Will a surplus of CRNAs affect AA salary??

[psychMDhopefully]

Hi, recent med school dropout who has been thinking about AA school. I see a lot here about the nurses putting out to many CRNAs, which is unfortunate since CRNAs and AAs do the same job. Too many CRNAs would affect AA job market right? I don't see how that wouldn't be the case. So less Jobs for AAs and down trending pay should be expected?

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[Man o War]

Hi, recent med school dropout who has been thinking about AA school. I see a lot here about the nurses putting out to many CRNAs, which is unfortunate since CRNAs and AAs do the same job. Too many CRNAs would affect AA job market right? I don't see how that wouldn't be the case. So less Jobs for AAs and down trending pay should be expected?

Yes, unfortunately.
My hope for AAs is the premier groups will preferentially hire them due to the toxic CRNA rhetoric. I know of a few groups already doing this. Those groups will likely pay better than average, just as they do for the doctors.
It is an absolute must that AAs expand practice rights into more states.

 

[btbam]

Yes, unfortunately.
My hope for AAs is the premier groups will preferentially hire them due to the toxic CRNA rhetoric. I know of a few groups already doing this. Those groups will likely pay better than average, just as they do for the doctors.
It is an absolute must that AAs expand practice rights into more states.

Thanks for the support. My fiancee is applying for peds surgery fellowship broadly since it's such a competitive fellowship. Unfortunately, as an AA I am geographically limited and we keep hoping she matches in a state I can actually work in otherwise it'll be a real headache. The CRNA lobbying power is real and scary. They have been brutally efficient at limiting our entry into new states.

I agree with OP's general premise about pay, although I'm not sure that's actually happening. In our large mixed AA/CRNA practice pay is the same, and the big hospitals in town are hiring 10+ new AA grads.

 

[It's lupus!]

Thanks for the support. My fiancee is applying for peds surgery fellowship broadly since it's such a competitive fellowship. Unfortunately, as an AA I am geographically limited and we keep hoping she matches in a state I can actually work in otherwise it'll be a real headache. The CRNA lobbying power is real and scary. They have been brutally efficient at limiting our entry into new states.

I agree with OP's general premise about pay, although I'm not sure that's actually happening. In our large mixed AA/CRNA practice pay is the same, and the big hospitals in town are hiring 10+ new AA grads.

I thought AAs could practice in other states without lisences under physician discretion or whatever medicolegal term. From what I read it was just pay being.lower.

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[Mehd School]

Probably. In my area though AA's are strongly preferred to CRNAs in PP groups.

 

[It's lupus!]

Probably. In my area though AA's are strongly preferred to CRNAs in PP groups.

Are we likely to see that as a growing trend?

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[Psai]

Are we likely to see that as a growing trend?

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God I hope so.

 

[zero0]

Probably. In my area though AA's are strongly preferred to CRNAs in PP groups.

This makes me cautiously optimistic...

Seriously though it's about time. How can any gas docs work alongside CRNAs after the crap they've pulled? Biting the hand that feeds them was a dumb move. Unfortunately the feds, desperate to remove physicians' leverage on capitol hill since that's the only thing holding back the fatcats from gobbling up what's left of the healthcare pie, still seem to overwhelmingly support CRNAs.

 

[narcusprince]

Hi, recent med school dropout who has been thinking about AA school. I see a lot here about the nurses putting out to many CRNAs, which is unfortunate since CRNAs and AAs do the same job. Too many CRNAs would affect AA job market right? I don't see how that wouldn't be the case. So less Jobs for AAs and down trending pay should be expected?

Do you really want to work around physicians? If you ever have a situation where you do a rogue action your past may be used against. I hate to say it but you might make a better crna then an AA. I say this as an anesthesiologist.

 

[DeadSpace]

I've heard of this happening to other AA's when something causes them to relocate to another state. You had to know when applying to these programs that there was only a handful of states you could practice within. It's a very risky bet going to school for something only 10-15 states recognize as a degree. With the CRNAs having a chokehold on legislation it doesn't seem like that is changing anytime soon. Just search around online to see what CRNAs say about AA's, it's like a shark in the water that smells fresh blood.

The other AA's who I have heard of in this situation just found another type of job or was a stay at home spouse helping with the kids. It's really nice in today's modern age to have somebody to take care of the children. It not only saves a lot of childcare expenses but I bet the kids benefit greatly by being raised by a parent over a nanny all day.

 

[psychMDhopefully]

Are we likely to see that as a growing trend?

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Do you really want to work around physicians? If you ever have a situation where you do a rogue action your past may be used against. I hate to say it but you might make a better crna then an AA. I say this as an anesthesiologist.

Do I really want to work around physicians? Sure, why not? If you are suggesting I wouldn't ask for help because I have been to med school and think I know better, its the exact opposite I would ask for help because I have a better idea of what I don't know than a CRNA. I'm aware of the extensive knowledge base it takes to be an attending and I know I am nowhere near that, I only did the first 2 years of med school I'm not going to "go rogue" ever.

 

[neusu]

Thanks for the support. My fiancee is applying for peds surgery fellowship broadly since it's such a competitive fellowship. Unfortunately, as an AA I am geographically limited and we keep hoping she matches in a state I can actually work in otherwise it'll be a real headache. The CRNA lobbying power is real and scary. They have been brutally efficient at limiting our entry into new states.

I agree with OP's general premise about pay, although I'm not sure that's actually happening. In our large mixed AA/CRNA practice pay is the same, and the big hospitals in town are hiring 10+ new AA grads.

How does this even work? Aren't AAs under the medical board? Why is it not just the board saying "OK, they can practice here?" Who are they lobbying?

 

[anbuitachi]

More crna means lower salary for everyone. Attending or AA. Here AA can't practice. Here we hire CRNA instead of attendings .

 

[jwk]

In most states, AAs would have to be a licensed provider, just like an MD or an RN. That is normally done through some sort of enabling legislation, whether that be a "free-standing" AA Practice Act, or some additional language added to a state's medical practice act. In some cases, PA legislation is amended and modified to include AAs. Georgia is unique in licensing AAs as PAs, because they were way ahead of the curve in passing PA legislation nearly 50 years ago that had language allowing for "specialty PA's" as they were developed. The AAs in Georgia are the only group that ever took hold with that concept.

It would be nice if the medical board could add AAs on their own. I'm not sure that's possible in any state. The exception is for the few states that allow AAs to practice under "delegatory authority" of a physician, something that would have to be allowed under the state's medical practice act. The best example of this is in Texas, where several hundred AAs practice, with the blessing and knowledge of the medical board. (Of course CRNAs oppose licensure of AAs in Texas each and every time it comes up in the legislature). Delegatory authority allows a physician to delegate certain medical acts to appropriately trained individuals. So, they can't take someone off the street and teach them anesthesia OJT, but they can delegate to an AA with a master's degree in anesthesiology.

While the number of states allowing AA practice creeps up (I think Indiana is the most recent), the number of practices open to hiring AAs has mushroomed over the last decade. I'm sure politics plays a part in this. But hey - if a CRNA wants to claim they're the equal or better than an anesthesiologist - and an anesthesiologist chooses to hire an AA instead - do you think I'm going to complain? Demand for AAs is high - there is virtually 100% job placement.

For those practices that want to remain all-MD - more power to you. We don't discourage that at all. But for those practices that want to utilize a true anesthesia care team practice where every patient has an anesthesiologist personally involved in their care, it's hard to beat AAs.

 

[It's lupus!]

In most states, AAs would have to be a licensed provider, just like an MD or an RN. That is normally done through some sort of enabling legislation, whether that be a "free-standing" AA Practice Act, or some additional language added to a state's medical practice act. In some cases, PA legislation is amended and modified to include AAs. Georgia is unique in licensing AAs as PAs, because they were way ahead of the curve in passing PA legislation nearly 50 years ago that had language allowing for "specialty PA's" as they were developed. The AAs in Georgia are the only group that ever took hold with that concept.

It would be nice if the medical board could add AAs on their own. I'm not sure that's possible in any state. The exception is for the few states that allow AAs to practice under "delegatory authority" of a physician, something that would have to be allowed under the state's medical practice act. The best example of this is in Texas, where several hundred AAs practice, with the blessing and knowledge of the medical board. (Of course CRNAs oppose licensure of AAs in Texas each and every time it comes up in the legislature). Delegatory authority allows a physician to delegate certain medical acts to appropriately trained individuals. So, they can't take someone off the street and teach them anesthesia OJT, but they can delegate to an AA with a master's degree in anesthesiology.

While the number of states allowing AA practice creeps up (I think Indiana is the most recent), the number of practices open to hiring AAs has mushroomed over the last decade. I'm sure politics plays a part in this. But hey - if a CRNA wants to claim they're the equal or better than an anesthesiologist - and an anesthesiologist chooses to hire an AA instead - do you think I'm going to complain? Demand for AAs is high - there is virtually 100% job placement.

For those practices that want to remain all-MD - more power to you. We don't discourage that at all. But for those practices that want to utilize a true anesthesia care team practice where every patient has an anesthesiologist personally involved in their care, it's hard to beat AAs.

I thought I read that AAs can practice under Physician direction without a license?

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[jwk]

I thought I read that AAs can practice under Physician direction without a license?

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Here's the current list - licensure, and delegation.

States, territories and districts in which CAAs work by license, regulation, and/or certification:  Alabama  Colorado  District of Columbia  Florida  Georgia  Indiana  Kentucky  Missouri  New Mexico  North Carolina  Ohio  Oklahoma  South Carolina  Vermont  Wisconsin  US Territory Guam

States in which AAs are granted practice privilege through physician delegation: • Michigan • Texas

 

[It's lupus!]

Here's the current list - licensure, and delegation.

States, territories and districts in which CAAs work by license, regulation, and/or certification:  Alabama  Colorado  District of Columbia  Florida  Georgia  Indiana  Kentucky  Missouri  New Mexico  North Carolina  Ohio  Oklahoma  South Carolina  Vermont  Wisconsin  US Territory Guam

States in which AAs are granted practice privilege through physician delegation: • Michigan • Texas

Ahhhhhhhhh. That makes sense. I thought it was weird cwu had a school in Texas but not licensing in the state. Thank you sir.

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[sevoflurane]

We train AAs. They love their rotation here.
I know where they are going as I am on the teaching faculty.
They are getting great jobs. It's obvious that anesthesiologists are picking AAs over CRNAs- It's a good move and I'm glad to be part of that.

 

[AdmiralChz]

We train AAs. They love their rotation here.
I know where they are going as I am on the teaching faculty.
They are getting great jobs. It's obvious that anesthesiologists are picking AAs over CRNAs- It's a good move and I'm glad to be part of that.

I echo this - we also have AA rotators come through here as well. Their job opportunities are solid, we are actually hiring a few AAs currently but all the students already have multiple offers from established groups in town!

We had both CRNAS and AAs in residency and everyone played nicely together in the sandbox, but through the grapevine this isn’t necessarily the case everywhere. Have some perserverence and work hard - one large group a couple cities away are hiring tons of AAs, and the hospital told the nurses to shut up and work or leave.

 

[anbuitachi]

We train AAs. They love their rotation here.
I know where they are going as I am on the teaching faculty.
They are getting great jobs. It's obvious that anesthesiologists are picking AAs over CRNAs- It's a good move and I'm glad to be part of that.

I echo this - we also have AA rotators come through here as well. Their job opportunities are solid, we are actually hiring a few AAs currently but all the students already have multiple offers from established groups in town!

We had both CRNAS and AAs in residency and everyone played nicely together in the sandbox, but through the grapevine this isn’t necessarily the case everywhere. Have some perserverence and work hard - one large group a couple cities away are hiring tons of AAs, and the hospital told the nurses to shut up and work or leave.

Are they getting saalaries comparable to CRNAs? ~200k for 40 hrs?
Just googled it but it seems like getting into AA school requires less time than CRNA school (straight after college for AA vs RN + ICU time before applying for CRNA). But it looks like the minimum requirements for AA is higher than the minimums for CRNA. Minimum of 800 clinical anesthesia hours for CRNA vs 2600 for AA........ which is about half a yr vs 1 yr in clinical anesthesia hours...
With these stronger minimums than CRNAs, and hopefully with anesthesiologists support, AAs shouldn't be losing this badly!

 

[chocomorsel]

Do I really want to work around physicians? Sure, why not? If you are suggesting I wouldn't ask for help because I have been to med school and think I know better, its the exact opposite I would ask for help because I have a better idea of what I don't know than a CRNA. I'm aware of the extensive knowledge base it takes to be an attending and I know I am nowhere near that, I only did the first 2 years of med school I'm not going to "go rogue" ever.

That’s not what he/she meant. He/she meant “your past” as in your dropping out of medical school for whatever reason. That may be used against you. Where did you get all the other s hit?

 

[psychMDhopefully]

That’s not what he/she meant. He/she meant “your past” as in your dropping out of medical school for whatever reason. That may be used against you. Where did you get all the other s hit?

Used against me how and when? Honestly the statement he made was weird and lacked clarity.

 

[chocomorsel]

Used against me how and when? Honestly the statement he made was weird and lacked clarity.

Rogue action as in overstep your boundaries as an “assistant”. You will be easily reminded that you are NOT a physician and dropped out of medical school. As in if you want to practice medicine you should have finished medical school. You’d better be careful and not overstep.

That was my understanding.

 

[Psai]

Are they getting saalaries comparable to CRNAs? ~200k for 40 hrs?
Just googled it but it seems like getting into AA school requires less time than CRNA school (straight after college for AA vs RN + ICU time before applying for CRNA). But it looks like the minimum requirements for AA is higher than the minimums for CRNA. Minimum of 800 clinical anesthesia hours for CRNA vs 2600 for AA........ which is about half a yr vs 1 yr in clinical anesthesia hours...
With these stronger minimums than CRNAs, and hopefully with anesthesiologists support, AAs shouldn't be losing this badly!

Hours and skills are irrelevant. It's all about the benjamins baby. They don't have the numbers or pac power to fight the crna war machine and need our help. I much prefer them; they don't spend their days bashing physicians online and in real life.

 

[It's lupus!]

- one large group a couple cities away are hiring tons of AAs, and the hospital told the nurses to shut up and work or leave.

This made me feel warm inside. hahah

 

[AdmiralChz]

Are they getting saalaries comparable to CRNAs? ~200k for 40 hrs?
Just googled it but it seems like getting into AA school requires less time than CRNA school (straight after college for AA vs RN + ICU time before applying for CRNA). But it looks like the minimum requirements for AA is higher than the minimums for CRNA. Minimum of 800 clinical anesthesia hours for CRNA vs 2600 for AA........ which is about half a yr vs 1 yr in clinical anesthesia hours...
With these stronger minimums than CRNAs, and hopefully with anesthesiologists support, AAs shouldn't be losing this badly!

I don’t know specifics but the students I work with are thrilled with their job offers and in residency they had the same contracts as the nurses.

There aren’t very many AAs out there, especially compared to the CRNA money mills churning out oodles of grads. But my experience with groups are if they are able to, they’d rather hire the AAs especially if the process is directed by the physicians (rather than hospital HR).

 

[dannyboy1]

I don’t know specifics but the students I work with are thrilled with their job offers and in residency they had the same contracts as the nurses.

There aren’t very many AAs out there, especially compared to the CRNA money mills churning out oodles of grads. But my experience with groups are if they are able to, they’d rather hire the AAs especially if the process is directed by the physicians (rather than hospital HR).

This will hurt us. If CRNA salaries drop than they are even more attractive to management than they are currently bringing our salaries down as well.

 

[anbuitachi]

I don’t know specifics but the students I work with are thrilled with their job offers and in residency they had the same contracts as the nurses.

There aren’t very many AAs out there, especially compared to the CRNA money mills churning out oodles of grads. But my experience with groups are if they are able to, they’d rather hire the AAs especially if the process is directed by the physicians (rather than hospital HR).

That'd be very impressive to be able to make 150 to 200k 2 years after college for a job that has good hours and not that much responsibility

 

[It's lupus!]

This will hurt us. If CRNA salaries drop than they are even more attractive to management than they are currently bringing our salaries down as well.

Wouldn't that only be applicable in states where they are autonomous at best?

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[AdmiralChz]

This will hurt us. If CRNA salaries drop than they are even more attractive to management than they are currently bringing our salaries down as well.

Um, what? I literally said I know of places where they are paid the same.

Also, in almost all practices this is comparing apples to oranges. So disagree?

 

[jwk]

Within the same practice, AAs and CRNAs are paid the same for the same position and amount of experience (or lack thereof). So 4 years out-of-school AA = 4 years out-of-school CRNA. The job descriptions are identical except for the title at the top of the page. We are a solid by-the-book ACT practice.

CRNAs are most likely NOT making $200k for a 40 hr week unless they're working in a CRNA-only practice. Private group practices and hospital-employed just aren't going to pay that much. That being said, it is quite possible for experienced AAs and CRNAs in a number of practices in our city to hit the $200k + mark, but they're working a lot more than 40 hours a week.

We happily hire CRNAs and AAs who are competent and willing to work in an ACT practice where the anesthesiologist medically directs EVERY case. However, the CRNAs are getting the "independent practice" and "we don't need an anesthesiologist" indoctrination LOUD and CLEAR in their schooling, so we have fewer CRNA applicants and hires by their own choice.

 

[Gastrapathy]

I just don't get you guys. Training another group of midlevels because they are playing nice now. Soon enough, they'll start feeling their oats too.

 

[DeadSpace]

I just don't get you guys. Training another group of midlevels because they are playing nice now. Soon enough, they'll start feeling their oats too.

Exactly. Who has heard about this new doctorate PA program that is trying to get started? They are now trying to use the title physician associate instead of assistant. Let's get real, advance practice degrees and these midlevel PA's and AA's are all just people training to take our job. We've already allowed things to spin past our control with the CRNAs but we're foolish to think eventually the AAs won't want to do the same thing. Laws and regulations may be in place currently that holds them to us but the same thing could be said for PA's for decades and look at what they're doing now. Give PA's 10 years before they are trying to open independent practices in rural areas just like NP's.

 

[nimbus]

I just don't get you guys. Training another group of midlevels because they are playing nice now. Soon enough, they'll start feeling their oats too.

The probability that you will be correct is 100%. It’s human nature. Creep is inevitable.

 

[Psai]

I just don't get you guys. Training another group of midlevels because they are playing nice now. Soon enough, they'll start feeling their oats too.

It's not that I don't know what will happen, I just dislike crnas enough to risk it. The vitriol they spew online against physicians is really quite disgusting. At least PA school doesn't systematically train their students to hate physicians by default and fill their heads with nonsense like "just as good or even better". Also PAs actually learn many relevant things during their time in school rather than nonsense like "nursing theory". I prefer them greatly as they are clinically superior with better personalities.

 

[It's lupus!]

From what I've heard PAs are pushing for this out of necessity not necessarily want. PAs are trying to compete with NPs for jobs in many places and feel like they can't because they are unable to expand in the ways that NPs have. I can't say as I blame them as it is their livelihood on the line. That being said, I'm not sure the same will apply to AAs IF the trend of MDs preferentially hiring AAs continues and CRNAs reach autonomy in most places before AAs receive licensing across all 50 states. The timing, I would SPECULATE, plays a large role in the dynamics of how the roles play out. Then again, back when the NP role was created everyone was under the impression they would be practicing in rural areas and under direct supervision...

 

[Money Moniker]

It's not that I don't know what will happen, I just dislike crnas enough to risk it. The vitriol they spew online against physicians is really quite disgusting. At least PA school doesn't systematically train their students to hate physicians by default and fill their heads with nonsense like "just as good or even better". Also PAs actually learn many relevant things during their time in school rather than nonsense like "nursing theory". I prefer them greatly as they are clinically superior with better personalities.

Don't bite off your nose to spite your face. Ultimately it's just a numbers game, supply and demand. A CRNA and an AA add to the supply, driving down the price of your services as well. It doesn't matter whether the CNRA hates you and the AA loves you, their impact on the supply and demand equilibrium is equivalent and the emotions and other BS walk. If they are in fact more competent than CRNAs, that just makes them a bigger threat to subsume anesthesiologists' remaining turf.

This thread is probably why they coined seemingly stupid phrases like "if you're in a hole, stop digging." Sounds like advice fit only for absolute *****s, but here we have a group of intelligent people thinking they're going to dig themselves out of the midlevel-hole by minting an even greater number of midlevels. What do you think is going to happen to the anesthesia labor market if you fight for the practice rights of these AAs? The CRNAs aren't just going to be driven out of the anesthesia labor market in a perfect 1:1 ratio as each new AA comes out of training to replace them, instead the AA will be a net addition to the already existing glut of "providers" employers can hire from with exceedingly predictable effects on labor rates of not just CRNAs, but anesthesiologists as well.

 

[Psai]

CRNA diploma mills are already pumping out way too many providers as it is. We don't control the number that are produced at all. Nice try nurse.

 

[W19]

Don't bite off your nose to spite your face. Ultimately it's just a numbers game, supply and demand. A CRNA and an AA add to the supply, driving down the price of your services as well. It doesn't matter whether the CNRA hates you and the AA loves you, their impact on the supply and demand equilibrium is equivalent and the emotions and other BS walk. If they are in fact more competent than CRNAs, that just makes them a bigger threat to subsume anesthesiologists' remaining turf.

This thread is probably why they coined seemingly stupid phrases like "if you're in a hole, stop digging." Sounds like advice fit only for absolute *****s, but here we have a group of intelligent people thinking they're going to dig themselves out of the midlevel-hole by minting an even greater number of midlevels. What do you think is going to happen to the anesthesia labor market if you fight for the practice rights of these AAs? The CRNAs aren't just going to be driven out of the anesthesia labor market in a perfect 1:1 ratio as each new AA comes out of training to replace them, instead the AA will be a net addition to the already existing glut of "providers" employers can hire from with exceedingly predictable effects on labor rates of not just CRNAs, but anesthesiologists as well.

My guess is you are a nurse pretending to be a med student...

 

[BorntobeDO?]

Lol, as someone who was a nurse before medical school, I would take the AA 9/10. Not every CRNA is malignant, but the schools seem predisposed towards making them that way anymore. I don't want to have to 'untrain' bad attitudes.

 

[deleted171991]

If I want bad attitudes, I have to look no further than my residents.

 

[anbuitachi]

If I want bad attitudes, I have to look no further than my residents.

Didn't realize you have residents! 🙂

 

[2Fast2Des]

In most states, AAs would have to be a licensed provider, just like an MD or an RN. That is normally done through some sort of enabling legislation, whether that be a "free-standing" AA Practice Act, or some additional language added to a state's medical practice act. In some cases, PA legislation is amended and modified to include AAs. Georgia is unique in licensing AAs as PAs, because they were way ahead of the curve in passing PA legislation nearly 50 years ago that had language allowing for "specialty PA's" as they were developed. The AAs in Georgia are the only group that ever took hold with that concept.

It would be nice if the medical board could add AAs on their own. I'm not sure that's possible in any state. The exception is for the few states that allow AAs to practice under "delegatory authority" of a physician, something that would have to be allowed under the state's medical practice act. The best example of this is in Texas, where several hundred AAs practice, with the blessing and knowledge of the medical board. (Of course CRNAs oppose licensure of AAs in Texas each and every time it comes up in the legislature). Delegatory authority allows a physician to delegate certain medical acts to appropriately trained individuals. So, they can't take someone off the street and teach them anesthesia OJT, but they can delegate to an AA with a master's degree in anesthesiology.

While the number of states allowing AA practice creeps up (I think Indiana is the most recent), the number of practices open to hiring AAs has mushroomed over the last decade. I'm sure politics plays a part in this. But hey - if a CRNA wants to claim they're the equal or better than an anesthesiologist - and an anesthesiologist chooses to hire an AA instead - do you think I'm going to complain? Demand for AAs is high - there is virtually 100% job placement.

For those practices that want to remain all-MD - more power to you. We don't discourage that at all. But for those practices that want to utilize a true anesthesia care team practice where every patient has an anesthesiologist personally involved in their care, it's hard to beat AAs.

Ehh I've seen quite a few AAs who are pretty much the same as CRNAs, that if it wasn't for their badges wouldn't be able to tell from their attitude. I wanted to be convinced that AAs are more receptive but they are all and one the same. Rotated at one asc where one of the AAs is infamous for doing her own thing and not take any feedback or direction, and told me doesn't like when attendings get involved, because that's what she's known for, heck the crnas there were better.

 

[DeadSpace]

Ehh I've seen quite a few AAs who are pretty much the same as CRNAs, that if it wasn't for their badges wouldn't be able to tell from their attitude. I wanted to be convinced that AAs are more receptive but they are all and one the same. Rotated at one asc where one of the AAs is infamous for doing her own thing and not take any feedback or direction, and told me doesn't like when attendings get involved, because that's what she's known for, heck the crnas there were better.

Exactly. They are playing nice now because they are so small in numbers and need our political lobbying power and money to advance their practice. Once we've done that for them, increased their numbers and work exclusively with them in our ACT practices, replacing the nurses, the behavior will change. You'll suddenly start seeing much more "autonomous AA's" who don't wait for us on induction, don't call us during a case and when the circulator asks who the attending is they'll give smart remarks (like the CRNAs), "I don't know, do you see anyone in this room, guess I don't have one". They'll say this right in front of me as a resident. The surgeon and circulator laughing (mocking) the attendings asking if they're out drinking coffee or sleeping.

Until we start getting back into the ORs running cases and directly practicing (instead of direction) I'm afraid we're going to be the pinata at the party ripe for punching. All we need now is to add more AAs to the mix so one more person can pick up the stick and take a swing.

 

[Money Moniker]

I'm not a nurse, and I think all midlevels should be relegated back to nursing duties and purged from the practice of medicine. The fact some of you think I must be a nurse because I pointed out that increasing the supply of midlevel providers in anesthesiology will be bad for anesthesiologists regardless of whether these midlevels are AAs or CRNAs reflects poorly on your intellects. It's such a basic, inarguable fact of not just economics, but common sense, that I'm amused you think you can dismiss it by calling me nurse and burying your heads in the sand.

I'm not going into anesthesiology, so do what you wanna do. I do think it is hilarious that instead of using what feeble political power you have to fight against the midlevel takeover of anesthesiology, you want to use it instead to accelerate the process by lobbying in favor of the one group of midlevels which cannot yet lobby on its own. Good luck with that.

 

[Psai]

Which part of we don't control the number of midlevel providers that are produced was difficult for you to understand? Midlevels aren't going away despite your apparent mastery of microeconomics 101.

You have zero experience in our field. You likely have just as little experience in healthcare or running a business and yet you think it's okay to come here to mouth off. You're not even close to being as smart as you think.

 

[AdmiralChz]

I'm not going into anesthesiology, so do what you wanna do. I do think it is hilarious that instead of using what feeble political power you have to fight against the midlevel takeover of anesthesiology,

... So, youre speaking from the perspective of what, a medical student? How do you know about the state of affairs in a specialty you don’t work in and have no training in?

I see you posted randomly in the EM forum, interested in that? That’ll be the next target for a united front from NPs and PAs (or, more “oversight”/“direction” from EM MDs similar to supervision ratios in anesthesiology). Head over to the EM forums for more info, if you don’t believe me.

If you’re going to stir the pot, at least do a better and more accurate job of it.

 

[anbuitachi]

Ehh I've seen quite a few AAs who are pretty much the same as CRNAs, that if it wasn't for their badges wouldn't be able to tell from their attitude. I wanted to be convinced that AAs are more receptive but they are all and one the same. Rotated at one asc where one of the AAs is infamous for doing her own thing and not take any feedback or direction, and told me doesn't like when attendings get involved, because that's what she's known for, heck the crnas there were better.

With an attitude like that, why is this person not fired?

 

[2Fast2Des]

Exactly. They are playing nice now because they are so small in numbers and need our political lobbying power and money to advance their practice. Once we've done that for them, increased their numbers and work exclusively with them in our ACT practices, replacing the nurses, the behavior will change. You'll suddenly start seeing much more "autonomous AA's" who don't wait for us on induction, don't call us during a case and when the circulator asks who the attending is they'll give smart remarks (like the CRNAs), "I don't know, do you see anyone in this room, guess I don't have one". They'll say this right in front of me as a resident. The surgeon and circulator laughing (mocking) the attendings asking if they're out drinking coffee or sleeping.

Until we start getting back into the ORs running cases and directly practicing (instead of direction) I'm afraid we're going to be the pinata at the party ripe for punching. All we need now is to add more AAs to the mix so one more person can pick up the stick and take a swing.

Agree completely, there is no less of the 2 evils for the long run via mid-level route. I chose Anesthesiology to have the ability to provide 1-1 care and apply my training and skills as every patient deserves. I don't know where and why this supervising thing came about, it's made the Anesthesiologist irrelevant imo, I feel like a good practice can run without having the "extra" guy\gal. If I was a bean counter I could see the role in going to an independent mid-level, and eliminate another extra salary. Getting back in the rooms is the best way to show that we actually exist. Why keep fighting for care team model if the team doesn't want to you on it?

 

[2Fast2Des]

With an attitude like that, why is this person not fired?

I guess when you do the same thing a certain way for many years you make yourself a niche and make yourself immune..