I have seen many a debate (AKA Argument) between AAs and CRNAs on this site and one thing that a number of AAs have said is they are not interested in working independently and are fine working under an Anesthesiologist (MDA). Fine, you guys said that, I did not put the words in your mouths.
Now, the three reasons I can see why there is an ad for CRNAs only.
1. The whole AA concept is the AA will work under the direct supervision of an anesthesiologist. The meaning of "direct" has been debated but both sides agree that if an AA is doing cases, an MDA has to be around somewhere. In the room, in the hallway, in the work room, in the office, etc. He does not have to be hovering over the AA but he has to be somewhere doing the supervision. And for that, he gets to bill for the anesthesia services provided by the AA and for his supervisory services. In general that means he can supervise 3-4 AAs or CRNAs or combination thereof and bill for each case in two different fashions.
Now, lets take the surgery center setting. Lets say you got a surgery center that has a mix of CRNAs and AAs doing cases. Now lets say the MDA calls in sick. The CRNAs due to their licenses can do their cases. The AAs on the other hand can not do cases without the MDA. So their cases either have to be done by the CRNAs or they have to be cancelled. Do that a few times and you can bet the surgeons will not be so happy with AAs. It has nothing to do with the surgeons not liking AAs, it has to do with surgeons not liking to have to reschedule their patients.
2. In the case of the AA, the MDA MUST ...absolutely MUST do certain things to show he is supervising properly in order to bill. In the case of a CRNA, if the MDA does not do all that is required, he can not bill for his supervisory services but he can still bill for the anesthetic as in most cases the CRNA works for the MDA as a paid employee. The MDA of course will get paid MORE for supervising the CRNA but if something happens and he does not do it, he does not get into trouble for failing to supervise and the CRNA does not get into trouble for not having supervision.
3. If a case comes in where the MDA feels he must sit down and do the case himself, the CRNAs can continue working in the other rooms. But in this situation, even tough the MDA is in the facility, he is tied up and can not be doing a case himself and be supervising others at the same time. The AAs would have to go on hold until the MDA was done with that case.
Having CRNAs gives the MDA more flexibility in scheduling and helps keep him out of trouble with the insurers and Medicare.
A lot of these issues can be resolved by AAs getting involved in their own licensing process. If you are on your own practice board you can help develop practice law to deal with a lot of these issues. If you sit back and just squeeze the bag, you will find others will write your practice laws and depending upon their agenda, you may find they boxed you nice and neat into a tiny box. I will give you one example you need to really watch for.
If YOUR practice law gets written that an MDA can only supervise 2 of you at a time whereas they can supervise 3-4 CRNAs at a time, you can bet the CRNAs will get a lot of jobs that should be available to you. The MDAs would not push for that, the AAs would not push for that but you can bet there are some CRNAs that would push for that.
On the flip side, who is to say that in 10-20 years after AAs have been around for a while, a program might come up where you can go and get a doctorate in anesthesia (like the CRNAs are moving towards) and with a doctorate degree, you can work independently. You can bet the MDAs would NOT like that as you would then be another group "competing with them" as they currently see the CRNAs. You can probably bet the CRNAs would not like that either. Only YOU GUYS having input into your own practice laws can prevent others from boxing you in..
Stick in there, with the boomers retiring, we need another pipeline of anesthesia providers.
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