Is the AA profession gaining ground?

ralatek · Apr 17, 2007

yep...but according to paindoc in another post, AAs where paid less than CRNAs and therefore a better option to employ AAs rather than CRNAs. Just curious is all.

GregRN · Apr 18, 2007

yep...but according to paindoc

That's your first mistake. Paindoc has also stated that the average general surgeon, oncologist, pulmonologist, neurologist, etc, makes in the 120's to 130's in a major metropolitan area in the Midwest (Chicago). :lol2:

Paindoc has a handful of agendas. Accuracy aint one of them.

You have to realize that the push for more AA's schools by the ASA has nothing to do with providing more qualified anesthesia providers for the benefit of the patient. With CRNA's having identical safety records as MDA's, and being able to provide the same record for less money, MDA's will do everything they can to limit the practice of CRNA's to protect their pockets. CRNA's are gaining more and more autonomy in every state and MDA's see this as an infringement on THEIR turf. The solution? AA programs, which require MDA supervision, thus keeping the hierarchy intact and protecting their pockets.

On another board the MDA's are routinely furious about CRNA's. They say the ASA is doing nothing to protect them and have said they are starting their own anti-CRNA PR campaign to inform and educate the public. My favorite part about this campaign? One poster said, "If we plan on doing this, we'll need some really good outcome studies..." The response, "We don't need outcome studies. We'll highlight the training differences between the two..." I could NOT stop laughing at that! In other words, "Results don't matter. It's slant and spin." I love it! All this talk about how far superior MDA's are to CRNA's and not a study to back it up! In an industry where everything must have data and evidence, it's being dismissed as unnecessary in this case. :lol2:

If a med student did their residency but decided to do 8 years in anesthesia instead of the usual 4 (numerous fellowships let's say), that person would be far better trained and have far superior outcomes when it comes to morbidity and mortality rates, correct? Maybe even twice as good as the typical MDA? Of course not. 8 years of residency is not necessary to provide safe anesthesia services. So, the question is, how much is necessary? And how would you measure it? The measuring part is easy and has already been defined: morbidity and mortality rates. How much training is necessary to provide identical morbidity and mortality rates of MDA's? CRNA's have already answered that question as well.

jimsrna · Apr 18, 2007

I am a CRNA and work in Wisconsin. I have been reading all of the posts regarding AA's vs CRNA's and I have some comments to add. First, the AA's can defend the fact that knowledge in sciences better prepares a practitioner for the OR. Granted, some biochem is useful during patient care, but not essential. As other people have pointed out, most MD's/CRNA's forget a lot of the basic sciences they learn in the beginning of their education. I work with MDA's and their day to day clinical knowledge is comparable to that of CRNA's. However, does this mean that I think that because they may have forgotten some of nonessential facts that the education of the MDA is interchangeable with a CRNA. The answer is no. On the other hand, I don't think academic knowledge equals quality care. I think it can influence it, but quality of care is very individual. Throughout my education, I have worked with many brilliant people(CRNA's, MDA's, RN's) that were book smart but were poor practitioners.

I think that the bigger issue here is the economics of healthcare. Flat out, I believe that wages will not continue to soar as they have. Even though we are facing an enormous anesthesia provider deficit, cuts are coming. Reimbursement is becoming less and less, not only for anesthesia providers, but for surgeons as well. The decrease in reimbursement is going to cause wages to drop and this drop will drive a lot of potential providers from the field.

The problem of not enough anesthesia providers has to be addressed. Studies have proven that educating MDA's if far more expensive than CRNA's. I don't know the cost of educating AA's. However, as I stated before, if salaries of MDA's drop from 400,000 to 200,000, there will be a drop in the number of doctors that enter the profession. I am not saying that MDA's go into anesthesia for the money, but they have to make enough to pay for their education. I believe that the anesthesia care team will be the standard. Who will make up this team will be determined.

I understand that AA's are proud of their profession and have every right to defend it, but our professions nor are our educations equal. Along the same line, a MDA's education or profession is not equal to that of a CRNA. MDA's have much more education and this education is medically focused beyond the basic sciences. I believe that MDA's are better suited to care for patients postoperatively because of this advanced education. They cared for patient throughout there medical school education. Along the same line, CRNA's are better equipped to care for patients secondary to both their nursing education and experience compared to AA's. This is not to say that there isn't a place for AA's, nor that some AA's are not better practitioners than some CRNA's. I do believe that AA's cannot and must not use their credentials interchagably with that of a CRNA. AA's cannot practice independently. In addition, a CRNA must not and should not compare their education with that of an MDA. However, what can be compared is quality of care. With that said, there is not any difference between CRNA's vs MDA's in regards to quality of care and I believe the same will be established for AA's vs. CRNA's.

I think that the idea that AA's will replace CRNA's is just not true. As others have pointed out, there are just a handful of schools with just a few AA's practicing. AA's have been around for a long time and if the ASA truly felt that AA's could replace CRNA's then that would have happened. If AA's were interchangeable with CRNA's, then why haven't their numbers increased of the last twenty years?

georgia_aa · Apr 19, 2007

One poster said, "If we plan on doing this, we'll need some really good outcome studies..." The response, "We don't need outcome studies. We'll highlight the training differences between the two..." I could NOT stop laughing at that! In other words, "Results don't matter. It's slant and spin." I love it! All this talk about how far superior MDA's are to CRNA's and not a study to back it up! In an industry where everything must have data and evidence, it's being dismissed as unnecessary in this case.

Well... I read THAT and absolutely laughed MY you know what off. Smearing a profession with no outcome studies to back it up?? Why the audacity of it!!! You guys kill me.

How is that any different from what you CRNAs and your beloved AANA are doing to AAs in their smear campaign across the country. Same exact thing.. no studies showing any difference at all, just as you said "slant and spin" highlighting training and experience differences. You guys are such hypocrites.

GregRN · Apr 19, 2007

Well... I read THAT and absolutely laughed MY you know what off. Smearing a profession with no outcome studies to back it up?? Why the audacity of it!!! You guys kill me.
How is that any different from what you CRNAs and your beloved AANA are doing to AAs in their smear campaign across the country. Same exact thing.. no studies showing any difference at all, just as you said "slant and spin" highlighting training and experience differences. You guys are such hypocrites.

Please don't lump me into that group. I have two very good friends who are beginning AA programs: one at Case Western, one at Emory. We look forward to one day all coming back to CO and working together when we've all graduated. Maybe I'm in the minority but I actually welcome AA's. There is PLENTY of work for all of us for many, many years to come.

Proverbs 16:3 · Apr 21, 2007

The issue here is how soon is soon. According to the passage at the top of this forum there are 32,000 CRNA, my data from 2005 is 29,500 so we are around 30,000. As well we are putting out about 2,000 new grads a year. As far as the AA profession with a handful of programs and actual practicing AA's it wil take them a while to build up numbers to even come close to closing the gap. This is why we must become involved and advocate that we are the superior providers and are more versatile being we can work without Anesthesiology supervision enabling us to fill the rural shortage that exists today.

Well said. i can't wait to be a member of the AANA. i'm not even out nursing school yet but i'm still excited to know i'll be a member of the greatest lobbying Associations in any nursing specialty in the very near future, if God permits.

deepz · Apr 22, 2007

If the truth hurts, that might explain the A$A aversion to it.
Ask your boss if he still goes around claiming to have done 300,000 cases by himself.
?

Here's an amusing cross-post..........

"Anesthesiologist Assistants-Another Trojan Horse?

http://www.asahq.org/Newsletters/2003/06_03/lte06_03.html

We've traveled this road before when there existed a "shortage" of nurse anesthetist providers and a concomitant ignorance of the complexities of safe anesthetics. The fact that 90 percent or more of the procedures were completed in an uneventful manner only enhanced the idea that anesthesia was no "big deal" and almost anyone could safely administer it to patients.

Only after a few of our esteemed colleagues became involved did we realize the true depth of the problem. It is this direct involvement of the physician in the process that has yielded our continuing march toward "safe" delivery of these noxious agents. Following the example of pioneer anesthesiologists, will we soon see "pilot assistants" take over the more mundane portions of a flight plan in a Boeing 747? Shouldn't we have the most highly trained professional involved at the most basic level of care to recognize and correct a "train of errors or omissions" early in the sequence to break the process? Piloting a complex aircraft and administering a complex anesthetic procedure are very similar beasts.

AAs do not address the true origins of the shortage of well-trained physician anesthesiologists. Only fair reimbursements will do that. Witness the number of hospitals that now financially support anesthesiologists to be available for tough Medicare cases. Where adequate reimbursements exist, there is no shortage of anesthesiologists to do the cases.

Now that our ASA leadership has endorsed the concept of AAs, anesthesiologists will begin to "supervise" two, three or four AAs doing the mundane, boring work while physicians engage in the more "heady" tasks of our profession. How long before AAs begin to think that they do not "need" us 90 percent of the time and try to launch out on their own, at full billing rate, of course, stating they are just as "good" as us? Does this sound familiar to the ASA leadership?

J--- E. C---, M.D.

Scottsdale, Arizona"

SigmaSRNA · Apr 23, 2007

My beef isn't with AAs specifically (meaning if you can do anesthesia and properly trained then you should be able to make a living out of it). My problem is the reason there is such a big push NOW by the ASA to promote the AA profession. When CRNAs weren't as free in the 80s and early 90s you barely even heard of an AA ( the reason that there's only 4 or 5 schools in 30 damn years). Why didn't the ASA pump up the AA profession then????Why now. Shortage huh? More like control and money. The TSA (Texas Society of Anesthesiologists) are trying to, on one hand, question the safety record of CRNAs plus trying to tighten our practice, and on the other, promoting the AA profession and even going so far as to say they can work in a 1:4 ratio. Doesn't make sense to me to promote safety and promote AAs (not saying AAs are unsafe). Just saying that they want AAs to practice like the very profession that's unsafe in their eyes(CRNAs).

n_g · Apr 24, 2007

Just face it. If the ASA wants AA's, it's just a matter of time before all 50 states will have laws to support them. Texas will accept AA's because they have a long history of being receptive to market competition. The ASA is throwing its full support behind AA's now because the AANA has gone militant on them. I have no doubt that this hard push by the AANA for independence and equivalence will backfire on them in the future by angering the MD's and reducing the salaries for CRNA's.

deepz · Apr 25, 2007

Baloney. If they haven't gotten traction with AAs in 30 years, I wouldn't lose any sleep over it. Fewer than a thousand of these well-intentioned folks exist.

Competition? The A$A wants competition?? More baloney. The A$A wants market dominance, not competition.

The AANA may 'militantly' defend CRNAs, yes; defend them from the anesthesia doctors' unrelenting attacks. But independence? No health care provider has true independence. None. Nurse anesthetists have always worked in collaboration with surgeons, for well over a hundred years now. And counting. Proudly. All 36 thousand of us.

deepz

n_g · Apr 25, 2007

When did CRNA's first get independence? It's only been 2001. Before that, there was no need to push for the AA's. The anesthesiologists are finally waking up. We haven't seen the full brunt of their resolve yet.

deepz · Apr 25, 2007

2001 is some strange fabrication, far as I can tell. ?? If one refers to Medicare billing, CRNAs were the first APNs to get individual Part B billing rights, dating back to 1987. CRNAs have functioned independently as anesthesia providers, working with surgeons of course, for a long, long time.

2001? Someone's been watching too many Spacey Odd movies, and dreaming up God-like fantasies.

!

When did CRNA's first get independence? It's only been 2001. Before that, there was no need to push for the AA's. The anesthesiologists are finally waking up. We haven't seen the full brunt of their resolve yet.