If PAs are fighting for independence Will AAs?

[RegionalKING]

This is my first post. Long time lurker but only made an account today because of what I recently read.

My concern as a current anesthesia tech and prospective AA student (getting ready to start applying this year) came from reading this story on PAs now fighting for independence.

http://tinyurl.com/hzcufsv

From what I can tell the PA in the video is a representative of their national association not just some random wackadoo taking out of his behind...

Will AAs look to do the same thing and if so will you guys not want to hire us after graduation? I plan to work with MDs for highest level of saftey but I do not want to get myself in a position where I have taken out tuns of student loans only to find I can no longer get a good job.

Thank you all and I appreciate your perspective on this. I apologize if this is the wrong place to ask the question but I do not know who else can answer it.

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[Noyac]

I wouldn't worry about it.
The answer is "yes" possibly but it's not like that will negate the need for AA's.
One of the big issues with anesthesiologists and nurses is the way the nurses go about requesting their independence. They are disrespectful in their approach. They are ignorant of the difference btw them and doctors (some of them).
I would probably be ok with the crna's practicing without an anesthesiologist in areas that can't get a doctor. But it is obvious that they wouldn't stop there. And when they do these cases (which are quite different in these areas) they begin to think they are equal. That's the problem. Whenever someone thinks that they don't need help from time to time, they then become dangerous. This is true even for the docs.

 

[Aether2000]

Absolutely they will.

 

[RegionalKING]

Absolutely they will.

But why? Seems like a perfect job to me. Great salary and someone to back you up. Why risk it?

 

[Psai]

But why? Seems like a perfect job to me. Great salary and someone to back you up. Why risk it?

Ego, ignorance and jealousy. Everyone wants to be a doctor but no one wants to put in the work.

 

[jwk]

We've been around for more than 45 years. We've never sought independent practice. We're committed to the anesthesia care team concept, lead by an anesthesiologist. Period.

Sorry to disappoint you - No ego, ignorance, or jealousy here, and I've been doing this since 1981. If you want to see how a true, efficient, and profitable ACT practice works, PM me and we can set up a site visit.

 

[AdmiralChz]

We've been around for more than 45 years. We've never sought independent practice. We're committed to the anesthesia care team concept, lead by an anesthesiologist. Period.

Sorry to disappoint you - No ego, ignorance, or jealousy here, and I've been doing this since 1981. If you want to see how a true, efficient, and profitable ACT practice works, PM me and we can set up a site visit.

Yeah, I tend to agree. Right now the number one thing on the AA radar is getting credentialed and allowed to work in ALL states - you can't even have the full practice conversation without state licensure. We should support them in expanding to all states, FYI. Your local and state PACs should be involved here.

 

[PressureSupport]

For centuries, medicine was taught as an apprenticeship. You attached yourself to a physician, and eventually saw enough and gained enough experience to do it yourself. All that changed after the Flexner Report in 1910 and we started training doctors using those recommendations and the model employed by Johns Hopkins: 2 years basic science, 2 years clinical education in a hospital, and then specialty training in residencies. American medical education quickly became the standard and the U.S. became the leader in medial innovation and healthcare.

Now, for a multitude of reasons, we're regressing back to the apprenticeship model with mid-levels (or extenders, or advanced allied practitioners or whatever the in vogue label is). The problem with being an apprentice for a whole career is that after 3 or 5 or 10 years of doing the same stuff every day, you start to wonder, "Why am I being supervised by a doctor at all?" The OP might feel happy with physician oversight now, but in 10 years I totally wouldn't blame him/her for wanting to independently wanting to prescribe that thiazide for the hypertensive 50-year old patient.

Here's the catch: medicine (especially anesthesiology) is about differential diagnosis, risk-benefit analysis, an exquisite understanding of physiology, and being a proficient consumer of scientific literature. These are skills taught in medical school. When I see a hypotensive patient, I don't reach for the purple stick like a nurse, I'm trained to think MAP - RAP = CO x SVR. When my patient is bleeding in the OR, I don't wait until the hemoglobin is 7 and decide to transfuse (like a nurse), I weigh risks and benefits and the patient's particular needs for oxygen delivery and decide a treatment.

Physicians provide superior medical care because we have superior training. You could do a 50-year apprenticeship and never truly grasp the actual science of the specialty (e.g. 55-year old CRNA who told me the etCO2 was broken because there was a 10-point difference between the number on the screen and the PaCO2 on a blood gas...). CRNAs are so self-impressed with their ability because they believe anesthesiology is about intubating and giving some phenylephrine. Unfortunately, many surgeons and hospital administrators think that is what we do. Double unfortunately, some anesthesiologists act like that is all we should do. My point is that PAs and NPs have an important role, but their training is inadequate for independent practice. We've got a whole lot of stupid in this country that has built up momentum behind us regressing back to Hippocrates-type apprenticeships (i.e. NP "school"). The most important thing is to be a DOCTOR, not a clock-watching, case-canceling, work-avoiding pansy.

 

[dhb]

Nice post

 

[sigrhoillusion]

For centuries, medicine was taught as an apprenticeship. You attached yourself to a physician, and eventually saw enough and gained enough experience to do it yourself. All that changed after the Flexner Report in 1910 and we started training doctors using those recommendations and the model employed by Johns Hopkins: 2 years basic science, 2 years clinical education in a hospital, and then specialty training in residencies. American medical education quickly became the standard and the U.S. became the leader in medial innovation and healthcare.

Now, for a multitude of reasons, we're regressing back to the apprenticeship model with mid-levels (or extenders, or advanced allied practitioners or whatever the in vogue label is). The problem with being an apprentice for a whole career is that after 3 or 5 or 10 years of doing the same stuff every day, you start to wonder, "Why am I being supervised by a doctor at all?" The OP might feel happy with physician oversight now, but in 10 years I totally wouldn't blame him/her for wanting to independently wanting to prescribe that thiazide for the hypertensive 50-year old patient.

Here's the catch: medicine (especially anesthesiology) is about differential diagnosis, risk-benefit analysis, an exquisite understanding of physiology, and being a proficient consumer of scientific literature. These are skills taught in medical school. When I see a hypotensive patient, I don't reach for the purple stick like a nurse, I'm trained to think MAP - RAP = CO x SVR. When my patient is bleeding in the OR, I don't wait until the hemoglobin is 7 and decide to transfuse (like a nurse), I weigh risks and benefits and the patient's particular needs for oxygen delivery and decide a treatment.

Physicians provide superior medical care because we have superior training. You could do a 50-year apprenticeship and never truly grasp the actual science of the specialty (e.g. 55-year old CRNA who told me the etCO2 was broken because there was a 10-point difference between the number on the screen and the PaCO2 on a blood gas...). CRNAs are so self-impressed with their ability because they believe anesthesiology is about intubating and giving some phenylephrine. Unfortunately, many surgeons and hospital administrators think that is what we do. Double unfortunately, some anesthesiologists act like that is all we should do. My point is that PAs and NPs have an important role, but their training is inadequate for independent practice. We've got a whole lot of stupid in this country that has built up momentum behind us regressing back to Hippocrates-type apprenticeships (i.e. NP "school"). The most important thing is to be a DOCTOR, not a clock-watching, case-canceling, work-avoiding pansy.

The sad thing is that during medical school and residency, I used to think, "Why am I even doing this?" I'd be studying for embryology thinking, "When am I ever going to use this?" I always thought that I'd learn and experience more just following whatever type of doctor I wanted to be for like 10 years right of of college and just find a job or take over when they one I was following retired or croaked. I guess one thing (probably of many) is that there really isn't any standardization. If you follow a ****ty doctor for many years then you just continue to practice ****ty medicine. At least with schooling and residency they have a way of ranking people.

 

[aneftp]

Hospitals continue to support mid level "independence" knowing full well they can employ or restrict their practices more than docs!!

If docs ever called out the AHA on this and just come out and say pass the savings from hiring an NP FOR $70-100k to the consumer when an in house doc would cost them 2x or more than I'll he fine.

But AHA will continue to play the game as long as they can pocket the differences between what actually goes to the NP and what goes into their corp pocketbooks

 

[urge]

Yes, they will.