In some MDA programs, there are no AA or CRNA students so the MDAs learn how to do anesthesia by actually doing anesthesia all of the time.
In other programs, there is a MDA and CRNA or AA program and the MDAs in training learn about the other providers and actually learns about and does some supervising.
Either way, when they get out and start practicing, they tend to practice the same way they learned in school. That all has to do with "comfort level."
There are also two other issues. The perception of anesthesia as a medical profession and the desire to make money.
Some MDAs do not want any AAs or CRNAs in the practice or even in the same town! They feel that if there are AAs or CRNAs, other doctors will not think of anesthesiology as an equal medical profession. "If a nurse can do it, why do we need MDAs?" And if the AA or CRNA can actually give a smoother anesthetic, imagine how that reflects on the MDA. This is a "status" issue.
The third issue is about income and in my opinion, maximizing the anesthesia care available. If a MDA sits down and does a case he gets 100% of the anesthesia fee. (Lets call that $300,000 per year for 1000 cases done in one operating room.)
However, if he supervises three AAs or CRNAs they split the fee on more cases. To make the math simple, if they split the fee 50-50, the MDA gets 50% on all the cases supervised and the AA/CRNA gets 50% on the cases they do. With this arrangement, the MDA will make three times what an AA or CRNA makes for supervising. (It works out using the same figures as above, the AA or CRNA will get $150,000 per year for doing 1000 cases, the MDA will get $450,000 per year, supervising 3000 cases. And instead of only one room running with MDA input, there are now three.)
This arrangement is fair in my opinion, but clearly DD has a problem with it. The MDA is assuming risk for three times as many cases, cases he is not directly 100% watching at all times. He is having to trust the AA or CRNA to not screw things up and to call when there is a problem. And bottom line, the MDA has a DOCTOR's degree vs the AA or CRNA who only have a masters. This is the "financial" issue.
The financial issue is something that is a problem in some situations. There are some MDAs who push the envelope on that issue. They will supervise four or even five AAs or CRNAs at a time. They will bill for an ASA 3 even if the patient is not that ill. They will call any add-on case, even if the patient is NPO and it is during the regular hours, an "emergency." And in one case in Minnesota, they were billing as if they were actually doing the case instead of supervising. These are by far the exception rather than the rule. All but one of the MDAs I have worked with in the past 32 years have been fair and honest. You do your work, they pay you as agreed, many giving a year end bonus if you did more than expected.
As the anesthesia crunch gets worse, you can bet the surgeons will start yelling loudly to the hospital administrators. Surgeons do not like having cases cancelled because the MDAs need "crew rest." They do not like having to do routine cases late into the evening because there are not enough MDAs. And since the ASA is not turning out enough MDAs, the solution will have to be to bring in CRNAs or AAs. And since the AANA is not turning out enough CRNAs, the job potential for AAs is going to be great in the next ten years.
Hang in there. AA practice laws will be passed by the majority of states in the next 10 years and I bet within 20 years, AAs will be allowed in all the states.
