Call to action: AA's in Texas

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Taurus

Taurus

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So, I called my Texas representative today...

Guy at his office said that while all CRNA's are against this bill, most of the Anesthesiologists they speak to are as well!!

I was pretty amazed, and after speaking to the guy (it was a staffer), he was pretty amazed any doc would back it too: It increases care for Texans across the board.

Keep callin', emailing...
 
you provided 2 links to sites that oppose the legislation. can you provide a link to a site that supports it...like the texas board of anesthesiologists?

if not, then it would seem that they are not too committed to the battle., which is not a good sign.
 
Coastie said:
So, I called my Texas representative today...

Guy at his office said that while all CRNA's are against this bill, most of the Anesthesiologists they speak to are as well!!

I was pretty amazed, and after speaking to the guy (it was a staffer), he was pretty amazed any doc would back it too: It increases care for Texans across the board.

Keep callin', emailing...
Click to expand...

Probably CRNA's calling pretending to be physicians.
 
Taurus said:
http://www.legis.state.tx.us/BillLookup/Text.aspx?LegSess=80R&Bill=SB1314
http://www.legis.state.tx.us/tlodocs/80R/billtext/html/SB01314I.htm

Here's the bill. Please explain to me why the ASA wouldn't support this. If they don't like it, then they need to fix it so they do like it. By now, they should have a template for getting AA's licensed at a state level.
Click to expand...

Just got an email in response to a question I asked the ASA.

"Yes, ASA is actively assisting TSA with on the AA licensure bill. I have been working very closely with their lobbyists and have sent them material that would support passage of this bill. ASA fully supports the licensure of AAs and works in conjunction with component societies that pursue AA licensure."

Lisa

So, it looks like the ASA is doing something. Great!​
 
Anybody care to contribute to the ASA political action committee to help with the fight?

I did. Haven't heard from any of you guys, though.
​
 
Coastie said:
So, I called my Texas representative today...

Guy at his office said that while all CRNA's are against this bill, most of the Anesthesiologists they speak to are as well!!

I was pretty amazed, and after speaking to the guy (it was a staffer), he was pretty amazed any doc would back it too: It increases care for Texans across the board.

Keep callin', emailing...
Click to expand...

If the staffer is convinced this is bad, then the CRNA's have done a better job of advocating their position than we have.

Take a look at Texas Society of Anesthesiology website:

http://www.tsa.org/

Not one mention of this bill. On the Texas CRNA website, it's the number one issue.

It's clear to me why the CRNA's have made so much progress. They're more organized and their members are very active. We need to get the message out to anesthesiologists nationwide that they need to wake up.
 
lushmd said:
In case anyone doubts that CRNAs vehemently oppose this (my, the hypocrisy...), check out this thread at allnurses.com. To follow up on poster's post, it seems that the TSA (Texas ASA) needs to take the lead on this and, if they do, the ASA will support them.
Click to expand...

Wow! That forum is interesting. I like the CRNAs who say that AAs just wish they could get into CRNA school. And if they wanted to do anesthesia at all, they should have went to CRNA school. Then knocking AAs for needing MD supervision!! If they would have stuck to what they were SUPPOSED to do (be supervised by MDs), there would be no need for AAs!
 
I e-mailed the TSA asking them to change the website.
​
 
Bravo, Bravisimo!! Good to know there are a "few good men" in this forum.
​
 
When does your name appear on the resident list of donors?
I donated and is not showing up.
 
Relax, It will show up.
​
 
<P>
badgas said:
Wow! That forum is interesting. I like the CRNAs who say that AAs just wish they could get into CRNA school. And if they wanted to do anesthesia at all, they should have went to CRNA school. Then knocking AAs for needing MD supervision!! If they would have stuck to what they were SUPPOSED to do (be supervised by MDs), there would be no need for AAs!
Click to expand...
</P>

I'm sorry...who are the ones that dictate what CRNA's are supposed to do? Ummmm....I don’t think it’s an Anesthesiologist. As much as you would like it...anesthesiologists do not control the practice of CRNA's.

I don’t mind AA's...they are there to assist the anesthesiologist (I guess because they don’t want work alone).

I work alone without an MDA anywhere and find that my anesthesia is far more effective and safe when there isn’t someone always walking in to get in the way. You can’t have two captains driving one ship.
 
Tell it like it is! These boys need to know that many counties in Texas have CRNA only Anesthesia. Many more have MDA's and CRNA's practicing together "solo" with a billing arrangement. Let them know that outide the Medical Center things are very different.
 
rmh149 said:
<P></P>

I'm sorry...who are the ones that dictate what CRNA's are supposed to do? Ummmm....I don't think it's an Anesthesiologist. As much as you would like it...anesthesiologists do not control the practice of CRNA's.

I don't mind AA's...they are there to assist the anesthesiologist (I guess because they don't want work alone).

I work alone without an MDA anywhere and find that my anesthesia is far more effective and safe when there isn't someone always walking in to get in the way. You can't have two captains driving one ship.
Click to expand...

Hmmmmm.......I wonder how far you are from the Mexican border🙄
 
rmh149 said:
<P></P>

You can’t have two captains driving one ship. [/COLOR]
Click to expand...

:laugh: :laugh: Captain???? :laugh: :laugh: Seriously?? :laugh: :laugh: I'm gonna start asking my nurses for orders because I must be their to assist them :laugh: :laugh: Oh wait! That was SUPPOSED to be you! I am w/ Ether in that we need AA's because they realize that they are assistants and not.... Hold on a sec.. :laugh: Can you say captains again?? :laugh:
 
Badgas,

A CRNA is OPENLY telling you on this forum that they can do the job without you. The AANA and these CRNA's believe you are not needed and are an expensive alternative to the equally qualified Nurse Anesthetist.

The law allows many CRNA's to work "solo" and bill for their services. The AANA is just a few bills/laws away from true legal equality. The DNAP will be the final nail in the coffin. Fortunately, Hospital by-laws will keep most CRNA's from practicing solo at our major medical centers. But, many community hospitals and outpatient centers will turn to the cheaper but equal provider of anesthesia. Like it or not, the DNAP is coming to a town and hospital near you.

Will the ASA, AcademicChairs or ABA do anything about this? Or, will the University Programs keep training your cheaper replacement? I am not innocent in this process but neither are most of you. I urge you to speak out about the subject at meetings, at lunch and during social gatherings.
You must begin the discusssion at the academic level because that is where the solution will start.
 
EtherMD said:
Badgas,

A CRNA is OPENLY telling you on this forum that they can do the job without you. The AANA and these CRNA's believe you are not needed and are an expensive alternative to the equally qualified Nurse Anesthetist.

The law allows many CRNA's to work "solo" and bill for their services. The AANA is just a few bills/laws away from true legal equality. The DNAP will be the final nail in the coffin. Fortunately, Hospital by-laws will keep most CRNA's from practicing solo at our major medical centers. But, many community hospitals and outpatient centers will turn to the cheaper but equal provider of anesthesia. Like it or not, the DNAP is coming to a town and hospital near you.

Will the ASA, AcademicChairs or ABA do anything about this? Or, will the University Programs keep training your cheaper replacement? I am not innocent in this process but neither are most of you. I urge you to speak out about the subject at meetings, at lunch and during social gatherings.
You must begin the discusssion at the academic level because that is where the solution will start.
Click to expand...

Ether,

I've read the majority of your posts and I agree with you 100%. I didn't see it at first, but I completely agree with your view on AA training now. I will do everything in my power to assure that when I finish residency, my assistants/co-workers won't be calling themselves.... :laugh: :laugh: CAPTAIN!
 
EtherMD said:
Tell it like it is! These boys need to know that many counties in Texas have CRNA only Anesthesia. Many more have MDA's and CRNA's practicing together "solo" with a billing arrangement. Let them know that outide the Medical Center things are very different.
Click to expand...



Ether...many of your ideas about CRNA's are correct and I agree with them. However, I do not like your usage of the term MDA. Please do not use this term. You are buying into CRNA propaganda. You are an MD just like everyone else who went to med school. Why cant you see that the AANA wants you to use this term to diminish your importance. Do not play into their hands!
 
rmh149 said:
<P></P>

I'm sorry...who are the ones that dictate what CRNA's are supposed to do? Ummmm....I don’t think it’s an Anesthesiologist. As much as you would like it...anesthesiologists do not control the practice of CRNA's.

I don’t mind AA's...they are there to assist the anesthesiologist (I guess because they don’t want work alone).

I work alone without an MDA anywhere and find that my anesthesia is far more effective and safe when there isn’t someone always walking in to get in the way. You can’t have two captains driving one ship.
Click to expand...




ok OB anesthesia Captain of the world...tell me.......how would you anesthetize a parturient with IHSS needing csection...........
 
I worked briefly with a hospital that had allowed CRNA's to practice in the past a solo-practioners.....supervised by the surgeons. I asked the surgeons how they did as a whole and EVERY SINGLE ONE of the surgeons did not feel comfortable with CRNA's practicing under their supervision on any case other than ASA1's for IHR, etc.

They explicitly said that CRNA's would just react to vital signs and not communicate well with the surgeons primarily because they did not understand the entire physiological picture of what was happening or what was about to happen.

The hospital found a 45-fold increase in morbidity & mortality of anesthesia related complications for CRNA's compared to Anesthesiologists. It was actually the surgeon's demanding to eliminate unsupervised CRNA practice that led to the hospital switching to a Anesthesia Care team practice.

So maybe we should start including surgeons in our efforts as well for further proof that this is an atrocity to the healthcare system and to patient care
 
Dude, make them publish their results!!!
 
urgewrx said:
Dude, make them publish their results!!!
Click to expand...

i made a comment about that to the hospital CEO and he acknowleged that although it would be in the patient's best interest across the US to "publish" these results, he mentioned somewhat humbly that there were probably many technical errors and such but the main point of it was that it definitely did show there to be an increased safety risk to having CRNA's practice solo.

His focus now was to allocate more $$$ to the anesthesia dept to hire more MD's since the CRNA's were planning on walking.

FYI, not a single CRNA left
 
badgas said:
Ether,

I've read the majority of your posts and I agree with you 100%. I didn't see it at first, but I completely agree with your view on AA training now. I will do everything in my power to assure that when I finish residency, my assistants/co-workers won't be calling themselves.... :laugh: :laugh: CAPTAIN!
Click to expand...

Anyone with some advice on who to contact, would it be just the AAAA, to begin utilizing these AA's in a state that does not show up on the list for AA's to practice. I have been talking this up with some of my friends in a state that has neither delegatory nor lic. for them to practice. They have told me they did not see anything in the practice act that specifically banned them either.
 
We need legistature allowing AAs to practice in all states. I wonder if they can be considered PAs (who just happen to especialize in anesthesiology) to help them achieve nationwide licensure.

I suggest those who live in TX start contacting the state legislature supporting AA practice privileges as someone already pointed out.
 
mille125 said:
ok OB anesthesia Captain of the world...tell me.......how would you anesthetize a parturient with IHSS needing csection...........
Click to expand...



to be honest I didnt expect a response from him.......he and others like him are going to kill somebody someday.....unfortunately, he will not take the fall...the hospital and surgeon will, allowing him to move on to the next victim......what a sad world
 
toughlife said:
We need legistature allowing AAs to practice in all states. I wonder if they can be considered PAs (who just happen to especialize in anesthesiology) to help them achieve nationwide licensure.

I suggest those who live in TX start contacting the state legislature supporting AA practice privileges as someone already pointed out.
Click to expand...

Sorry PA practice is linked to NCCPA certification which is only open to graduates of accredited PA programs.

David Carpenter, PA-C
 
Lizard1 said:
I worked briefly with a hospital that had allowed CRNA's to practice in the past a solo-practioners.....supervised by the surgeons. I asked the surgeons how they did as a whole and EVERY SINGLE ONE of the surgeons did not feel comfortable with CRNA's practicing under their supervision on any case other than ASA1's for IHR, etc.

They explicitly said that CRNA's would just react to vital signs and not communicate well with the surgeons primarily because they did not understand the entire physiological picture of what was happening or what was about to happen.

The hospital found a 45-fold increase in morbidity & mortality of anesthesia related complications for CRNA's compared to Anesthesiologists. It was actually the surgeon's demanding to eliminate unsupervised CRNA practice that led to the hospital switching to a Anesthesia Care team practice.

So maybe we should start including surgeons in our efforts as well for further proof that this is an atrocity to the healthcare system and to patient care
Click to expand...

The Surgeons like CRNA's but they know the truth: Nurses can not function at the level of a well-trained Physician Anesthesiologist. This is the reason my Group receives a large subsidy from the hospital as does MANY other Groups across the USA. Even with a DNAP Nurses need Physician level back-up at major medical centers. This is not rhetoric but fact and MOST CRNA's know this. But, this is where the debate begins. How many do you need and what ratio of MD/DO to CRNA is acceptable (bare minimum)? Unfortunately, the better the CRNA (this means the average CRNA with a DNAP should be better) the fewer Anesthesiologists the hospital needs.
Is 1:7 acceptable? What about 1:8? OR, is the ratio 1:5 which allows SOME follow-up with care/interaction with the case? I believe the maximum is 1:5 but the AANA would disagree.
 
Why cant PA's work in Anesthesiology? Just curious. it would make since since they practice in every other specialty. Hire some PA's, hold there hand for a couple months. make them read Morgan. Poof CRNA replacements.
 
apellous said:
Why cant PA's work in Anesthesiology? Just curious. it would make since since they practice in every other specialty. Hire some PA's, hold there hand for a couple months. make them read Morgan. Poof CRNA replacements.
Click to expand...


hence the AA...........
 
toughlife said:
We need legistature allowing AAs to practice in all states. I wonder if they can be considered PAs (who just happen to especialize in anesthesiology) to help them achieve nationwide licensure.

I suggest those who live in TX start contacting the state legislature supporting AA practice privileges as someone already pointed out.
Click to expand...


AA's and PA's are two separate fields. AA's have an entirely separate and distinct educational track, although obviously some of the same knowledge base. A number of PA's have gone through an AA program and have dual certification, and Emory has a PA to AA bridge program that can shorten the program track by a semester.

AA's, along with MD's and CRNA's are the only recognized anesthesia providers by CMS and private insurors. There is no provision for a PA to be reimbursed for providing anesthesia services.

From a personal standpoint - I greatly appreciate those of you who are supportive of the AA concept and the expansion of our practice rights to all states. The Texas AA bills are in committee as we speak, so we need all the positive support we can get. Those of you with ties in or to Texas are especially needed to help push through this legislation.
 
jwk said:
AA's and PA's are two separate fields. AA's have an entirely separate and distinct educational track, although obviously some of the same knowledge base. A number of PA's have gone through an AA program and have dual certification, and Emory has a PA to AA bridge program that can shorten the program track by a semester.

AA's, along with MD's and CRNA's are the only recognized anesthesia providers by CMS and private insurors. There is no provision for a PA to be reimbursed for providing anesthesia services.

From a personal standpoint - I greatly appreciate those of you who are supportive of the AA concept and the expansion of our practice rights to all states. The Texas AA bills are in committee as we speak, so we need all the positive support we can get. Those of you with ties in or to Texas are especially needed to help push through this legislation.
Click to expand...


JWK what has been the response of the ASA to this bill? Have you contacted them to ask for their support?

The ASA appears to support AAs based on this:

http://www.asahq.org/Newsletters/2003/03_03/frazier.html
http://www.asahq.org/Newsletters/2007/01-07/whatsNew01_07.html
 
Since the majority of counties in Texas don't have anesthesiologists, AA's won't do the patients any good since they can't practice. That's what we're here for are the patients.....right???????????????
 
dogbone65 said:
Since the majority of counties in Texas don't have anesthesiologists, AA's won't do the patients any good since they can't practice. That's what we're here for are the patients.....right???????????????
Click to expand...


Well, the idea is that once AAs are allowed to practice in Texas, they can replace the CRNAs in the big cities while the CRNAs move to the small rural towns and use their independence to practice solo there. Aren't they always arguing about how they don't need MD/DO supervision to practice?

Here's your chance, and that of the AANAs, to put your money where your mouth is.
 
dogbone65 said:
Since the majority of counties in Texas don't have anesthesiologists, AA's won't do the patients any good since they can't practice. That's what we're here for are the patients.....right???????????????
Click to expand...
Many of those "majority of counties in Texas don't have anesthesiologists" don't have hospitals either. Absolutely classic AANA propaganda.
 
jwk said:
They're on board of course. Steve Goldfien and the AA Education and Practice Committee as well as the Governemental and Legal Affairs Office of the ASA are stellar as always.
Click to expand...

Awesome.

I like the last paragraph on Goldfien's article as it shows the CRNA problem is not unique to the US

" It was an insufficient supply of anesthesiologists that led to the creation of the AA profession in 1969.1 It was again insufficient supply that led to the rediscovery of AAs, while their quality education and commitment to the anesthesia care team became the impetus for ASA's increasing support for their profession. Interestingly, as Great Britain struggles with the same problem, it also has discovered the relative merits of AA practice. In a recent editorial, the European Journal of Anaesthesiology2 states: "There are two reasons why we feel that the AA model represents a better plan for anaesthetic practice in the U.K. (and other countries through Europe) than the CRNA model. Firstly, AAs are trained by anaesthesiologists in accredited universities. Secondly, there is a long history of friction between CRNAs and anaesthesiologists in the U.S. It is clear that CRNAs will continue to seek the right of independent practice. They are continually trying to &#8216;eat our lunch.' They are also suffering from &#8216;job creep.' There are cases of nurse anaesthetists with doctorates introducing themselves as &#8216;Hello, I'm Dr. X, your nurse anesthesiologist.'"
 
toughlife said:
Awesome.

I like the last paragraph on Goldfien's article as it shows the CRNA problem is not unique to the US

" It was an insufficient supply of anesthesiologists that led to the creation of the AA profession in 1969.1 It was again insufficient supply that led to the rediscovery of AAs, while their quality education and commitment to the anesthesia care team became the impetus for ASA’s increasing support for their profession. Interestingly, as Great Britain struggles with the same problem, it also has discovered the relative merits of AA practice. In a recent editorial, the European Journal of Anaesthesiology2 states: “There are two reasons why we feel that the AA model represents a better plan for anaesthetic practice in the U.K. (and other countries through Europe) than the CRNA model. Firstly, AAs are trained by anaesthesiologists in accredited universities. Secondly, there is a long history of friction between CRNAs and anaesthesiologists in the U.S. It is clear that CRNAs will continue to seek the right of independent practice. They are continually trying to ‘eat our lunch.’ They are also suffering from ‘job creep.’ There are cases of nurse anaesthetists with doctorates introducing themselves as ‘Hello, I’m Dr. X, your nurse anesthesiologist.’”
Click to expand...

That's fair enough except it's, "Hello, I'm Dr. X with anesthesia" or "from the department of anesthesia" rather than "your nurse anesthestist."
 
Once the DNP arrives, we can expect the nurses to introduce themselves as "DR X, anesthestist." The word "Doctor" will no longer have the practical meaning of "Physician" Perhaps we should start referring to ourselves as "Dr X, physician anesthesiologist", or even better as "Dr X, perioperative physician"
​
 
Most CRNA's won't use the title "doctor" in a clinical setting as it is deceptive. We are proud of our education and believe "Nurse Anesthetist with a Doctorate in Anesthesia" is an honest approach.

AA's are a "failed idea" by the ASA. The AANA has proven that CRNA's can handle Anesthesia is any setting solo. I am proud of being a CRNA and support the AANA's fight against AA's in Teaxas.
 
FSUCRNA said:
Most CRNA's won't use the title "doctor" in a clinical setting as it is deceptive. We are proud of our education and believe "Nurse Anesthetist with a Doctorate in Anesthesia" is an honest approach.

AA's are a "failed idea" by the ASA. The AANA has proven that CRNA's can handle Anesthesia is any setting solo. I am proud of being a CRNA and support the AANA's fight against AA's in Teaxas.
Click to expand...


If they are a failed idea, why are you wasting your time fighting them? We are also proud of being anesthesiologists and wholeheartedly support the fight against CRNAs.
 
toughlife said:
If they are a failed idea, why are you wasting your time fighting them? We are also proud of being anesthesiologists and wholeheartedly support the fight against CRNAs.
Click to expand...

We are used to fighting against the ASA. We have made great progress in the public and private sectors in proving we are competent providers more than capable of doing solo anesthesia.

AA's are an invention of the ASA and a tool used by them to hurt the AANA and CRNA's. That is why we fight to keep these inferior providers from being licensed. The USA doesn't need another anesthesia provider but the ASA wants a lacky to do its bidding. Solo CRNA's like myself don't need an MDA to hold my hand or take my money. The AA is totally dependent on the MDA to earn a living unlike me. Every day CRNA's give Anesthesia independetly across the USA and we have plans to do more of it. This is something you better get used to.
 
FSUCRNA said:
We are used to fighting against the ASA. We have made great progress in the public and private sectors in proving we are competent providers more than capable of doing solo anesthesia.

AA's are an invention of the ASA and a tool used by them to hurt the AANA and CRNA's. That is why we fight to keep these inferior providers from being licensed. The USA doesn't need another anesthesia provider but the ASA wants a lacky to do its bidding. Solo CRNA's like myself don't need an MDA to hold my hand or take my money. The AA is totally dependent on the MDA to earn a living unlike me. Every day CRNA's give Anesthesia independetly across the USA and we have plans to do more of it. This is something you better get used to.
Click to expand...
Wow - there's an entire post without a single original thought, just a regurgitation of drivel from the AANA. Typical.

But of course that's all most CRNA's can do, since 99% of them have never worked with or met an AA - they have to depend on the AANA to provide them with their talking points and propaganda.
 
The AANA doesn't want AA's practicing in Texas or anywhere else. But, AA's can practice in a few States like Georgia so the current plan is containment.
I am a loyal member of the AANA and support keeping AA's out of most States.

Nothing personal but this is politics. The ASA wants AA's to hurt CRNA's and lower salaries. We are going to fight like mad to prevent this. The AANA is a great organization and I support them 100%.
 
FSUCRNA said:
Most CRNA's won't use the title "doctor" in a clinical setting as it is deceptive. We are proud of our education and believe "Nurse Anesthetist with a Doctorate in Anesthesia" is an honest approach.
Click to expand...

Yeah, nurse anesthetist with a doctorate in anesthesia isn't confusing at all to a patient. B/c you know exactly what the next question out of the pt's mouth will be. "So are you a Dr. or Nurse?" How do you plan on answering this one?

FSUCRNA said:
Solo CRNA's like myself don't need an MDA to hold my hand.
Click to expand...

A little knowledge is a dangerous thing
 
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