CRNA vs AA (help)

[kennysrn]

I am working on a paper in my Health Care Law & Policy class r/t pending legislation in North Carolina (S394) to "...authorize the licensure and regulation of anesthesiologist assistants." I would love to hear the opinions of those with a lot more experience and knowledge than myself. It is difficult to find an unbiased opinion on the internet.

[Outdoor1]

Kenny, doubt you will get an unbiased opion here since you are on a CRNA site, but oh well. AA's threaten the existence of CRNA's so ofcourse we don't want them to have licensure in any more states than they already do. The reason MD's like them is because they are just what their title says they are. They are assistants. For the most part they function just like a CRNA, but do not legally have the autonomy of a CRNA which is great for the MD's. They use AA's in the same capacity as CRNA's in most places, but they really can't be challenged at all by an AA as far as billing, etc.

That's just a tid bit, but i am in school and have some work to do. I hope you get more information from others. Good luck

[kennysrn]

Thanks for the input. The more I read Senate Bill 394 (NC) the more I think the issue is about making sure CRNAs have to be supervised by physicians at all times rather than licensing AAs. I guess there isn't a risk of AAs seeking autonomy like CRNAs???

[RAYMAN]

No, AA's are tied to there MD supervisors so there isn't the risk, right now I don't think, of them being independent. CRNA's can independently provide anesthesia because they have been doing it for many, many years with excellent results. The MD's like AA's because of $$. Their territory is not threatened by AA's. I would suggest you read the book Watchful Care if you would like a good history on CRNA's.

[etherdave]

I am getting close to retirement. I will be slowing down over the next few years. There are many in the same boat as I am and the number of jobs keep on increasing. The MDAs are in the same boat and they are using this pending shortage to push their agenda of increasing the number of AA's to fill in the gap. It seems that recruitment into the CRNA programs will be the only way to slow this trend down. Just my opinion.

Etherdave

[jwk]

S394 in NC is a dead issue. That session of the legislature ended several months ago. The part of the bill dealing with CRNA supervision was already a moot point due to a ruling by the NC Supreme Court that, in effect, requires CRNA "supervision" by a physician.

AA's are not trying to "threaten the existence" of CRNA's (unless a free-market economy bothers you) and most of us work with CRNA's every day. There has never been an instance where individual AA's or our professional organizations have sought to limit the practice of CRNA's.

Unfortunately the reverse is not the case, as the expansion of AA practice is fought tooth and nail at every turn by both national and state nurse anesthesia organizations. Most of the arguments against us are not based in fact or even common sense. For the couple of you that have heard anecdotal horror stories about AA's from your best friend's 3rd cousin's next-door neighbor, please save your breath. We all have horror stories about the CRNA / orthopedist / OB / ER doc / ICU nurse / RT / anesthesiologist / and even AA at the hospital we used to work at. In the end, it all comes down to $$$, one way or another.

AA's do not and will not seek practice autonomy. We are committed to an ACT practice model and are limited to practicing in that manner. Many of you practice independently in one way or another - more power to you. I'm not trying to stop you. I do not and will not have that opportunity, nor will I seek it. I'm perfectly happy where I am, as are many of you who also practice with anesthesiologists every day, whether in collaboration, medical direction, supervision, or whatever you'd like to call it. Depending on the state, location, or hospital policy, we do the same things you do with the exception of practicing independently and pain procedures. In hospitals that use both CRNA's and AA's, our practice and compensation are identical.

There is a TON of work to go around for all of us. We can't find enough anesthetists of either type in my group, and many others are in the same boat. The southeast US continues to grow rapidly in population across all age groups, and there simply aren't enough anesthetists around to fill the demand. Signing bonuses and tuition reimbursement abound. Compensation and benefit packages are larger than I ever thought possible. Sooner or later things will level off or the bubble will burst or Medicare will implode, but for the forseeable future, opportunities for all of us look pretty darn good.

I'd love to see the rhetoric between all the groups tone down. It's largely unproductive, and in the end, we all want the same thing - to care for our patients the best way we know how and get paid a reasonable amount for our services considering the level of education, expertise, and medico-legal risk involved in providing those services. Some want to practice in big hospitals doing big cases. Some want to live in hunting/fishing heaven making a fine living covering several small rural hospitals. Others are perfectly happy in GI endoscopy centers (I can't explain it, but they are ;) ) There's plenty of room for everyone at the table. Anyone interested in one of my call shifts next week?

I had a perfectly civil and enjoyable online chat a couple weekends ago with several of you including yoga (former AANA pres). Not a bad word about darn AA's or freakin' CRNA's from either side. Just a nice chat about a variety of things - one AA, two CRNA's plus that kid who created this website. I hated to cut my side short after an hour, but the honey-do list just wasn't getting done.

Some of you probably aren't happy I'm around, but I'm the token AA - there's also a token pharmacist and perhaps a couple of others. I try and stay out of the political discussions on this forum for the most part, but this one was a little hard to ignore totally. And of course my opinions are biased, as are yours. If we're not proud of, and willing to defend our chosen profession, something's wrong.

:fencing:

[kennysrn]

Thank you for taking the time to share your information with me. The last thing I wanted to do was to cause turmoil between medical professionals. I think we definitely need to focus on the primary goal of quality patient care, but after I chose my topic for this paper, I realized that I was in over my head and didn't have access to all of the information I needed to present both sides. :2in1:

[RAYMAN]

plus that kid who created this website. :pound:

JWK, I've always enjoyed your posts here and at other places and am glad to have you aboard. I know you are fairly heavily involved in recruitment and hiring at your place and we are both in the southeast, so I was wanting to ask you to expound a little more on your statement about job conditions in this area of the country. What trends have you been seeing and how do you perceive things to be in this area? If you'd like to pm me that's fine.