Here's what AAs really think of CRNAs

Specialties CRNA

Published

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 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: 656-8848.

Hello all...I am new to the board.

After posting some comments in another CRNA forum on this subject, I was encouraged to join this discussion. I would like to give my thoughts from the perspective of someone who has worked with AA's at Grady Memorial Hospital in Atlanta Ga., a level one trauma center.

First let me say that there were around 45 AA's and 7 CRNA's. I had been giving anesthesia for 15 years when I went there, having worked as a solo in offices and also within the team concept in large academic institutions. I worked with many fine AA's and certainly counted them as friends. The atomosphere in Atlanta city proper is that AA's and CRNA's do not do regionals, most blocks, central lines, intubate without an MDA. Within these restrictions I can say that most of the AA's were as competent as most of the CRNA's. Meaning: some of each category suck.

The MAJOR difference that is EXTREMELY obvious to any CRNA who has worked outside of Atlanta, is the amount of restriction placed on the CRNA relevant to the amount of restrictions imposed on an AA by the very nature of their education. Their programs TEACH that they will never work independently and that they must consult an MDA for most patient care decisions. It is engrained into the AA that the MDA is the boss and that they exist only to be his extension. Since this understanding is very clear from the start of their education, there is never a question of their place in relationship to the MDA and the residents.

I read another CRNA's thoughts and he put it best: "An AA will do nothing unless he is directed to and a CRNA will do everything unless he is directed not to." (use she if you like) Truely this can describe the practice situation I found myself in. This is not to slight AA's, this is simply the way their training is designed.

As for patient outcomes, I am unaware of any study that can be designed to measure outcomes comparing just the CRNA to the AA since an AA will never practice independantly by law. As for the team concept, I would venture to say there is unlikely to be an adequate study done there also since the variable of the intensity of supervision would likely be scewed. (AA's receiving more, especially if an all MD/CRNA institution is included.)

As for salaries, the AA from Atlanta might be one of my freinds who worked 60-80hrs per week, otherwise he never made $160,000. The average starting salary for a new grad, CRNA or AA, was aprox $85K when I left Atlanta 1 year ago. I made aprox $115K (yes I had a great schedule and worked elsewhere).

There are 2 things I disliked working in an AA institution: LOW PAY, EXTREME RESTRICTION of PRACTICE. To me, these are the issues that affect CRNA's. AA's can become very proficient in technical skills, they can also develope that "sense" that comes from working with ICU patients (though they WILL NOT arrive with it when they are done with their training). That being said....if I was a 22 year old kid in Atlanta with a BS in geology and wanted to find a career...I would go to EMORY in a heartbeat, get my AA in two years and start making money. I did find it VERY difficult to adapt to teaching AA students, since I never knew what they knew and what they didn't....at least with an SRNA you know they have seen a patient with 10 different meds infusing and won't say "How do you know what to do with all that?"

I looked at both Emory's and the school in Ohio that teach anesthesia assistants. The students must take all pre-med classes and the MCAT before applying to the schools. What is the point in that? If I'm taking pre-med classes and have to study for, pay for, and lose sleep over the MCAT, I'm definitely applying for med school! Why would a person want to do all of this pre-med stuff just to go out and be supervised by someone that was a pre-med just like you?

I guess to each his own. PA's take pre-med classes but they don't have to take the MCAT, do they?

For now, I believe the positive thing we can take from this discussion is that just like there is a nursing shortage, there is also a shortage of anesthetist providers. There should be an abundance of employment opportunities for both CRNAs and AAs.

It is a common assumption (at least from what I have heard) that students who attend AA school are those who applied to medical school, but did not get in. I attended Case Western Reserve University in Cleveland as an undergraduate, and I know many of the people who are attending CWRU in the AA program. The minimum requirements to get into that program are:

undergraduate GPA of 2.75

pre-med curriculum (courses in chemistry, biology, physics, anatomy, and calculus)

MCAT score of 20

The website for their program is linked here: http://www.anesthesiaprogram.com .

Since I do love to call myself a princess, I'm going for "Princess Anesthetist". Kinda has a nice ring to it!

give me a break...

Thanks for the insight Gregsto.

this a vauge discription of classes. what does "pre-med" classes mean. I always thought of "pre-med" as code for I dont' know what the hell i wanna do but i like science.

anatomy, check

physiology check

micro check

chem check

nurtition check

phycology check

human developent check

pathophysiology again check

what is the diffrence in what we do and what they do?????

physics?? lol.. is that it. physics.. hmmmmmmmm

i took physics, does that make me better? x's2 got a's :rotfl:

this a vauge discription of classes. what does "pre-med" classes mean. I always thought of "pre-med" as code for I dont' know what the hell i wanna do but i like science.

anatomy, check

physiology check

micro check

chem check

nurtition check

phycology check

human developent check

pathophysiology again check

what is the diffrence in what we do and what they do?????

physics?? lol.. is that it. physics.. hmmmmmmmm

not to say you are wrong but most nurses don't take the upper level chem or biology classes. so there is a difference there. and only one of the AA schools requires the MCAT, Case I think. just clarifying these two points.

gregsto, i really enjoyed your post. especially since you have first hand knowledge.

thanks much for the input swumpgas and gregsto. good to hear from you!

and crnastudent, a 2.75 gpa and mcat 20 aren't going to get you into any med school worth its accreditation unless you go offshore, have a fairy godmother, or buy your admission. so, cwru's minimal standards are lower for aas than future physicians.

i just dislike the notion that someone who majored in something like art history and can eloquently describe the difference between monet and manet, but who has never even touched a patient as a caregiver, need not acquire any patient care experience prior to admission, get through a program in 2 1/2 years, and then administer anesthesia, even if it is "supervised". and you can't tell me that those pre-med courses do anything to prepare you for patient care. what are you going to do, draw a diagram of succinylcholine during induction, for goodness' sake?

georgia_aa,

thank you for your response. however, my comments still stand.

as you stated,

the only thing that i cannot do is practice independantly. beyond that, i am trained and fully capable of doing anything that a crna can do. honestly, i can't rise to the level of crna practice by virtue of my training??
i respectfully beg to differ with you on that statement. again, please understand that this is not an insult or personal attack. however, while your assertions may be true in your department, aa life beyond the perimeter offers the following reality (and i bet you know why):

4731-24-04 anesthesiologist assistants: prohibitions.

(a) nothing in this chapter of the administration code or chapter 4760. of the revised code shall permit an anesthesiologist assistant to perform any anesthetic procedure not specifically authorized by chapter 4760. of the revised code, including epidural and spinal anesthetic procedures and invasive medically accepted monitoring techniques. for purposes of this chapter of the administrative code, "invasive medically accepted monitoring techniques" means pulmonary artery catheterization, central venous catheterization, and all forms of arterial catheterization with the exception of brachial, radial and dorsalis pedis cannulation.

(b) an anesthesiologist assistant shall not practice in any location other than a hospital or ambulatory surgical facility.

© an anesthesiologist assistant shall not practice except under the direct supervision and in the immediate presence of a supervising anesthesiologist as defined in this chapter of the administrative code and chapter 4760. of the revised code.

effective: may 30, 2003

note: this excerpt from the ohio practic regs governing aas

Ah come on geecue, why can't I be "princess anesthetist" if you are "geecue"? Keep in mind this whole name thing came about to lighten up this thread, when things were heated over the title anesthesia nurse. I'd love to hear anything the rest of you have come up with!

athlein, i'm glad you looked that up, that was my project for when i got home today. seems there is some discrepency about what is allowed by the mda and allowed by law.

questionable practices. proves a point. (many actually)

d

Hi Everyone,

I was getting concerned that this thread was growing increasingly hostile. I was worried that all I was succeeding in doing was fanning the flames which was not at all my intent.

To address the CRNA from Grady. Some of what you said is absolutely true. The restrictions placed on CRNA/AA practice are the norm in the Atlanta area. Very few anesthetists (I am referring to both CRNAs and AAs when I use this term) perform regionals in MD run practices. His observation that anesthetists don't do central lines may have been true at Grady, but we do them every day at my center. At St. Joseph's hospital, a major cardiac center, all anesthetists may insert central lines after demonstrating proficiency at it. I do know that there were some restrictions placed on AAs in Ohio that are in the process of being resolved, but in Atlanta I do everything except regional blocks. In Macon, I know for a fact that AAs are doing lots of regionals.

As far as salary goes, yes my 160k was earned by working lots of OT. I have a young family and am willing to take on all I can get. My base is 115K and I typically work 2 doubles a week plus one weekend a month call from home. When I stated my salary I was not boasting as DEEPZ called it, but merely pointing out that we do not accept lower pay than CRNAs which has been commonly stated.

I am absolutely committed to the anesthesia care team approach. I believe that it is the safest way to receive an anesthetic in the US. If my patient is not doing well or something happens surgically and I just need help, I like knowing that I can have 5 board certified anesthesiologists in the room within 60 seconds. I know, I know, your patients never have problems and nothing unexpected ever happens right?? To me, it's not about showing everyone that I can handle everything myself, but doing what is safest for the patient. Having more than one person in the room skilled at anesthesia during those critical moments is just intuitively more safe to me. The reality is that the MDA doesn't come into the room and take over and shove me out of the way, but rather we work together as a team to get the patient past whatever the problem may be. It is a collaboration where our skills and knowledge complement one another. The line that an AA will do nothing without being told is a total bunch of crap. We can just agree to disagree on that point and call it a day.

Again, if you read my posts I have never said anything that could be construed as CRNA bashing. That being said, I do believe that your leadership is hurting you on the national level. In every instance that we have sought legislation allowing us to practice, the AANA has argued that we are not qualifed by virtue of not being nurses first. They completely ignore the fact that 60-70% of every AA class did indeed have healthcare experience before enrolling in AA school (resp therapy, EMT, and yes even a few RNs being the most common). In each and every case, the legislators travelled to Atlanta, Ohio, or other states in which AAs practice and saw with there own eyes AAs and CRNAs coexisting peacefully and doing the EXACT SAME JOB. In many instances CRNAs train AA students and vice versa (shocking!!). So in light of what they see with their own eyes, the AANA rhetoric just doesn't ring true and you come off as a group with a huge chip on your shoulders just trying to protect your turf.

Please, I want to keep this friendly. I really think that most of you don't really know the first thing about us and I'm just trying to dispel some of the falsehoods. I know for a fact that you don't have to be a nurse to be a talented, skilled, compassionate anesthesia provider. What you DO have to be is intelligent, analytical, able to think fast on your feet, and have the ability to funtion in a fast paced, and at times very tense environment. If you don't possess those attributes, nurse or otherwise, you will not be a good anesthetist.

BTW, I did get into medical school (3 acceptances) but chose AA instead. I was a little older and decided not to invest the amount of time it would take to get there. I'm very happy with my choice.

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