What % of procedures....

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Matty44

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are AAs typically allowed to do? I just saw a job posting for an AA and it contained the following job info:

Will AA insert Central Venous catheters? Never. Will AA insert arterial catheters? Never. Will AA insert lumbar epidural catheters? Never. Will AA administer spinal anesthesia? Never. Will AA administer Axillary Brachial Plexus Blocks? Never. Will AA administer other regional anesthesia blocks? Never.



Does this sound normal? Now, I just finished my undergrad, so granted, I have pretty much zero knowledge about what kind of procedures are typically done in anesthesia, but from other posts, it seemed to me that CRNAs and AAs did almost everything that an anesthesiologist does (besides pain management :D) until perhaps there is a rare complication with a case. So what's the more common situation? Does an AA get do do most everything, or are they limited quite a bit in what they are allowed to do? I used to work in an ER where the PAs just saw all the ankle sprains and bloody noses, and that was about it, while the MDs/DOs saw all the "cool" stuff? One of the reasons I'm looking at becoming an AA is that it seems like they were able to participate in most, if not all, aspects of anesthesia....am I wrong?
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I have a suggestion for you:
If you want to do all the procedures that an anesthesiologist does and practice anesthesiology then why don't you go to medical school??



Matty44 said:
are AAs typically allowed to do? I just saw a job posting for an AA and it contained the following job info:

Will AA insert Central Venous catheters? Never. Will AA insert arterial catheters? Never. Will AA insert lumbar epidural catheters? Never. Will AA administer spinal anesthesia? Never. Will AA administer Axillary Brachial Plexus Blocks? Never. Will AA administer other regional anesthesia blocks? Never.



Does this sound normal? Now, I just finished my undergrad, so granted, I have pretty much zero knowledge about what kind of procedures are typically done in anesthesia, but from other posts, it seemed to me that CRNAs and AAs did almost everything that an anesthesiologist does (besides pain management :D) until perhaps there is a rare complication with a case. So what's the more common situation? Does an AA get do do most everything, or are they limited quite a bit in what they are allowed to do? I used to work in an ER where the PAs just saw all the ankle sprains and bloody noses, and that was about it, while the MDs/DOs saw all the "cool" stuff? One of the reasons I'm looking at becoming an AA is that it seems like they were able to participate in most, if not all, aspects of anesthesia....am I wrong?
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Planktonmd said:
I actually have a strong feeling that you are trolling and trying to stir controversy but let's see.
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I haven't read all his old posts, but his questions seem reasonable to me.

What you get to do as an AA vs. CRNA probably depends on the group you work for. My guess is if the group has both CRNAs and AAs they will both get to perform similar procedures. If you prove yourself to be good at them, you'll get to do more. Some places may have a policy where only the docs get to do the procedures (such as the place you have listed). I don't think there are national laws, however, putting limits on what procedures the two can perform (as long as it's under a docs supervision).

Bottom line, each place will have it's own policies. You can't be guaranteed that the place you want to go will be the most lenient in terms of what you get to do.
 
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MMM.... now that's something I want to do. Give away all the procedures to someone who doesn't want to be bothered with the time and money involved in training, then assume liability for them. Sweet!!
 
Matty44 said:
Anyone else have any thoughts? Basically it sounds like AAs and CRNAs are permitted to do any procedure an anesthesiologist performs as longs as their supervising anesthesiologist is comfortable with them doing it, is that correct?
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First - please don't use gaswork.com as a guide to anything.

Second - plank, lighten up. The kid is asking legit questions.

Third - The procedures and cases that anesthetists do in ACT practices is entirely practice dependent. There are no laws prohibiting AA's or CRNA's from doing epidurals, spinals, blocks, A-Lines, CVP's, or Swans. It is entirely up to the group or hospital that you work for. If CRNA's are allowed to do these procedures in a given practice, then so are the AA's, or vice versa. The position of the AAAA is that unless otherwise provided for in state law or regulation, the anesthesiologist/group/hospital at the local level is best able to make the determination as to the scope of practice of it's individual anesthesia practitioners.

Many practices, particularly in private practice but also in academia, use their anesthetists in all types of cases. I know many AA's and CRNA's involved with hearts, major neuro cases, transplants, big peds cases, thoracic and vascular, etc. Note that few of these cases are done routinely or non-emergently in small-town CRNA-only hospitals. That's not a slam at CRNA's, just fact.

In my particular practice, there are no restrictions or policies that would bar AA's or CRNA's from any type of case that we do. The exception would be cases where the surgeon or patient specifically request an MD only - that is a rare occurrence for us. Our MD's all still do cases, but they are no more likely to do a "big case" than we are - keep in mind that with a true ACT practice, an anesthesiologist is involved with every case. But also in our practice, our anesthetists don't do regional anesthesia or central lines. As noted, that is entirely practice dependent - I also moonlight for another group and do both regionals and central lines.
 
jwk said:
First - please don't use gaswork.com as a guide to anything.

Second - plank, lighten up. The kid is asking legit questions.

Third - The procedures and cases that anesthetists do in ACT practices is entirely practice dependent. There are no laws prohibiting AA's or CRNA's from doing epidurals, spinals, blocks, A-Lines, CVP's, or Swans. It is entirely up to the group or hospital that you work for. If CRNA's are allowed to do these procedures in a given practice, then so are the AA's, or vice versa. The position of the AAAA is that unless otherwise provided for in state law or regulation, the anesthesiologist/group/hospital at the local level is best able to make the determination as to the scope of practice of it's individual anesthesia practitioners.

Many practices, particularly in private practice but also in academia, use their anesthetists in all types of cases. I know many AA's and CRNA's involved with hearts, major neuro cases, transplants, big peds cases, thoracic and vascular, etc. Note that few of these cases are done routinely or non-emergently in small-town CRNA-only hospitals. That's not a slam at CRNA's, just fact.

In my particular practice, there are no restrictions or policies that would bar AA's or CRNA's from any type of case that we do. The exception would be cases where the surgeon or patient specifically request an MD only - that is a rare occurrence for us. Our MD's all still do cases, but they are no more likely to do a "big case" than we are - keep in mind that with a true ACT practice, an anesthesiologist is involved with every case. But also in our practice, our anesthetists don't do regional anesthesia or central lines. As noted, that is entirely practice dependent - I also moonlight for another group and do both regionals and central lines.
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Even in opt-out states, a doc is responsible for what the CRNA does, right? Usually a surgeon, I guess. So is that surgeon held responsible when a CRNA screws up an epidural? What if there's a high spinal with a poor outcome, or nerve damage during a peripheral block. Is the surgeon responsible?
 
isoman2000 said:
No.
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That's the AANA would like you to believe anyway.

Interestingly - malpractice insurance premiums are on the rise for "independent" CRNA's. Some have drank the koolaid - the insurance companies have not.
 
Matty44 said:
are AAs typically allowed to do? I just saw a job posting for an AA and it contained the following job info:

Will AA insert Central Venous catheters? Never. Will AA insert arterial catheters? Never. Will AA insert lumbar epidural catheters? Never. Will AA administer spinal anesthesia? Never. Will AA administer Axillary Brachial Plexus Blocks? Never. Will AA administer other regional anesthesia blocks? Never.



Does this sound normal? Now, I just finished my undergrad, so granted, I have pretty much zero knowledge about what kind of procedures are typically done in anesthesia, but from other posts, it seemed to me that CRNAs and AAs did almost everything that an anesthesiologist does (besides pain management :D) until perhaps there is a rare complication with a case. So what's the more common situation? Does an AA get do do most everything, or are they limited quite a bit in what they are allowed to do? I used to work in an ER where the PAs just saw all the ankle sprains and bloody noses, and that was about it, while the MDs/DOs saw all the "cool" stuff? One of the reasons I'm looking at becoming an AA is that it seems like they were able to participate in most, if not all, aspects of anesthesia....am I wrong?
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All of this is practice dependant as has been said. I imagine the CRNAs at the pratice you looked at have the same restrictions.

As a resident at Emory I am lucky to also have a AA school here as well. Today I had a 2nd year AA student working with me today and I helped him with 2 central lines and 2 art lines. So yes they should be trained in a variety of the same procedures we as anesthesiologist will perform.
 
isoman2000 said:
No.
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Tell that to the OB Doctor I know that got sued for a CRNA mishap. He settled the case and the family still wants his license. The patient died as the result of Solo CRNA negligence but the OB doctor was the "supervising" Physician because the State was not an "opt-out" one.

He settled because the family was litigating for a cool 10 million and the insurance carrier said settle or you are on your own buddy.

Blade
 
BLADEMDA said:
Tell that to the OB Doctor I know that got sued for a CRNA mishap. He settled the case and the family still wants his license. The patient died as the result of Solo CRNA negligence but the OB doctor was the "supervising" Physician because the State was not an "opt-out" one.

He settled because the family was litigating for a cool 10 million and the insurance carrier said settle or you are on your own buddy.

Blade
Click to expand...

Aside: Can you give some details about that case. In another thread perhaps.
 
911_turbo said:
Aside: Can you give some details about that case. In another thread perhaps.
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If you join the private forum/Club I will provides lots of details about that case. I will explain what you should look for in your next job, what to expect to earn, how to evaluate a practice, etc.

As a bonus you can read my AANA rants which are frequent in the Private Club. The AANA is a propaganda machine. The problem is that CRNA's are starting to actually believe the propaganda themselves. This means patients are going to die at the hands of some really weak Solo CRNA's.

Why not PM Toughlife and join?

Blade

Remember, the AANA believes that even the "weakest" CRNA is qualified to practice Anesthesia Independently right out of school. That same ICU Nurse who was pretty clueless in the Unit is practicing Anesthesia Solo with an 8th percentile exam score and little real world experience.
 
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