swumpgas

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 to maintain their anticipated lifestyle. It's about control.

Let me divert the thread.. AMA is considering FMG (Foreign Medical Graduates) (IMG to be politically correct), that do not meet standards for an internsahip in the US to get licensure, for rolls in medicine. Possibly working as NURSES. in the US and Canada, due to the Nursing shortage. Lab techs, etc. Not sure what mechanism would be used to verify their skill levels, or even aptitude. But it is being talked about. These are DOCTORS in their own countries that will be stepped down in STATUS to the roll of nurse. Talk about attitide problems? skill deficits? Just something to think about and Look out for. http://www.asianlabour.org/archives/000813.html http://www.inq7.net/globalnation/sec_new/2004/feb/09-01.htm http://www.malaya.com.ph/mar05/edtorde.htm http://www.parl.gc.ca/committees/simc/evidence/06_95-05-10/simc06_blk101.html

Just something to think about... conflicts in rolls in regard to standards, eg: prescriptive authority. I believe as an FNP, you need protocals, and the approved formulary? to work with? CRNAs have bypassed Prescriptive authority by choice as it would require a "collaborating MD" the type of person we like to avoid. While the concept is interesting, I think there are some things that should be looked at carefully. My wife is an FNP with Rx authority, but I have always enjoyed the freedom of not having a list or collaborating MD to look out for, I have gotten around the issue a few times when our hospital pharmacist has transferred an order I wrote in Hospital, to a community drugstore, enabling the patient to "pick up " the meds needed.. Just a lookout..

This is exactly the way the MDA's want it, LEGISLATED control of anesthesia competitors. It is a matter of control. Right now, the autonomy of the CRNAs and the fact that NO states require supervision of a CRNA by an anesthesia MD , they do not have as much control as they desire. As bigger hospital staffs fill up with MDA's , they need to move into areas of the country that have had traditionally CRNA anesthesia. Most small hospitals are happy with CRNA only anesthesia. By requiring that there be an MDA to "supervise", it adds uneeded cost to the budget. Most CRNA's with these small hospitals have worked there for years, been a part of the community, and are very much appreciated.

ok, flowers or chocolates?

I would be interested in some honest input from your friend that changed to CRNA anesthesia. The A$A is always touting CRNA's that have become MDA's, posting quotes about how "undertrained" they were as CRNA's That's a matter of the school and desire, not the whle profession. Does your friend feel the he/she is mpre prpared for anesthesia as a CRNA coming from an AA background.? Interesting situation.

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.

Who actually did your anesthesia? are you sure it was personally done by that MDA, or just saw a white coat appear, do you pre op chat, then turn you over to a CRNA to actually do the work. In bigger "Team" places, you may be so doped up that you don't even recall who actually does your anesthesia. That is one of the little "tricks" used to do ghost anesthesia. Let people think because an MDA sees them preop, says "I'll be doing your anesthesia", dopes the person up, and the case is actually done by a CRNA, or AA, while the MDA goes back to the stock ticker. Or Donuts. Most times, the actual anesthesia "doer" is setting up for the case, the MDA sees the patient, and the patient is dragged ito the room with no idea of who is really doing the work. did they have donuts on their breath?

nice article from the Florida Papers how AA's via MDA's got their collective feet in the door http://www.palmbeachpost.com/opinion/content/auto/epaper/editions/tuesday/opinion_04175f9ff233c01e00db.html MONEY!!!!!!!

There are definitely moves afoot, snuck into legisation by ASA minions to begin AA training programs in other states. Many have been shot down.. Also surreptitious attemptst to introduce AA's into the VA healthcare system. Now a given of the VA healthcare system is that a practitioner licensed in any state may work in any VA hospital anywhere.. This is an attempt to get AA's working in VA Hospitals even in states that do not allow the practice of AA's as well as adding to the cost of VA healthcare by requireng that an MDA be present to supervise the AA when providing anesthesia. PA's (Physician Assistants) came into being initially in the 60's as an attempt to use the skills of medics and corpsmen trained in the military. By using them informally, then formally, the PA came into being, with sub specialties, Ortho, Medicine, Surgery, etc. there is no aneshtesia counterpart of the Medic/corpsman to be incorporated into the roll as a PA. That roll has traditionally been filled by well trained CRNA's in times of war. The Military schools of anesthesia are excellent. The web site for the AA's goes into some detail http://anesthesiology.emory.edu/PA_Program/whatis.html if you read betwqeen the lines of Emory's own web site, you should be able to see the "Hems and Haws" as the difference between classs A Practitioner (PA) and class B praxctitioner (AA) Here is a quote from the Emory web site: describing AA's "Because his knowledge and skill are limited to a particular specialty, he is less qualified for independent action." the Original PA's will not even accept AA's as PA's. http://www.aapa.org/ The duties of the PA and the Advanced Nurse practitioner more overlap, with prescriptive authority being given to both under varying circumstances , state by state. again, it's a matter of background training of the individual. The web of deception is a tangled one, with legislation being made under the sheets, on the golf course, at cocktail or fundraising parties, etc. Sometimes we are lucky in rooting it out, sometimes some slip by. CRNAS are traditionally doing the workload while MDA's who are being paid to "Supervise" may be out on the golf course, wheeling and dealing with legislators.

It is a matter of correcting misinformation spread by yourself and your MDA masters. Lies will not go unchallenged, just as touted studies by the ASA in regard to saftey of anestheisa (Silber, Pine et all), but did not stand up to scrutiny by independant clinicians. Technician and bagsqueezer are terms MDA's use to designate and denigrate those that are not trained in the medical model, part of the old boys club. I admire your trips for humanities sake. There is not enough recognition of those that do volunteer work for the poor, either on purpose or the poor and indigent population. Let us not forget the sole purpose for the creation of the anesthesia assistant 40 years ago I bellieve. CRNA's got too uppity, did not jump to the whim of those that would dictate methods of practice and needed to be slapped down. This cannot be ignored. Statements from the ASA "leaders", your own Atlantian MDA Neeld, who claims to have pesonally performed 300,000 anesthetics in his lifetime.. as a clinician, you should see that is impossible for anyone younger than Methuselah. Misinformation, Misrepresentation, and outright lies are rampant among your MDA mentors, in an effort too control anesthesia services. I do not have a quarrel with MDA's that do their own cases, but those that sit back and sponge off the efforts and labors of others, be it CRNA, or AA, I hold in contempt. Do not equate an AA with a CRNA. The keyword ASSISTANT is placed in your title by design by your bosses. You are their assistant, not a colleague, not a peer.

There never has been a requirement that CRNA's be supervised by and anesthesiolgist (MDA), only a doctor, generally the supervising surgeon, and that only applied in about 27 states. The Bush administration, rather that follow the recommendations of HCFA after a few years of researching the subject., dumped the rule that CRNA's no longer needed supervision to be reinbursed by Medicare (via HCFA) It was left to individual states to decide if MD (not MDA) supervision was reuired at the state level. To this date, I believe 12 states have made the decision to not require any MD supervision. Most other states did not have any requitrement at all. I was strictly an issue to reimbursement. Rather than take up a lot of bandwidth here, I would refer you to the Association web page http://www.aana.com there's a ton of infor there about just the issues you are asking about. You will find becoming a CRNA very "challenging", but a very worthy goal. Good Luck.. http://www.ifna.info/

Ahh, the difference in background training... can you give an enema and not have the sheets all discolored? When you spend time ducking Mortar fire in combat in Vietnam and trying to provide safe anesthesia to our troops, I'll consider your statement as being able to do all a CRNA can, as a possibility. There were no MDA's in the line hospitals. They were back in the rear. in the big towns. There are 2 CRNAs names on the Vietnam Memorial Wall Jerome E. Olmsted Kenneth R. Shoemaker among other RN's that gave it all Sharon Ann Lane How many AA's are in Iraq? When you are called out of bed at 3AM to provide anesthesia for a bunck of teens that have wrappeed their car around a telephone poll, without having a back up MDA to call in to help or "supervise"... then the situation will be different. Surgeons have said for years tha monkeys can be trained to do anesthesia, maybe a bit of exaggeration, but just as the MDA's tout a background in medicine is needed for anesthesia, it also applies to AA's with NO background in medicine, or medical science. You are and will always be technicians, or "Bag squeezers". Serving at the whim of your overseer. doing their bidding. Asking permission.. Your restrictions on performance are not the doing of CRNA's, it is the doing of the control freak MDA's that establish the legislation FOR YOU to practice, so there is never another group of bagsqueezers that are allowed independance. You may be the finest person in the world, but do not equate youself with those that have gone before you and paved the way, and have a 120 year track record for safety. Send me an email fro Iraq

>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> This is bound to make a lot of eyeballs roll back in a lot of heads, but ya gota understand the history of Nurses in anesthesia and MD's in anesthesia. I'm sure anyone knows that early anesthesia was traditionally done by Nurses.. They were more "Vigilant" (attentive) than the residents and interns , then came the surplus MD situation. It's a matter of control. CRNA's on a day to day basis "witness" the clinical skills of Anesthesiologists, (from now on MD-A for short) These are the guys that are supposed to be our superiors.. and in many cases, they are good.. not superior, but at least equal.. Then there historically has been the Foreign Trained MD that chose Anesthesia, because they could not speak enough English to enter private practice. Their skill level might have been good, but their other skills lacked. For years MD-A's were looked down upon by their surgeon colleagues for some of those reasons. And at the other extreme is the MD that is not trained in anesthesia at all, possibly taking a rotation in anesthesia for a few months, then calling themselves an Anesthesiologist. They are still out there, maybe as a GP doing anesthesia ,to a lesser degree, but still mucking about. Then there are the ones that cannot pass their boards in anesthesia, but call themselves "board Eligible" and work as MD-A's. Now this fussin has been going on for at least 40 years that I have been passing gas and longer between CRNA's , that usually come from the tops of their classes, are somewhat over achievers, and clinically excellent, in comparison with some of the older so called MD-A's that just squeezed through med school. The issue now is about control of anesthesia provision and competition, by the MD-A's, that by law, and standard practice have no real control over CRNA practice. CRNA's are technically supervised by a surgeon, as part of a team effort in most states, but Surgeons do not know a lot about modern anesthesia . It's about all they can do to stay on top of their own Board requirements. So the CRNA-AA fuss stems from the CRNA / MD-A control issue. They have been unsuccessful in legislating control over CRNA's, so they have created their own Newtech Anesthesia provider.. The Anesthesia Assistant. And these folks have put down their sliderules from engineering, Botany, Chemistry , etc degrees, and come into a patient care field without any background in human science (eg Nursing background-- remember all the hoops you all had to go through, taking care of patients? Enemas till clear. talking to the family of a child that just died, Psych and OB training, etc,wrestling with the drunk in ER, and worse as part of your nursing backgrounds? ) This is not a put down of Anesthesia assistants, they have just been sucked into the CRNA MD-A turf Battle... All proposed legislation to permit Anesthesia Assistants to work has required that they be SUPERVISED by an MD-A--- talk about built in control.. there is NO requirement in ANY state that a CRNA must be supervised by an MD-A , but MD-A's would love this requirement, and control. There is an old saying among CRNA's , that we all get smarter at 3:30, when the MD-A's go home, and we are left there by ourselves, finishing the schedule, or being on call the rest of the night, with no supervision.. The Anesthesia Programs at Emory and other places, were started as a direct attempt by MD-As to gain control over anesthesia. Note, it was not mentioned that the MD-A's actually do the cases, Lord no.. that would make it difficult to sit in the lounge and watch the stock ticker and eat donuts.. I do not really have a problem with AA's, but again I do not personally know any. They may be the greatest people in the world, I don't know. I do know, that by law, their wings are Clipped,, they may not make independent decisions , insert invasive cardiovascular lines, do regional anesthesia in most situations (another facet of "Control") God forbid the MD-A should be stuck in the bathroom or have an MI and they had to make a clinical judgments, that is not in their armamentarium. When I have my next surgery, I want my anesthesia done by someone that can give me an emergency enema if needed, without calling an MD-A for advice. Oh yea, someone made the comment about the US being the only place that uses CRNA's... Untrue, and it is being experimented with in England, Australia, Canada, and many other places that have traditionally had only MD-s Doing anesthesia.. they are beginning to see the light.. Many Anesthesia Assistants are trying to pass themselves off as Physician's Assistants. The Nation Physician Assistant Assn, states in no uncertain terms, that Anesthesia Assistants are NOT the equivalent of Physicians Assistants. http://www.aapa.org/gandp/aas2.html You can see Emory's evaluation of the 2 on their own web site http://anesthesiology.emory.edu/PA_Program/whatis.html As nurses you have seen the good and bad Physicians. And the control issues. This is what I all comes down to. Control and MONEY.. I'm done ....you can wake up now..