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Article on AA legislation

Discussion in 'Anesthesiology' started by joshmir, Apr 21, 2004.

  1. joshmir

    joshmir Senior Member
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    I found this to be an intersting read, maybe others would to. Original poster's comment's precede.
    ********************

    yes, there are currently only 2 programs however that will change soon as legislation passed by the senate this week extends aa practice area from 15 to 50 states. aa's are trained in a program similar to a crna program and when used at the same facilities crna's and aa's have the same scope of practice and salary except that crna's can work independently in around 13 states while aa's always have to have a supervising anesthesiologist in the hospital(not the o.r.) for back up.

    Senate passes bill to allow assistants to give anesthesia
    By Jim Ash, Palm Beach Post Capital Bureau
    Thursday, March 25, 2004


    TALLAHASSEE -- The Senate voted Wednesday to create a new national category of health care provider -- anesthesiology assistant -- despite opponents who claim it will put patients at greater risk.

    Supporters of the measure (SB 626) contend it will drive down health care costs by allowing anesthesiologists to rely on highly trained but less expensive assistants.

    "Members, we have to get a grasp on health care costs in this state," said the bill's sponsor, Sen. Mike Fasano, R-New Port Richey.

    Critics warn that anesthesiology assistants, who require the equivalent of a master's degree and two years of specialty training, aren't qualified to deal with potential problems that could arise during surgery. They also complained that the bill required a supervising anesthesiologist only to be in the same hospital during surgical procedures, not in the same operating room.

    In a compromise, sponsors agreed Wednesday to require "on-site, personal supervision" by an anesthesiologist who is present in the office or in the surgical suite when the procedure is being performed "and who is in all circumstances immediately available."

    Opposition to the House version of the bill landed Rep. Susan Bucher, D-Royal Palm Beach, in hot water with Republican leaders last week when she accused sponsors of being motivated by campaign contributions. The House Rules Committee is investigating the comments as well as complaints from the Department of Children and Families staff members and other legislators who have accused Bucher of being abusive.

    Bucher said the changes make the bill better, but she still opposes it.

    "I'm glad they did that," she said, "but I still don't know who's going to enforce this. I cannot support this bill."

    Anesthesiologists and the Florida Medical Association support the bill. Supporters say a handful of other states license anesthesiology assistants without safety problems.

    Critics say they doubt any savings will be realized.
     
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  3. InGasWeTrust

    InGasWeTrust Member
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    CRNA?

    CRNA's are taking over?

    The sky is falling?

    CRNA's can supervise AA's? No...


    MDA's should be scared about their jobs and salary due to CRNA's? Umm....No
     
  4. DireWolf

    DireWolf The Pride of Cucamonga
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    Am I reading this article correctly?

    Here's what I got out of it:

    1. MDA's want this law to pass, so they can supervise AA's and make more money.

    2. CRNA's don't want this to pass, because this will allow the AA's to invade on their turf.

    3. This law would basically give AA's the same practice/billing rights as CRNA's.
     
  5. MacGyver

    MacGyver Membership Revoked
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    This is all fine and good, until the AAs decide that they dont want to work under MDAs anymore and push for independent practice rights.

    I give it 5 years, tops, before they start pushing for independence.
     
  6. DireWolf

    DireWolf The Pride of Cucamonga
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    I was a little confused myself about the MDA's support of the bill. Doesn't this just give AA's more power to start lobbying for more rights? I guess the MDA's figure that giving AA's more rights will shift the CRNA's lobbying efforts to AA's and take some of the heat off. :confused:
     
  7. juddson

    juddson 3K Member
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    Whoa,

    You guys are missing the underlying thread here. CRNA's have now effectively secured the right to get out from under MDA's. This permits them (for all intents and purposes) to bill independantly and therefore they no longer represent "profit centers" for MDA's. This bill is supported by MDA's in Florida PRECISELY because it permits them to replace their CRNA's 'working capital" with AA's. It is the inevitable result of the loss of "supervision privileges" (and the revenues that go with it) for MDA's who no longer are needed in the OR for that purpose. This AA bill brings that supervisory role BACK into the OR for MDA's. THAT's why they support it.

    As AA's also start to demand independance (and they will) this supervisory role will also be lost to MDA's.

    Consider one other issue: as AA's come in they will (naturally) be performing the more basic cases which had previously been the domain of CRNA's. As this happens, CRNA's will find it necessary to concern themselves with relatively more complex cases in order to remain competitive - which means . . . well you know where I am going with this.

    Judd
     
  8. Gator05

    Gator05 Resident
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    I disagree about CRNA's taking on more complicated patients. The learning curve is not a simple one, but with several plateaus. The very most difficult cases are done by fellowship-trained MDA's, a level CRNA's simply cannot attain. If anesthesiologists begin to occupy more roles in critical care, they will be in an even better position to provide perioperative care at a level other mid-level practitioners can only dream of...

    In this respect, CRNA's are no different than any other mid-level practitioner. They are fantastic at the routine, but will always be behind the curve on difficult/dangerous cases.
     
  9. MacGyver

    MacGyver Membership Revoked
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    You are incredibly naive if you think CRNAs will do the same procedures now as they are doing in 5 or 10 years.
     
  10. jwk

    jwk CAA, ASA-PAC Contributor
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    Juddson - learn some facts about AA's first.

    AA's will not demand independence. We are part of the Anesthesia Care TEAM and always will be. We've been around 30 years and haven't asked to practice independently yet.

    I'm not sure why you think AA's will be doing "the more basic cases which had previously been the domain of CRNA's". AA's are involved in all types of cases, including neuro, cardiac, and transplants. CRNA's are involved in complex cases as well. Maybe in an academic setting you don't find anesthetists doing complex cases, but out in the private practice world, it's a whole different ball game.
     
  11. bestiller

    bestiller Member
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    I do believe that AAs are suing in Ohio for increased scope of practice. The ASA is making a BIG mistake hitching it's wagon to these people. I mean :confused: a BS degree in anything w/ no patient/ clinical experience and in 24 months passing gas, I mean come on! Lessen the qualifications for what we do and you cheapen the profession! AAs are not even allowed to practice in most states and are being prohibited by law in others.
     
  12. jwk

    jwk CAA, ASA-PAC Contributor
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    Spoken like a true CRNA.

    An AA in Ohio is suing to clarify the language of the legislation, not for increased scope of practice. They've already been doing central lines and regionals for 30 years.

    A BA degree in PE, no patient experience, and in just under 4 years, you can be an MD. Of course you don't like docs either. You're just as good as they are, right?

    And remind me if you will. How many CRNA's have NO DEGREE AT ALL? Don't worry, I'll answer for you - about 1/3. A 2-3 year ADN or nursing diploma, and a 2 year anesthesia certificate is all it takes.
     
  13. bestiller

    bestiller Member
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    AHH! From The Mecca of AA country Atlanta GA! I do believe AAs are suing in Ohio to change language in law that says "assist" means "doing" epidurals. You can put the "liberal" spin on that all you want but, anyway you look at it it's increased scope of practice. I don't know what you mean about the "no degree at all thing & the ADN degree". No CRNA programs accept ADNs , you have obviously gotten into the fentanyl at work. To assume that only CRNAs are anti AA is also drug induced paranoia. You're riding high right now w/ "Big Daddy" The ASA $bank rolling you. MDAs and CRNAs are reproducing like cock roaches right now(which is a mistake) and soon the market (2 years) will be saturated. The ASA will then forget that they know you. The truth is The ASA and AANA are where they are b/c they have the $funds to grease the legislative wheels, standing on your own, 700-1000 AAs can't do that w/ any impact. The opt-out issue will also lose steam in a saturated provider market. At this point you (AAs) will probably be relegated to turning over ORs and starting IVs.
     
  14. jwk

    jwk CAA, ASA-PAC Contributor
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    Be very careful about accusing someone of "getting into the fentanyl at work" and being in a "drug-induced paranoia".

    There are thousands of CRNA's working today with no degree, roughly 1/3 of the 31,000 in practice. They can't get into CRNA school NOW without a BSN and a year of critical care, but that's a relatively recent requirement. Personally, I'm not sure even that those requirements would have been added had it not been for the AA's "upping the ante" with their master's degrees from the start 30 years ago.
     
  15. Fermata

    Fermata Hold me.
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    So I gotta ask: why not just go the traditional route and become an anesth doc?
     
  16. bestiller

    bestiller Member
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    Sorry about the fentanyl joke, you don't have access to fentanyl. MDAs sign it out and administer it for you, so that it is safely administered. You assume that anyone anti-AA must be a CRNA. The New York Society of Anesthesiologists President recently gave a very good speech about why he does not support or condone AAs, I urge you to look it up. Read the letters to the editor of The ASA Journal from time to time, see how many MDAs are anti- AA and of course anti- CRNA. Incidentally, you did not answer the question about the Ohio law suit, b/c it is an increase in scope of practice. You can admit it, I know you think it's a big secret hidden in legal language. You seem to be caught on the "AAs have been around for 30 years", just think when the 1st AA graduated MDAs and CRNAs had been practicing anesthesia for over 70 years. Your greatness and need is visible in your 700-1000 or so, practicing AAs and the # of states you can practice in. Just think chiropractors can practice in all 50 states and you can't, as a matter of fact your outlawed in some. You assume that I am a CRNA, and based on that I pose this question to you. If you could magically trade your degree for mine, would you? I know it's hard to honestly answer that question, that leash has got to be tight! :)
     
  17. jwk

    jwk CAA, ASA-PAC Contributor
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    I sign out and administer my own drugs to my patients. If you're going to flame AA's, at least learn some facts and stop regurgitating the stuff you've heard from your professional associations.

    Most of the anti-AA senitiment comes from the CRNA's. It has nothing to do with patient care and everything to do with competition, which they're deathly afraid of. The MDA's that are against AA's are also against CRNA's - the don't want ANY non-physician anesthesia providers, period. At least they're consistent in their views - they don't like me or you! If you have a copy of the speech from the NY president, I'd love to see it. Did he bash AA's only, or all non-anesthesiologist anesthesia providers?

    I read the letters to the editor in the ASA Newsletter every month - I'm a member and have a copy delivered to my door. BTW, there is no "ASA Journal".
     
  18. bestiller

    bestiller Member
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    JWK, answer the questions posed above! Are you afraid to? I hope you go through your patient's charts better than you read these posts. AAs do want increased scope of practice. In a few years CRNAs will want to supervise them and few years after that AAs will seek to legally remove "assistant" from their title. :) PS I did some editing, my apologies! :D
     
  19. jwk

    jwk CAA, ASA-PAC Contributor
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    OK, here's your answers:

    The Ohio lawsuit asks for a clarification of the language of the law, because there is debate about the intent. AA's in Ohio have been placing regionals and central lines for 30 years. When the current law was passed a couple of years ago, a new attorney general offered an opinion that this new law, as written, prohibited AA's from doing regionals and central lines. Since this interpretation by the AG was a change from 30 years of practice, an individual AA sued to clarify the language. There is no other process in Ohio by which this can be done except by filing suit or having the legislation revised.

    AA's have been around for 30 years. What will you say 100 years from now? AA's have only been around 130 years and CRNA's have been around for 200? I'll go ahead and cut off your next statement which would be something along the lines of "AA's won't be here in 100 years, or they'll just be starting IV's for the CRNA's", since I'm sure that is your fondest hope.

    Was there something in my posts that said we were "great"? All I've ever claimed is that we are well-educated, competent providers of anesthesia care that operate within the anesthesia care team model of practice which is the safest mode of practice for patients. Simple concept, simple fact.

    As for the number of states we practice in - yes it is limited, but it is expanding, and is more than what we started with. Besides the states we are already practicing in, we are recognized providers by CMS, TriCare, the VA, and private insurers. And as you know, HB 1290 is an entirely CRNA self-serving piece of legislation in Louisiana that would ban AA's - as of this writing, the bill has not been signed into law by the governor. It's amazing to me that the valuable time in the legislature was taken to ban a profession that can't practice in Louisiana anyway. Any guess as to who might have proposed that legislation? Hmmmmmmmmm.

    Would I trade my degree for yours? Assuming you have a degree, NO. I have a very successful career doing what I want to do, with an excellent lifestyle and great family. And I have no leash around my neck.

    Please clarify for all of us if you are in fact a CRNA (or SRNA or wannabee). Also, you have never responded to the fact that 1/3 of CRNA's hold no degree, or at least they didn't when they finished anesthesia school. Are they "lesser" CRNA's because of that? And if you are a CRNA, do you consider yourself the equivalent of an MDA like many of your cohorts in so many states?
     

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