the southeast.

    As far as the whole salary issue is concerned let me dispel a CRNA myth right now. AA's do NOT work for less than CRNAs. Salary is determined solely based on experience and what you bring to the table as well as supply and demand. I am at the very top of the salary scale in my department. There are many AAs and CRNAs that do not earn what I earn in my group. This is true in all mixed practices - end of story.

    Why does the ASA support us. Very simple - we are not their competitors. We exist solely for one purpose and that is to allow the MDA to supervise and bill for up to 4 anesthetizing locations at once. I have heard the term physician externder used when discussing AAs and CRNAs in this type of practice. It is entirely accurate. You as CRNAs are going up against the ASA at the national level on a regular basis. You see yourselves as their equivalent and that is why they are less than friendly when it comes to the politics of anesthesia.

    Mull this over for a while and let me know your thoughts. I will end by saying that it is not the AAs that made this an adversarial relationship. Every single AA practicing in America today works side by side with CRNAs. We are advocates for the team approach to anesthesia care and I truely believe that it is what is safest for our patients. If you want to practice solo in rural USA - go for it. I will NEVER compete with you for those jobs.
  8. by   nec
    Thank You for the information nec
  9. by   NCgirl
    Okay, maybe I also have a complex, but I dislike the term "anesthesia nurse" same as deepz. I think it misleads the public into thinking I'm just a regular RN (which could just be a 2 year degree), who helps the doc out. If the public was educated as to what I truly do, maybe that term wouldn't be so touche. "Anesthetist" I think moreso speaks to what I do on a daily basis (or will do when I graduate). JMHO......
  10. by   loisane
    While I can understand the need to look at issues from a personal level, using specific/individual examples, I would like to ask that we step back and take a more global look at the CRNA vs. AA comparison.

    Medicine is a profession. Physicians were the first to establish themselves as professionals in health care, and standardize their education and licensing.

    Nursing is also a profession. We are younger, but we have a well established system of educational and licensing standards.

    The practice of nurse anesthesia by CRNAs is accountable to the standards of the nursing and the governmental institutions that regulate nursing.

    Who are AAs accountable to? My understanding is that they are not professionally accountable (GeorgiaAA of course, is welcome to comment on this). Since AAs are by definition assisting the physician, it is the physician who is professionally accountable for the AAs actions. (The AA may be personally accountable, but that is a different standard from professional accountability). They are truly physicain extenders. This is congruent with organized anesthesiology's position that all anesthesia is the practice of medicine. They believe the only role for non-physician anesthesia providers is to perform delegated medicine. The physician is always accountable, at the top of the pyramid.

    So, the central issue as I see it (stay with me now)- is this a correct position? Is society best served by the physician always in charge model? Are other licensed health care providers incapable of safe, effective care without the direct supervision of a physician?

    Our culture has a strong pro-physician bias. This often leads to the (erroneous in my opinion) view that CRNAs are a "second best". Everybody wants the best of care for themselves and their families, and we have been conditioned to believe that the only way to receive that is from a physician. Everyone else is second best. There was a time, when physicians were first establishing professional standards, that this was actually true. But I believe health care has evolved past that.

    Nursing is a profession. Nurses have a legitimate role in patient care, separate from physicians. We are not physician extenders. Medicine does not control us. We have our own license, our own professional regulatory Board and our own professional standards.

    Nursing stands on its own. I don't agree with the model that requires CRNAs to always be subordinate to the anesthesiolgist. But I am not looking to replace all of them with CRNAs. What is so wrong with wanting to work side by side as equals? Those in medicine who would like to see us subserviant need to know that we aren't their hand maidens, and we aren't going back to that. Nurse anesthesia is leading the way, and the rest of nursing will follow.

    loisane crna
  11. by   user69
    Quote from ncgirl
    okay, maybe i also have a complex, but i dislike the term "anesthesia nurse" same as deepz. i think it misleads the public into thinking i'm just a regular rn (which could just be a 2 year degree), who helps the doc out. if the public was educated as to what i truly do, maybe that term wouldn't be so touche. "anesthetist" i think moreso speaks to what i do on a daily basis (or will do when i graduate). jmho......


    [font='times new roman']i think that the term "anesthetist" is probably the best for letting the patient know what the professional does. i do not think that the term "anesthesia nurse" is particularly flattering. i guess i was just in shock by the amount of anger that a silly title (that is technically correct) generated.
  12. by   alansmith52
    Iam glad I have metors like you.
  13. by   athomas91
    GeorgiaAA - i don't think anyone here is against you personally ...but....
    1. I (upon graduation) will NOT be an anesthsia nurse - that is like being an ER nurse (which i once was)...i will be a NURSE ANESTHETIST....
    who...can function independently anywhere....period.

    2. AA's on the other hand...can only function in 2? states...and ONLY under the supervision of an MDA...whether you all follow those rules or not..they are in place....

    i am sorry to hear the practice of the CRNA's in Georgia are so subclavians etc.... i for one would move and work elsewhere.

    loisane....great post.

    deepz....i kinda dig the hostility...keep it coming baby...

    and one last comment....(and again not a personal attack) - GeorgiaAA - AA's have a long way to go (if they can even get that far) before tackling the rest of the states.

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