I've tried to ignore the most recent dribble on this thread but I feel compelled to answer. I try to keep my posts very short as nearly 100% of my long posts have been deleted but I'll spend 5 minutes on this in the hope that a few of you actually see it before it is mysteriously trashed. The relationship of the few hundred AAs now allowed to practice with MDAs is one born out of a twofold NECESSITY. In marked contrast the relationship of CRNAs practicing with MDAs is one born primarily out of GEOGRAPHY. Let's first examine necessity. AAs by their own admission and by the deliberate dictation of ASA sponsored AA state practice laws, are not competent nor allowed in any arena to render any care with out an MDA. This is not my opinion, it is indisputable fact. AAs by necessity must practice with an MDA, no exceptions. But notice I mentioned above that this necessity is twofold. It is also necessary for the MDA to make utterly sure with out any doubt that the AA will always provide a billing opportunity for the MDA and never be in a position to effect economical competition between AA and MDA providers. There is no other reason the ASA seeks to perpetuate the long failed and relatively recently resurrected AA experiment. The ASA spends PAC money promoting AA state practice rights not for the well being of the AA but solely for the future economic well being of the MDA. You can argue all you want that these statements are not true but in the end, those of us on both sides of this issue who have been around the anesthesia block for a while know exactly what's going on. Failing to admit these truths will not change them. But more on that later. Let's turn to geography. Is it any wonder that two groups of highly educated professionals (CRNAs & MDAs) choose to live in desirable areas of this country? Is it also any wonder that the MDA seeks and in the majority of cases succeeds in setting themselves up in ACT practice arrangements in the majority of these locations? Thus if you are a CRNA wishing to live in these desirable areas you have little choice but to join an ACT practice literally by default. There are exceptions. In major and minor metropolitan ares throughout the country, CRNAs are providing safe care in areas historically ignored by the MDA. Specifically, office based surgery sites where the MDAs effectively priced themselves out of the market three to four decades ago. This allowed CRNAs the opportunity to establish independent (clinically and financialy) practices which have thrived. With the HUGE shift away from inpatient to office based surgery that has occurred in the past thirty years, the MDA now finds himself out of the loop and way late for the party. Unable to reap the increasingly lucrative economic benefits of these locations as these practices are getting along just fine with out them thank you, the ASA has taken an interesting approach. One ironically that they far to frequently accuse the American Association of Nurse Anesthetists (AANA) of using. They seek to control through legislation what they cannot control in the free market. How you ask? Why through the back door of course! Witness the methodical state by state ASA campaigns through legislatures and state medical boards to "regulate" office based surgery (read anesthesia) for the "safety" of the patient. What's really behind this? They want a piece ot the economic action. "Regulation" is the instrument they are using to attain the true goal: mandated MDA involvement and thus mandated economic benefit for the MDA. Is the MDA economic benefit theme beginning to sound a bit familiar? Does it not resound with you? Are the bells starting to go off just a wee bit? Are you waking up to the true reasons causing the struggle for control of the practice of anesthesia and thus the resulting financial befits of that control? Most post on this board hope to influence the hapless undergrad in biology or chemistry. Tens of thousands of these folks graduate every year from fine institution all over this country. They have worked hard and earned a college degree and for that I respect them and congratulate them. Why then do I describe them as hapless? Because with out continuing to some kind of graduate school, these hard working folks are unlikely to ever gain substantial lucrative employment. You know who you are. Most of you woke up to this fact as the real world loomed somewhere in your senior year. It is this target audience the ASA attempts to woo with a quick back door entry into what may or may not prove in the long run be a lucrative profession (read ASA President Lema, specifically his predictions on MDA supervisory ratios and then relate that to current AA state law on the same subject). There are to many ironies on this subject to begin to mention so we will return to a familiar theme. The potential salaries that are dangled like bait in front of you are in some cases very similar to the salaries that the MDAs vehemently begrudge the CRNA. Check out Blade and others on studentdoctor.net . Every right they spend ASA PAC money to buy for AAs to insure MDA economic goals they have vigorously tried to deny CRNAs. Why attempt for over close to a century to fight Nurse Anesthetist over these rights only to dish them out VERY carefully to AAs? One reason and one reason alone. Unlike the CRNA, in all circumstances the AA is a two legged guaranteed billing opportunity for an MDA and thereby poses no economic threat. Finally, much has been made over the relevance of CRNAs capable of independent practice working in the ACT model. At the end of the day, give me a CRNA with that knowledge, training, ability, capability, competency and legal authority over a doctors assistant any day no matter who is roaming the hallway outside the OR. Equal? Not even close.
