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AA vs. CRNA

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smh126

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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...
 

midazme

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just looking for an unbiased opinion...

good luck.

here's my 0.02: when it comes down to it, the only person who will be allowed to provide anesthetic care to me and my loved ones is an anesthesiologist. they have more training, both in the theory and practice of anesthesia. they understand the science behind the machines, and can function without the gadgets that make modern anesthesia seem so 'boring' and 'routine'. they are the only ones with the medical background to understand how anesthetic care is more than just making sure the patient is asleep, and they understand how to provide safe medical management in adverse conditions. they are the only ones who can truly butt heads with surgeons when a particular course of action seems unsafe.

as for AAs vs CRNAs, i really don't see much of a difference. neither of them are anesthesiologists, and if a warm body is all that's needed for a case, then they should be about the same. even when things are getting hairy, as long as they have quick access to an anesthesiologist's expertise when things hit the fan, i'm willing to bet that they are equivalent.

(as a side note, the difference between CRNAs and junior residents has become amazingly clear during my senior year of residency. it's just staggering how quickly residents can surpass even the most seasoned CRNA within a few short months. add to that the specialty rotations that CA-2 and -3s do, and it's like night and day.)
 

jwk

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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.
 
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sevoflurane

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-AAs and CRNAs have virtually identical training programs in anesthesia.
-CRNAs have life experience as an RN and nursing education. AAs do not.
-According to AANA, education and training differences between anesthesiologists and CRNAs make no difference whatsoever in outcome.
-According to AANA education and training differences between CRNAs and AAs make all the difference in the world.
-CRNAs are trying to cut our throats. AAs are not.

Give me an AA every time.

Yep. It's not rocket science. AA over Crna every single time.

:thumbup:
 
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MRW

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-CRNAs have life experience as an RN and nursing education. AAs do not.
I am a 41 year old AA student making a lifestyle career change. I have more life experience than many CRNAs not to mention a fair bit of relevant and useful career experience.
 

nycitygas

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How does anesthesiologist and AA supervision work? 1:2 or can u max it out 1:4 like with CRNAs?
 

jwk

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How does anesthesiologist and AA supervision work? 1:2 or can u max it out 1:4 like with CRNAs?

In most states, it's 1:4, the usual medical direction ratios.
 

Josh L.Ac.

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-According to AANA, education and training differences between anesthesiologists and CRNAs make no difference whatsoever in outcome.
-According to AANA education and training differences between CRNAs and AAs make all the difference in the world.

I love this.
 

nycitygas

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In what states have AA made the most progress? I read online that in Georgia, AAs have made significant progress and have become the preferred choice. Any truth to that?
 

btbam

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In what states have AA made the most progress? I read online that in Georgia, AAs have made significant progress and have become the preferred choice. Any truth to that?

I'm in the Emory AA program and I would say that in my metro Atlanta clinical rotations, ~80% of the midlevel providers are AAs.
 

jwk

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In what states have AA made the most progress? I read online that in Georgia, AAs have made significant progress and have become the preferred choice. Any truth to that?

Ohio and Georgia are homes to the original AA programs, and you will find a lot of AA's in those two states. There are an increasing number in Florida and Texas and a number of the other states in which we practice. I'm most familiar with Georgia, where you will find AA's in almost every hospital of any significant size in Georgia, and where many of the larger hospitals majority-AA staffs and AA's serving as chief anesthetists.
 

Seria

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Although the topic of CRNA vs. AA has been beaten to death, :beat:
I shall throw in my 2 cents to this conversation.

There are distinct differences between a CRNA and an AA.

An AA is required to work under the DIRECT supervision on an MD (anesthesiologist). A CRNA cn practice independently. This provides a CRNA with more autonomy than an AA.

An AA can only work in a certain number of states (17 since 2011?) within the US. A CRNA can work independently with all 50 US states. A CRNA may work internationally within countries such as France, Denmark, Spain, etc.

The training for both are different as well, as jwk detailed in an earlier post. If a CRNA should decide to leave anesthesia for any reason, they have their RN license to fall back on (at a drastic price difference, of course). Both careers take less time than 4 years of medical school and typical 4 year residency combination! On the straightest path for both careers:


AA - 4 years undergraduate + 2 year AA program = 6 year track
CRNA - 4 year BSN + bare minimum 1 year of ICU (depending on the program) + 2-2.5 CRNA program (I believe 3 year doctoate level programs will be mandatory by 2015) = 7.5-8 year track as of 2012

A nurse, like a PA, also has the choice to diverge into many areas of health care (home health, neuro, med/surg, peds, psych, etc). An AA specifically pertain to anesthesia only. An AA must work exclusively in anesthesia.

Each career appeals to individual preferences. Each career offers different advantages and disadvantages - educational requirements, number of employment opportunites, location of job openings, price of education and more! At the end of the day, the focus should be on providing the best possible care to the patient - AA, CRNA or MD. :highfive:
 

jwk

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Although the topic of CRNA vs. AA has been beaten to death, :beat:
I shall throw in my 2 cents to this conversation.

There are distinct differences between a CRNA and an AA.

An AA is required to work under the DIRECT supervision on an MD (anesthesiologist). A CRNA cn practice independently. This provides a CRNA with more autonomy than an AA.

An AA can only work in a certain number of states (17 since 2011?) within the US. A CRNA can work independently with all 50 US states. A CRNA may work internationally within countries such as France, Denmark, Spain, etc.

The training for both are different as well, as jwk detailed in an earlier post. If a CRNA should decide to leave anesthesia for any reason, they have their RN license to fall back on (at a drastic price difference, of course). Both careers take less time than 4 years of medical school and typical 4 year residency combination! On the straightest path for both careers:


AA - 4 years undergraduate + 2 year AA program = 6 year track
CRNA - 4 year BSN + bare minimum 1 year of ICU (depending on the program) + 2-2.5 CRNA program (I believe 3 year doctoate level programs will be mandatory by 2015) = 7.5-8 year track as of 2012

A nurse, like a PA, also has the choice to diverge into many areas of health care (home health, neuro, med/surg, peds, psych, etc). An AA specifically pertain to anesthesia only. An AA must work exclusively in anesthesia.

Each career appeals to individual preferences. Each career offers different advantages and disadvantages - educational requirements, number of employment opportunites, location of job openings, price of education and more! At the end of the day, the focus should be on providing the best possible care to the patient - AA, CRNA or MD. :highfive:

Not sure why you thought this needed reviving - your own "beating a dead horse" should have been a clue to yourself that maybe this post was pointless.

The ONLY real difference between AA's and CRNA's is the ability of CRNA's to work independently. And let's be honest - this occurs largely in smaller hospitals (especially those where hospitals have a financial incentive to use CRNA's and a dis-incentive to utilize anesthesiologists because of the difference in Medicare payouts) and plastic surgery/GI/ASC centers. The larger the hospital, the chances of CRNA's practicing independently of anesthesiologists plummets - most hospitals of any significant size and especially those doing higher acuity patients and more complex procedures will have anesthesiologists either medically directing or supervising anesthetists and/or actually doing the anesthesia for cases personally.

It's funny how you want to play with the numbers. AA's - 6 years of formal education after high school. CRNA's - 6-6.5 years of formal education. You want to imply that somehow CRNA's are superior based on that extra 1/2 year. Yet CRNA's also want to claim they're equivalent or better than anesthesiologists with TWICE the education of CRNA's. Hmmmmm. OK. Which camp do you belong to?
 
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jetproppilot

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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.

Very well said

SIR.
 
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