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    Re: AAs vs. CRNAs Archived Message

    Posted by stanley kristiansen@sbcglobal. on January 20, 2008, 8:42 am, in reply to "Re: AAs vs. CRNAs"

    Sharon the AA and the CRNA function in much the same way in an ACT practice. An ACT practice is one in which the anesthesiologist (not MDA) some of them HATE that acronym, supervises the delivery of the anesthetic. The supervision can be as tight as the anesthesiologist to be called for any drug to be administered and for any change in the vital signs to the AA, or CRNA hollering as they go to the OR "hey I am taking them back".
    The argument has been cloaked in safety issues but IMHO it is not safety but who controls anesthesia that the argument is really about. They cannot prove anesthesiologists are better then CRNA's. Not one study has indicated that one type of provider is safer then the other.
    As CRNA's can practice independently the question often is why should an anesthesiologist receive 50% of the fee just to be in the building?
    For example a routine surgery that any provider has done hundreds or thousands of times, a knee arthoscopy, on a healthy young patient. The anesthetic risk is negligible and the case has been done so often everyone knows what to, where is the need for supervision? In case of complications the CRNA (and I assume the AA) have been trained on what to do. The times I have seen an anesthesiologist intervene it is to do the exact same thing that the original provider was already doing, and I have seen CRNA's bail out anesthesiologists when they loose their heads. Usually it is a matter of experience vs. a degree. I assure an AA that has been practicing for 25 years is more competent then a new graduate CRNA or new graduate anesthesiologist or vice versa.
    The argument is about MONEY and a profession. If I can (and do by the way) independently provide anesthetic services why should I have any of the money being handed over to a "supervisor" and o a personal note why should I be "supervised"? As I said no one has found any benefit to it, and studies show no difference in outcome regardless of the provider.
    CRNA's see AA's as a tool of the ASA to try to bring the AANA to heel, as they are in their own words a more compliant provider, or in the AAAA's charter, "committed to the ACT" The argument on both sides is not driven by safety but by MONEY.
    The AA's can never be a threat to the money making of an anesthesiologist because they are established by the state medical boards and thus by law required to have an anesthesiologist supervise them. By law not by ability. The AANA and CRNA's in general do not welcome AA's for that simple reason. If AA's were independent CRNA's still would not be thrilled but the shrillness of the argument from both sides would be much less.

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