Here's what AAs really think of CRNAs

[Athlein1]

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 with "anesthesia nurse"? If it sounds condescending in print, can you imagine how it would sound out of his mouth? What arrogance.

At least there is a phone number listed at the end of the article. Let's call Rob and let him know what we think of his little article!

Read carefully, SRNAs, this is a grim foreboding...

Licensed anesthesiologist assistants help access to medical care

By Rob Wagner

MY VIEW

Re: "Don't weaken the standards for anesthesia providers" (My View, April 11).

Maybe you or someone you know has had surgery delayed. Perhaps hospitals in your

area have closed operating rooms as they have in Miami, Jacksonville, Tampa and

elsewhere in Florida.

One reason for growing problems of this nature for patients is a shortage of

anesthesia providers. These are the assistants who help

physician-anesthesiologists perform the critical task of putting you to sleep

before surgery.

There is a common-sense solution rapidly making progress in the Florida

Legislature and around the country, which is to license anesthesiologist

assistants (called AAs). Key legislative action is expected today in Florida's

House Health Care Committee on HB 1381/SB 2332 and it is important that

lawmakers support it.

They need to be assured that this legislation will not weaken standards because

AAs are highly trained and perform the same function as anesthesia nurses. AAs

like myself serve patients in 16 states and have impeccable safety records. AAs

have worked with a high level of safety for 30 years in Georgia and Ohio.

AAs are required to have three times the hands-on, clinical training than are

most anesthesia nurses who currently assist anesthesiologists. Before we are

allowed to enter AA school, we must take the same courses physicians take as

pre-med students. Nurses do not do that. In fact, as the chief anesthetist at

St. Joseph's Hospital in Atlanta, I am in charge of both AAs and anesthesia

nurses.

If you are "going under," who would you rather have assisting the

anesthesiologist; someone trained to work directly with him or her, or a nurse?

We enjoy our professional relationships with our nursing colleagues. Yet nursing

organizations in Florida continue to misinform, even scare the public, calling

our profession "new" and "experimental."

Try telling that to the prestigious Emory University in Atlanta or Case Western

in Cleveland, which have been training AAs for more than three decades. Or try

to tell that to boards of medicine that oversee AAs in the states in which we

practice and whose members readily vouch for our safety record.

Try telling that to Medicare, the nation's largest health insurer, which

reimburses AAs and anesthesia nurses at the same rate. This means our skill

levels are viewed equally. And tell the insurance companies. They charge no

difference in malpractice insurance fees between anesthesia nurses and AAs,

meaning our safety records are equal. Try telling that to the Florida Medical

Association, American Medical Association and American Society of

Anesthesiologists, whose members resoundingly support our working in Florida. In

the era of malpractice crisis, doctors are certainly not going to support

"experimental" health care providers.

Why, then, would the anesthesia nurses be opposed to this? In a word, money.

Because of nurse shortages, their salaries are artificially high, up to $150,000

in Florida. If you made that kind of living, wouldn't you try to keep the

competition out?

This nursing shortage is well documented on the Web sites of Florida schools

that train anesthesia nurses, the U.S. Department of Health and Human Services,

and yes, even on the anesthesia nurses' own Web site, http://www.aana.org, where the

shortage is called "serious" and "acute."

To help relieve the problem, two institutions, the University of Florida and

Nova Southeastern, are ready to open special schools for anesthesiologist

assistants in Florida. Would those schools offer programs if they didn't think

AAs are in great demand? Would they risk their reputations on an "experimental"

profession? Of course not.

One AA can mean five more patients per day will get their surgery. That's 1,200

patients per year treated with the help of only one AA. If you are or know one

of those patients, I'm sure you would be grateful to the Florida Legislature for

passing this common-sense legislation.

--------------------------------------------------------------------------------

Rob Wagner is chief anesthetist at St. Joseph's Hospital in Atlanta and

president of the American Academy of Anesthesiologist Assistants, PO Box 13978

Tallahassee, FL 32317 Phone: [phone].

[alansmith52]

I am editing my post. I relized that I wrote how I felt. which was the intent of the author of that article. (to get me and others rouled up).

I spent all day in the library and I guess as I read the article I got mad because I feel like am working too hard to be degraded like that.

I am however intrested in what they tell AA's about us in school.

Do they call us "anesthesia nurses"?

[teeituptom, BSN, RN]

Im a nurse with 3 decades in service

If Im having surgery I want an AA, not an CRNA.

and also for my family

[smiling_ru]

Im a nurse with 3 decades in service

If Im having surgery I want an AA, not an CRNA.

and also for my family

Teeituptom,

I am curious, why would you prefer an AA to a CRNA?

[K38s]

"Try telling that to Medicare, the nation's largest health insurer, which

reimburses AA and anesthesia nurses at the same rate. This means our skill

levels are viewed equally."

Hmmmm. Doesn't Medicare reimburse CRNA and MDA at the same rate? I wonder how the ASA feels about Bobby making the claim that AA practice on the same level as Anesthesiologists?

[air]

Im a nurse with 3 decades in service

If Im having surgery I want an AA, not an CRNA.

and also for my family

jeeze

what happened?

i always thought nurses are a decent bunch.

the worse they could do is make sure you are ok from start to the end of your procedure.

Why pick one provider over another?

[smiling_ru]

"Try telling that to Medicare, the nation's largest health insurer, which

reimburses AA and anesthesia nurses at the same rate. This means our skill

levels are viewed equally."

Hmmmm. Doesn't Medicare reimburse CRNA and MDA at the same rate? I wonder how the ASA feels about Bobby making the claim that AA practice on the same level as Anesthesiologists?

AA do not receive direct reimbursement, they must be supervised therefore, the anesthesiologist bills for supervised cases. This is in contrast to CRNA's who can bill directly.

[georgia_aa]

Okay - I can't stand it any longer.

I am an AA with over 14 years of experience and currently practicing in Georgia. I have nothing but the highest regard for my CRNA colleagues and count some of them as among my closest friends. The article that you are referring to was written by Rob Wagner our association president over 1 year ago during the unsuccessful bid for licensing legislation in Florida in 2003. If you do a Google search, his is the ONLY article that you will find written by an AA attempting to set the record straight. Meanwhile you will find article after article and editorial upon editorial written by CRNA's calling us a bunch of incompetents. Now I ask you, who has been more professional and courteous through this whole thing.

Rob's characterization of AA's functioning the same as CRNA's is exactly correct in medically directed departments. Here in Georgia, our job descriptions and salaries are exactly the same (I made over $160k last year). That's alot of money for a tech isn't it?? .

If you would like to engage in a friendly discussion about AA's in an attempt to educate yourselves about us, I would be very happy to participate. Please understand, I am PRO - CRNA. I have no reason not to be. I work by definition under the supervision of an MDA. I can't practice alone, nor do I want to. If you want to flame me and get me thrown off the forum, be my guest. But it would behoove you to learn more about us because we will be coming soon to a state near you.

[Sheri257]

If you want to flame me and get me thrown off the forum, be my guest. But it would behoove you to learn more about us because we will be coming soon to a state near you.

Hey, I'm listening. As far as I'm concerned, welcome to the board. I personally hope you're not thrown off because I definitely would like to hear from the other side.

I have so many questions but, how do you compare your practice to a CRNA's? There's been many posts about AA's supposedly driving down CNRA salaries in Georgia. Is this true? How do you view the criticism from CRNA's, not so much from the political/personal aspect, but the actual merits of the arguments, both pro and con?

We're not all hostile here.

[nilepoc]

If you want to flame me and get me thrown off the forum, be my guest. But it would behoove you to learn more about us because we will be coming soon to a state near you.

I would like to take you up on your offer.

During my nursing preperation to gain entry into CRNA school I worked indirectly with an AA. he seemed very competent and was a very amicable person. Unfortunately at the time I was unaware of the tensions between AAs and CRNAs. So I never sat down with this person to have a talk with him.

My first question to you is....

What is the difference in your practice from that of a CRNA? Do you do central axis blockade? Do you plan your own anesthetic or does the MDA suggest one and you follow it (corolary question if you decide to change the plan mid case, do you have to consult with the anesthesiologist)? The place I am currently training in, allows the CRNAs to plan and implement their own anesthetic plans (If the CRNA chooses to, they can do the entire induction themselves). CRNAs are also allowed to practice the placement of central lines, and regional anesthesia beyond central neuraxial blockade. I imagine that the scope of practice varies from institution to institution. If I remember correctly AAs lost the ability to provide central blockade in the last couple of years in Ohio.

(This question is not particularly fair to ask, as it insinuates that you are of the opinion of the question. If you choose not to answer it, i will understand. Please do not consider it an attack, as it is just me being curious) Why does the ASA see CRNAs as a threat, yet embraces AAs (especially if AAs are comparing themselves to CRNAs to prove how valuable they are)? I guess what I am asking is what do AAs bring to the table that CRNAs do not. Or in your opinion what makes us different? Because obviously we are different. I like to say that there are anesthesiolgists that I would not let water my lawn and ohers I would seek out to give me anesthesia. Likewise with the CRNAs I know. I imagine if I knew more AAs, I could say the same thing. A title does not make for a safe provider, but it does predjudice peoples opinions of the provider.

How long did it take for you to feel comfortable caring for patients with multi system disease? I know that the time I spent in the ICU prior to entering CRNA school really helped me attain this comfort level.

Those questions ought to be enough to open up a discussion.

I ask that this remain civil, and I would like to thank you for this opportunity.

Craig

[Athlein1]

georgia_aa,

i appreciate the fortitude it took to respond to my post. by your reply, i assume that you have been reading this forum for awhile. if that is indeed the case, you will surely recognize that i am intensely interested in this issue. i welcome the opportunity to hold an open, honest, objective debate. your reply to nilepoc's post is eagerly anticipated.

however, in the interest of that open, honest, objective debate, let's correct a couple of misstatements from the get-go:

meanwhile you will find article after article and editorial upon editorial written by crna's calling us a bunch of incompetents.

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?

rob's characterization of aa's functioning the same as crna's is exactly correct in medically directed departments. here in georgia, our job descriptions and salaries are exactly the same

perhaps that is the case with your particular medically-directed department, but that statement is misleading. i'm betting you work in the atlanta metro area or another well-populated area of the state where that statement is likely true. i will also concede that your statement is likely correct in some settings when crnas and aas are employed alongside one another in the same medically-directed department under the guise of the "anesthesia care team" model. however, do you really assert that hospitals in georgia (with anesthesiologists) that employ crnas restrict them to the limited scope of practice of an aa?

i made over $160k last year

now, according to your own association's president, a salary of that magnitude is "artificially high"; such remuneration is an argument, in fact, for the creation of additional schools for aas and the passage of legislation in florida to allow aas to practice in a kind-hearted attempt to relieve that state of its "anesthesia nurse" shortage. interesting indeed.

[pnurseuwm]

So it's sounding like this: Both professions get paid the same, but one must always be under the watchful eye of a doctor and the other can work independently... even working in an all CRNA group if one wished...

Is this about right?