Dave "J" - CRNA's Random Thoughts Regarding Anesthesiologist Assistant's and Anesthesia Practice...
Dave J. is a CRNA who is posting insightful Q & A's on AAMessageBoard.com. Please visit and ask questions about AA's and CRNA's. Dave shares his clear nonbiased views about Anesthesiologist Assistants and CRNA's and how they might work as team players in the near future. Ask Dave J!
Alright , I’m not going to bicker with you, but seriously I want a thought out answer from a couple of you. What is your problem with Anesthesiologist Assistant’s? Is your problem with us or the ASA/MDA's? You can spout how we are unproven, but frankly you probably have never even met one of us. We've been around for over 30 yrs and if we were not capable, that would have been determined by now. So that leaves the ASA. Fine the MDA's get paid more, some are controlling micromanagers, but they are also the ones paying over 15k in liability. More important, in general practice if the pt crashes it is a proven fact that more hands are better than one. The surgeons don't know our drugs, most of the nurses in the O.R. aren't even ACLS Certified.
Most of CRNA comments are either just to insult or complain about having to work for a doctor. In many states the AANA doesn't want to have to be under any doctor. Instead, hundreds of thousands of dollars are spend annually on legal fees to block AA's or to fight the ASA. This isn't a ploy to improve healthcare, it's a ploy to increase the CRNA bank account. Respond HERE
Herman - CRNA Insurance is low because most carriers base the rate on Physician Supervision. Thus, a larger portion of the liability is shifted to the MDA. This is why MDA malpractice averages more than $20,000 per year and CRNA rates are about $3,000 per year. If CRNA "Independent" Practice was the norm then rates for CRNA's would increase significantly. Only a fool believes Nurse Anesthesia is "safer" than MD Anesthesia. The rates reflect Malpractice limits and less "perceived" malpractice exposure for the supervised CRNA.
What would your rate be if insurance carriers based the premium on the "opt-out" law? That is, if the lawyers could not sue the doctor supervising the Nurse what would CRNA premiums run? I suspect at least 2-3 times what you are currently paying. Thus, you are enjoying the best of both worlds right now: Low premiums based on the false assumption of supervision. Ride the wave while it lasts.
The MDA doing his/her own case pays $20,000 per year for malpractice coverage. In my area the rate is more like $4,000 for a CRNA doing the exact same case SOLO. My point is that the insurance companies have not recognized the increased liability of CRNA's doing their own cases without supervision. Most base the malpractice rates on the team model when in fact the CRNA is acting like an MDA. Hence, the best of both worlds comment.
As for Anesthesiologist Assistant's being safer than CRNA's I did not make that statement. Both are mid-level providers whose function is very similar. From an intellectual stand-point, I do not see how an AA with ten years of experience could not do everything as well as a CRNA with ten years. The major difference is that the AAAA is not spewing false propaganda that 27 months of clinical training is equivalent to 4 years of medical school and 4 years of residency. Patients are not better off with a lesser trained provider most of the time. Despite lack of clinical trials, the ASA believes the team model offers patients excellent clinical care provided the MDA is doing his/her job of proper supervision.
Anesthesiology is the Practice of Medicine and will remain such despite the propaganda of the AANA. Just because an experienced surgical technician can do a hernia repair, cataract removal, C-section, etc. does not mean society should allow him to do so. This should be the same for Mid-Level providers in the fields of Anesthesia, Family Medicine, Critical Care, Optometry, etc. Unfortunately, with the cost of health care in the USA being so expensive and the shortage of medical personnel these originations are gaining ground with their MD supervisors in the right to "act alone" in the performance of their duties. The legislatures across the country are giving Mid-Level providers more and more autonomy each year.
Facilities can save money by hiring a CRNA and deleting the MDA supervisor. The facility can use AANA propaganda to justify the action. But, is this for the "benefit" of the patient or the benefit of the CEO.
#1. CRNAs have been doing their "own cases" without MDA supervision for years. The "OP OUT" is just a Medicare issue and has not changed the practice, just the payment.
#2. Do you really believe that insurance companies are so far behind the times that they have missed an opportunity to jack up the rates?
#3. CRNAs have never said they are "equal" to a MDA. What has been said is that CLOSED CLAIMS reviews show that solo vs. team practice has the same percentage of "bad" outcomes. What I proposed is a concurrent study of the various anesthesia modalities to see if one type is better than another. I also said I bet Anesthesiologist Assistants and Certified Registered Nurse Anesthetists are equally safe. But until someone does a valid study, we (you and I) can make all the claims we want.
Now, my point about "independent" CRNA practice still stands as stated: If you want to act like a doctor, get paid like a doctor (Medicare reimburses CRNA's and MDA's the same) then you need to assume the liability of a doctor. Thus, a $4,000 malpractice premium means the insurance company is treating you like a Nurse with a doctor in charge of the case.
I make no statements or claims as to which provider is better/safer in the O.R. But, I do know which provider pays the MOST in malpractice insurance and which one lawyers PREFER to "sue" when possible.
Please do not read into my statements about Independent CRNA practice. Many surgeons recognize the value of a good CRNA and even prefer certain CRNA's over MDA's. But, the liability concern is still there for many of them. They simply do not discuss it openly with most CRNA's. In states without the opt-out law in place the surgeon truly believes that he/she is in charge of the case and any resulting complication is their problem. With another Physician in the room providing Anesthesia they believe that liability is equally shared by both MD's.
Thus, the MDA pays $20,000 per year and the Independent CRNA pays $4,000 per year for malpractice. This differential only "fuels" the surgeon's perceptions about Independent CRNA practice. These beliefs and feelings are why Independent CRNA practice is not the norm in most medical centers and out-patient centers. However, when the cost of the anesthesia provider directly affects the surgeon's income like a Plastic Surgeon's office, Surgeon owned out-patient center, etc. then the added "risk" (perceived not necessarily real) becomes worth it.
Anesthesiologist Assistant's restore the Mid-Level provider back to the position that he/she is truly qualified for; he/she can provide safe anesthesia under the supervision of a Physician trained in Anesthesia.
The ASA truly believes this is the "best" care for patients in the USA. Unfortunately, our legislators do not always have the patient’s best interest in mind when making policy. As you have noted in the past, follow the money trail and in this case the CRNA money trail.
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