Utah AA bill

[Mman]

You guys are out of your minds. It is never a good idea to train a whole bunch of new people to do what you can do. Basic supply/demand will always win out. Just wait, it’s anesthesia assistant now, soon it will be anesthesia associate (just like PA’s).

the single biggest difference between CRNAs and AAs is that CRNAs are nurses and they are like some big mafia union. It's an unending army of people that will flood every politician with a message in favor of whatever that subgroup of nurses wants. You are a nurse midwife? Well you just got 30,000 LPNs telling their senator why you should be delivering babies unsupervised. Nurse practitioners get every floor nurse in the world talking about how NPs should be providing unsupervised care to any patient. Independent CRNA practice? Sure, why not? There was apparently a bill introduced in congress this week to limit essentially price gouging by nursing staffing agencies on locums during the pandemic (or something like that). My social media was filled with posts talking about how politicians are trying to cap nursing pay when their job sucks so much despite the bill actually being related to the profiteering of the staffing agencies and not the actual pay of the nurses.

Somehow when you go to nursing school you get indoctrinated into this belief that all nurses should be doing more and more and more independent of any supervision or direction by physicians. If anyone questions it, just ask them if they have ever had to carry the little preemie baby to the morgue or helped clean up the trauma bay after the patient died? I mean you can't question the motivations of a nurse, right? Basically angels from heaven in all parts of their life.


(and no I don't hate nurses and have several friends and relatives that are wonderful nurses, but their profession is despicable when it comes to lobbying)

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[dannyboy1]

Takes the same to train a crna as it does to train AA. The pool is not changing much

I am not sure how you could read the comments in the article, or really any CRNA comments that come out when this stuff happens, and continue to support CRNAs. I like and have gotten along with most all CRNAs I've worked with, but my understanding is that they are all AANA members and supportive of AANA efforts. That's just a full stop, absolute NO, in my mind.

So let’s play this out, all 50 states pass AA legislation. New AA schools open all over the place ( and they will, schools need an ever expanding source of revenue). Now you have a whole bunch of mid-levels fighting for the same jobs. Now CRNA’s are hungry and desperate. Since they have the right to practice independently, they will aggressively lobby hospitals/AMC to push independent practice for CRNA’s and to eliminate the “unnecessary” MD’s. (I get that they already do this but if they are competing with AA’s for jobs the rank and file will join in). Get ready for a race to the bottom in which no one except for the AMC will win…

 

[dannyboy1]

I am not sure how you could read the comments in the article, or really any CRNA comments that come out when this stuff happens, and continue to support CRNAs. I like and have gotten along with most all CRNAs I've worked with, but my understanding is that they are all AANA members and supportive of AANA efforts. That's just a full stop, absolute NO, in my mind.

I don’t support CRNA’s or AA’s. To be perfectly frank, all I want is for the market conditions to provide me the best $$ for my labor. I don’t see that training a whole new array of mid levels help that…

 

[OptionOffense]

i think crnas are overtrained.. the 3 year education and "doctorate" is unnecessary and just an educational money making scam.. we dont need someone to be able to intubate and place LMAs and alines or start cases by themselves or even wake up by themselves. i can do all that stuff and be there for all that stuff, i just need you to watch the monitor, have a basic understanding of whats going on, and call me if there is a problem.

very true

 

[OptionOffense]

You guys are out of your minds. It is never a good idea to train a whole bunch of new people to do what you can do. Basic supply/demand will always win out. Just wait, it’s anesthesia assistant now, soon it will be anesthesia associate (just like PA’s).

I get it. But at this point we have no choice. There will NEVER be enough MDs to stool sit. NEVER. CRNAS are already training themselves like crazy. We NEED AAs to replace them in the anesthesia care team. They are calling themselves Nurse OLogists

 

[OptionOffense]

I don’t support CRNA’s or AA’s. To be perfectly frank, all I want is for the market conditions to provide me the best $$ for my labor. I don’t see that training a whole new array of mid levels help that…

Its either you have a job medically directing AAs or sitting your cases getting paid like a midlevel when CRNAs eventually dupe the dummies in washington for parity.

 

[Mman]

There will NEVER be enough MDs to stool sit. NEVER.

not even close to enough. The need for anesthesia services has exploded over the last 10 years or so nationally and the rate of graduation of residents barely budges. We would probably need to quadruple residency spots for 15-20 years to have enough physicians to personally administer all the anesthetics.

 

[coffeebythelake]

I don’t support CRNA’s or AA’s. To be perfectly frank, all I want is for the market conditions to provide me the best $$ for my labor. I don’t see that training a whole new array of mid levels help that…

To do that we need to oppose CRNA and AANA agenda

 

[Endee]

To do that we need to oppose CRNA and AANA agenda

AAs in the medically directed ACT provide the best and strongest bulwark against CRNA encroachment. The battle has to be fought where it is. AANA has had very limited to no success in states with stronger AA presence because they know that ACT groups will respond to independent practice by replacing their CRNAs with AAs.

 

[IMGASMD]

not even close to enough. The need for anesthesia services has exploded over the last 10 years or so nationally and the rate of graduation of residents barely budges. We would probably need to quadruple residency spots for 15-20 years to have enough physicians to personally administer all the anesthetics.

Or rolled back anesthesia services.
Why the fuk are we giving propofol to every single colonoscopy? Why does cataracts surgery needs anesthesia?

There’s so much waste within the system. Sure sure I shouldn’t cut off the hand that feeds me, but really?

The culture of just fix it, just cut it off, just buy a new one….

But congrats to Utah. I hope my state will be able to pass similar legislation soon too.

 

[coffeebythelake]

Or rolled back anesthesia services.
Why the fuk are we giving propofol to every single colonoscopy? Why does cataracts surgery needs anesthesia?

There’s so much waste within the system. Sure sure I shouldn’t cut off the hand that feeds me, but really?

The culture of just fix it, just cut it off, just buy a new one….

But congrats to Utah. I hope my state will be able to pass similar legislation soon too.

Don't know how GI procedures are practiced elsewhere, but at my shop patients get anesthesia supported cases only of thry are medically complicated, the procedure itself is complicated, or they've failed with conscious sedation. I think this is a good balance without wasting personnel time and resources. Most GI docs appreciate anesthesia support but also understand for routine cases it does add extra time.

As for cataracts I agree 95% of patients could get through them with some oral ativan and calming words.

 

[IMGASMD]

Don't know how GI procedures are practiced elsewhere, but at my shop patients get anesthesia supported cases only of thry are medically complicated, the procedure itself is complicated, or they've failed with conscious sedation. I think this is a good balance without wasting personnel time and resources. Most GI docs appreciate anesthesia support but also understand for routine cases it does add extra time.

As for cataracts I agree 95% of patients could get through them with some oral ativan and calming words.

We don’t really do screening colonoscopy in the hospital much anymore. But for those FM, who can only get credentialed at a hospital, they still come.

GI doctors bitch and moan when they have to do anything with conscious sedation without anesthesia.

 

[RemyMcswain]

Or rolled back anesthesia services.
Why the fuk are we giving propofol to every single colonoscopy? Why does cataracts surgery needs anesthesia?

There’s so much waste within the system. Sure sure I shouldn’t cut off the hand that feeds me, but really?

The culture of just fix it, just cut it off, just buy a new one….

But congrats to Utah. I hope my state will be able to pass similar legislation soon too.

I don’t think the problem is on our end. It’s the GI docs scoping everything with a pulse. I think most patients should get a propofol anesthetic.

Agree though. Tremendous amount of waste. I wish we could just say No to things.

 

[OptionOffense]

I don’t think the problem is on our end. It’s the GI docs scoping everything with a pulse. I think most patients should get a propofol anesthetic.

Agree though. Tremendous amount of waste. I wish we could just say No to things.

Try doing mass colonoscopies w/o legitimate anesthesia. It wont work.

 

[RemyMcswain]

Try doing mass colonoscopies w/o legitimate anesthesia. It wont work.

Exactly. I mean the waste is coming from the GI docs scheduling an EGD for every case of acid reflux. Pretty much all those patients should get a propofol anesthetic from us

 

[nimbus]

Try doing mass colonoscopies w/o legitimate anesthesia. It wont work.

They do mass colonoscopies on the west coast without anesthesia. Works well for most people. One of our orthopedists got versed/Demerol. He likes to say, “you could have driven a truck up my ass and I wouldn’t have cared.”

 

[coffeebythelake]

Exactly. I mean the waste is coming from the GI docs scheduling an EGD for every case of acid reflux. Pretty much all those patients should get a propofol anesthetic from us

How else are the gi docs going to make their sweet rvus?

 

[coffeebythelake]

They do mass colonoscopies on the west coast without anesthesia. Works well for most people. One of our orthopedists got versed/Demerol. He likes to say, “you could have driven a truck up my ass and I wouldn’t have cared.”

what kind of dosing are we talking about for the conscious sedation? I've seen some 70 or 80 year olds get 10 mg versed and 500 mcg fentanyl for GI cases and I just shake my head

 

[OptionOffense]

what kind of dosing are we talking about for the conscious sedation? I've seen some 70 or 80 year olds get 10 mg versed and 500 mcg fentanyl for GI cases and I just shake my head

There is no way youve seen this

 

[OptionOffense]

They do mass colonoscopies on the west coast without anesthesia. Works well for most people. One of our orthopedists got versed/Demerol. He likes to say, “you could have driven a truck up my ass and I wouldn’t have cared.”

You dont know what mass colonoscopies is. 10 in a day aint it

 

[sevo00]

What’s the best way we can support Pro-AA legislation in our state?

 

[nimbus]

You dont know what mass colonoscopies is. 10 in a day aint it

Maybe not. Are mass colonoscopies considered a good thing? Anyway we don’t do anesthesia for routine colonoscopies here.

 

[nimbus]

what kind of dosing are we talking about for the conscious sedation? I've seen some 70 or 80 year olds get 10 mg versed and 500 mcg fentanyl for GI cases and I just shake my head

Don’t think he got that much. He said he was aware the whole time. Just didn’t care. My wife also had colonoscopy with versed/Demerol. But she doesn’t remember anything and was discharged an hour later.

 

[coffeebythelake]

There is no way youve seen this

Had one a few days ago. Colonoscopy. Tortuous colon with history of abdominal surgery with adhesions that might have made it more difficult. Not a drinker, not on benzos, not on pain meds, no substance use history. They tried, they failed. I read the sedation report.. 10 versed 500 fent patient said she doeznt remember but told she awas awake and kept asking for more, GI doc couldn't do procedure. Came back a few weeks later for propofol.

 

[GassYous]

Maybe not. Are mass colonoscopies considered a good thing? Anyway we don’t do anesthesia for routine colonoscopies here.

You can really rack up units on a day with 15-20

 

[mtbtx]

Hey, a big win!

Had one a few days ago. Colonoscopy. Tortuous colon with history of abdominal surgery with adhesions that might have made it more difficult. Not a drinker, not on benzos, not on pain meds, no substance use history. They tried, they failed. I read the sedation report.. 10 versed 500 fent patient said she doeznt remember but told she awas awake and kept asking for more, GI doc couldn't do procedure. Came back a few weeks later for propofol.

infiltrated iv lol.. was absorbed sc?

 

[coffeebythelake]

Hey, a big win!

infiltrated iv lol.. was absorbed sc?

Who knows. Certainly a big dose for conscious sedation. Om average these gramps and grannies would get like 3-5 of versed and 100 fent. So it is an outlier and maybe the procedure was just very uncomfortable for this particular pt

 

[SonGoku751]

You guys are out of your minds. It is never a good idea to train a whole bunch of new people to do what you can do. Basic supply/demand will always win out. Just wait, it’s anesthesia assistant now, soon it will be anesthesia associate (just like PA’s).

If you want to work in and advocate for physician only anesthesia settings, that's a prerogative that I take no contention with at all. No one else comes close to being as qualified as anesthesiologists to put patients under and bring them back.

However, as has been mentioned in this thread already, there aren't enough anesthesiologists to sit every case in the country (and at the rate they're being cranked out, this is going to be the case for the foreseeable future.) The ACT is most likely here to stay. With that in mind, why not employ and support the anesthetist who isn't competing for your job, who isn't arguing that the ACT is superfluous, and hasn't done so since its inception (nearly six decades).

Through their curriculum, CAAs are trained to work solely within the ACT (unlike many CRNA programs), are taught to understand their limitations, and are instructed by anesthesiologists in their curriculum (rather than militant CRNAs who don’t know what they don’t know while simultaneously believing they know everything there is to know).

An important distinction that separates AAs from PAs (correct me if I'm wrong on this point Endee or Jwk. This is something a SAA has told me over the subreddit): An AA program must be affiliated with both a medical school and anesthesiology department. Unlike PA schools, they can’t just open shop whenever. If the department gets even a whiff of independent rhetoric being espoused to SAAs, they can have the program discontinued by withdrawing their support.

It also just isn’t a likely scenario due to pragmatic considerations if nothing else. The AA profession is incredibly niche and small. AAs don’t have the numbers, they don’t have the money, and they came to the anesthesia game way too late to ever have enough of either to take on both the ASA and AANA at the same time (which is what would happen if they started to advocate for independent practice rights). They already routinely lose court case hearings against the AANA just for the right to practice in various states even when they have consistent backing from ASA, there being a huge need for more anesthesia providers in many parts of the country, and a safe practice track record spanning over half a century. If for whatever bizarre reason quad A leaders thought that lobbying for independent practice rights would be a sound decision and in the best interest of the future of the profession, they’d get curved stomped.

I understand these midlevel scope creep concerns considering every other midlevel has bitten the hand that feeds them given enough time, but there are reasons to believe AAs will be different for both the present and long run.

 

[OptionOffense]

Had one a few days ago. Colonoscopy. Tortuous colon with history of abdominal surgery with adhesions that might have made it more difficult. Not a drinker, not on benzos, not on pain meds, no substance use history. They tried, they failed. I read the sedation report.. 10 versed 500 fent patient said she doeznt remember but told she awas awake and kept asking for more, GI doc couldn't do procedure. Came back a few weeks later for propofol.

I cannot even imagine giving someone that much to a spontaneously breathing patient. Your obligation is to find that gastroenterologist and politely and tactfully redirect them.

 

[Katheudontas parateroumen]

This is a win for anesthesiologists and AA alike. I’ve worked with many AAs and CRNAs. They are one in the same. Qualified to help out in the ACT model. And like someone said above, I just need someone to know the basic what’s going on and not screw things up, I as the anesthesiologist will be there for all the crucial parts. The AAs understand that role much more than the CRNA.

I understand that this is fighting fire with fire and eventually a race to the bottom. But as long as procedures need to be done at this crazy pace, there will be work. At this time, if more AAs come into play, anesthesiologists and corporations will begin to phase out CRNAs who demand more money than AAs on average. Anesthesiologists are happier to work with colleagues that see more eye to eye and corporations will be making more money. Win some win some for both sides for now.

 

[secretasianman]

The real difference is that they are regulated by the board of medicine, which is an actual board that has public safety in mind, unlike the nursing board which will tell you “I’m sorry it happened but strong work Dr nurse” when a patient dies. This is the difference between the medical standard of care and nursing (fake doctor DNP) level of care. If you are a layperson reading this board, you must ask yourself: if I am getting anesthesia, does the person looking after me have any accountability whatsoever? If I am about to die, do I want a real physician involved in my anesthetic care? It’s a no brainer to me.

 

[OptionOffense]

This is a win for anesthesiologists and AA alike. I’ve worked with many AAs and CRNAs. They are one in the same. Qualified to help out in the ACT model. And like someone said above, I just need someone to know the basic what’s going on and not screw things up, I as the anesthesiologist will be there for all the crucial parts. The AAs understand that role much more than the CRNA.

I understand that this is fighting fire with fire and eventually a race to the bottom. But as long as procedures need to be done at this crazy pace, there will be work. At this time, if more AAs come into play, anesthesiologists and corporations will begin to phase out CRNAs who demand more money than AAs on average. Anesthesiologists are happier to work with colleagues that see more eye to eye and corporations will be making more money. Win some win some for both sides for now.

This isnt even about the money. ( i know it is) It's about the toxicity that the nurses bring to the table in every single aspect. It is absolutely awful. Good ****in riddance. We need to train AAs to replace them in every single state. They want to sell themselves as independent, go be independent the new anesthetist.org are in town. www.anesthetist.org

 

[jwk]

This isnt even about the money. ( i know it is) It's about the toxicity that the nurses bring to the table in every single aspect. It is absolutely awful. Good ****in riddance. We need to train AAs to replace them in every single state. They want to sell themselves as independent, go be independent the new anesthetist.org are in town. www.anesthetist.org

The level of nurse anesthetists toxicity and arrogance has gone up exponentially in the last 10 years. It was only about 25 years ago they started requiring a BSN to get into anesthesia school. They moved to a masters degree to keep up with AAs who had already been granting them for more than 20 years. And now the absurd DNP concept so they can try to call themselves doctor and anesthesiologist, even though the degree ads zero clinical training beyond the masters level, and is widely available online for those who already have their masters.

I'm with ya - you want to be independent? Go be independent. I doubt there's a CRNA school in the entire country that trains their students with zero MD participation. It just doesn't happen. Which of course always begs the question of why MDs are training a group of people who claim MDs are unnecessary. C'mon lurking CRNAs - prove me wrong.

 

[coffeebythelake]

The level of nurse anesthetists toxicity and arrogance has gone up exponentially in the last 10 years. It was only about 25 years ago they started requiring a BSN to get into anesthesia school. They moved to a masters degree to keep up with AAs who had already been granting them for more than 20 years. And now the absurd DNP concept so they can try to call themselves doctor and anesthesiologist, even though the degree ads zero clinical training beyond the masters level, and is widely available online for those who already have their masters.

I'm with ya - you want to be independent? Go be independent. I doubt there's a CRNA school in the entire country that trains their students with zero MD participation. It just doesn't happen. Which of course always begs the question of why MDs are training a group of people who claim MDs are unnecessary. C'mon lurking CRNAs - prove me wrong.

Why are MDs training CRNAs? This has got to stop. They can go train themselves.

 

[OptionOffense]

Which of course always begs the question of why MDs are training a group of people who claim MDs are unnecessary. C'mon lurking CRNAs - prove me wrong.

That's the thing though. When I would see SRNA students (I dont work with CRNAs any longer), I would in no way shape or form have anything to do with their training, no evaluations, no didactics. I would not even be privvy as to anyone's backround but I agree in the past ten years it has gone over the top. Really nuts. This latest installment of changing their names to nurse anesthesiologist entirely is just mental illness. There is no describing it.

 

[IMGASMD]

Can you run 1:3 or 1:4 with AAs?

 

[coffeebythelake]

Can you run 1:3 or 1:4 with AAs?

Training is the same. Why not the same supervision ratios?

 

[Endee]

Can you run 1:3 or 1:4 with AAs?

Yes

 

[ValentineD]

I suspect most of the CRNAs commenting have never worked with CAAs, they have simply fallen victim to the propaganda machine. Once upon a time, I was the second CAA at a shop that only employed CRNAs previously. I was universally despised for a period of time but they all eventually come around once the novelty wears off and you don't do anything notable to give them new material to discuss in the break room.

 

[OptionOffense]

I suspect most of the CRNAs commenting have never worked with CAAs, they have simply fallen victim to the propaganda machine. Once upon a time, I was the second CAA at a shop that only employed CRNAs previously. I was universally despised for a period of time but they all eventually come around once the novelty wears off and you don't do anything notable to give them new material to discuss in the break room.

Im sure it was a very contentious environment. They were doing bad things to your lunch, putting gum on your seat. Mean girl **** right?

 

[coffeebythelake]

Im sure it was a very contentious environment. They were doing bad things to your lunch, putting gum on your seat. Mean girl **** right?

Fits the AANA m.o.

 

[Status Sciaticus]

look like it passed both houses. just waiting on the governor to sign.

 

[SonGoku751]

It’s official folks!

 

[Status Sciaticus]

It’s official folks!View attachment 352249

Next step, every other state. I can all but taste CRNA tears. Mmm salty.

 

[GassYous]

Next step, every other state. I can all but taste CRNA tears. Mmm salty.

Too soon rip

 

[Status Sciaticus]

Too soon rip

i was referring to their tears being salty. but yes, pour one out for the homie.

 

[OptionOffense]

We need this in all 50 states.