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.......AA's are a lacky :
The art of disagreeing without resorting disagreeable name-calling is a noble goal.
.......AA's are a lacky :
NC does not allow AA's at present, thanks in large part to your friends and mine, the AANA, NCANA, and numerous individual CRNA's.
Several legislators in NC are under scrutiny or investigation for possible ethics or campaign finance violations after the AA bill was held up by the committee chairman despite it's being passed by an overwhelming vote of the healthcare committee, and despite it already passing the full senate.
http://www.journalnow.com/servlet/S...SJ_BasicArticle&c=MGArticle&cid=1173350599729
I completely agree that this should be sent to the ASA/ASA-PAC.
I think you will be pleasantly surprised with the reply.
Texas believes in the free market.
Can someone explain (I apologize if this has been addressed, but in my following of this forum I have seen this question posed and not satisfactorily addressed) why backing AAs does anything except postpone the problem?
I mean, I guess we do need to postpone the problem since it is already upon us. That's fine... I just wanted to make sure that's all it did, and that we are still looking for all of the other avenues of correcting the underlying problem.
Great news, though!
The benefit of AA's is that they give anesthesiologists more choices. They are no longer dependent on CRNA's. However, I think AA's are just a band-aid. Once their numbers grow large enough, they too will seek independence since their scope and role is exactly that of a CRNA. At least, AA's will give anesthesiology more time (20 years?) and control to formulate a future for the profession. The future probably will mean more supervision and less hands on delivery of gas by anesthesiologists. Maybe more perioperative work and rounding. With 36k CRNA's, the genie can't be put back in the bottle. It's unlikely we can roll back CRNA independence either. We can't deny that the profession is changing, but we should be taking the lead in shaping that transformation, not the CRNA's.
Again - and again - AA's are NOT interested in independent practice. We have already been here more than 35 years. It simply isn't in the cards. We are and always have been committed to the anesthesia care team concept with an anesthesiologist heading up the team. We believe that each patient deserves the involvement of an anesthesiologist with their surgical procedure. The AAAA and ASA work very well together and will continue to do so for many years to come.
There is a shortage of anesthesia providers nationwide - severely so in some areas. There aren't enough anesthesiologists (never will be) and there aren't enough CRNA's (never will be) to make up for the attrition of current providers and increase in demand from an aging population. AA's are an excellent, time-proven option to increasing available anesthesia services while at the same time making sure that an anesthesiologist is participating in the care of every patient in the practices that we work with.
The AAAA is committed to the ACT model.
You won't know for sure until their numbers reach in the thousands. Using history and human nature as my guide, I stick with my original claim. To me, it's not a question of if but when it will happen. I still support AA's over CRNA's though because it gives us more choices.
Well, there you go a CRNA telling us not to back the AA's. So that must be what we should do . Listen, it has been stated many times on here that AA's are controlled by the medical board (physicians) so there will never be a chance of independent practice. There may however be a push for extended scope of practice which we will have to monitor. That just tells me that the push for more AA's is working and making the CRNA's nervous. Lets keep up the push. Some colleagues of mine from CO just lost a couple of CRNA's and replaced them with AA's . They said it was a mild uproar but quickly subsided when they seen how qualified they were.
Oh how funny this is to watch.
EtherMD and jwk would have us all believe that there is any difference in "intent" from the AAs or CRNAs. Truth is, its all about money. How long before the AAs seperate and become another type of CRNA? EtherMD and jwk will long be gone from the profession by then and we will be holding the ball.
The right way to fight is to stop wasting resources and money on AA programs and put the money into MD/DO Residency programs which are failing (per the ASA itself). Why isnt the answer MORE MD/DOs as opposed to another midlevel?
Some colleagues of mine from CO just lost a couple of CRNA's and replaced them with AA's . They said it was a mild uproar but quickly subsided when they seen how qualified they were.
That's what we're always pointing out. Once someone actually meets or works with an AA, they quickly realize we're not the incompetent uneducated idiots that the AANA would have you believe that we are. One reason the Florida legislation passed on the third attempt several years ago was that several of the Florida legislators that initially voted against us finally realized that they had been flat-out lied to by CRNA's and their assorted "professional" organizations.Some colleagues of mine from CO just lost a couple of CRNA's and replaced them with AA's . They said it was a mild uproar but quickly subsided when they seen how qualified they were.
Well, there you go a CRNA telling us not to back the AA's. So that must be what we should do . Listen, it has been stated many times on here that AA's are controlled by the medical board (physicians) so there will never be a chance of independent practice. There may however be a push for extended scope of practice which we will have to monitor. That just tells me that the push for more AA's is working and making the CRNA's nervous. Lets keep up the push. Some colleagues of mine from CO just lost a couple of CRNA's and replaced them with AA's . They said it was a mild uproar but quickly subsided when they seen how qualified they were.
Listen fool.
If i was a CRNA why would i promote more MD/DO programs? Are you daft?
Im sick of being labeled something im not just because I dont agree with the rhetoric you people blindly spit out. My mother is a former CRNA who became an anesthesiologist, my dad is a surgeon. I was a Nurse who when to med school. Believe me, i know the politics here very well since i grew up on them.
Regardless of what jwk says, AA = another person doing your job. PAs were also "under the medical board" and are pushing yearly for more independence, and are getting it. AA = the PA of anesthesia. To be so short sighted as to believe that the medical board will have dominion over a midlevel for ever and ever is akin to believing in fairy tales when the proof is all around you that it dosent happen that way. Id rather see more DOCTORS put out than more COMPETITORS regardless of their pretty names. Take a bit of a loss now to have more MD/DOs to solidify the profession 10 yrs form now.
If residency programs are in "doodoo" now, how will they be 10 years from now when we have ignored them, spent all our money creating AA programs and they have decreased by 50% since CRNA and AAs can do the job and there is little need for the anesthesiologist? Come now, are you all that short sighted?
My preference would be no midlevels at all. All anesthesia should be given by a anesthesiologist. However, that's not the case because we allowed midlevels into the game. It's too late to turn back the clock.
There aren't enough anesthesiologist so we need help from midlevels. If we have to have a midlevel in the OR, I would choose an AA over a CRNA.
Listen fool.
If i was a CRNA why would i promote more MD/DO programs? Are you daft?
Im sick of being labeled something im not just because I dont agree with the rhetoric you people blindly spit out. My mother is a former CRNA who became an anesthesiologist, my dad is a surgeon. I was a Nurse who when to med school. Believe me, i know the politics here very well since i grew up on them.
Regardless of what jwk says, AA = another person doing your job. PAs were also "under the medical board" and are pushing yearly for more independence, and are getting it. AA = the PA of anesthesia. To be so short sighted as to believe that the medical board will have dominion over a midlevel for ever and ever is akin to believing in fairy tales when the proof is all around you that it dosent happen that way. Id rather see more DOCTORS put out than more COMPETITORS regardless of their pretty names. Take a bit of a loss now to have more MD/DOs to solidify the profession 10 yrs form now.
If residency programs are in "doodoo" now, how will they be 10 years from now when we have ignored them, spent all our money creating AA programs and they have decreased by 50% since CRNA and AAs can do the job and there is little need for the anesthesiologist? Come now, are you all that short sighted?
Most of the push for "independence" is to remove barriers that frankly make the supervising physician's job more difficult. You claim to understand the politics then spit out this garbage.
Can you give an example of PA's pushing yearly for independence and getting it. More rhetoric. Yes there is a very small dissatisfied minority that really should have gone to medical school. Most of the push for "independence" is to remove barriers that frankly make the supervising physician's job more difficult. You claim to understand the politics then spit out this garbage.
David Carpenter, PA-C
Hey Dave
Well this quote:
Is a perfect example of rhetoric. I could post the PA stuff but why bother? You just confirmed it for me.
Nice ad hominen attack. In my state 100% chart consignature requirement within two weeks. Doc's went to the state board and said lets get rid of this. Not the PA's the Doc's. PA's among others not sure if this was a good idea. End result a change where the signature requirement goes down as the PA gains more experience. Doc's are happy (doesn't really affect the PA's). I'm sure you would label this a press for "independence". The physicians that are affected by it saw it as affecting their business and practice of medicine. Once again proof?
David Carpenter, PA-C
David,
The Same Group of militant CRNA's that wants "Independence" at any cost also despises the very concept of "AA." Thus, the AANA is fighting to keep AA's from practicing their field wherever possible. The AANA is run by these militant CRNA's and has been for at least the past twenty years.
When they can't win an argument with logic they use fear/scare tactics on Anesthesiologists and the Public. In this case it is the bogus "they will want Independence too" without knowing all the facts (or even caring about the facts).
Blade
Physician assistants in a battle regarding supervision
They are fighting against regulations requiring a certain amount of physician supervision:
The osteopathic group maintained at the hearing that patients do not get quality health care from a PA if the supervising physician does not initially see the patient and have on-site supervision.
The opposition groups say the two-year PA training, masters level degrees and prior medical work does not qualify them to see patients alone, without the doctor being in the building.
I think it's money-grubbing on the part of PAs, who want to maintain or increase hours on the job, and the doctors, who want to keep the office open and generating income when they aren't around. This has nothing to do with patient access to care.
I've heard about PAs working by themselves under the license of a doctor. The doctor may be allowing several PAs to work under him/her and collecting revenue from all of them.
How can we require a doctor to be educated for minimum 7 years, a PA 2 years, and allow them to do the same job? Why do we require so much from doctors, or so little from PAs? I think that primary care providers learn the bulk of "how to do it" on the job. So a PA who has been working for a while probably has a really good grasp on everything primary care. So should they be able to practice without a doctor in the office? Are they the same as a doctor?
If I was a PA I'd want more autonomy so I could demand more money for increased responsibility, and then I could eventually push for laws allowing me to open my own primary care clinic without physician supervision.
As a doctor, I'd want to allow more PA autonomy to an extent. Just enough so I could keep PAs under me so that they couldn't go out on their own, but enough autonomy so they could see all my patients and I could simply pull my income off their backs.
The News-Leader of Springfield, Mo., has an article about the state's new PA supervision legislation .
A Missouri bill passed late Monday will ensure that patients will still have access to physician assistants in rural health clinics.
The bill, which affects rural and inner-city sites across the state, awaits the governor's signature.
The bill allows physician assistants, or PAs, to treat patients unsupervised 34 percent of the time as long as their supervising doctor is on site 66 percent of the time.
When not on site, the doctor must be readily available for consultation by telecommunication and be within 30 miles of the PA's facility.
It's passage is being hailed by the Missouri Academy of Physician Assistants.
This is a true victory for Missouri patients and for our profession, said Paul Winter, president of Missouri Academy of Physician Assistants. Without a change in law, some health clinics would have been forced to reduce operating hours or close completely, leaving thousands of Missourians to travel greater distances for medical treatment or go without.
Well, its a victory of some sort. The local medical establishment there actually supported it (i believe) which is interesting. It is certainly a degradation of the supervision rule b/t PAs/physicians.
To me they local medical board was 'ok' with it b/c it means they make more money bot being there.... always back to money.
*sigh*
Here are some Physician comments on the story.
here are a couple of many. Eventually, every 'midlevel' wants to usurp the parent. Its common and not a personal condemnation, as you suggest.
Well, its a victory of some sort. The local medical establishment there actually supported it (i believe) which is interesting. It is certainly a degradation of the supervision rule b/t PAs/physicians.
To me they local medical board was 'ok' with it b/c it means they make more money bot being there.... always back to money.
For those interested in avoiding Noyac's ban on politics, the AANA and CRNA's our colleagues in the Pain Forum have an excellent debate going on.
"Bloated CRNA salaries" is a heated discussion and a very active thread.
Apparently, the moderator at that forum has no problems with open discussion.
Blade