vector2

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"...This is where physician assistants (PAs) and advanced practice nurses (APRNs) come in. Many people don't realize that PAs and APRNs have been around for over 50 years. Both professions trace their roots to another physician shortage. In the late 1960s, in the throes of the Vietnam War, the U.S. was in desperate need of physicians but it couldn't get them trained fast enough to help during combat. The solution: PAs and APRNs, who are trained to practice medicine and advanced practice nursing, respectively, and help provide essential health care to those who need it most.

For 50 years, a plethora of research has shown that PAs and APRNs are safe, reliable, high quality health care providers and essential members of the health care team. But too often critics claim that because they have not gone through physician training, they cannot provide exceptional medical and surgical care. In fact, they already do. A recent comprehensive review of PA and APRN outcomes from 2008 to 2018 found that PAs and APRNs had similar outcomes compared to physicians including hospital length of stay, readmission rates, quality and safety and patient and staff satisfaction
..."


Now, obviously the AAAA doesn't share this position that has been longstanding with APRNs and somewhat of a recent development with PA-Cs, but doesn't it seem like almost an inevitable evolution that mid-level orgs would want more money and more autonomy for its members, especially when the barrier to such entry is surmountable solely by legislative means? Thoughts, @jwk ?
 

Endee

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Disagree that it’s inevitable. AAAA as an organization has institutional protections to prevent this from happening. AAAA and ASA are closely intertwined with ASA leaders on AAAA’s board and AAAA leaders deeply involved in ASA. Furthermore, anesthesiologists sit on the board of the AA certification body as well as the AA educational program accreditation committee as well.

AAAA issued a position statement a couple years ago reaffirming their dedication and commitment to working exclusively in the anesthesiologist led team specifically due to the scope of practice creep pushed by other non physician organizations.
 
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There aren't enough AAs to try to pull off this kind of stunt.

These jerks will use the pandemic as an excuse to advance their agenda as well as try to block any countermeasures. "You're going to denegrate your fellow healthcare workers? During a pandemic?!!?!??!!?!?!"

Next time I see a crna step up to work in the icu would be the first.

They even do this editorializing bull**** in usnews job rankings:

Physician is 5th btw, after the assistants and the nurses. Anesthesiologists are separate from physicians as well. But I guess 14 is better than 39.
 
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RadsWFA1900

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"...This is where physician assistants (PAs) and advanced practice nurses (APRNs) come in. Many people don't realize that PAs and APRNs have been around for over 50 years. Both professions trace their roots to another physician shortage. In the late 1960s, in the throes of the Vietnam War, the U.S. was in desperate need of physicians but it couldn't get them trained fast enough to help during combat. The solution: PAs and APRNs, who are trained to practice medicine and advanced practice nursing, respectively, and help provide essential health care to those who need it most.

For 50 years, a plethora of research has shown that PAs and APRNs are safe, reliable, high quality health care providers and essential members of the health care team. But too often critics claim that because they have not gone through physician training, they cannot provide exceptional medical and surgical care. In fact, they already do. A recent comprehensive review of PA and APRN outcomes from 2008 to 2018 found that PAs and APRNs had similar outcomes compared to physicians including hospital length of stay, readmission rates, quality and safety and patient and staff satisfaction
..."


Now, obviously the AAAA doesn't share this position that has been longstanding with APRNs and somewhat of a recent development with PA-Cs, but doesn't it seem like almost an inevitable evolution that mid-level orgs would want more money and more autonomy for its members, especially when the barrier to such entry is surmountable solely by legislative means? Thoughts, @jwk ?

We aren’t physicians but we want to basically do their job anyway so please let us. Lol
 

NicMouse64

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At least the comments on the hill all are tearing apart the author........."Give The Hill a medal for the most incoherent headline of the decade." AKA if you can't write a headline why should you be trusted with medical care.
 

jwk

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Now, obviously the AAAA doesn't share this position that has been longstanding with APRNs and somewhat of a recent development with PA-Cs, but doesn't it seem like almost an inevitable evolution that mid-level orgs would want more money and more autonomy for its members, especially when the barrier to such entry is surmountable solely by legislative means? Thoughts, @jwk ?
The way the AA laws and regulations are set up, independent practice just isn't going to happen. CMS requires AAs to be medically directed. That's not going to change. Individual state laws typically require us to be licensed with an anesthesiologist. The federal and state requirements really intertwine. AAAA is firmly supportive of the Anesthesia Care Team with a physician anesthesiologist as the head of that team. I've been an AA for 40 of the 50 years the profession has been in existence. Independent practice just isn't an issue for us.

Medical direction just isn't as onerous as many make it out to be. I've seen it work just fine in very large as well as very small practices. However - it does take commitment on the part of the anesthesiologist to affirm that each and every anesthetic done in their department has an anesthesiologist personally involved. A lot of docs talk the talk - sadly, some don't walk the walk. I can't tell you how many practices have AAs but limit their utilization because the anesthesiologist is out the door at 5pm every day, or because the group has ceded full control of their OB anesthesia services to CRNAs because they hate OB. With the exception of independent practice, an AA can do ANYTHING a CRNA can do, and the scope of practice is determined by the hospital and state law, just as it is with physicians.
 
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Southpaw

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The way the AA laws and regulations are set up, independent practice just isn't going to happen. CMS requires AAs to be medically directed. That's not going to change. Individual state laws typically require us to be licensed with an anesthesiologist. The federal and state requirements really intertwine. AAAA is firmly supportive of the Anesthesia Care Team with a physician anesthesiologist as the head of that team. I've been an AA for 40 of the 50 years the profession has been in existence. Independent practice just isn't an issue for us.

Medical direction just isn't as onerous as many make it out to be. I've seen it work just fine in very large as well as very small practices. However - it does take commitment on the part of the anesthesiologist to affirm that each and every anesthetic done in their department has an anesthesiologist personally involved. A lot of docs talk the talk - sadly, some don't walk the walk. I can't tell you how many practices have AAs but limit their utilization because the anesthesiologist is out the door at 5pm every day, or because the group has ceded full control of their OB anesthesia services to CRNAs because they hate OB. With the exception of independent practice, an AA can do ANYTHING a CRNA can do, and the scope of practice is determined by the hospital and state law, just as it is with physicians.

Good post. I've maintained for years here, in spite of all the grumbling, that anesthesiologists are their own worst enemy. I maintain that belief.
 
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ProRealDoc

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The way the AA laws and regulations are set up, independent practice just isn't going to happen. CMS requires AAs to be medically directed. That's not going to change. Individual state laws typically require us to be licensed with an anesthesiologist. The federal and state requirements really intertwine. AAAA is firmly supportive of the Anesthesia Care Team with a physician anesthesiologist as the head of that team. I've been an AA for 40 of the 50 years the profession has been in existence. Independent practice just isn't an issue for us.

Medical direction just isn't as onerous as many make it out to be. I've seen it work just fine in very large as well as very small practices. However - it does take commitment on the part of the anesthesiologist to affirm that each and every anesthetic done in their department has an anesthesiologist personally involved. A lot of docs talk the talk - sadly, some don't walk the walk. I can't tell you how many practices have AAs but limit their utilization because the anesthesiologist is out the door at 5pm every day, or because the group has ceded full control of their OB anesthesia services to CRNAs because they hate OB. With the exception of independent practice, an AA can do ANYTHING a CRNA can do, and the scope of practice is determined by the hospital and state law, just as it is with physicians.


Well said. Too many lazy people in anesthesia.
 
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gasdoc77

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Its so true but dont worry. Theyll be opening up reidencies where you train side by side with MD residents. So you are actually equivalent.
Isn't this already the case now that HCA has residencies? The logical next step will be offering guaranteed residency positions in exchange for unfavorable post-residency binding work agreements. Medicine in general has become a profit driven $hit-show.
 
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jwk

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Isn't this already the case now that HCA has residencies? The logical next step will be offering guaranteed residency positions in exchange for unfavorable post-residency binding work agreements. Medicine in general has become a profit driven $hit-show.
This is related to the other dirty little secret about student nurse anesthetists. Free labor. Plenty of groups depend on it and profit off of it. It's disgusting.
 
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dr doze

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This is related to the other dirty little secret about student nurse anesthetists. Free labor. Plenty of groups depend on it and profit off of it. It's disgusting.

Has the recent ASA position statement change on them as “qualified anesthesia personnel” changed behavior?
 

T-burglar

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Can someone explain to me this: Acute Surgical Pain Management Fellowship - MTSA
Besides sounding like an accelerated mini residency full of gaps. How could they get privileges to perform blocks? How could they get privileges to perform TEE? Are we addressing that somewhere?
Outside of large community hospitals and academic centers, where its hard to attract physicians, medicine is the wild west. You could have a respiratory therapist intubate you for your cardiac surgery by a dinosaur surgeon with dementia.
 
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Teillard

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Outside of large community hospitals and academic centers, where its hard to attract physicians, medicine is the wild west. You could have a respiratory therapist intubate you for your cardiac surgery by a dinosaur surgeon with dementia.
No you couldn't. How do you expect anyone to take you seriously when you make statements like this? And then have at least one anesthesiologist emoji endorse it? And midlevel's are to blame?
 
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T-burglar

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You don’t think there are places where a R.T. intubates heart surgery patients in the OR? Or did you think I meant that there is nobody trained in anesthesia anywhere in the hospital when this happens ?
 
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You don’t think there are places where a R.T. intubates heart surgery patients in the OR? Or did you think I meant that there is nobody trained in anesthesia anywhere in the hospital when this happens ?

???
 

chocomorsel

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You don’t think there are places where a R.T. intubates heart surgery patients in the OR? Or did you think I meant that there is nobody trained in anesthesia anywhere in the hospital when this happens ?
I know RTs intubate. But very, very unlikely in the OR, especially for cardiac cases.
However, if you know something we don’t, please do share. Where is this horrid place RTs are in the room for cardiac surgery?
 

blockstar

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The way the AA laws and regulations are set up, independent practice just isn't going to happen. CMS requires AAs to be medically directed. That's not going to change. Individual state laws typically require us to be licensed with an anesthesiologist. The federal and state requirements really intertwine. AAAA is firmly supportive of the Anesthesia Care Team with a physician anesthesiologist as the head of that team. I've been an AA for 40 of the 50 years the profession has been in existence. Independent practice just isn't an issue for us.

Medical direction just isn't as onerous as many make it out to be. I've seen it work just fine in very large as well as very small practices. However - it does take commitment on the part of the anesthesiologist to affirm that each and every anesthetic done in their department has an anesthesiologist personally involved. A lot of docs talk the talk - sadly, some don't walk the walk. I can't tell you how many practices have AAs but limit their utilization because the anesthesiologist is out the door at 5pm every day, or because the group has ceded full control of their OB anesthesia services to CRNAs because they hate OB. With the exception of independent practice, an AA can do ANYTHING a CRNA can do, and the scope of practice is determined by the hospital and state law, just as it is with physicians.
Where I work the CRNAs on OB primarily work 24s and we come for c sections and not typically epidurals. One of the angrier CRNAs tried to complain about an AA working in OB under the same conditions as him like we had to be in the room with the AA for everything they did. I told the angry CRNA the AA could practice the exact same way and he threw a fit but ultimately didnt matter. Do you mind diving in a little to what a CRNA would be allowed to do differently? Its not like states have individual rules about who can or cant do an epidural right? Except for the bogus states that dont license AAs.
 

abolt18

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Where I work the CRNAs on OB primarily work 24s and we come for c sections and not typically epidurals. One of the angrier CRNAs tried to complain about an AA working in OB under the same conditions as him like we had to be in the room with the AA for everything they did. I told the angry CRNA the AA could practice the exact same way and he threw a fit but ultimately didnt matter. Do you mind diving in a little to what a CRNA would be allowed to do differently? Its not like states have individual rules about who can or cant do an epidural right? Except for the bogus states that dont license AAs.
I doubt that many states may put limitations on what the AA can do, as that's up to the physician supervising and the hospital credentialing them, but they may have specific requirements for practice for AAs. For example I know the state of Kentucky requires that an AA ALSO be a certified PA who trained at a 4-year PA program (they are not all 4 years). Guess how many people in Kentucky meet those requirements? Probably not many.
 

jwk

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Where I work the CRNAs on OB primarily work 24s and we come for c sections and not typically epidurals. One of the angrier CRNAs tried to complain about an AA working in OB under the same conditions as him like we had to be in the room with the AA for everything they did. I told the angry CRNA the AA could practice the exact same way and he threw a fit but ultimately didnt matter. Do you mind diving in a little to what a CRNA would be allowed to do differently? Its not like states have individual rules about who can or cant do an epidural right? Except for the bogus states that dont license AAs.
My scope of practice according to my Georgia license is "Practices anesthesiology under the supervision of a licensed anesthesiologist". My group and my hospital set specific limits on what I can or cannot do, just as they do with physician credentialing and privileging. There is no law requiring the anesthesiologist to be physically present in the OR (other than the usual induction/emergence/intervals required under TEFRA) while an AA is working. Except for "independent practice" there is nothing that a CRNA can do that I would be unable to do.
 
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blockstar

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My scope of practice according to my Georgia license is "Practices anesthesiology under the supervision of a licensed anesthesiologist". My group and my hospital set specific limits on what I can or cannot do, just as they do with physician credentialing and privileging. There is no law requiring the anesthesiologist to be physically present in the OR (other than the usual induction/emergence/intervals required under TEFRA) while an AA is working. Except for "independent practice" there is nothing that a CRNA can do that I would be unable to do.
Thanks thats what I thought.
 

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