We are hiring our first AA

[Planktonmd]

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We are hiring our first AA and our CRNA's are not very happy.
It's going to be interesting!

 

[lvspro]

👍I'm very curious to see how things pan out with an "alternative" provider. Please keep us in the loop with occasional updates.

 

[mack bronson]

I am semi-******ed and a fourth year med student, so the combo does not help me at all, but what exactly is an AA and how does the training differ from a CRNA?

 

[Lokhtar]

I've been trolling this forum for a while, and I thought that CRNA = AA? I guess not though.

EDIT: I found this. So I have a question: why have two separate degrees? I am still not clear on what is different?

 

[TheSandMan]

I've been trolling this forum for a while, and I thought that CRNA = AA? I guess not though.

EDIT: I found this. So I have a question: why have two separate degrees? I am still not clear on what is different?

sort of along the same idea as DO/MD and DMD/DDS. At the end of the day, it really doesn't matter much

 

[toughlife]

show them they are replaceable. Hopefully this trend will let them see that they need to ask the AANA to endorse the ACT model or else.

 

[johankriek]

good job.. I think aas should get licensed in every single state. But i also really believe that PA-Cs should get involved with anesthesia as well. It would take a good 14 months to train pas to be our true assistants.. CRNAs have talked their talk too long and we need to take action NOW. once we start getting AAs and PA-Cs to start doing anesthesia in the OR we can gradually phase them out of existence.. I currently do my own cases and would never supervise a CRNA

 

[jwk]

We are hiring our first AA and our CRNA's are not very happy.
It's going to be interesting!

Congrats and way to go Plankton!!! It takes some guts both for y'all to hire them and for that AA to come there, especially if they're the first one and coming in by themselves. It's tough breaking the ice. Most places that hire AA's for the first time are a little worried, but since you're obviously already a care team practice, they should fit right into your system just fine. And most places have found that they end up fitting in great, and why not? They're going to be doing the same thing that your CRNA's do.

 

[jwk]

I've been trolling this forum for a while, and I thought that CRNA = AA? I guess not though.

EDIT: I found this. So I have a question: why have two separate degrees? I am still not clear on what is different?

In practices that have both AA's and CRNA's, there is no difference.

 

[Josh L.Ac.]

Congrats and way to go Plankton!!! It takes some guts both for y'all to hire them and for that AA to come there, especially if they're the first one and coming in by themselves. It's tough breaking the ice. Most places that hire AA's for the first time are a little worried, but since you're obviously already a care team practice, they should fit right into your system just fine. And most places have found that they end up fitting in great, and why not? They're going to be doing the same thing that your CRNA's do.

I would like to know how many anesthesia groups in Kansas City would like to hire AA's because as a student, I'm nervous about applying.


Seems like many groups are nervous. Hopefully if the groups like Plankton's disseminate positive information about hiring AA's, other groups will unpucker a little and there will be more competition and opportunity in the area of midlevel anesthesia.

 

[Teillard]

Plankton,

Just curious, does your group employ the CRNA's or are they hospital employees? And how did you sell it to them? Is it seen as a business decision or an attempt to torque the CRNA's? I can't imagine an anesthesia group falling on its sword just to get a rise out of some CRNA's. There is a way hire PA's without total group decompensation, but from the tone of your post, thats not what you're after. Beware the principle of unintended consequences. The surgeons will be watching too.

 

[dingozlife]

😱 <--is watching too... sending shivers down my spine...

 

[Noyac]

I can't imagine an anesthesia group falling on its sword just to get a rise out of some CRNA's. There is a way hire PA's without total group decompensation, but from the tone of your post, thats not what you're after. Beware the principle of unintended consequences. The surgeons will be watching too.

The surgeons don't care who is doing their anesthesia as long as the cases get started on time and the pts survive the anesthetic without complications. As far as the AA vs crna anesthetic, there is no difference. They are the same.

The way to hire without total decompensation is easy. Just hire whomever you feel will benefit your group in some way. If others are threatened then to bad. If they leave then they were not loyal members anyhow. Hiring an AA is no different than hiring another crna. Its all about manpower and getting the cases done in a safe and effective manner.

Crna's will piss and moan about an AA coming into the group but they won't go anywhere. But if they do then you have room to hire another AA. 👍

 

[Taurus]

👍👍👍

I hope others follow your example!

 

[dingozlife]

wait...thats like introducing more supply to the market so the cost to buy 1 fresh apple is cheaper than buying an apple that bites you in the arse.

 

[jwk]

I would like to know how many anesthesia groups in Kansas City would like to hire AA's because as a student, I'm nervous about applying.


Seems like many groups are nervous. Hopefully if the groups like Plankton's disseminate positive information about hiring AA's, other groups will unpucker a little and there will be more competition and opportunity in the area of midlevel anesthesia.

There are already AA students rotating at hospitals in KC and St. Louis. The demand is definitely there - the Missouri Society of Anesthesiologists fully supports AA's in Missouri and is working hard to get the UMKC school up and running and providing clinical sites for their students as well as some of the other AA programs.

 

[jwk]

The surgeons don't care who is doing their anesthesia as long as the cases get started on time and the pts survive the anesthetic without complications. As far as the AA vs crna anesthetic, there is no difference. They are the same.

The way to hire without total decompensation is easy. Just hire whomever you feel will benefit your group in some way. If others are threatened then to bad. If they leave then they were not loyal members anyhow. Hiring an AA is no different than hiring another crna. Its all about manpower and getting the cases done in a safe and effective manner.

Crna's will piss and moan about an AA coming into the group but they won't go anywhere. But if they do then you have room to hire another AA. 👍

Bingo - you hit the nail on the head. It's the classic "cutting your nose off to spite your face". Is a CRNA going to leave a perfectly good practice to make a political statement? Not likely, and if they do, there's an AA or another CRNA that can step into their place.

Keep in mind - we're not trying to run out the CRNA's in a practice. We're not coming in expecting to replace anyone. Unlike the AANA that wants to rule the anesthesia world (or at least the US version of it), AA's simply want to be able to practice. We have no problems working with CRNA's. We do it every day. My practice has about 3 dozen each of AA's, CRNA's, and MD's. The only cut-throat competition between the groups occured last week in our first annual Anesthesia Jeopardy game. 😉 Otherwise, we all get along great.

 

[InductionAgent]

I've been trolling this forum for a while, and I thought that CRNA = AA? I guess not though.

EDIT: I found this. So I have a question: why have two separate degrees? I am still not clear on what is different?

This has been addressed before, but for those not clear on the issue, there are major difference both in training and in ambition of CRNAs and AAs:

CRNAs all have BSN nursing degrees. Then they must work at least one year in critical care nursing or recovery room nursing. Then they do a 27 to 36 month CRNA schooling. Their organization, the AANA is all for being able to provide anesthesia completely independently of physician supervision. In several states they can.

Contrast this to AAs, who need a bachelor's degree to enter their training program, but it need not be in a healthcare field, nor are they required to have work experience in healthcare. Following the completion of their training, they may only practice under the supervision of an anesthesiologist. Their mission statement makes it clear that they have no ambition to practice unsupervised, and in no state are they empowered to do so.

 

[dingozlife]

what's a BSN degree? what does it stand for?

nm did quick google search and found out: bachelor degree in nursing.. but shouldnt that be BDN? BS nursing degree ?

 

[Josh L.Ac.]

There are already AA students rotating at hospitals in KC and St. Louis. The demand is definitely there - the Missouri Society of Anesthesiologists fully supports AA's in Missouri and is working hard to get the UMKC school up and running and providing clinical sites for their students as well as some of the other AA programs.

The [nursing] rumor mill is that the AA program at UMKC is hitting a snag with clinical sites because the CRNA's legally [part of the Missouri AA practice law] will have nothing to do with the AA's and the result is not enough anesthesiologists to work with the AA students at the sites UMKC was going to use.

 

[Planktonmd]

Plankton,

Just curious, does your group employ the CRNA's or are they hospital employees? And how did you sell it to them? Is it seen as a business decision or an attempt to torque the CRNA's? I can't imagine an anesthesia group falling on its sword just to get a rise out of some CRNA's. There is a way hire PA's without total group decompensation, but from the tone of your post, thats not what you're after. Beware the principle of unintended consequences. The surgeons will be watching too.

This was not done to make a political statement. We simply needed providers and an AA responded, we felt that it's time to change the local culture.
The CRNA's are employed by the group and a few of them expressed their unhappiness with the situation and are threatening to leave, but the majority of them did not have a problem with it.

 

[jwk]

The [nursing] rumor mill is that the AA program at UMKC is hitting a snag with clinical sites because the CRNA's legally [part of the Missouri AA practice law] will have nothing to do with the AA's and the result is not enough anesthesiologists to work with the AA students at the sites UMKC was going to use.

It's not easy starting up a program, but they already have clinical sites available and anesthesiologists willing to teach. The AA students going there from other schools have had nothing but great things to say about the rotations, and have had minimal if any problems with the CRNA's they've met. Missouri, like so many other places, has a shortage of anesthesia providers.

And actually, as far as the state law is concerned, (if you read closely) it doesn't say anything about CRNA's and AA students.

 

[Josh L.Ac.]

It's not easy starting up a program, but they already have clinical sites available and anesthesiologists willing to teach. The AA students going there from other schools have had nothing but great things to say about the rotations, and have had minimal if any problems with the CRNA's they've met. Missouri, like so many other places, has a shortage of anesthesia providers.

And actually, as far as the state law is concerned, (if you read closely) it doesn't say anything about CRNA's and AA students.

HA. The message I was told is that CRNA's are strictly forbidden from supervising or instructing any AA students.


Although seriously, the few SRNA folks I've talked to understand my inkling to become an AA. At least they would give me dubs on the floor.

 

[Teillard]

This was not done to make a political statement. We simply needed providers and an AA responded, we felt that it's time to change the local culture.
The CRNA's are employed by the group and a few of them expressed their unhappiness with the situation and are threatening to leave, but the majority of them did not have a problem with it.

OK, I misunderstood.

 

[jwk]

HA. The message I was told is that CRNA's are strictly forbidden from supervising or instructing any AA students.


Although seriously, the few SRNA folks I've talked to understand my inkling to become an AA. At least they would give me dubs on the floor.

AA students, unlike CRNA students, are happy to receive instruction from anyone that is willing to teach.

As I understand Missouri law, there is no prohibition about CRNA's teaching AA students. Read it carefully. 😉

 

[cfdavid]

We are hiring our first AA and our CRNA's are not very happy.
It's going to be interesting!

F..ck them. Michigan is not known for it's AA presence, but when I shadowed at a pretty large hospital, there was ONE AA out of approx. 40 CRNAs.

I asked him if he was a CRNA and he said, "no, I'm a PA". I'm like, "oh, your an AA". Then, I went on to ask why there weren't more AA's in MI. This was in front of another CRNA, mind you. His response was, "well, it's kind of a political thing". The CRNA didn't say anything (actually he was a pretty nice guy, but one of those that could have been a cement finisher in another life). No offense to cement finishers, cause I have some experience in how valuable a GOOD one really is! lol

 

[cfdavid]

I would like to know how many anesthesia groups in Kansas City would like to hire AA's because as a student, I'm nervous about applying.


Seems like many groups are nervous. Hopefully if the groups like Plankton's disseminate positive information about hiring AA's, other groups will unpucker a little and there will be more competition and opportunity in the area of midlevel anesthesia.

Assuming you're refering to applying to an AA program, you will NOT have a hard time getting a job in any of the 14+ (I may be outdated) states in which they are fully recognized. At Case Western's AA program, students were getting recruited with some nice offers at the begining of their 2nd year.

 

[cfdavid]

This was not done to make a political statement. We simply needed providers and an AA responded, we felt that it's time to change the local culture.
The CRNA's are employed by the group and a few of them expressed their unhappiness with the situation and are threatening to leave, but the majority of them did not have a problem with it.

I know it's easier said than done, and even a bit naive to suggest that this threat is totally benign. But, even they can be replaced, even with more accomodating CRNAs, if necessary. Otherwise, this generally and historically spoiled group needs to get used to it, and adjust their attitudes.

 

[Noyac]

ASA's scope of practice for AA's and crna's for those interested:

http://www.asahq.org/career/aa.htm

http://www.asahq.org/Washington/09Scope.pdf

 

[swpm]

The only cut-throat competition between the groups occured last week in our first annual Anesthesia Jeopardy game. 😉

I think the most important question raised in this thread is, who came in 2nd? Did the AAs beat out the CRNAs?

 

[toughlife]

I know it's easier said than done, and even a bit naive to suggest that this threat is totally benign. But, even they can be replaced, even with more accomodating CRNAs, if necessary. Otherwise, this generally and historically spoiled group needs to get used to it, and adjust their attitudes.

That's right. They need to get used to the ACT model or show them the door. Heck, even residents who are physicians (in-training, but physicians nevertheless) need to be supervised, let alone crnas.

BladeMDA was right afterall, the AAs are definitely where's at.

 

[Coastie]

Reading the ASA website, seems that AA's have far superior training in Anesthesiology than CRNA's, as evidenced by the 2600 clinical hours minimum versus 800 clinical hours minimum (AA vs CRNA), as well as the requirement that AA schools be at an Academic Medical Center versus any community hospital for the CRNA's.

Furthermore, with regards to certification, AA's must keep theirs up with recurrent tests of greater length than CRNA's, while the CRNA's just do one exam, and that's it for life.

The choice is very clear: AA's are the future of the anesthesia.

ASA's scope of practice for AA's and crna's for those interested:

http://www.asahq.org/career/aa.htm

http://www.asahq.org/Washington/09Scope.pdf

 

[Taurus]

Reading the ASA website, seems that AA's have far superior training in Anesthesiology than CRNA's, as evidenced by the 2600 clinical hours minimum versus 800 clinical hours minimum (AA vs CRNA), as well as the requirement that AA schools be at an Academic Medical Center versus any community hospital for the CRNA's.

Furthermore, with regards to certification, AA's must keep theirs up with recurrent tests of greater length than CRNA's, while the CRNA's just do one exam, and that's it for life.

The choice is very clear: AA's are the future of the anesthesia.

It's the same for PA vs NP. NP's and CRNA's like to mislead everyone into thinking that their nursing undergrad adds substantially to their training. It doesn't. They're learning some medicine for a few years in NP and CRNA schools and it's not even that rigorous compared to medical school.

If the CRNA wants to leave and make a political statement, then don't let the door hit you in the arse!

The anesthesiologists hold the ultimate trump card: we control who gets hired.

 

[primadonna22274]

I believe there is *ONE* PA residency program in Anesthesiology. Not sure where. I'll try to google it. I think it would be an interesting training on top of the nuts and bolts of PA education. Traditionally, a PA who wanted to work in anesthesia had to then do an AA program or med school-->MDA.
Good for your group. This is one PA who will keep her fingers crossed for you!
....nope, darn it, I guess I lied. Either there used to be a program or I heard somebody talking about developing one...would be a good idea though.... http://www.appap.org if you're interested in perusing the PA residencies that are available or feel ambitious enough to develop one for anesthesia....

 

[stone123]

Could someone explain to me why an anesthesiology group would hire AAs vs CRNAs if they both have to be supervised? Can an MDA supervise more AAs at a time or is it because the AAs salaries are cheaper to pay? There would have to be some financial benefit for the group wouldn't there, or is the decision truly based on politics, ie to upset the CRNAs?

 

[jwk]

Could someone explain to me why an anesthesiology group would hire AAs vs CRNAs if they both have to be supervised? Can an MDA supervise more AAs at a time or is it because the AAs salaries are cheaper to pay? There would have to be some financial benefit for the group wouldn't there, or is the decision truly based on politics, ie to upset the CRNAs?

Let's turn it around - why would you hire CRNA's instead of AA's?

And why would there "have to be some financial benefit for the group" to hire an AA over a CRNA? BTW, they cost the same. If you're short on anesthetists in your group, and you have two fully qualified types of providers to fill those vacancies, why not hire an AA?

Nitecap, is that you?

 

[Planktonmd]

Could someone explain to me why an anesthesiology group would hire AAs vs CRNAs if they both have to be supervised? Can an MDA supervise more AAs at a time or is it because the AAs salaries are cheaper to pay? There would have to be some financial benefit for the group wouldn't there, or is the decision truly based on politics, ie to upset the CRNAs?

The pay is the same, and the supervision is the same as well.
These are anesthesia providers that are as qualified as CRNA's and we don't see a reason why we shouldn't hire them if they apply.
Actually if we don't hire them we would be favoring one provider over another and that wouldn't be fair.

 

[stone123]

The pay is the same, and the supervision is the same as well.
These are anesthesia providers that are as qualified as CRNA's and we don't see a reason why we shouldn't hire them if they apply.
Actually if we don't hire them we would be favoring one provider over another and that wouldn't be fair.

Maybe what I should have asked is why are many anesthesiologists pro AA and anti CRNA other than the political bad blood between the AANA and the AMA? I thought maybe there is some sort of financial benefit to using AAs related to billing or supervision. If not, then I don't see anything wrong with using both. I know CRNAs who feel their job is threatened by AAs and I know even more MDAs who feel their job is threatened by CRNAs, but I don't know any MDAs who feel threatened by AAs. Something is wierd about that don't ya think?

 

[cfdavid]

Maybe what I should have asked is why are many anesthesiologists pro AA and anti CRNA other than the political bad blood between the AANA and the AMA? I thought maybe there is some sort of financial benefit to using AAs related to billing or supervision. If not, then I don't see anything wrong with using both. I know CRNAs who feel their job is threatened by AAs and I know even more MDAs who feel their job is threatened by CRNAs, but I don't know any MDAs who feel threatened by AAs. Something is wierd about that don't ya think?

I think you've answered your own question, don't you?

 

[Plastyc]

Are AA's allowed to do regional procedures or start invasive lines?

 

[Planktonmd]

Are AA's allowed to do regional procedures or start invasive lines?

They can do everything as long as there is a supervising Anesthesiologist.

 

[Planktonmd]

Maybe what I should have asked is why are many anesthesiologists pro AA and anti CRNA other than the political bad blood between the AANA and the AMA? I thought maybe there is some sort of financial benefit to using AAs related to billing or supervision. If not, then I don't see anything wrong with using both. I know CRNAs who feel their job is threatened by AAs and I know even more MDAs who feel their job is threatened by CRNAs, but I don't know any MDAs who feel threatened by AAs. Something is wierd about that don't ya think?

That is incorrect.
Anesthesiologists (that you keep calling MDA's) are not anti CRNA's. They never were and never will be against CRNA's, remember that Anesthesiologists are the ones that train CRNA's and supervise them in the real world.
The only issue is that there is a silly politically motivated group of CRNA's trying to claim that anesthesiology is nursing and most physicians don't agree with that, actually most CRNA's don't agree with that either.
They just need to grow up.

 

[ytrap]

That is incorrect.
Anesthesiologists (that you keep calling MDA's) are not anti CRNA's. They never were and never will be against CRNA's, remember that Anesthesiologists are the ones that train CRNA's and supervise them in the real world.
The only issue is that there is a silly politically motivated group of CRNA's trying to claim that anesthesiology is nursing and most physicians don't agree with that, actually most CRNA's don't agree with that either.
They just need to grow up.

Anesthesiology is the practice of medicine. Anesthesiology is also the practice of nursing. That is not the opinion of a few CRNAs; that is the law. The fact that anesthesiology is also the practice of nursing doesn't make it any less of a medical specialty. Unfortunately, many of you do not see how having yet another non-MD become proficient in a medical specialty can be counter productive. When pts consistently see that different factions of non-MDs are often "hands on" providers of their anesthesia, they will think that is the norm. You want it to be a medical specialty, but you will support ANOTHER non-MD provider to practice your specialty (in the real world, with very little, if any, supervision). We have to remember that MDs do not define what constitutes the practice of "nursing". Its a hard pill to swallow, but I got it down a long time ago. The sooner you swallow it, the less concerned you will be. Lets just do whats best for the patient. So if you whole-heartedly believe pts are in jeopardy under care from CRNAs practicing independently in rural America, what are YOU going to do about? Who is going to personally see to it that each CRNA in rural America is practicing under the supervision of an anesthesiologist? Therein, lies the difference between AAs and CRNAs. I don’t agree or disagree with that, but it’s the truth. I respect AAs, but fair is fair.

 

[ytrap]

Why were my other posts deleted?

 

[johankriek]

Anesthesiology is the practice of medicine. Anesthesiology is also the practice of nursing. That is not the opinion of a few CRNAs; that is the law. The fact that anesthesiology is also the practice of nursing doesn't make it any less of a medical specialty. Unfortunately, many of you do not see how having yet another non-MD become proficient in a medical specialty can be counter productive. When pts consistently see that different factions of non-MDs are often "hands on" providers of their anesthesia, they will think that is the norm. You want it to be a medical specialty, but you will support ANOTHER non-MD provider to practice your specialty (in the real world, with very little, if any, supervision). We have to remember that MDs do not define what constitutes the practice of "nursing". Its a hard pill to swallow, but I got it down a long time ago. The sooner you swallow it, the less concerned you will be. Lets just do whats best for the patient. So if you whole-heartedly believe pts are in jeopardy under care from CRNAs practicing independently in rural America, what are YOU going to do about? Who is going to personally see to it that each CRNA in rural America is practicing under the supervision of an anesthesiologist? Therein, lies the difference between AAs and CRNAs. I don’t agree or disagree with that, but it’s the truth. I respect AAs, but fair is fair.

hey nitecap whats up?

 

[core0]

Anesthesiology is the practice of medicine. Anesthesiology is also the practice of nursing. That is not the opinion of a few CRNAs; that is the law.

Actually anesthesiology is the practice of medicine. Anesthesia is also practiced by nurses. Notice it does not say CRNAntesthiologist.

David Carpenter, PA-C

 

[ytrap]

Nevermind.

I want this point to be made: Comparing MINIMUM requirements to AVERAGE requirements is not accurate or professional. I will see about getting that changed, never paid attention to that before.

Thank you all for your time.

 

[ytrap]

Actually anesthesiology is the practice of medicine. Anesthesia is also practiced by nurses. Notice it does not say CRNAntesthiologist.

David Carpenter, PA-C

Actually, it is listed as anesthesiology, but who's counting? Look it up.

 

[core0]

Actually, it is listed as anesthesiology, but who's counting? Look it up.

From the AANA website. I bolded the parts that concern you to make sure you don't miss them:

Certified Registered Nurse Anesthetists at a Glance

Nurse anesthetists have been providing anesthesia care to patients in the United States for more than 125 years.


The credential CRNA (Certified Registered Nurse Anesthetist) came into existence in 1956. CRNAs are anesthesia professionals who safely administer approximately 27 million anesthetics to patients each year in the United States, according to the American Association of Nurse Anesthetists (AANA) 2005 Practice Profile Survey.

CRNAs are the primary anesthesia providers in rural America, enabling healthcare facilities in these medically underserved areas to offer obstetrical, surgical, and trauma stabilization services. In some states, CRNAs are the sole providers in nearly 100% of the rural hospitals.

 

[core0]

hey nitecap whats up?

I don't think that its nitecap since he/she actually new what the profession was called. Although the whole safeguard the patients who live in rural America thing sounds strangely familiar😀.

David Carpenter, PA-C