Posted by Mr. Curious |
- Re: The Future???
Posted by Dave J on August 5, 2009, 4:22 pm, in reply to "The Future???"
134.197.137.200I am a CRNA, retired Military.
Whenever one group is not supplying needs, another group comes in.
Right now neither the MDA/DOA schools nor the CRNA schools are graduating enough of either or combined to supply the demands of today. With the baby boomers about to retire, neither is coming close to fulfilling demands of the future.
And neither is setting up to do so. The CRNAs are moving towards a Doctorate type program so basically they will be anesthesiologists by another route. That is greatly going to increase cost and reduce the overall numbers who can afford the schooling. With the nursing shortage, the pool they can pull from is also in trouble. I do not see much expansion of the CRNA career field.
The Anesthesiologists are also in a bit of a bad situation. With the CRNAs shooting more directly at their jobs and the cut in pay by Medicare and other agencies, many doctors are not going to see anesthesiology as a area to work in. Why work where you have NURSES doing about the same thing?
So there is going to be a shortage of anesthesia providers. And the AAs are right there as a growth "industry" ready, willing and ABLE to do the job.
I say this because I am not worried about competition as there is more than enough work to go around. I am more concerned about the USA having a lack of qualified anesthesia providers and people dying as a result.
My only demand of the AA programs is they turn out people who are professional, who know WHY they do the things they do, and not a bunch of technicians who know how to push a syringe but not know what it is "Propofol before Succ."
If a proposal for an AA practice law comes up in Nevada where I live and work, I will support it. Call me a traitor to my "kind" but I beleive the higher standard of care is having people to provide the care, not who gets to give it.
Thank you for your time.
- Re: The Future???
Posted by AN on August 8, 2009, 9:21 am, in reply to "Re: The Future???"
64.203.215.149Dave, that was a great post. I am a senior AA student about to start my final year of clinical rotations. I'm planning to contact an MDA in Las Vegas, where my uncle lives, to see if he would be interested in allowing me to rotate at his site for a month. I would love to know where you practice. I don't think me coming to that site will start the ball rolling exactly for the state, but I want to experience a hospital outside the southeast and figured that would be a great site. Let me know some info about your practice if you are nearby.
- Re: The Future???
Posted by CRNA in CALIF on August 9, 2009, 7:01 pm, in reply to "Re: The Future???"
67.118.50.175AN.... I did a lot of locums work in Nevada through the years.
Here is the situation in Nevada.
Las Vegas. Up to about 15 years ago CRNAs only worked at one hospital and a surgery center. That started changing big time and now they do a lot of OB, surgery center stuff and GI Clinic stuff. Of course SIX of them had to surrender both their Anesthesia and Nursing licenses over the hepatitis issue last year.
Parhump. New hospital. I believe they have one CRNA and looking for another. (No MDAs)
Mesquite. New Hopsital. Three CRNAs. (No MDAs)
Reno. Anesthesiologists only. Problem is, not enough of them so a lot of elective cases get canceled due to them being too tired. They will not bring in CRNAs but they may buy into the AA concept. (The last CRNA in Reno, working at the VA hospital retired last year.)
Rural Nevada.
Elko. I think they have a total of 8 CRNAs between the hospital and surgery center. (No MDAs)
Ely. Two CRNAs. (No MDAs)
Winnemucca One full time CRNA with locums relief. (No MDAs)
Fallon (2-3 CRNAs, one MDA but he does his own cases and does not get any money for the cases the CRNAs do.
Tonopah. Hospital was sold to a private group back around 1994-5 and the first thing they did was close OB and the OR, losing the one CRNA they had.
Hawthorne. 10-15 years ago had a locums CRNA come for a couple of days a week and they did some minor surgery.
I think there were around 400 CRNA licenses issued in Nevada but most are expired. Many CRNAs probably thought there was work out here and got a license only to find the jobs are very limited.
Right now there is no provision for AAs in the state. I seriously doubt if a MDA in Las Vegas is going to bring in an AA with no legal recognition. Also, Nevada has a legislature that meets every other year. It just met in 2009 so the next session will be in 2011. If you have a MDA friend in Vegas you might suggest he approach the legislature about getting an AA bill passed at that time. The Nevada Association of Nurse Anesthetists is pretty disorganized (as compared to California for example) and exists pretty much in name only. It does not have the membership or the clout to fight an AA bill in any effective manner so I would bet the bill would pass.
Also as Dave J said in a post quite a while ago, if you guys want to be professional then you need to write up your own practice standards and not let the MDAs control that aspect of your profession. Try to get set up under a Board other than the Medical Board and not be under the thumb of the MDAs at the license level. - Re: The Future???
Posted by AN on August 9, 2009, 9:06 pm, in reply to "Re: The Future???"
64.203.215.149PS - The reason why the AAAA doesn't write our "own practice statements" and relies on the ASA is because as a physician assistant organization, we want to assure the AMA that we plan to work as PAs and not threaten their job market. The PA Anesthesia providers accept the role of a PA and team up with the ASA to work together. Due to the education received(Master of Medical Science & Patient Monitoring degree) only works as a assistant degree, therefor the AAAA feels it necessary to work closely with the AMA/ASA due to our need of MDs to practice just like the general PA profession. - Re: The Future???
Posted by AN on August 9, 2009, 8:51 pm, in reply to "Re: The Future???"
64.203.215.149Thanks so much for the info! It seems like there is a pretty large shortage in the state. I can't imagine surgery centers only working with 1 or 2 anesthesia providers! I guess I am just use to seeing/working within hospitals that run 10-20 rooms at a time, all with separate providers (CRNAs and AAs). As of now, the legality of the situation wouldn't be a problem. As a student, an MDA could allow me to train under him/her or under a willing CRNA as a "deligatory state". This means the ANS provider I am associated with can tell me what I can/cannot do. This is being used in TX where AAs work at several hospitals in the Houston area under deligatory until they pass a bill. I will communicate your advice to the MDA in Vegas as soon as I get the ball rolling with him. As of right now, it is just hopeful wishing to set up a rotation, but with the shortage info from you and the weak AANA branch in Nevada, it may be a good time to expand!
Thanks again for the supportive info!
God bless. - Re: The Future???
Posted by Dave J. on August 13, 2009, 9:00 pm, in reply to "Re: The Future???"
67.118.50.175Not surgery centers, hospitals. The small rural hospitals have CRNAs covering OB and OR. - Re: The Future???
Posted by stanley
on August 6, 2009, 10:35 am, in reply to "Re: The Future???"
96.254.197.169The shortage of anesthesia providers is real, the shortage has abated somewhat with the economic downturn, whether this change is temporary or not time will tell, CRNA graduation has doubled in the last 5 years and new programs are opening every day, in addition more and more people are entering nursing every day as jobs disappear and the medical field is the most stable employer out there, the bottleneck is in training new nurses nurse educators get paid crap.
The AA would be a viable option except for its total domination by the ASA, the care team model as it stands (4-1) ratio has no science behind it, there is some evidence that a team model increases the safety somewhat,(extra hands) but the ratios in which this effective are unknown and the extra hands do not have to be an MD. A situation in which 20% of your assets may or may not be used is not effective particularly in a time of escalating costs and decreased revenues.
The fight between the ASA and the AANA is in the end about who controls the money for anesthesia, AA's are one means the ASA wishes to maintain its control. I could be far more supportive of AA's if the organization were not so blatantly subservient and at the mercy of the ASA.
Like all of health care the current system is unsustainable the AA is just a way of maintaining the status quo with a different provider. - Re: The Future???
Posted by jcole on August 5, 2009, 4:48 pm, in reply to "Re: The Future???"
98.249.225.46Dave J please contact info@AnesthesiologistAssistant.com...great writing!! - Re: The Future???
Posted by Logistics on August 4, 2009, 2:53 pm, in reply to "The Future???"
76.101.9.61If you consider the direction that healthcare reform is headed, it seems likely that AAs and CRNAs will both be in high demand. The decreased compensation that will likely follow from reform, however it manifests itself, means that anesthesiologists will be looking for ways to keep their bottom line high. The only way to accomplish such an endeavor is to perform multiple cases at once, thereby necessitating increased employment of AAs and CRNAs. Looking forward, it also seems unlikely that CRNAs going to a doctarate level degree will serve to benifit healthcare in any way or form. CRNASs (with doctarates) would be looking for greater compensation in a world where the same job can be done for a lesser value by already well trained anesthesia providers. In addition, a doctarate program takes longer to complete, again providing no benifit to healthcare, which is already short on anesthesia providers. So, my opinion is that CRNAs and AAs will increase in demand and that compensation for our services will change very little. - Re: The Future???
Posted by robert
on August 2, 2009, 4:56 pm, in reply to "The Future???"
99.19.3.232It's real simple. No money and lots of promises. MDA's worthless and lazy, AA's useless and dependent. One provider with a 130 year track record and the USA of a emdoressment.
CRNA only baby!! get used to it, it's here and now. - Re: The Future???
Posted by MRW on August 3, 2009, 12:46 am, in reply to "Re: The Future???"
72.186.211.143How does dropping ether on a mask and hoping for a <20% mortality rate equate to anything in today's operating room? Is this what you spend your time in CRNA school learning?
Why is it that every CRNA with a chip on their shoulder and a soul full of vitriol is such an insecure blowhard?
Fact: all major advances in anesthesia were made by "lazy" MDs
Fact: 90% of CRNA's practice in the same "useless and dependant way" as AA's.
Fact: ANAA has to lie in order to prevent AA practice from expanding to new states
Fact: AA's are steadily adding new states to practice in despite the lies.
Fact: New AA schools continue to open.
Fact: More AA's will graduate in the next 4-5 years than currently are in the workforce.
AA-C, baby! Get used to it, it's here and now and it is scaring the pants off you. - Re: The Future???
Posted by AA Someday
on August 2, 2009, 6:52 pm, in reply to "Re: The Future???"
69.136.34.35I have no idea what "emdoressment" is. - Re: The Future???
Posted by GL
on July 21, 2009, 7:57 pm, in reply to "The Future???"
76.188.100.1691. CRNA's to DNAP's - they will not overthrow or even rid of MDA's, that's not going to happen.
2. This is it... AA's will be affected just like all other jobs in health care will be affected if this health reform goes through. Think an increasingly HUGE demand, and only making like 50% of what you would be making. As it stands (I've been keeping a very very close eye on this topic), the reform is losing ground, and it looks like a 60-70% chance it's not going to happen as is. I agree, I'd graduate with over 100k in debt, and not make enough to pay it back.
3. Last I heard, Oklahoma was opening up. I'm not sure if any new states are joining anytime soon. - Re: The Future???
Posted by Mr. Curious
on July 21, 2009, 8:04 pm, in reply to "Re: The Future???"
69.136.34.35I'm all for some sort of healthcare reform, but I don't think slashing salaries is the answer. If that happens you're not longer going to get the best and the brightest going into this profession. - Re: The Future???
Posted by GL
on July 21, 2009, 10:21 pm, in reply to "Re: The Future???"
76.188.100.169Exactly my point. Please don't misinterpret my opposition to this plan as an opposition to reform in general, or being content with the current status. I agree, for patient's, health care is too expensive. But this bill, universal care, is NOT the answer.
In it, will be an increase in demand on the system, and a decrease in budget and resources. They'll make cuts in the system, one of which will be inevitably and inexorably, salary of every health care provider out there.
As individuals involved in the field of health care itself, we should be for reform, looking out not only for the well being of our patients, but the fiscal well being of all as well. There is an answer out there, this bill isn't it.
At least that's my two cents on it, take it for what it's worth. And you are correct, with that system, it will deter the deserving, the bright and the willing from entering the health care field.
