plimpington

I'm only a second year, so I don't really know all that much about how things work, but what I do know is that unless the under-supply issue becomes so bad that physicians find themselves workin more hours than they want too (or other logistical realities make the practice generall unpleasant) physician groups (whether they are Radiologists, MDA's, Dermatologists, etc.) do everything they can to create provider shortages, not solve them. It seems to me that CRNA's (or SRNA's or MDA's) should endevour to do everything they can to reduce the provider numbers if salary protection is the number one goal. That goes for any provider. History suggests that all physician groups have followed this tact for at least 75 years and it is probably responsible for the salary structurers present there. Am I wrong about this? Plimp

Well, I'm not skeptic - in fact quite the opposite. I agree that economics will be the sole driver of anesthetic care in the future, and things being as they are, I don't see a place in medicine for MDA's. I take with a grain of salt your assertion that you feel there is a place for MDA's in medicine in the future. Why? What do they do that you cannot? Judd

Honestly, I'm having trouble understanding why everybody seems so defensive on this subject. I'm not even a doctor yet. Just how much baggage do you think I could be bringing to these discussions? I don't think the question is in need of any rephrasing. There's no assumption surrounding it. I wanted to know if the AANA (or CRNA's as a group) see any place in the future of medicine for MDA's. You seem to suggest that they do (and then you bring up the ASA - what makes you think I agree with the ASA???). AND WHAT makes you think that just because I've asked the question, I'm making some normative judgement about the scope of CRNA practice? I;m not. I have NO IDEA whether a CRNA is capable of subsuming the whole of the scope of practice of an MDA, nor do I assume they cannot. Likewise, I HAVE NO IDEA whether an MDA is overtrained (basically 8 years of training) in light of the fact that CRNA's can do all anesthesia with only 4 years of training, thus making the MDA inefficient and overpaid. From my perspective, in any event, I can't understand your position on this issue. If the CRNA has equal expertise throughout the entire scope of practice as an MDA does, why should there be a place in anesthesia for an overpaid provider below the subspecialty level? Why would the free market for medical care ever "select" MDA's to administer anesthesia when they (1) don't have any extra expertise than CRNA's do, and (2) do not provide better care, and (3) cost about twice as much $$$? This makes no sense to me. So, ask yourselves these questions and post here: (1) do MDA's do something that I do not do, and (2) is that extra something worth the extra cost of an MDA? If the answers to these questions are "no", I don't see a place for MDA's in healthcare below the subspecialty level, and therefor would probably do something else with my own career. I'm asking for objective career advice - nothing more. plimpington

I'm not sure why you are defending yourself against attacks I did not make. I'm not sure why I should leave the AANA out of the discussion. If I am interested in knowing what the professional goals of CRNA's are, doesn't it make sense to mention their professional association. They set policy, lobby, etc. Nor did I presume to refute any of the positions of the AANA. I merely wanted to know if the AANA saw any place for MDA's in the future of medicine. There's no question in my mind that the AANA is much more powerful than the ASA is. Plimpington

Whoa whoa, One thing is clear though. Outside certain fellowship areas (pain, acute care, etc.) the scope of CRNA practice is concurrent with the whole scope of anesthesia practice as a whole. Therefore, the MDA (as far as I can gather) brings no special expertise to the practice of gas (below the sub-specialty level, anyway) and is, therefore, just another provider. That being the case, I can't see ANY future for MDA's below the subspecialty level. Even in those situations where two providers are better than one, why would anybody pay the higher MDA salary when the CRNA is cheaper and provides not only the same quality of care, but also provides care throughout the entire scope of MDA practice. What does the MDA bring to anesthesia (below the subspecialty level) other than an extra set of hands (for which, as you say, there are plenty of stools to go around)? If it's just an extra set of hands - I don't see a future in MDA. I think it's clear from these posts that it is just an extra set of hands. plimpington

So as to avoid the cliche'd "don't feed the troll" response, I'll try to be as open as possible. I'm starting med school in the fall and have (had?) considered MDA as a possible choice. But not a day goes by on the med forums where one does not see threads regarding the dwindling prospects of MDA's due to an increasing scope of practice for CRNA's. Assuming the CRNA M&M rates are about the same as those for MDA's, in your view (or that of the AANA) is there ANY place at all for MDA's in the future of medical care? That is, is the ultimate goal (er, the ultimate position) of the AANA to expand the scope of practice of CRNA's to subsume the WHOLE of the scope of practice of MDA's - OR, does the AANA still see a role for MDA's, and therefor recognizes an upper limit to the scope of CRNA practice? Plimpington