Hey Everyone-
I have been doing rotations in Anes. and was recently introduced to the concept of the anesthesiologist assistant (AA). A CRNA was talking about how one was going to be hired at that particular facility and she was passionately against it, claiming that they are unprepared. I looked them up online (she kept saying aa, aa, aa-never what it stood for and I was curious) and they seem to be equivalent to PAs, just specialized for gas. This particular CRNA is known to cause stirs so...
I'm wondering what the general consensus is about AAs as Anes. providers?
Do those of you in practice see them as equivalents to CRNAs as colleagues?
Are CRNAs only opposed to them because they could replace them?
Do you believe AAs are more/less/equally equipped to provide care?
Is the legislation limiting their practice only driven by CRNAs or is there a legitimate concern over their training/abilities?
Personally, every CRNA that I have met has seemed knowledgable and responsible. But it does seem like having a stronger science background (like an aa) would be advantageous in this field.
Not trolling, just looking for an unbiased opinion...
I don't know that you'll find an unbiased opinion, but here are some facts for you.
The
ONLY difference between AA's and CRNA's is that AA's function solely within the Anesthesia Care Team, and CRNA's, in some states and some practices, may practice independent of an anesthesiologist. That's it.
AA's administer anesthesia for ALL types of surgical cases. From ear tubes to liver transplants, D&C's to pedi hearts, and everything in between. Scope of practice is defined by state law, and further refined by hospital medical staff policy, just like physicians. AA's in many practices place invasive monitors as well as perform some regional anesthesia techniques including epidurals and SAB's. It is at the discretion of each hospital/practice to decide what the allowable scope of practice is for an AA (which of course can't exceed state law but may be more restrictive). This same discretion/limitation applies to CRNA's as well. AA's do not participate in chronic pain management procedures as this clearly crosses the line into the practice of medicine.
AA students come from a variety of backgrounds, and hold bachelor's degree majors in many different areas. Like many medical students, not all will have health care experience, nor will they have a degree in biology or chemistry, but each and every one of them has a strong premedical course background, with biology, inorganic and organic chemistry, and calculus based physics. They must take the MCAT and/or GRE (depending on the school). AA's graduate with a master's degree from a university program affiliated with a medical school anesthesia department, including Emory, Case Western, and the new satellite Case program affiliated with Baylor.
The AA concept is not new - AA's have been around for 40 years. The AA concept originated in the late 60's, and was proposed by Drs. Steinhaus, Gravenstein, and Volpitto. This was a time when CRNA's usually received a certificate in anesthesia, frequently from a hospital-based CRNA program. At that time there was no degree requirement for CRNA's. Indeed, today there are many thousands of CRNA's practicing who have no degree whatsoever, just a nursing diploma and an anesthesia certificate. The AA was intended to be a provider at a level of proficiency in between that of a CRNA and physician anesthesiologist, with a high level of both clinical and technical expertise to take advantage of the new technologies emerging in anesthesia, particularly invasive and non-invasive electronic monitoring. You may not realize that in the late 60's, anesthesia monitoring consisted of a finger on the pulse, a manual blood pressure cuff, and a stethoscope. Many cases back then were not even done with an EKG.
AA's are practicing in 17 states and DC. The ONLY reason AA practice has not expanded further is due to the opposition of the AANA, it's state associations, and individual CRNA's who are simply scared of the competition.
OK - those are the facts. Here's the opinion. The CRNA you spoke with clearly has no knowledge of AA's or AA practice, and is capable only of regurgitating what they have been spoon-fed by the AANA. It's truly amazing how many lies have been told by CRNA's about AA's (including the one you talked to apparently) and untold hours and millions of dollars, in their quest to prevent the expansion of AA practice. The hypocrisy is astounding. They talk out of one side of their mouths about anesthesiologists trying to limit CRNA practice, while at the same time out of the other side of their mouth they're trying to do the same thing to AA's.
For those who are of the mindset that only an anesthesiologist should be performing anesthesia, I won't be able to change that opinion. The simple fact is that there are not enough anesthesiologists, nor will there ever be, to enable an anesthesiologist to personally perform every anesthetic. However, every surgical patient deserves to have an anesthesiologist involved with their care, as espoused in the Anesthesia Care Team concept. Every AA works within that framework. Unlike CRNA's, who view anesthesiologists as an unnecesary expense, AA's recognize the value of an anesthesiologist-led team. AA's are capable, competent, and cost effective. We do not seek to replace CRNA's, but AA's are a viable option to those departments and practices that recognize their expertise and abilities.
