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].

[Peeps Mcarthur]

How interesting,

Why the gap in education?

AAs are basicly premeds........8 cred Genchem,8 cred Organic 8 cred Physics, 8 cred calculus, 8 cred English........a BS in premed is certainly more difficult than a BSN. Still, this doesn't change much yet.

Isn't there a difference in clinical hours?

Again, why the gap in training?

[Sheri257]

I know most of you are very new to these issues. But listen to those of us that have been around awhile. There is a history here, a pattern of behavior. This is part of a bigger picture.

loisane crna

I have been listening. But, quite frankly, there doesn't seem to be compelling arguments coming from the CRNA side. They say AA's don't have enough training, but there's no evidence that patient outcomes are adversely affected. They say MDA's are greedy, but the same argument can be made against CRNA's. They say clinicals may be adversely affected but, once again, no one seems to know for sure.

I agree with GeorgiaAA that the Florida decision is probably significant and, IMHO, it's a sign that CRNA's aren't doing a great job of selling this to the public. Perhaps we don't fully understand all of the details and history on this issue, but then, the Florida legislators apparently didn't either.

And, in the end, that's what really matters since the bottom line is: CRNA's have just lost another state on this issue. Not exactly a ringing endorsement that the CRNA arguments are working, is it?

[deepz]

......the Florida decision is probably significant and, IMHO, it's a sign that CRNA's aren't doing a great job of selling this to the public. Perhaps we don't fully understand all of the details and history on this issue, but then, the Florida legislators apparently didn't either......

The 'public' doesn't craft legislation, Lizz. Never underestimate the corruptibility or the ignorance of legislators. And then there's gullibility. Like the average consumer, legislators are prone to *assume* that a physician is inherently better at any medical-related task. Does not apply to anesthesia, obviously. Such unfounded presuppositions have landed many a consumer in the graveyard. Or worse. There are worse things than death.

By allowing lesser-qualified providers like AAs in Florida, the true losers will be the patients.

Just MHO

deepz

[Sheri257]

Actually, I agree Deepz. I've spent a lot of time covering legislatures (in three states, BTW) as a former journalist. I certainly understand the politics, etc. But, until you have hard evidence that patients will actually lose, instead of hypotheticals, I think it's a lost argument and can easily be perceived as a money squabble more than anything else.

I'm not saying it's right. I'm just viewing the issue from a practical standpoint. All of this stuff about what MDA's have done to CRNA's, or vice versa, probably doesn't matter much in the end. Until there's hard evidence, rather than mere predictions that this is a bad thing for the public, I don't think CRNA's will win on this one.

[loisane]

But, until you have hard evidence that patients will actually lose, instead of hypotheticals, I think it's a lost argument and can easily be perceived as a money squabble more than anything else.

There are other ways for patients to lose other than bad clinical outcomes. If you examine the finances, AAs are not a sound investment for our future. The money that will be spent on creation of new programs to educate providers with a more limited scope of practice than CRNAs, could be spent on our system of nurse anesthesia education that is already in place.

And why do we need AAs in the workforce anyway? By the time a significant number of new graduates are out in practice, our present nurse anesthesia education system will have produced enough graduates to meet the manpower needs.

These are also the kind of things responsible legislators should be looking at. But that pro-physician bias is a powerful force.

loisane crna

[user69]

there are other ways for patients to lose other than bad clinical outcomes. if you examine the finances, aas are not a sound investment for our future. the money that will be spent on creation of new programs to educate providers with a more limited scope of practice than crnas, could be spent on our system of nurse anesthesia education that is already in place.

loisane crna

are you suggesting that the money spent by the aa students (in 2001 emory's web site says that is 62k) should be taken away form the aas and used to support the crna educational system? or are you saying that there are public funds that are going to support these private programs that would be better spent to subsidies crna programs?

[deepz]

......until you have hard evidence that patients will actually lose, instead of hypotheticals, I think it's a lost argument and can easily be perceived as a money squabble more than anything else......

Money squabble, yes. But POWER also, the urge to control anesthesia nationwide as much or more than the MONEY motivates A$A to push AAs on the public.

Folks like GeorgiaAA may be proud and boastful of making $160 K a year, but if those same folks actually understood just how exploited they are, if they grasped just how much unearned income the MDAs profit from the AAs' labors, if they knew the true dollar amounts, they'd revolt. As I say, personally, I'd rather pick cotton.

The Atlanta MDAs are sort of like smart bankers, passing out impressive titles, like Chief Anesthetist, to their underlings instead of pay raises.

Just MHO

deepz

[jelrtLPN]

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

This sounds so familiar, I'm an LPN, constantly being compared to the RN, but in the larger scheme of things, we are there for the paitent,not our egos. I do plan to go on for my RN. Not to say im an RN, but to further my education in the hopes of furthering my patients and family knowledge of thier disease process.. I will remember how i started out in this field, a nurses aid, for 10 years , then a nursing student, where im sure the term, "eat thier young came from", i've been an LPN for 10 years now, soon my RN. I will treat all health care workers i come across with respect, isn't that what it's all about anyway?

[loisane]

are you suggesting that the money spent by the aa students (in 2001 emory's web site says that is 62k) should be taken away form the aas and used to support the crna educational system? or are you saying that there are public funds that are going to support these private programs that would be better spent to subsidies crna programs?

no. i am making the case that is not a wise allocation of an educational system or a government's resources/dollars.

but it is true that both physician and nursing programs receive public/federal dollars in a variety of ways. i don't know about aa programs.

loisane crna

[Sheri257]

Folks like GeorgiaAA may be proud and boastful of making $160 K a year, but if those same folks actually understood just how exploited they are, if they grasped just how much unearned income the MDAs profit from the AAs' labors, if they knew the true dollar amounts, they'd revolt. As I say, personally, I'd rather pick cotton.

Oh, I agree. But this is where the CRNA argument also gets sidetracked, IMHO. Nobody really cares who gets paid what, even though you guys do, and understandly so. I'm not arguing against your point but, at the same time, this is not an issue that's going to drum up support for CRNAs. Especially since the wages for both AA's and CRNA's are still somewhat better than picking cotton.

You guys really need to develop evidence on AA patient outcomes. That's the way to really nail this thing, IMHO. Loisane's point about education funding may be a good one, but it probably won't influence public policy nearly as much as patient endangerment.

[Kiwi, BSN, RN]

Replacing existing AA programs with Nurse Anesthesia graduate programs would be key to solving some problems. Namely, there would be more RNs to help with the nursing shortage. I am going to nursing school with the sole intention of pursuing graduate studies. However, I will be doing my time as an RN until I'm accepted - this goes for many other nursing students.

I thought about going the M.D. route, and was encouraged. It is simply not a goal of mine to have the ability to diagnose a sinus infection. By way of the four-year BSN I am working towards and after some time in the ICU, I feel I will be prepared to learn the scope of anesthesia.

There is a saying in India, and it goes something like this:

We all live three lives - we are first students, then become masters, then become teachers.

I know that I will be a student for most of my life :)

I genuinely appreciate those who have mastered the art of anesthesia (both CRNAs and MDAs). Never underestimate the history of anesthesia practice.

[duckboy20]

I agree that there does need to be a study regarding MDA's giving anesthetics, CRNA's solely giving anesthetics not under the direction of an MDA, CRNA's with MDA's, and MDA's with AA's. Needs to see the comparison of patient outcomes. There has already been studies done that have shown no difference between the CRNA and MDA with each one by thereself or together. Just need to look at MDA's and AA's and see what the outcomes are. Don't think that there is gonna be many people looking to fund this research but it should be done, then we can get a more accurate picture.