TEXAS CRNA's Call to action. Stop the potential AA bill!

[Outdoor1]

WHY SB 1314 AND HB 3313 ARE BAD PUBLIC POLICY

THIS IS A SCOPE OF PRACTICE FIGHT!

FACTS:

With insufficient funds for critical needs in the state, why create a licensure advisory board and licensure process for fewer than 20 people in Texas?

The Texas Medical Board (TMB) already has a backlog of over 2500 applications from badly needed physicians who cannot get licensed in Texas because TMB does not have adequate staff. The problem is so severe that TMB is receiving a supplemental appropriation to begin to address the backlog.

Anesthesiologists Assistants (AAs) do not improve access to anesthesia services because AAs can only work under the supervision of a board certified Anesthesiologist.

Anesthesiologists practice in only 70 Texas counties and one-fourth are NOT board certified.

Once licensure occurs, the next move will be to start an AA school that will drain money away from the existing anesthesiology and nurse anesthetists educational programs.

This legislation increases liability of the supervising Anesthesiologist in all cases and the health care facility if it employs an AA.

This is a pocket book issue. Anesthesiologists can make twice as much supervising 4 providers than they can actually providing care to a patient.

Passage of SB 1314 and HB 3313 WILL effect YOU!

Action Required:

Call, write, e-mail or visit your State Senator

Call, write, e-mail or visit your State Representative

Ask your friends, family and co-workers to call, write, e-mail or visit their legislators, and

Visit your legislator at the Capitol in Austin or in their district office to voice your displeasure on SB 1314 and HB 3313.

Texas must focus on accessible, affordable, high quality health care by Anesthesiologists and Certified Registered Nurse Anesthetists.

[jwk]

The supervision for AAs varies ont he state, but many states do not require that the MDA be on-site to monitor the AA.

There's also talk of eliminating the supervision requirements or at least toning them down to allow AAs solo practice.

CRNAs have absolutely no logical grounds to oppose the right of AAs to practice their chosen profession. Studies have shown that CRNAs, MDAs, and AAs all have equivalent outcomes.

To oppose AAs because you fear they will take your job is a paranoid delusion, the same paranoid delusion that MDAs used for years to try and outlaw CRNAs and now you CRNAs are using the EXACT SAME IDIOTIC LOGIC against AAs that the MDAs used against you.

I guess CRNAs are exaclty like the MDAs when it comes to using BS tactics to try and create a monopoly. I thought you guys were better than that.

I agree with what you say EXCEPT that an anesthesiologist must indeed be on-site with AA's. We don't practice solo.

[Josh L.Ac.]

From what I just saw on an allied health website (linked from the AMA website), the average salary of an AA is 90-110K, which is not much lower than then 120-140K for CRNAs that was posted earlier.

Sounds like a good opportunity considering you don't have to get a BSN or work a couple years in the ICU. Plus the AA programs are shorter by a year - at least using the stats from the one at Case Western and the CRNA school at Truman that I am looking at.

Is that the concern, that AAs don't have enough training?

[paraiba T]

I don't know if my other post went through, and I don't want to type all that other stuff over. JWK, its a good thing I was not trying to impress you with my professionalism over the internet. The bottom line is most CRNA's don't want AA's around. We can argue the logic behind it all day. It doesn't matter if AAs don't see the logic, no one has to answer to AA's. There are somethings you have to be a CRNA to understand.

[Sheri257]

I'm confused. If memory serves ... I thought AA's could already practice in Texas. What does this bill do that would make it any different?

:typing

[Nitecap]

Listen the most logical solution to any shortage in Texas is to increase the number of CRNAs and Anesthesiologists. Both camps are already increasing numbers in Texas as we speak. Why do we need an AA liscensing board for so few Texas AAs. Lets just divert the time and resourses to increasing MD and CRNA output.

To all TEXAS SRNAs and CRNAs and Nurses this bill will effect you. PLease goto txana.org. From here goto the voter vioce section let your senator/representative no you dont want them to support this bill. Its a fight for your profession no doubt. Once the AA profession catches fire it will attract similar applicants as PA programs which have been overwhelmed with fresh out of undergrad applicants with no clinical back ground what so ever. Yes these PAs serve a purpose and many are really good, however many work in clinics or for docs and dont have to make decisions on the fly like we do in the OR. DO you really want a fresh out of school AA with an undergrad in Education or Exercise Science putting you to sleep with only 1 yr of patient care experience that they recieved in AA school. Yes I know AA school is 2 yrs but a year of that is didactic since most seem to be front loaded. IF AAs get a board in Texas you can put your money on it that AA programs will pop up all over TX. That means a flooding of the market with a less proven provider. You do the math. To thwart this we must take action now. Sources close to the politics of this have warned that they expect the TSA to prob. insert supervision language somewhere in this process.

Texas law makers need to be bombarded with letters, emails, phonecalls and faxs urging them not to support these bills. Its time to step up guys/gals.

[n_g]

AA's in Texas is good for CRNA's. It frees up CRNA's from working in those big cities so that they can work in the small towns. AA's will increase patient access to anesthesia.

[platon20]

Listen the most logical solution to any shortage in Texas is to increase the number of CRNAs and Anesthesiologists. Both camps are already increasing numbers in Texas as we speak. Why do we need an AA liscensing board for so few Texas AAs. Lets just divert the time and resourses to increasing MD and CRNA output.

To all TEXAS SRNAs and CRNAs and Nurses this bill will effect you. PLease goto txana.org. From here goto the voter vioce section let your senator/representative no you dont want them to support this bill. Its a fight for your profession no doubt. Once the AA profession catches fire it will attract similar applicants as PA programs which have been overwhelmed with fresh out of undergrad applicants with no clinical back ground what so ever. Yes these PAs serve a purpose and many are really good, however many work in clinics or for docs and dont have to make decisions on the fly like we do in the OR. DO you really want a fresh out of school AA with an undergrad in Education or Exercise Science putting you to sleep with only 1 yr of patient care experience that they recieved in AA school. Yes I know AA school is 2 yrs but a year of that is didactic since most seem to be front loaded. IF AAs get a board in Texas you can put your money on it that AA programs will pop up all over TX. That means a flooding of the market with a less proven provider. You do the math. To thwart this we must take action now. Sources close to the politics of this have warned that they expect the TSA to prob. insert supervision language somewhere in this process.

Texas law makers need to be bombarded with letters, emails, phonecalls and faxs urging them not to support these bills. Its time to step up guys/gals.

This reeks of a scared little person who wants patients to suffer so that he can artificially ratchet up incomes for his provider group.

Your tone/attitude is EXACTLY the same thing that MDAs said about CRNAs.

This is about access to healthcare for PATIENTS! Your attitude is just as wrong as the MDAs who used it to fight againts CRNAs in the past.

I'd better never hear you use that argument "CRNAs are needed for patient access" again because obviously you dont care about patients, you only care about protecting your turf.

I'll say this again: studies have consistently proven over and over again that AAs, CRNAs, and MDAs all have equal outcomes and safety rates.

The gas provider shortage should be addressed by increasing participation at ALL LEVELS, including AAs, CRNAs, and MDAs. This entire thread reeks of self-protectionism BS which is directly contradictory to better patient outcomes via better access to providers.

[ECMOismygame]

Listen the most logical solution to any shortage in Texas is to increase the number of CRNAs and Anesthesiologists. Both camps are already increasing numbers in Texas as we speak. Why do we need an AA liscensing board for so few Texas AAs. Lets just divert the time and resourses to increasing MD and CRNA output.

To all TEXAS SRNAs and CRNAs and Nurses this bill will effect you. PLease goto txana.org. From here goto the voter vioce section let your senator/representative no you dont want them to support this bill. Its a fight for your profession no doubt. Once the AA profession catches fire it will attract similar applicants as PA programs which have been overwhelmed with fresh out of undergrad applicants with no clinical back ground what so ever. Yes these PAs serve a purpose and many are really good, however many work in clinics or for docs and dont have to make decisions on the fly like we do in the OR. DO you really want a fresh out of school AA with an undergrad in Education or Exercise Science putting you to sleep with only 1 yr of patient care experience that they recieved in AA school. Yes I know AA school is 2 yrs but a year of that is didactic since most seem to be front loaded. IF AAs get a board in Texas you can put your money on it that AA programs will pop up all over TX. That means a flooding of the market with a less proven provider. You do the math. To thwart this we must take action now. Sources close to the politics of this have warned that they expect the TSA to prob. insert supervision language somewhere in this process.

Texas law makers need to be bombarded with letters, emails, phonecalls and faxs urging them not to support these bills. Its time to step up guys/gals.

slippery slope. there are only 4 AA schools nationwide, 2 in georgia. AAs have been practicing in Georgia with CRNAs for over 40yrs. i still see lots of jobs for CRNAs in Georgia, those dam AAs didnt kick out CRNAs from that state, lol. i hope 10 AA programs open up in texas! AAs can already practice in Texas, all they want is licensure, whats so wrong with that?

http://www.asahq.org/Newsletters/2003/03_03/boudreaux.html

The Texas Experience

In 1997, Greater Houston Anesthesiology, P.A. (GHA) recognized the need for additional dependent anesthesia providers. This need arose out of a shortage of qualified anesthesiologists and nurse anesthetists that developed in the mid-1990s. Adverse changes in the medicoeconomic environment for anesthesiologists drove most qualified medical graduates into other specialties. To date, there continues to be limited availability of qualified anesthesiologists and anesthetists.

During this personnel shortage, GHA faced a variety of new obligations and opportunities in the Houston area. After an appropriate period of due diligence, a decision was made to augment GHA's existing anesthesia care team with AAs to optimize the delivery of physician-directed anesthesia care.

Prior to their introduction into Texas, GHA sought out the guidance and approval of the Texas State Board of Medical Examiners (TSBME) to ensure that supervision of AAs would be allowed under the Texas State Medical Practice Act. After a presentation to the TSBME Standing Orders Committee in September 1997, it was deemed appropriate to utilize AAs as defined by the Medical Practice Act, Section 3.06 (d)(1), (2), (3) and (4). In a letter of confirmation from the president of TSBME, he stated: "This Section of this Act pertains not only to anesthesiologist assistants but to any qualified and properly trained person or persons acting under the physician's supervision conducting any medical act which a reasonable and prudent physician would find is within the scope of sound medical judgment to delegate if, in the opinion of the delegating physician, the act can be properly and safely performed by the person to whom the medical act is delegated and the act is performed in its customary manner, not in violation of any other statute, and the person does not hold himself out to the public as being authorized to practice medicine."

Subsequent to this opinion, TSBME promulgated "Guidelines for Anesthesiologist Assistants." Though the guidelines originally recommended a 1:2 supervision ratio, this ratio has recently been changed to 1:4. The guidelines also recommend that the supervising anesthesiologist be board-certified. This document can be accessed at .

In both the hospital and ambulatory surgical setting, AAs have proven to be valuable, highly qualified members of the anesthesia care team in Texas. In addition to the Houston area, AAs have worked in Dallas, San Antonio and Galveston. All government and commercial insurers recognize payment for anesthesia services involving AAs.

[n_g]

So how long do you guys think these salad days will last? Being paid $140k for just a master's degree out of CRNA school can't last indefinitely. How many people were foolish to think that the dot-com bubble would last indefinitely too? Medicare will catch on and reduce reimbursements drastically in the future. Of all the specialties, I heard that anesthesiology is getting hit the hardest by the Medicare cuts in the next few years. I think that this is because anesthesiology has been regarded for a long time as a physician occupation. If the CRNA's are showing that it can be done, then they are proving that it doesn't require a physician to do it. Therefore, the reimbursements will drop to reflect a job that can be done by someone with only a master's degree. I think that the CRNA's own success will hurt them down the road.

[Alpha13]

AA's in Texas is good for CRNA's. It frees up CRNA's from working in those big cities so that they can work in the small towns. AA's will increase patient access to anesthesia.

You are very confused about what is good for CRNAs my friend.

Guys, I know it's tempting to use every opportunity to start a debate about AAs but is this really a good time to? Please I implore you, do everything you can too stop this bill. I know if a bill like that ever comes to Cali I'm going to be known by name to my congresspeople. I'd call every day, mail every day, start a political rally at my school ("Support our troops overseas.. and stop the AA bill!"), even grease the wheels a bit if I could.

Not that I hate AAs mind you, hell I'm a liberal Californian so I like pretty much anything. But these outsiders are a threat to our profession, and thus our well being! Are you proud texans going to allow it in your state?

I'm being a bit facetious, but seriously don't treat this thing like some pidley little nuisance guys, because if you do, it will come back to bite you.

Alpha

[paindoc]

1. My position is based on cold hard facts that are irrefutable. I have trained 3 RNs to give anesthesia over the past 10 years, and they have successfully administered propofol general anesthesia in an office setting to more than 10,000 patients without any hospital admissions of these patients, respiratory or cardiac arrests, or bad outcomes. This proves beyond a shadow of a doubt that RNs can do exactly what CRNAs would do in an office setting and with the same outcome for less than 1/3 the income of a CRNA. The patient chart includes charting similar to anesthesiologists and CRNAs use in practice.

2. CRNAs may be useful in certain settings but they are certainly not required and cannot demonstrate enhanced safety over a RN trained to administer MAC or general to a ASA 1 or 2 outpatient for short procedures.

I have been there, and done that, so there is simply no sophistry here. CRNAs in many situations could certainly be replaced by AAs and in most cases of outpatient office anesthesia by RNs. Then the anesthesia shortage would disappear, and CRNAs could use their skills to treat the ASA 3-5 patients that would benefit from their efforts.

[Nitecap]

AA's in Texas is good for CRNA's. It frees up CRNA's from working in those big cities so that they can work in the small towns. AA's will increase patient access to anesthesia.

AA's are not good for texas. What Texas needs is to continue increasing production of the proven and more versatile providers which are CRNAs and Anesthesiologists. The Texas Nurses Association is totally against the AA bill. All nurses should unite.