First, I'd like to say I'm just a lowly nursing student. I'm not a CRNA so I am, by and large, ignorant on this subject. I've tried to do some board searches but couldn't find much except some general discussion on this issue.
However, a good friend of mine is a Washington D.C. attorney who is representing CRNA's before the local city council. Apparently they are fighting some action from the Board of Medicine which recognized AA's, and the CRNA's are requesting that the AA's also become licensed PA's before they are allowed to practice in D.C. Apparently the CRNA's are arguing that the patient outcomes with these AA's aren't as good as CRNA's, but I don't have any specifics or data on this claim.
My attorney friend says the Health Department is supporting the CRNA's, and that hearings were held on this issue just today, but the outcome is uncertain. I've also heard of CRNA's fighting similar actions by the Veterans Adminstration to allow AA's in their hospitals.
My question is: Are these political battles growing in number, and what do you think the outcome/trend will be, let's say, in ten years? I know that there are only two AA schools in the country, but the physicians definitely seem to be pushing for this. (My attorney friend says this comes at a time where two D.C. area colleges are planning to launch new CRNA programs and he thinks this has something to do with the D.C. action.)
Unfortunately, I don't have much more information than this. (I'm trying to bug my attorney friend to send me more data, but he's very busy.)
So what do you guys think about all of this? Will the AA's win on this eventually and, if so, what does this mean for CRNAs?
Please excuse my ignorance but it seems that there are too many health professionals trying to do other peoples' jobs.... here in Australia, CRNA's, PA's and AA's dont exist....
Does anyone have any statistics research on intra- and post-operative complications versus the education level/designation of the anaesthesia provider?
Amy.
There is a lot od MIS information spread by MDA, finding studies that can be twisted to show something. these have all been shot down as irrelevant or or misleading. Just a few links to verify this and others:
as an aside, I had the PLEASURE of meeting one of your own Aussie "Anaesthetists" , the late Dr. Michael Bookalil, in Vung Tau Vietnam 36 years ago. He was nothing but complimentary about anesthesia care delivered by American CRNAs. He did not blink at all with the CRNA, but bought me an "Emu" instead. A class "A" gentleman .
If American MDAs had 1/3 as much class as he did, there would be no CRNA/MDA conflicts, just mutual respect.
Does anyone have any statistics research on intra- and post-operative complications versus the education level/designation of the anaesthesia provider?
Amy.
The Pennsylvania Study published only in the ASA sanctioned journal was a flawed piece of research indicating MDA directed anesthesia to be safer than that delivered by CRNAs. If CRNA anesthesia was truly less safe than MDA practice, I suspect CRNA liability rates would be much greater than they are now.
I am reminded of somthing a good friend related to me after he had delved into some thermodyamics book.
there is some law that states if "things arn't maintained they will invariably corupt".
to me this means just by the fact that AA's are being considered by legislators at all means that eventually coruption will occur although I hope not. we are the balancing force.
it happens with everything,, I could list some examples but I would see like a right winged nut head.
They want control. No more or less complicated than that. No one spends time, money or energy pushing for something unless it benifits them directly. I promise you, they want control of the money, scheduling and cases. They want pts to have to come to THEM. Not the other way around. CRNS's threaten this by practicing in smaller hospitals in rural environ's. Ask them. They'll tell you.
My main question to the CRNA's who don't have a clue as to what an AA truly is or does is WHAT ARE YOU SO AFRAID OF?
if you think our arguments are primarily out of fear - you have not read the entire posts...patient safety is first....and we all know what AA's do - and we are well aware how their practice differs from ours. please don't come to a nursing board and not expect a pro-nurse discussion - that is somewhat self-explanatory.
if you think our arguments are primarily out of fear - you have not read the entire posts...patient safety is first....and we all know what AA's do - and we are well aware how their practice differs from ours. please don't come to a nursing board and not expect a pro-nurse discussion - that is somewhat self-explanatory.
Sorry, I just joined the forum, so I haven't had time yet to make it through the dozens of pages of posts on the CRNA vs AA issue.
Those of us who are AA's contributing to these discussions are only trying to provide some factual information and correct the misinformation and rumors that seem to abound about us. Most of the CRNA's reading these posts have never worked with AA's.
Patient safety is first with us as well. If patient safety is not your concern, whether AA or CRNA, you are in the wrong profession.
And I'm curious to know what you mean by "...and we all know what AA's do". Obviously, you don't.
we know what AA's do - they provide anesthesia - .....???? how is that misleading? the primary difference between AA's and CRNA's is that 1. AA's don't neccesarily have to have any medical experience/training/background - CRNA's of course do and 2. CRNA's can work independently and without supervision whereas AA's cannot...
was that clear enough?
i won't waste time repeating multiple posts w/ the same arguments. but patient safety is primary -
and we all know what AA's do - and we are well aware how their practice differs from ours.
How many of the members of this board know what AA's do based on facts and not based on the hype put forth by both sides of the argument? It only takes reading a few posts to realize that there is much confusion over the facts around what an actualy does and what an AA is legaly allowed to do.
(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.
this was from ohio. but if you go back and read the posts by several AA's: do what they say they are doing match what this says. i realize they may be in different states but i would guess the wording is very much the same in any other state.
georgia aa specifically stated he did these things. if the georgia statute is anything like the ohio one then he is practicing well outside his scope.
(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.
this was from ohio. but if you go back and read the posts by several AA's: do what they say they are doing match what this says. i realize they may be in different states but i would guess the wording is very much the same in any other state.
georgia aa specifically stated he did these things. if the georgia statute is anything like the ohio one then he is practicing well outside his scope.
d
These practices were accepted and written for the AA's by their overseers, the ASA, to get the foot in the door.
Note the "control factors" built in by their "creators"
so this is the legal issue.
as far as clinical difference, there is no date to show a difference, between AA/CRNA or for that matter CRNA/MDA... none.
just simply the matter of independant judgement and experience working without "remote controls" attached.
CRNA's have been fighting for years to have the supervision requirement by ANY MD removed in a few states. This was accomplished, to be placed into law 2001, based on HCVA case review and shooting down the much touted (by the ASA) silber study (as irrelvant)
the law change was torpedoed at the last moment by the incoming Bush andministration at the last moment (politics, money, cronieism)
the option was for indivudual states the make their own decision via opt out, most are.. 12 or 13 so far I believe, so their small hospitals can have anesthesia coverage, in areas that are not "lucrative" enough, for an MDA
this was from ohio. but if you go back and read the posts by several aa's: do what they say they are doing match what this says. i realize they may be in different states but i would guess the wording is very much the same in any other state.
georgia aa specifically stated he did these things. if the georgia statute is anything like the ohio one then he is practicing well outside his scope.
d
that is my exact point. you quote a statute for a single state and mention that you assume that the georgia rules are the same even though it was stated earlier in the forum that georgia licenses aas under a pa license. and you make the assumption that georgiaaa is operating outside of his legal space based on rules from half way around the country by a state that treats aas in a different legal light. my point was just that there is still much confusion over what an aa is and what he does. and that your earlier comment that "and we all know what aa's do - and we are well aware how their practice differs from ours." is inaccurate.
swumpgas
14 Posts
There is a lot od MIS information spread by MDA, finding studies that can be twisted to show something. these have all been shot down as irrelevant or or misleading. Just a few links to verify this and others:
http://www.aana.com/patients/hcfa/pastudy.asp
http://www.aana.com/press/2003/041103.asp
http://www.aana.com/crna/prof/quality.asp for a bit of light reading.
as an aside, I had the PLEASURE of meeting one of your own Aussie "Anaesthetists" , the late Dr. Michael Bookalil, in Vung Tau Vietnam 36 years ago. He was nothing but complimentary about anesthesia care delivered by American CRNAs. He did not blink at all with the CRNA, but bought me an "Emu" instead. A class "A" gentleman .
If American MDAs had 1/3 as much class as he did, there would be no CRNA/MDA conflicts, just mutual respect.