Anesthesiologist Assistants Alluding to Independent Practice
In the recent second quarter Anesthesiologist Assistant (AA) newsletter a very interesting article appeared by AA program director of the Quinnipiac program William Paulsen entitled “Are Anesthesiologist Assistants really equivalent to Nurse Anesthetists (CRNAs)?”. He had a lot to say about Nurse Anesthetists and AAs in this article.
Some of the most interesting quotes from him as pasted below with my commentary afterward:
“Why would anyone hire an AA if they were only equivalent to a nurse anesthetist in the operating room during the day? Nurses offer billing advantages, call advantages and the ability to provide services to a broader range of patients if you include plastic surgery of*fices and dental offi*ces to name a few. Why would physician anesthesiologists raise the money to enter a legislative battle to have AAs licensed or registered in their state?”
In this quote Mr Paulsen makes it clear that the advantages of CRNAs in providing expansion of care to rural areas as well as urban areas are significant whereas AAs cannot work in these areas without an Anesthesiologist which becomes cost prohibitive. He relates how CRNAs can take call independently and that even in a practice with Anesthesiologists CRNAs provide greater value and flexibility. Obviously there is a significant disincentive to hiring and advocating for AAs in any practice and in many they cannot exist at all as they limit the service to surgeons, hospitals and patients by their very nature.
It does not take a genius to see what the solution to this conundrum would be for AAs. After all, they are told (as this article states) that they are “as good as Nurse Anesthetists” at every turn. They tell each other that, indoctrinate their students with the idea and the American Society of Anesthesiologists also advocates this statement. It does not take a leap of faith to see that if a CRNA can do all these things that AAs cannot due to being shackled by the requirement to work directly with an Anesthesiologist so too can an AA? Right? This is not complicated logic at all.
Although Mr Paulsen falls just short of stating that AAs should also be able to work the way a CRNA can, he clearly alludes to this injustice. Of course he cannot say anything which would suggest an AA could work without an Anesthesiologist as it would likely result in professional suicide. Why is this? Simple. AAs would then also become competitors for anesthesia dollars against Anesthesiologists as well. Since AAs were created to be dependent providers working only under an anesthesiologist (including the word ‘assistant’ within their professional title) anything which would eliminate the financial and professional protection benefits which AAs confer to the Anesthesiologists they work for would be blasphemy. Mr Paulsen explains the sole reason why Anesthesiologist would hire an AA over a CRNA in the quote below:
“The answer could be that they (Anesthesiologist) are looking for
This statement is the crux of the article and in it Mr Paulsen makes it clear that the reason Anesthesiologists seek to bring AAs into a state and hire them is entirely for political gain and guild protectionism. He clearly shows that AAs cannot expand access to care, are not a fiscally responsible option and are not as flexible even within a practice with Anesthesiologists as a CRNA is.
Well, unless of course they are independent as well. Right?
The ASA will eventually experience a revolution from their dependent assistants. It is coming and this is not the first time we are hearing it (AA who sued in Ohio to expand their practice or the bill in NM to allow them to work without an MDA present). They have created their own Trojan horse, brought it into their homes and perpetually equate them to Nurse Anesthetists. Will they really be surprised when they fight to have the same rights as CRNAs?