Will AA's try to replace us?

[Gasmaster]

---

Members don't see this ad.

CA-1 here. Our institution uses a lot of CRNAs and trains SRNAs as well. While not ideal, they all seem to be hard workers. We don't have any AAs or AA-students.

From what I've read, a lot of people on this forum seem to think that AA's are a way out of the CRNA problem. But is this really true? What will stop AA's from wanting to practice independently after observing enough cases? It seems as though this might be opening up an avenue for even more midlevels to get into anesthesia without putting in the time/work like doctors do.

Blade, Jet, etc your opinions/comments would be amazing

 

[Mman]

CA-1 here. Our institution uses a lot of CRNAs and trains SRNAs as well. While not ideal, they all seem to be hard workers. We don't have any AAs or AA-students.

From what I've read, a lot of people on this forum seem to think that AA's are a way out of the CRNA problem. But is this really true? What will stop AA's from wanting to practice independently after observing enough cases? It seems as though this might be opening up an avenue for even more midlevels to get into anesthesia without putting in the time/work like doctors do.

Blade, Jet, etc your opinions/comments would be amazing

AAs are regulated by the board of medicine in each state. CRNAs are through the board of nursing. Nurses are always angling for more independence in all areas and try to sneak it through left and right. AAs being regulated by the board of medicine would have to be granted independent practice by the MDs themselves. Totally different animal.

 

[Arch Guillotti]

AAs are regulated by the board of medicine in each state. CRNAs are through the board of nursing. Nurses are always angling for more independence in all areas and try to sneak it through left and right. AAs being regulated by the board of medicine would have to be granted independent practice by the MDs themselves. Totally different animal.

What he said.

 

[Endee]

What will stop AA's from wanting to practice independently after observing enough cases?

1) The law. AA practice is written in state statutes to only be able to work under the supervision of a physician anesthesiologist.

2) Our entire profession's philosophy. We support physician led anesthesia as the practice of medicine. We are members of the ASA and state societies. We donate to ASAPAC. Sometimes, we donate to ASAPAC with a higher percentage participation than anesthesiologists. We put our money where our mouth is in support of physicians.

Supporting AA's is supporting physician led anesthesiology well into the future.

 

[jwk]

1) The law. AA practice is written in state statutes to only be able to work under the supervision of a physician anesthesiologist.

2) Our entire profession's philosophy. We support physician led anesthesia as the practice of medicine. We are members of the ASA and state societies. We donate to ASAPAC. Sometimes, we donate to ASAPAC with a higher percentage participation than anesthesiologists. We put our money where our mouth is in support of physicians.

Supporting AA's is supporting physician led anesthesiology well into the future.

Beat me to it. 😉

 

[Consigliere]

AA >>> crna

 

[Socrates25]

CA-1 here. Our institution uses a lot of CRNAs and trains SRNAs as well. While not ideal, they all seem to be hard workers. We don't have any AAs or AA-students.

From what I've read, a lot of people on this forum seem to think that AA's are a way out of the CRNA problem. But is this really true? What will stop AA's from wanting to practice independently after observing enough cases? It seems as though this might be opening up an avenue for even more midlevels to get into anesthesia without putting in the time/work like doctors do.

Blade, Jet, etc your opinions/comments would be amazing

Never underestimate someone else's greed. Anesthesiologists in particular. Lets not forget CRNAs never would have the foothold they do now, except that greedy anesthesiologists wanted to "supervise" them for an extra 200k per year.

If there's a model where anesthesiologists can sell out their field (i.e. give AAs increasing levels of independence so MDs can run more rooms simultaneously and make more money) then it will probably happen.

PAs are controlled by medical boards too, yet every year they get increasing relaxation of their "supervision." For example, they go from having to get all of their charts signed to 50% to 25% to 10% to 1 in a 100. Or they go from having to have an MD on site at all times, to only on-site 50% of the time, to NEVER being on site.

Its not just the PAs pushing for this -- they have greedy MDs behind them who are voting for these changes at the medical board level so they can "supervise" 50 PAs at remote sites and bill for all of them simultaneously.

The AAs will use MD greed just like the CRNAs have.

 

[jwk]

The AAs will use MD greed just like the CRNAs have.

AA's came around at almost the exact same time as PA's - 40+ years of the AA profession says you're simply wrong. The whole concept of AA's is rooted in the anesthesia care TEAM concept.

There are plenty of hospitals around with no anesthesiologist at all, just CRNA's - or a single anesthesiologist "supervising" a dozen or more CRNA's.

 

[IlDestriero]

Never underestimate someone else's greed. Anesthesiologists in particular. Lets not forget CRNAs never would have the foothold they do now, except that greedy anesthesiologists wanted to "supervise" them for an extra 200k per year.

If there's a model where anesthesiologists can sell out their field (i.e. give AAs increasing levels of independence so MDs can run more rooms simultaneously and make more money) then it will probably happen.

PAs are controlled by medical boards too, yet every year they get increasing relaxation of their "supervision." For example, they go from having to get all of their charts signed to 50% to 25% to 10% to 1 in a 100. Or they go from having to have an MD on site at all times, to only on-site 50% of the time, to NEVER being on site.

Its not just the PAs pushing for this -- they have greedy MDs behind them who are voting for these changes at the medical board level so they can "supervise" 50 PAs at remote sites and bill for all of them simultaneously.

The AAs will use MD greed just like the CRNAs have.

Absolutely true, though there are not and will never be enough MDs to cover all the anesthetics administered at every site in the US every day, so we need extenders of some kind.
What's true or even "the law" now can be easily changed tomorrow.
They're a better choice, for now.
They donate to our PAC because they need us to push their agenda. Eventually they will not.
Don't forget that.

 

[jwk]

Absolutely true, though there are not and will never be enough MDs to cover all the anesthetics administered at every site in the US every day, so we need extenders of some kind.
What's true or even "the law" now can be easily changed tomorrow.
They're a better choice, for now.
They donate to our PAC because they need us to push their agenda. Eventually they will not.
Don't forget that.

"Absolutely true" (actually it's false) "though there are not and will never be enough MDs to cover all the anesthetics administered at every site in the US every day, so we need extenders of some kind." (True, and AA's are your best choice - there's not a snowball's chance of yet another non-MD anesthesia provider)

"What's true or even "the law" now can be easily changed tomorrow." Also false - changing the law to even allow AA practice has been like pulling teeth - going in a different direction simply isn't going to happen.

"They're a better choice, for now." AA's are a better choice, period, unless you're the type of practice where your CRNA's suddenly become remarkably competent and practice independently after 3pm and on weekends and holidays, like so many practices who claim to be ACT, but in reality only do so 7-3 M-F.

"They donate to our PAC because they need us to push their agenda. Eventually they will not." That's not why we donate to the ASA-PAC. Your agenda is the same as ours. Come talk to us at the ASA Annual Meeting in San Francisco in October, or at the ASA Legislative Conference each May. We're there - and have been for years.

Of course you're free to believe what you want - history so far has proved your opinions incorrect, and more importantly, should have convinced you that CRNA's are most certainly not the answer to the problem at hand.

 

[Gasmaster]

In terms of supervising a CRNA v an AA, how is it different? Is it still max 4:1?

In an ACT model, how does supervising a CRNA and an AA differ in terms of what each does in the OR?

 

[IlDestriero]

Nothing that I wrote is incorrect.
Get practice rights in 50 states and some real numbers and watch what happens.

 

[jwk]

In terms of supervising a CRNA v an AA, how is it different? Is it still max 4:1?

In an ACT model, how does supervising a CRNA and an AA differ in terms of what each does in the OR?

AA's are utilized under a "medical direction' model, so 1:4 is the max. That concept is also noted in the legislation of a number of state AA laws.

In an ACT practice, AA's and CRNA's have exactly the same scope of practice. There is nothing that a CRNA can provide in an ACT practice that an AA cannot. AA's are practicing in all surgical specialties and subspecialties.

 

[JLM]

I'm with JWK on this. AAs typically were not nurses. They were not brought up with the indoctrination that the nurses receive throughout their education. A lot of them were paramedics and RTs - a group which, in my view as a paramedic myself, is not out to replace physicians and would never presume themselves to be on equal footing.

They practice medicine, not nursing, and do so under the board of medicine.
They are educated in the medical model, meaning they actually know some science.
And I find them to be a much more agreeable group of human beings overall.


The ACT model is not going anywhere. You can deal with what you have now, which is likely only going to lead to increased supervision ratios and fewer jobs (if supervision even remains a requirement in most states) ... or you can get on board with this thing and try to salvage this profession as the practice of medicine and not of nursing.

Maybe even consider contributing to their PAC as they do ours. As a resident I contributed to both. Or, you can keep reading Internet forums and hoping someone will fix it.

 

[Endee]

Nothing that I wrote is incorrect.
Get practice rights in 50 states and some real numbers and watch what happens.

What you're suggesting is a paradigm shift that would uproot philosophy that has been rooted in the profession since its inception. It just won't happen. I've sat in on board meetings of the AAAA and there is not even an inkling of interest in changing the way the profession works right now.

It's not a one way street either. The ASA has a vested interest in the national success of AA's. For decades, the AANA has built the framework for their agenda of supplanting anesthesiologists and making them redundant or unnecessary. And with their ability to call their practicing anesthesia "nursing" they have been successful in winning legislative battles across the country against anesthesiologists. AA practice protects anesthesiologist jobs as much as it does create opportunities for AAs. All MD-practices aren't going to last forever if the health care system continues to go down the road its going.

John Zerwas, Jane Fitch, Jeffrey Plagenhoef, Mary Dale Peterson, Mark Warner, Howard Odom, Jay Mesrobian.. these are just a few of the current and past ASA leaders who have been active supporters of the AA profession. Do you really think AA advocacy would go all the way to the top of the national organization of anesthesiologists if it was anything other than an alliance of shared ideals and goals?

I'm sorry you're bitter about what the other midlevel profession has done over the last several years but you won't find that nonsense here, ever.

 

[IlDestriero]

I support AA legislation. It's the better arrangement for our specialty at this time. I'm not suggesting they'll replace us.
The ASA leadership, state societies, etc. support AAs because it's in their best interest to support AA expansion. The AA society supports our PAC because it's in their best interest to partner with us to help them achieve their goals.
Until it's not anymore.
Then things change.
That's not bitterness, that's the way the world works.
However, CRNAs will fight AA expansion to the death state by state, and hospital to hospital after that. I suppose that's good that they expend some effort there for a while.
I just don't trust the long term agendas of any other groups. You shouldn't either.
Surgeons, administrators, mid levels, nurses, support and ancillary services. Watch what happens if the fees are all bundled.

 

[Consigliere]

I agree completely with jwk and wholeheartedly support AA's.