Anesthesia Assistant

[dee1]

Is it possible to sit for the CRNA exam after getting a MMSc. in Anesthesia from a top anesthesia assistant program.:saint:
The graduates do the same job at most hospitals but have different titleS. CRNA or PA.

[trp100329]

I seriously doubt that one could sit for the CRNA certification exam with a degree from an AA school. First, you have to be a nurse to be a nurse anesthetist.

According to the American Association of Nurse Anesthetists website (www.aana.com), the first requirement is "...current, unrestricted licensure as a registered professional nurse." The second requirement is completion of an accredited nurse anesthesia program.

I wonder if a CRNA or SRNA graduate would be allowed to sit for the AA exam? My guess is, probably not.

Terri


Is it possible to sit for the CRNA exam after getting a MMSc. in Anesthesia from a top anesthesia assistant program.:saint:
The graduates do the same job at most hospitals but have different titleS. CRNA or PA.

[ethernaut]

no (to both)

[MmacFN]

Dee

As opposed to getting into the politics of it, ill just cover the quick info.

1st of all AAs are not PAs. They are 2 entirely different animals.

2nd of all, CRNA training and AA training are NOT interchangeable.
CRNAs are trained in all aspects of anesthesia including regional and can practice independently in every state in the US. AAs are not doing regional in most places and when they are, have to be directly (in the room) supervised by an MDA and are only in 17 states. To my knowledge AA cannot do any sortof peripheral blocks whereas CRNAs are trained to and can.

CRNAs can work without an anesthesiologist whereas AAs cannot.

So really, they not only have different titles but also do different jobs in many instances. When the MDA goes home at 3 pm and the only provider in the hospital is a CRNA there is clearly a difference in the job since an AA cannot do this.

The reason that AAs could not sit for the CRNA boards is the same reason why an MD cannot sit for the CRNA board and a CRNA cannot sit for the MD boards. You have to be an RN to be a CRNA you have to be an MD/DO to be an MDA.

As for 'top' AA programs, well there are only 5 so im not sure there is much difference from one to another.

Why do you ask?



Is it possible to sit for the CRNA exam after getting a MMSc. in Anesthesia from a top anesthesia assistant program.:saint:
The graduates do the same job at most hospitals but have different titleS. CRNA or PA.

[944S]

First of all I see this is your first post on this forum and on behalf of everyone I welcome you to it.

I find it hard to believe your inquiry is genuine but giving you the benefit of the doubt I will do my best to answer your questions. But first of all I have a question for you. If they both do the same job why would an AA want to be a CRNA?

No, it is not possible for an AA to sit for the CRNA exam because AA's do NOT do the same job. You are correct that in the ACT practice they are both supervised but, CRNA's are allowed to practice by law, totally independent of an Anesthesiologist in all 50 states. AA's by law and anesthesiologist design have to be directly supervised at all times by an MDA. The ASA would not take too kindly to their creation trying to gain any resemblence of independence which is exactly what an AA would be doing by trying to be a CRNA.
Another difference between the professions is CRNA's are REQUIRED to have been taking care of critically ill patients in the ICU/equivalent setting for a minimum period of a year before ever starting anesthesia school. This includes managing ventilators, titrating drips and others skills unique to caring for critically ill patients. To be competitive the vast majority have many years of experience prior to starting.

I am sure AA's are wonderful health care providers in their own right after completing their education but the bottom line is ZERO pt care experience is required to enter the profession. While the individual AA might have some experience, the only requirement is the chemistry, physics and math courses required for the MCAT.

Once again welcome no matter what your profession.

[MmacFN]

very true

And not all AA programs require pre med classes and the MCAT as some on SDN seem to suggest.

As i understand it most AAs are not RNs. That being the case in their 27 month programs they have to learn basics such as what IVs and Foleys are as well as anesthesia.

Much todo is made about the greater number of clinical hours AAs have but it is important to also note that CRNAs come with an average or 5-7 years of professional clinical experience as well as their RN educational clinical time + the CRNA clinical time. During the AA clinical time they must learn what all the medical terminology, diseases, lab work, IV solutions, diagnostic tests, medical A&P etc etc. The list of things the RN comes with a knowledge of that an AA does not is voluminous to say the least.

I have no doubt that AAs do a great job in the environment they are allowed to work in. AAs are good people looking to be apart of this cool anesthesia world, cant fault them for that!

[ethernaut]

very true

And not all AA programs require pre med classes and the MCAT as some on SDN seem to suggest.

As i understand it most AAs are not RNs. That being the case in their 27 month programs they have to learn basics such as what IVs and Foleys are as well as anesthesia.

Much todo is made about the greater number of clinical hours AAs have but it is important to also note that CRNAs come with an average or 5-7 years of professional clinical experience as well as their RN educational clinical time + the CRNA clinical time. During the AA clinical time they must learn what all the medical terminology, diseases, lab work, IV solutions, diagnostic tests, medical A&P etc etc. The list of things the RN comes with a knowledge of that an AA does not is voluminous to say the least.

I have no doubt that AAs do a great job in the environment they are allowed to work in. AAs are good people looking to be apart of this cool anesthesia world, cant fault them for that!

don't you mean "a part of" .. :musik_wos1:

[MmacFN]

damn you Grammer-Police!

[6hipguns]

The short answer is No. You have to be a graduate of an accredited program to qualifiy to take the CRNA boards.

[6hipguns]

The AA clinical hours are not counted the same, in nurse anesthesia programs the hours reported are 'bag time', only from anesthesia start to finish. The AAs count all time in the clinical area, often you'll be in the OR 10 hours and maybe have half that in 'bag time'

[trp100329]

damn you Grammer-Police!

That would be "grammar" police, there, Mikey! :) You know we love you, man!

Terri

[MmacFN]

Oh that was painful.


That would be "grammar" police, there, Mikey! :) You know we love you, man!

Terri

[MmacFN]

Ah

I didnt know that. Well thats totally different then.


The AA clinical hours are not counted the same, in nurse anesthesia programs the hours reported are 'bag time', only from anesthesia start to finish. The AAs count all time in the clinical area, often you'll be in the OR 10 hours and maybe have half that in 'bag time'

[jwk]

very true

And not all AA programs require pre med classes and the MCAT as some on SDN seem to suggest.

As i understand it most AAs are not RNs. That being the case in their 27 month programs they have to learn basics such as what IVs and Foleys are as well as anesthesia.

Much todo is made about the greater number of clinical hours AAs have but it is important to also note that CRNAs come with an average or 5-7 years of professional clinical experience as well as their RN educational clinical time + the CRNA clinical time. During the AA clinical time they must learn what all the medical terminology, diseases, lab work, IV solutions, diagnostic tests, medical A&P etc etc. The list of things the RN comes with a knowledge of that an AA does not is voluminous to say the least.

I have no doubt that AAs do a great job in the environment they are allowed to work in. AAs are good people looking to be apart of this cool anesthesia world, cant fault them for that! :itsme: OK - you know I gotta step in sooner or later. After all, I am the official token AA here. :itsme"

For the OP - no, an Anesthesiologist Assistant cannot challenge the CRNA exam, although we actually offered many years ago to do just that but were turned down. No real surprise there, and of course CRNA's can't challenge the AA exam.

For Mike - you're right, most AA's are not RN's, although quite a few have gone through the various AA programs over the years. The idea that none of the students have clinical experience is blatantly false, although it is a commonly used argument. Some do not have patient care experience, but most do. Many have been respiratory therapists, paramedics or PA's. In addition, all the programs require pre-med coursework. Depending on the program, they all require some combination of biology, physics, inorganic and/or organic chemistry, biochemistry, calculus, etc. All of the programs require either the MCAT or GRE.

I'm not sure where the idea came from that clinical hours are counted differently. "Bag time"? Gimme a break. Regardless, an AA student is not spending half his time in clinicals sitting doing nothing as 6hipguns implies. That's absurd.

As I've stated numerous times on other boards (y'all go there too ;) ), CRNA's and AA's in the same practice do exactly the same thing for the same compensation. Independent practice is the main difference - CRNA's can, AA's do not. But if you want to do major cases in major hospitals, there are going to be anesthesiologists around and participating in the care of the patient at some level. That's a simple fact. Cardiac surgery, major neuro, transplants, and numerous other types of cases are simply not done in hospitals staffed solely by CRNA's. Although state law may allow independent practice, hospital policies can be and often are more restrictive as far as scope of practice.

Although many CRNA's I'm sure have several years of clinical experience prior to starting their anesthesia training, there are many that do not. The requirement is one year in a critical care setting, for which the definition is left to the individual program. I am personally familiar with a number of CRNA's who were accepted into their training programs when they had not only six months of critical care experience, but only six months of practice as an RN. They did of course have their full one year of experience prior to the time they started their anesthesia program.

And finally, there is another major difference between the two fields that is rarely mentioned by my esteemed nurse anesthesia colleagues. AA's are required to maintain their certification not only by submitting 40 CME credits every two years, but must also take and pass a recertification exam every 6 years as a continued demonstration of their qualifications to practice. With the advent of a similar mandatory recertification program for anesthesiologists that started 6-7 years ago (CME's plus exam every 10th year), CRNA's remain the only one of the three providers without a recertification exam required once their educational program has been completed.

Just trying to bring a little balance back to the discussion.

[MmacFN]

Jwk

Thanks for the clarification :)

Only reason i mentioned the pre med / MCAT is cause many of the SDN dolts seem to constantly mention it as if thats the standard and truly it isnt. As you said a combo of those type classes as well as GRE is acceptable. Not like thats cake, just not what some of them think.

While i agree that AAs and CRNA are often similar within the ACT practice i wonder if there are not differences in particular skills? Are AAs in all ACT practices allowed to do epidurals, spinals and other regional? I was under the impression this was not the case most of the time and only when an MD is in the room?

As for CRNAs having just one year, thats true they are out there. I dont think thats anywhere near a large percentage tho. The big thing is that for CRNAs its a requirement to have 1 year of acute care (tho most schools ONLY accept ICU) whereas there is no requirement for AAs to have any experience at all. Thats the real point In my opinion. An AA student could be (and im sure many are) walking into a hospital for the very first time when they start AA school. That is quite a disparity itself.

Looking at the AA schools website, it does appear that they are counting clinical hours by clinical days and not cases. How could they peg the exact hours each semester if they were not? For me, the only time that is counted is from start to finish of each case. If im there 12 hours but only did 5 hours of anesthesia, thats all i get credit for. Nothing else counts (not procedures or preops postop etc). As it stands now, if i went by hours, this is where i would sit:

Time in clinical over 30 month program = 6 am - 4 pm per day but lets call them 8 hour days as opposed to 10 that im there for.
1st 3 months was solid didactic 5 days a week.
2st 3 months i was there 2 days a week = 192 hr
3nd 3 months is 3 days a week = 288 hrs
4rd, 5th, 6th, 7th, 8th, 9th 10th semester is 4 days a week = 2688 hours
total hours = 3168 hours in clinical. (not including call time)
I got 2 weeks off 1st 2 semesters = 16 hr
2 week off in semester 4&5 = 64 hours
2 weeks off in semesters 6,7,8 = 64 hours
1 week in 9 & 10 = 32 hours
total off = ~ 200 hours
So total clinical time = 2968 hours (not including call)

The average AA program is ~ 2500 hours clincal to learn everything.

Now on the websites for the AA programs they clearly count the hours that they add up to 2500+ based on days not on time in the OR. So if we are counting the same way then the clinical hours are about equal. This is, of course, except for all the clinical time spent learning the things an RN comes already with.

I also understand that an AA can write the certification exam before finishing the AA program. Im not sure i understand the reason for this? On your cert website it says this

must be a student in good standing in an accredited program who will be graduated from that program within 180 days of the Certifying Examination. Seems odd one can take the cert exam 6 months before they have even graduated from a 24-27 month program...

In anycase, this isnt a political thread and i dont wanna get into that, but i do want the facts to be right out there. Here they are:

AAs have no requirement for experience prior to AA school and so the curriculum must be designed to teach those who have none. Therefore, the time spent in clinical and class (which is about the same as my own program) must teach everything an RN already knows + anesthesia.

CRNAs come in with a minimum 1 year experience. This is not common as most RNs do not already have a BSN upon starting to work as an RN. However, thats the minimum. Of course thats not taking into account the years of clinical experience they gained as an RN student. The program is spent on anesthesia since there is an expectation that the RN has previous knowledge and skills. While CRNAs will also take MSN or MS classes many of them are relevant to anesthesia but for a few.

CRNAs & AAs must pass either the GRE or (AA - MCAT) (CRNAs - MAT). Neither appear to have any solid cutoff numbers for admission.

CRNAs & AAs both must pass a certification exam.

AAs can do this exam 180 days or 6 months before graduation while CRNAs cannot even apply to take it until AFTER graduation.

AAs do have more clinical time listed in the course description but it appears they are counting days not actual hours in cases only (which is how CRNA programs count the required hours). When counting this way they are near identical.(based on looking at the curriculum descriptions). It is likely that both AAs and CRNAs get more clinical time than listed in programs.

AAs are not required to take the entire pre med curriculum but are required to take many of the pre med classes which are certainly very work intensive.

CRNAs are required to have either a BSN or another science degree for entrance.

AAs and CRNAs both appear to have a 3.0 GPA admissions cutoff

CRNAs have a min pass for every class of 83%. Anything less can result in dismissal or probation. (None of the AA programs have this requirement listed)

CRNAs can work independent of MDA AAs cannot

CRNAs are trained to do all forms of anesthesia including all regional anesthesia as well as central lines & Swans. I believe AAs are trained in the same manner. There are state law issues which restrict AAs from doing any regional (dont know about lines) entirely and some states where an MDA must be in the same room as its being done.

CRNAs can respond to inhospital anesthesia requests without the MDA and perform any needed interventions (codes, central lines, regional anesthesia etc). AAs cannot do with without an MDA present as this would be remote supervision. At my clinical site the CRNAs run the entire OB department for example.

At any time a CRNA in an ACT practice can actually work unsupervised (no TEFRA) as needed if there are not enough MDs to do so. AAs cannot do this.

CRNAs do not have a repeat exam requirement post certification where AAs are required to "re-write" the exam in 6 years. Both require CEs

AAs can currently only work (to full scope) in 15 states i believe and have some limited practice in 3-4 others. CRNAs have an unrestricted practice in all states.

Now as i understand them, those are the facts.

Having said that, AAs are not evil people. I dont see them as "inferior" in any derogatory sense. The AA training is rigorous and certainly not a cake walk. What really separates the CRNA and the AA is that the CRNA education prepares a CRNA to work independently and includes all the knowledge needed to do so. An AA program does not as it will never be an issue. AA training is clearly intended to produce a dependent provider, thats not a bad thing its a mission of the profession and its anesthesiologist creators. A CRNA could certainly work in an ACT practice and likely be near (or totally) in the same role as the AA depending on department/hospital policy.

There will be crappy CRNAs, AAs and MDAs regardless of educational model or focus. It is that way in every profession.

In anycase, good discussion jwk.

[ed3]

There is always the undertone of how superior the prerequisites are for AA programs. The fact that the undergraduate education of CRNAs is spent getting acclimated to healthcare more than compensates for the lack of a few loosely related courses (however challenging they may be). The RNs with only one year of experience are not the norm. I’m not sure what you consider “many”. :) A lot of the CRNA program websites state that most people who get accepted have more than one year of experience.

I’m not sure what percentage of AAs have healthcare experience, but based on the information available on AA websites (such as how many people had a degree in x), I would presume that many AA students don’t have healthcare experience. I would like to believe that most AAs have experience, but I haven’t found any evidence that proves that to be true. I’m sure some AAs have experience, but “most” seems to be a stretch based on the information I have seen. Maybe someone will provide reliable proof…?

The link below is an AA website with students listing their degrees and previous experience. Skimming through the bio’s I think I found 1 (maybe) with real healthcare experience. Maybe this is atypical? Then again, there is only so much to compare it to.
http://www.anesthesiaprogram.com/students.htm


BTW- Thank you jwk. :) PM box was full. He still hasn’t contacted them, so ungrateful. :dunno:

[jwk]

Having said that, AAs are not evil people. I dont see them as "inferior" in any derogatory sense. The AA training is rigorous and certainly not a cake walk. What really separates the CRNA and the AA is that the CRNA education prepares a CRNA to work independently and includes all the knowledge needed to do so. An AA program does not as it will never be an issue. AA training is clearly intended to produce a dependent provider, thats not a bad thing its a mission of the profession and its anesthesiologist creators. A CRNA could certainly work in an ACT practice and likely be near (or totally) in the same role as the AA depending on department/hospital policy.

There will be crappy CRNAs, AAs and MDAs regardless of educational model or focus. It is that way in every profession.

In anycase, good discussion jwk.And I thought I was up late...

Are we different? Of course.

Are AA's an inferior provider? Absolutely not.

Are AA's required to work with anesthesiologists? Yes - that's not a bad thing in our eyes, but is frequently held up to ridicule, even though the majority of CRNA's also work in ACT practices. Supervision or medical direction does not mean physically present and standing next to us, as it doesn't with CRNA's in practices that bill according to TEFRA. The idea that we can't function without them hovering is false. There is nothing that prohibits AA's from responding to codes BTW.

There is nothing that I'm aware of in any state law that prohibits regional anesthesia or line placement by AA's. All of the AA programs have always taught line placement, 2 of the 4 teach placement of regionals. I think the main reason for the difference there is strictly geographic custom. Atlanta (Emory) has always been an area where the MD's did the bulk of regionals, and the South U. program was started by the former director of the Emory program. Case and Nova have taught lines and regionals from the beginning, and I anticipate all future programs to teach it as well. However, nothing prohibits students from learning regional techniques in their clinical sites, but there is no formal requirement for AA students to perform regionals. Regardless, the techniques are easy to learn and AA's that join practices where the anesthetists do regionals quickly learn those techniques and become credentialled at their individual facilities to perform them. (BTW, is credentialling the bane of everyone's existence?)

As far as the certifying exam - yes, it can be taken before graduation. It's only offered once a year, in June, and at present, all the programs finish in June or August as I recall, so no one takes it six months prior to graduation. And let's be honest - those last few months of school for both CRNA's and AA's is honing the skills you've already learned and gaining valuable experience. The heavy "book learning" is done much earlier, as I assume it is with most CRNA programs. During their second year, AA's still have a few hours of classroom/seminar time each week up until the time of graduation. Students at some remote clinical sites may still be required to participate in these via videoconferencing - it's hard to attend an M&M in Savannah if you're in Kansas City.

I don't want to keep going back and forth too much on this thread - history has shown us that the discussions eventually deteriorate to a pretty low level. I don't really think I'm going to change anyone's mind about AA's - I gave up on deepz many moons ago. :) We are the devil incarnate to many, but we're here to stay and growing each year in both number of practitioners and states available for us to practice. Sooner or later, you'll probably bump into us, either in person or online, just like me, Mike, Jan, and Drew did a while back.

[MmacFN]

Thanks for the info jwk.

I do like it that we can have civil discourse about the differences in our professions. Obviously we will have opposing opinions on some issues which will never change and thats just to be expected.

Now back to our regularly scheduled programing!

[AmiK25]

And I thought I was up late...

Are we different? Of course.

Are AA's an inferior provider? Absolutely not.

Are AA's required to work with anesthesiologists? Yes - that's not a bad thing in our eyes, but is frequently held up to ridicule, even though the majority of CRNA's also work in ACT practices. Supervision or medical direction does not mean physically present and standing next to us, as it doesn't with CRNA's in practices that bill according to TEFRA. The idea that we can't function without them hovering is false. There is nothing that prohibits AA's from responding to codes BTW.

There is nothing that I'm aware of in any state law that prohibits regional anesthesia or line placement by AA's. All of the AA programs have always taught line placement, 2 of the 4 teach placement of regionals. I think the main reason for the difference there is strictly geographic custom. Atlanta (Emory) has always been an area where the MD's did the bulk of regionals, and the South U. program was started by the former director of the Emory program. Case and Nova have taught lines and regionals from the beginning, and I anticipate all future programs to teach it as well. However, nothing prohibits students from learning regional techniques in their clinical sites, but there is no formal requirement for AA students to perform regionals. Regardless, the techniques are easy to learn and AA's that join practices where the anesthetists do regionals quickly learn those techniques and become credentialled at their individual facilities to perform them. (BTW, is credentialling the bane of everyone's existence?)

As far as the certifying exam - yes, it can be taken before graduation. It's only offered once a year, in June, and at present, all the programs finish in June or August as I recall, so no one takes it six months prior to graduation. And let's be honest - those last few months of school for both CRNA's and AA's is honing the skills you've already learned and gaining valuable experience. The heavy "book learning" is done much earlier, as I assume it is with most CRNA programs. During their second year, AA's still have a few hours of classroom/seminar time each week up until the time of graduation. Students at some remote clinical sites may still be required to participate in these via videoconferencing - it's hard to attend an M&M in Savannah if you're in Kansas City.

I don't want to keep going back and forth too much on this thread - history has shown us that the discussions eventually deteriorate to a pretty low level. I don't really think I'm going to change anyone's mind about AA's - I gave up on deepz many moons ago. :) We are the devil incarnate to many, but we're here to stay and growing each year in both number of practitioners and states available for us to practice. Sooner or later, you'll probably bump into us, either in person or online, just like me, Mike, Jan, and Drew did a while back.

JWK,

I do have a question for you regarding the clinical hours in AA programs. I do not want to start an arguement and would like to first state that I really have nothing against AAs in general. However, could you please tell me how the 2500 clinical hours are counted? I have always heard (as others have stated above and you did not deny) that they are simply hours in the OR, not hours giving anesthesia. As stated above, we are only allowed to count hours in an actual case. In addition, we do not count cases that we did not start (which, in a call shift or afternoon shift, can be pretty substantial), not to mention preops, postops, intubations, etc.... In my senior year alone, I would have almost 2500 hours of "clinical time" (average of 50 hours/week, 50 weeks of the year...we get 2 weeks off each year), but to count that as anesthesia time seems dishonest to me. I'm just wondering what the truth is and what your opinion is on the matter.

Thanks,
Ami

[6hipguns]

I believe the ACT is on the way out, it's not efficient. I work in a large MD/CRNA group where the CRNAs are employed by the MDs, covering 2 hospitals and 4 sugicenters. We do not use the ACT because you can cover more cases with fewer personnel if everyone does their own cases. As reimbursement gets cut more and more, I think it'll be the death of the ACT. A couple years ago, another practice 50 miles away did away with the ACT also. Another advantage to not using the ACT, is you don't need to worry about billing fraud and do you hold up emergence until the MD gets into the room, or move along. I would be cautious about investing time and money in an AA program because as the health care environment continues to change, you could find job opportunities more and more limited. As the money tightens up it's amazing how quickly things can change.

[ed3]

heheh

Well I do feel bad for the AAs. I think that the vast majority of them (especially the new ones entering the programs) have no idea that they are being used by the ASA as a weapon vs CRNAs.

After being told that AA = CRNA it must be a sobering realization once they are in school and find out that that just isn't true. CRNAs can work independently and do more within the ACT model as they do not require, at any time by law, for an MDA to be in the building or even there to do anesthesia of anykind. This is not true for AAs.

What is often misunderstood by people is that the ACT is not the law. There is no law anywhere within the USA which says that a CRNA must have an MDA there for induction, emergence etc (TEFRA LAWS for medicare patients ONLY) at anypoint in time. What the law says is that for the MDA to get paid 50% of that case they must be there. That is the ONLY reason by LAW that they must be there. So, in any ACT practice a CRNA can still work without an MDA at anytime but an AA can never do that.

Anything which suggests medical direction in the ACT is little more than department policy but certainly not law. So regardless of how an ACT practice may be conducted in any specific hospital, it is certainly not the law and therefore AA do not = CRNAs in an ACT practice by definition.

Clearly the reality of the law becomes obvious when one looks at hospitals where MDAs and CRNAs work in the same OR but no ACT exists. There are practices across the country where a CRNA could be in room 1 and an MDA in room 2 with no law or supervision in existence billing separately. Right there proves the reality of the situation.

Those who would have you believe differently are just trying to fool you into believe propaganda so you 'fall in line'.

Just wanted to respond to this...it was something said in another thread.

:)... I'm not buying into the "us against them” mentality. We all know that ACT is not law, but that is how the majority of CRNAs practice (according to the AANA website). You can say "by definition" or "by law" or whatever else, but at the end of the day in ACT practices AAs do function the same (maybe similarly is a less offensive term) as CRNAS.

I don’t feel sorry for AAs. If they can find a way to be anesthesia providers without dealing with the bs in nursing or going to medical, then more power to them. They will have it made if they can successfully expand their territory. They will never be independent, but neither will many CRNAs. Although, I personally I like the option of being independent, but many people just want a “good paying” meaningful job….they don’t always have to be the “chief”.

[MmacFN]

Hey Edisto

You have a couple things wrong here, ill see if i can make em a little clearer.


:)... I'm not buying into the "us against them” mentality. We all know that ACT is not law, but that is how the majority of CRNAs practice (according to the AANA website). You can say "by definition" or "by law" or whatever else, but at the end of the day in ACT practices AAs do function the same (maybe similarly is a less offensive term) as CRNAS.


No, you are incorrect here. 1st, yes, 65% of CRNAs work in collaboration with MDAs. However, they are not bound by practice laws as AAs are. So, in the OR when something NEEDS to be done the CRNA can do it without and MDA and bill differently. This can never happen with an AA. In practice, this actually does happen in alot of ACTs across the country.

Second, there are not that many practices WITH AAs. Less than 1% of the anesthesia providers in the country makes this the exception not the rule. So while it may be true that in the ACT practices where AAs are they work the same, it dosen't mean that all ACT practices across the country function in this way and, in fact, many do not (especially when it means monetary loss or an upset surgeon). This can simply not happen with an AA.


I don’t feel sorry for AAs. If they can find a way to be anesthesia providers without dealing with the bs in nursing or going to medical, then more power to them. They will have it made if they can successfully expand their territory. They will never be independent, but neither will many CRNAs. Although, I personally I like the option of being independent, but many people just want a “good paying” meaningful job….they don’t always have to be the “chief”.

For those in ACT practices thinking they are escaping liability they are in for a hard lesson. CRNAs are EQUALLY as liable as the MDA is for anything they do. There is no more "liability" for MDAs. Most RNs dont know it but even they practice this way. If an MDA gave an incorrect order and you follow it you are also liable for that order. The only difference is that the RN will carry less overall liability (ie: monetary payout) than the MD. In the OR ACT setting however, this is not the case. CRNAs are held to the EXACT same standards, liability and therefore "payout" as their MDA counterparts. This is well documented in case law. So the CRNA in an ACT would 'payout' as much as they would were they working in a CRNA only practice.

While a regular RN could go get another job tomorrow, A CRNA who has been sued (indy or act) may not be employable or insurable if they have a track record of incidents the same as an MD or DO would.

[ed3]

MmacFN… I understand all of that (probably more than you think I do)…but the fact still remains that they are anesthesia providers, and when they are used, they often function very similarly to a CRNA in the same practice (those were the words of a CRNA who works with AAs). I am addressing what actually happens, not what is legal or illegal. I have read all of the reasons as to why people are so anti-AA, but it all seems kind of petty.

[MmacFN]

edisto

I think you are missing the point. You have been told about ACT practices where AAs actually exist, essentially less and 1% of them. In ACT practices where there are NO AAs the practice is not always the same as it is in those with AAs.

Look, here is a perfect example.

Case is late MDA cant make it into the room, you start the case and bill 'non medically directed', no need for an MDA whatsoever. Case gets done and everyone is happy. An AA can never, ever by law, do this. So in those ACT practices where this does, in fact, happen if they were to hire AAs, they (AAs) could NOT EVER, do these things and therefore, it isnt what "actually" happens everywhere. The CRNAs in the same practice, however could.

Thats the point. The ACTs with AAs are not an example of what "acutally" happens in the rest of the country. ACTS all over the country work differently and in many places it is common practice that cases occur (especially at night) non-medically directed (ie: NO MDA). This is allowed for CRNAs within the ACT practice but is clearly NOT allowed for AAs ever.

No matter what the ACT is like, this is always an option with CRNAs but is not one with AAs. That means they are not "the same".

People are Anti-AA for a very good reason. The ASA created and now promote them as a direct way to 'hurt' CRNA practice.

Im not going to bother explaining the considerable difference this means to an ACT practices' flexibility to you, you 'dont know what you dont know' and don't have all of the information. It is well explained and evidenced in the private forums for the CRNAs and SRNAs who are interested.

Edisto, i know you are just trying to get a better understanding of how this all works but you are making assumptions on flawed "someone told me that" information. You might read "watchful care' to get a better understanding of where this protectionist attitude you are seeing comes from.

[ed3]

edisto

I think you are missing the point. You have been told about ACT practices where AAs actually exist, essentially less and 1% of them. In ACT practices where there are NO AAs the practice is not always the same as it is in those with AAs.

Look, here is a perfect example.

Case is late MDA cant make it into the room, you start the case and bill 'non medically directed', no need for an MDA whatsoever. Case gets done and everyone is happy. An AA can never, ever by law, do this. So in those ACT practices where this does, in fact, happen if they were to hire AAs, they (AAs) could NOT EVER, do these things and therefore, it isnt what "actually" happens everywhere. The CRNAs in the same practice, however could.

Thats the point. The ACTs with AAs are not an example of what "acutally" happens in the rest of the country. ACTS all over the country work differently and in many places it is common practice that cases occur (especially at night) non-medically directed (ie: NO MDA). This is allowed for CRNAs within the ACT practice but is clearly NOT allowed for AAs ever.

No matter what the ACT is like, this is always an option with CRNAs but is not one with AAs. That means they are not "the same".

People are Anti-AA for a very good reason. The ASA created and now promote them as a direct way to 'hurt' CRNA practice.

Im not going to bother explaining the considerable difference this means to an ACT practices' flexibility to you, you 'dont know what you dont know' and don't have all of the information. It is well explained and evidenced in the private forums for the CRNAs and SRNAs who are interested.

Edisto, i know you are just trying to get a better understanding of how this all works but you are making assumptions on flawed "someone told me that" information. You might read "watchful care' to get a better understanding of where this protectionist attitude you are seeing comes from.

I was thinking the same thing when I wrote my reply. I'm not saying they are the "same"....but AAs and CRNAs are very similar...all of the other stuff is just politics. If AAs are so "different" then why are they such a threat? Once again, I understand everything you have said, but I think you are reading too much into my post. I understand that CRNAs don't like competition, and don't want the restrictions of AAs placed on them....but I don't think any of this has to do with pt safety, which is what I thought CRNAs were most concerned with... You can brush it off and say I don't know what I'm talking about, but as you always say "follow the money".

[ethernaut]

I was thinking the same thing when I wrote my reply. I'm not saying they are the "same"....but AAs and CRNAs are very similar...all of the other stuff is just politics. If AAs are so "different" then why are they such a threat? Once again, I understand everything you have said, but I think you are reading too much into my post. I understand that CRNAs don't like competition, and don't want the restrictions of AAs placed on them....but I don't think any of this has to do with pt safety, which is what I thought CRNAs were most concerned with... You can brush it off and say I don't know what I'm talking about, but as you always say "follow the money".

well, in the OR, yea.. that's true re: pt safety,
but, on the outside, i believe we're most concerned with still having a job in the future....
hence, the AA "argument"..

[ed3]

well, in the OR, yea.. that's true re: pt safety,
but, on the outside, i believe we're most concerned with still having a job in the future....
hence, the AA "argument"..


I get that... But you are doing the same thing MDs have done to you...(maybe not you)

[ethernaut]

I get that... But you are doing the same thing MDs have done to you...(maybe not you)

i can see your point, and on some level, that might be true.
but you have to remember that the ASA is/has been trying to
change our responsibilities, billing, independence, etc...
i don't believe CRNAs are doing that, maybe lobbying, i don't know.
but definitely not in the same league as MDAs to CRNAs..

[ed3]

MmacFN has been replying for a long time. I'm kind of scared.

[MmacFN]

*sigh*

Did you read that post at all?

What i was saying has nothing to do with safety or educational comparison (thats a whole other discussion), it is about the ACTUAL differences between CRNA and AA practice even inside an ACT. This directly relates to patient accessibility (and surgeon) to anesthesia services.

So no, this is not at all politics. Its a very real legal restriction of practice. CRNAs are never "restricted" to the same practice of an AAs just because they both work in the same practice. You could easily have CRNAs working and practicing 'non-directed' whenever needed right beside AAs who MUST have the MDA there to do anything. This is a significant difference.

Money is always a motivator in everything. However, from a service, billing and legal perspective, CRNAs and MDAs have NO differences. AAs are absolutely different in all 3 of those respects.

There are groups across the country where CRNAs and MDAs work in the same ORs but all do their OWN cases. There is NO "ACT" practice. What you do not understand is that an "ACT" is merely a billing arrangement for MDAs to successively bill 50% for up to 4 medicare cases. It has NOTHING to with anything other than that. The only provider who is restricted in any practice is the AA who cannot participate in anesthesia care in any other way than under the direct derogatory authority of the MDA.

Politics & money are one thing, but significant differences in practice, service and indeed, education/preparation can truly impact patient access, safety and outcome.

This wont be something you understand until you educate yourself in regards to the history, legal differences and practice rights. Currently, your simply making it up as you go with not a shred of evidence to back up a single statement you have made.

Before you continue with this argument, research it.


I was thinking the same thing when I wrote my reply. I'm not saying they are the "same"....but AAs and CRNAs are very similar...all of the other stuff is just politics. If AAs are so "different" then why are they such a threat? Once again, I understand everything you have said, but I think you are reading too much into my post. I understand that CRNAs don't like competition, and don't want the restrictions of AAs placed on them....but I don't think any of this has to do with pt safety, which is what I thought CRNAs were most concerned with... You can brush it off and say I don't know what I'm talking about, but as you always say "follow the money".

[ethernaut]

*sigh*

Did you read that post at all?

What i was saying has nothing to do with safety or educational comparison (thats a whole other discussion), it is about the ACTUAL differences between CRNA and AA practice even inside an ACT. This directly relates to patient accessibility (and surgeon) to anesthesia services.

So no, this is not at all politics. Its a very real legal restriction of practice. CRNAs are never "restricted" to the same practice of an AAs just because they both work in the same practice. You could easily have CRNAs working and practicing 'non-directed' whenever needed right beside AAs who MUST have the MDA there to do anything. This is a significant difference.

Money is always a motivator in everything. However, from a service, billing and legal perspective, CRNAs and MDAs have NO differences. AAs are absolutely different in all 3 of those respects.

There are groups across the country where CRNAs and MDAs work in the same ORs but all do their OWN cases. There is NO "ACT" practice. What you do not understand is that an "ACT" is merely a billing arrangement for MDAs to successively bill 50% for up to 4 medicare cases. It has NOTHING to with anything other than that. The only provider who is restricted in any practice is the AA who cannot participate in anesthesia care in any other way than under the direct derogatory authority of the MDA.

Politics & money are one thing, but significant differences in practice, service and indeed, education/preparation can truly impact patient access, safety and outcome.

This wont be something you understand until you educate yourself in regards to the history, legal differences and practice rights. Currently, your simply making it up as you go with not a shred of evidence to back up a single statement you have made.

Before you continue with this argument, research it.

so, as i was reading this, i was wondering...
if MDAs have to meet the tefra rules for gettin' puh-haid..
is there something in the CRNA teaching rules or the like that would be comparable to the MDAs in regard to overseeing students where there's no MDA?

[MmacFN]

Good question I have no idea how that works!


so, as i was reading this, i was wondering...
if MDAs have to meet the tefra rules for gettin' puh-haid..
is there something in the CRNA teaching rules or the like that would be comparable to the MDAs in regard to overseeing students where there's no MDA?

[ed3]

*sigh*

Did you read that post at all?

What i was saying has nothing to do with safety or educational comparison (thats a whole other discussion), it is about the ACTUAL differences between CRNA and AA practice even inside an ACT. This directly relates to patient accessibility (and surgeon) to anesthesia services.

So no, this is not at all politics. Its a very real legal restriction of practice. CRNAs are never "restricted" to the same practice of an AAs just because they both work in the same practice. You could easily have CRNAs working and practicing 'non-directed' whenever needed right beside AAs who MUST have the MDA there to do anything. This is a significant difference.

Money is always a motivator in everything. However, from a service, billing and legal perspective, CRNAs and MDAs have NO differences. AAs are absolutely different in all 3 of those respects.

There are groups across the country where CRNAs and MDAs work in the same ORs but all do their OWN cases. There is NO "ACT" practice. What you do not understand is that an "ACT" is merely a billing arrangement for MDAs to successively bill 50% for up to 4 medicare cases. It has NOTHING to with anything other than that. The only provider who is restricted in any practice is the AA who cannot participate in anesthesia care in any other way than under the direct derogatory authority of the MDA.

Politics & money are one thing, but significant differences in practice, service and indeed, education/preparation can truly impact patient access, safety and outcome.

This wont be something you understand until you educate yourself in regards to the history, legal differences and practice rights. Currently, your simply making it up as you go with not a shred of evidence to back up a single statement you have made.

Before you continue with this argument, research it.

MMacFN... OK, you're right. AAs and CRNAs are vastly different. I should have never compared them...in fact I should just pretend they don't exist. They won't be here 5 years from now. They do not provide anesthesia, and they are in no way used similarly to CRANAs in an ACT practice. I just said all that stuff b/c I wanted to look cool on here. CRNAs are not treating AAs the way MDs treat them. Everything said by CRNAs on this board is the belief of every CRNA practicing. I have not researched this topic at all b/c if I did I would be agreeing with everything that has been said. AAs have shown that they are clealy not able to practice anesthesia safely. You are right about this issue, and anything I say is wrong, clearly I don't have the intelligence to understand anything you have said.

Happy?

[armygas]

Edisto,
Here is a question for you......

How will the influx of AAs into the anesthesia world improve the access of healthcare in rural communities AND reduce the overall costs of healthcare in Metropolitan areas?

[ethernaut]

Edisto,
Here is a question for you......

How will the influx of AAs into the anesthesia world improve the access of healthcare in rural communities AND reduce the overall costs of healthcare in Metropolitan areas?

ouch !
army, you sure you don't have a bayonet on the end o' yer finger ??
(however logical and appropriate this question may be...)

[MmacFN]

The present the evidence for your argument.

So far it consisted of "I talked to a CRNA who works with AAs"

What you are doing is classical avoidance/diversion via ad hominem attacks on me. Believe me, I have proven over and over again that i DO MY RESEARCH.



MMacFN... OK, you're right. AAs and CRNAs are vastly different. I should have never compared them...in fact I should just pretend they don't exist. They won't be here 5 years from now. They do not provide anesthesia, and they are in no way used similarly to CRANAs in an ACT practice. I just said all that stuff b/c I wanted to look cool on here. CRNAs are not treating AAs the way MDs treat them. Everything said by CRNAs on this board is the belief of every CRNA practicing. I have not researched this topic at all b/c if I did I would be agreeing with everything that has been said. AAs have shown that they are clealy not able to practice anesthesia safely. You are right about this issue, and anything I say is wrong, clearly I don't have the intelligence to understand anything you have said.

Happy?

[ed3]

Edisto,
Here is a question for you......

How will the influx of AAs into the anesthesia world improve the access of healthcare in rural communities AND reduce the overall costs of healthcare in Metropolitan areas?

Armygas...I understand they won't. However, that is not reason enough for me to be anti-AA. I see them as people who want to provide anesthesia who weren't interested in nursing or med school. They want the same thing you want...a decent paying job that they are interested in.

[armygas]

Another question:

Scenario,

Everytime an AA administers an intravenous agent during the case or performs and airway maneuver/intervention for example without the physical presence of an Anesthesiologist, is that AA performing an illegal act?

[ed3]

The present the evidence for your argument.

So far it consisted of "I talked to a CRNA who works with AAs"

What you are doing is classical avoidance/diversion via ad hominem attacks on me. Believe me, I have proven over and over again that i DO MY RESEARCH.

MMacFN, when have I ever attacked you? You can't be serious. If you don't want to believe I have researched this issue, fine, but don't say I have been attacking you when clearly I haven't. All of my replies to you have been intentionally short. I think talking with someone who has worked with an AA is enough evidence for a discussion board. It really isn't that serious. This person has had more interaction with AAs than you have had (correct me if I'm wrong). All I have said is that they are similar, and work similarly in an ACT practice...what the is so offensive about that?

[armygas]

Finally,

If an AA does not have at least a telephonic conversation with an Anesthesiologist regarding each intervention during a case, is that AA breaking the law?

If an event occurs, how much time is wasted contacting an Anesthesiologist before a proper intervention is put into place? Is that safe?

[ed3]

Another question:

Scenario,

Everytime an AA administers an intravenous agent during the case or performs and airway maneuver/intervention for example without the physical presence of an Anesthesiologist, is that AA performing an illegal act?

Don't know...but I do know that AAs claim that the presence of an anesthesiologist is never required. Whats the correct answer?

[ed3]

Finally,

If an AA does not have at least a telephonic conversation with an Anesthesiologist regarding each intervention during a case, is that AA breaking the law?

If an event occurs, how much time is wasted contacting an Anesthesiologist before a proper intervention is put into place? Is that safe?

I see your point. And clearly I see the advantages to being a CRNA (which is why I want to become one). All I'm saying is that I'm not going to be anti-AA. :)

[armygas]

"An anesthesiologist assistant may not prescribe, order, or compound any controlled substance, legend drug, or medical device, nor may an anesthesiologist assistant dispense sample drugs to patients. Nothing in this paragraph prohibits an anesthesiologist assistant from administering legend drugs or controlled substances; intravenous drugs, fluids, or blood products; or inhalation or other anesthetic agents to patients which are ordered by the supervising anesthesiologist and administered while under the direct supervision of the supervising anesthesiologist."

[armygas]

"An anesthesiologist assistant may not prescribe, order, or compound any controlled substance, legend drug, or medical device, nor may an anesthesiologist assistant dispense sample drugs to patients. Nothing in this paragraph prohibits an anesthesiologist assistant from administering legend drugs or controlled substances; intravenous drugs, fluids, or blood products; or inhalation or other anesthetic agents to patients which are ordered by the supervising anesthesiologist and administered while under the direct supervision of the supervising anesthesiologist."
What exactly does this mean in the participating states? Does it vary from state to state?

[ed3]

According to AAs, supervision does not mean “standing over the shoulder” (I’m assuming it does?). Most AAs claim that they are rarely physically supervised by an MDA. I know there has been a lot of debate about the definition of "supervision and collaboration". If I were to take your statement as is, I would say that it means that an MD needs to be standing right there, however I have been informed that this is not the case, and the way that is worded is misleading. I know that AA practice does vary by state. In some states AAs work through some kind of “delegate” system (tx? is or was one of the states). Can’t remember the term off the top of my head, but I could easily find that info and pretend I knew it all along. :) I’m not saying I know every detail about AAs, but when I considered the profession for a millisecond I did thoroughly research it. I did not memorize the nuances in AA practice from state to state. I guess I would be cheating if I looked it up. But technically, an AA can work in any state that has a VA hospital. :) I understand everything that has been said, but attempted not to make it a “big deal” (hence my brief replies). I don’t mind debates, but everything being a “big deal” gets kind of old. If people want to take my lame attempt at being polite as ignorance, so be it. I can understand I am a bit of villain around here, but just b/c I don’t agree with what’s popular doesn’t mean I am attacking anyone personally.

[armygas]

According to AAs, supervision does not mean “standing over the shoulder” (I’m assuming it does?). Most AAs claim that they are rarely physically supervised by an MDA. I know there has been a lot of debate about the definition of "supervision and collaboration". If I were to take your statement as is, I would say that it means that an MD needs to be standing right there, however I have been informed that this is not the case, and the way that is worded is misleading. I know that AA practice does vary by state. In some states AAs work through some kind of “delegate” system (tx? is or was one of the states). Can’t remember the term off the top of my head, but I could easily find that info and pretend I knew it all along. :) I’m not saying I know every detail about AAs, but when I considered the profession for a millisecond I did thoroughly research it. I did not memorize the nuances in AA practice from state to state. I guess I would be cheating if I looked it up. But technically, an AA can work in any state that has a VA hospital. :) I understand everything that has been said, but attempted not to make it a “big deal” (hence my brief replies). I don’t mind debates, but everything being a “big deal” gets kind of old. If people want to take my lame attempt at being polite as ignorance, so be it. I can understand I am a bit of villain around here, but just b/c I don’t agree with what’s popular doesn’t mean I am attacking anyone personally.
I don't think you are a villain, but I do think you might be a bit innocent. Do not for one minute think that the implementation of AAs was to provide better patient care. A small group of physicians came up and implemented this idea to delete CRNAs from their practice. Why hasn't this provider type gained in popularity in the "over 30" years of its' existence (only 5-6 schools in over 30 years????)? B/C the utility of these providers is limited that is why. It doesn't make good sense for an anesthesiologist to hire an AA over a CRNA in a small to moderate practice as that anesthesiologist but be the only one in the group and thus cannot be in all places at all times. In the large settings, there are many anesthesiologists available so it doesn't matter. How many AAs practice in the small to moderate ACT settings?

Think about it......................................

[ethernaut]

According to AAs, supervision does not mean “standing over the shoulder” (I’m assuming it does?). Most AAs claim that they are rarely physically supervised by an MDA. I know there has been a lot of debate about the definition of "supervision and collaboration". If I were to take your statement as is, I would say that it means that an MD needs to be standing right there, however I have been informed that this is not the case, and the way that is worded is misleading. I know that AA practice does vary by state. In some states AAs work through some kind of “delegate” system (tx? is or was one of the states). Can’t remember the term off the top of my head, but I could easily find that info and pretend I knew it all along. :) I’m not saying I know every detail about AAs, but when I considered the profession for a millisecond I did thoroughly research it. I did not memorize the nuances in AA practice from state to state. I guess I would be cheating if I looked it up. But technically, an AA can work in any state that has a VA hospital. :) I understand everything that has been said, but attempted not to make it a “big deal” (hence my brief replies). I don’t mind debates, but everything being a “big deal” gets kind of old. If people want to take my lame attempt at being polite as ignorance, so be it. I can understand I am a bit of villain around here, but just b/c I don’t agree with what’s popular doesn’t mean I am attacking anyone personally.

are you joking or are you serious?
every state i think has a VA.
AAs can't work in every state.
that's clearly delineated, isn't it?

[armygas]

are you joking or are you serious?
every state i think has a VA.
AAs can't work in every state.
that's clearly delineated, isn't it?
This is a very "iffy" scenario. I contacted the VA Healthcare Administration in this regard and they stated that AAs can practice in VA facilities if the Administration of that hospital allows. The contact also informed me in the same breath that currently they did not know of any that were doing so.

However, AAs DO NOT (and CAN NOT) practice in ANY Military Treatment Facility (Active Duty).

[ethernaut]

This is a very "iffy" scenario. I contacted the VA Healthcare Administration in this regard and they stated that AAs can practice in VA facilities if the Administration of that hospital allows. The contact also informed me in the same breath that currently they did not know of any that were doing so.

However, AAs DO NOT (and CAN NOT) practice in ANY Military Treatment Facility (Active Duty).

so, technically AAs "COULD" work in every state (where there's a VA) ?

[armygas]

so, technically AAs "COULD" work in every state (where there's a VA) ?
ONLY in the VA hospital and ONLY if the institution's administration approves it. But, I still haven't seen that happen.

[ed3]

I don't think you are a villain, but I do think you might be a bit innocent. Do not for one minute think that the implementation of AAs was to provide better patient care. A small group of physicians came up and implemented this idea to delete CRNAs from their practice. Why hasn't this provider type gained in popularity in the "over 30" years of its' existence (only 5-6 schools in over 30 years????)? B/C the utility of these providers is limited that is why. It doesn't make good sense for an anesthesiologist to hire an AA over a CRNA in a small to moderate practice as that anesthesiologist but be the only one in the group and thus cannot be in all places at all times. In the large settings, there are many anesthesiologists available so it doesn't matter. How many AAs practice in the small to moderate ACT settings?

Think about it......................................

Armygas, I love your word choice. You are always very level headed.

I can understand where you are coming from. I realize there are not as many benefits to hiring an AA, but they are filling a void. There is not a CRNA for every available anesthesia position. I think CRNAs should be more focused on differentiating themselves from AAs, as opposed to bashing or trying to get rid of AAs. Sure, by law CRNAs have a lot more freedom, but what the law will allow, hospital policy often limits. I think I would be more understanding if more CRNAs were independent practitioners. But from my perspective there is a lot of “hooping and hollering” about something that is not the norm. It would be very hard for anyone (AA, MDA, or me) to make the CRNA-AA comparison if most CRNAs didn’t work in the ACT setting. I understand that in more rural areas (where there is a greater need for anesthesia providers) AAs are pretty much irrelevant. I have heard several reasons as to why AAs were created, and all I can say is that they are here now…and I realize that the AAs themselves are just people trying to make a living. I think the focus should be on trying to end the “war” instead of trying to get rid of the enemy…b/c when we do that we are really no better than are other adversaries. I know this is not realistic to some people, but you have to start somewhere (will it end when every AA is out of a job?). It doesn’t matter why the war was started, we can move forward and accept (and further increase) our differences (not really “our”… I’m not in it). Is getting rid of AAs going to increase the number of CRNAs working independently? It seems there is a very vocal group in support of independence, but there is an even larger group that is happy where they are (ACT). “Numbers” are the only thing I can go by.



BTW- I am very much a villain, there is one member who wants to petition to have me banned. After the way MmacFN “reacted”, I think it’s a very real possibility.

Maybe that is an innocent point of view, but I would rather spend my energy trying to fix the problem without putting someone else out of a job…There are so many CRNAs that even if AAs were to expand, we wouldn’t see the results in our lifetime.

[ethernaut]

there'll be no banning..
unless you are a secret sales rep..
then you'd be lynched .. :2in1:

[armygas]

Armygas, I love your word choice. You are always very level headed.

I can understand where you are coming from. I realize there are not as many benefits to hiring an AA, but they are filling a void. There is not a CRNA for every available anesthesia position. I think CRNAs should be more focused on differentiating themselves from AAs, as opposed to bashing or trying to get rid of AAs. Sure, by law CRNAs have a lot more freedom, but what the law will allow, hospital policy often limits. I think I would be more understanding if more CRNAs were independent practitioners. But from my perspective there is a lot of “hooping and hollering” about something that is not the norm. It would be very hard for anyone (AA, MDA, or me) to make the CRNA-AA comparison if most CRNAs didn’t work in the ACT setting. I understand that in more rural areas (where there is a greater need for anesthesia providers) AAs are pretty much irrelevant. I have heard several reasons as to why AAs were created, and all I can say is that they are here now…and I realize that the AAs themselves are just people trying to make a living. I think the focus should be on trying to end the “war” instead of trying to get rid of the enemy…b/c when we do that we are really no better than are other adversaries. I know this is not realistic to some people, but you have to start somewhere (will it end when every AA is out of a job?). It doesn’t matter why the war was started, we can move forward and accept (and further increase) our differences (not really “our”… I’m not in it). Is getting rid of AAs going to increase the number of CRNAs working independently? It seems there is a very vocal group in support of independence, but there is an even larger group that is happy where they are (ACT). “Numbers” are the only thing I can go by.



BTW- I am very much a villain, there is one member who wants to petition to have me banned. After the way MmacFN “reacted”, I think it’s a very real possibility.

Maybe that is an innocent point of view, but I would rather spend my energy trying to fix the problem without putting someone else out of a job…There are so many CRNAs that even if AAs were to expand, we wouldn’t see the results in our lifetime.

I think the problem ensues when AAs are advertised as a suitable alternative to CRNAs; there is no comparison. They are not a replacement for CRNAs, they cannot legally "make" on-the-spot decisons.

[MmacFN]

Edisto


I dont think you are a villain and i would never ban someone for an opposing opinion, ever.

[ed3]

Edisto


I dont think you are a villain and i would never ban someone for an opposing opinion, ever.


You're a much better Admin than me. I ban people for a few minutes, then reinstate them. :pound: