Utah House of Representatives are currently in session. And they have a bill in their hands that is so important to me and my family. It's hard, and frustrating, to watch from a thousand miles away while a bunch of politians and lobbyists decide whether or not your husband's profession can practice in Utah. There isn't a whole lot we can do. Since we don't live in Utah, we can't write "our" representative. We don't have one. So basically, I am asking anyone and everyone who is willing to take a second to ask their reps to support HB 109.
House Bill 109 would allow Anesthesiologist Assistants (AAs) to be licensed and practice in Utah. This does not mean that any hospital or anesthesiologist or anyone for that matter, has to HIRE AAs. It simply allows for the option. I am almost flabbergasted that this is even a hard bill to pass. But sure enough, it is. In fact, this is the fourth year that HB 109 has been proposed for Utah law. So, you might wonder, why hasn't it passed? The answer is simple. Nurse anesthetists. As a group, they have large lobbying power and put lots of money into political activism. They are a tough group to recon with. AAs are essentially job competition for CRNAs. And that my friends is where the political battle begins. And because I would never ask you to blindly support a bill, here are the facts regarding AAs.
The duties of AAs are identical to those of Certified
Registered Nurse Anesthetists (CRNA’s), despite different educational
backgrounds. In providing assistance to
a supervising anesthesiologist, AA’s are trained to:
-
Assist the supervising anesthesiologist in
developing and implementing an anesthesia care plan for a patient;
-
Obtain a comprehensive patient history, perform
relevant elements of a physical exam, and present the history to the
supervising anesthesiologist;
-
Pretest and calibrate anesthesia delivery
systems and obtain and interpret information from the systems and monitors;
-
Assist the supervising anesthesiologist with the
implementation of monitoring techniques;
-
Establish basic and advanced airway
interventions, including intubation of the trachea and performing ventilatory
support;
-
Administer intermittent vasoactive drugs and
start and adjust vasoactive infusions;
-
Administer anesthetic drugs, adjuvant drugs, and
accessory drugs;
-
Perform epidural anesthetic procedures, spinal
anesthetic procedures, and other regional anesthetic techniques under the
direction of the supervising anesthesiologist;
-
Administer blood, blood products, and supportive
fluids;
-
Provide assistance to a cardiopulmonary
resuscitation team in response to life-threatening situations
Opponents of this bill argue:
- They have no prior healthcare experience
Although AA's are not required to have
previous healthcare experience before acceptance to an accredited AA program,
the majority of AA students do have healthcare experience nonetheless.
Anesthesia technicians, phlebotomists and even nurses are common applicants to
AA school. Physicians are also not
required to have previous healthcare experience prior to medical school, yet
during their training they gain the experience needed to become our healthcare
professionals. Similarly, AA’s gain
sufficient healthcare experience during their training to be effective and safe
anesthesia providers. AA programs vary from 24-27 months with a minimum of 2,500 clinical hours.
- They can be admitted to AA school with any
degree
Most AA students
have received a bachelor's degree in a field of science. Some have received a
non-science degree. However, all AA students are required to take pre-medical
coursework, including the MCAT and/or GRE, just as medical school students are
required to do. Acceptance to AA school
is very competitive; in fact it is comparable to medical school. Physicians are
also able to receive bachelor’s degrees in non-science fields prior to medical
school, yet they are our healthcare professionals. The AA profession was designed to implement mid-level anesthesia providers into an anesthesia care team (ACT) that could go directly to medical school if necessary. It is not uncommon for AA's to continue their education and become physicians.
- They are not able to work independently
The AA profession has been around for just
over 40 years, whereas the CRNA profession began in the late 19th century. In over 150 years, with over 35 times as many
CRNA's as AA's, nurse anesthetists have been able to lobby for independent
practice for quite some time. They can now work independently in 17 states. Although AA's are as qualified as CRNA's to
administer anesthesia, AA's do not seek independence as they believe it is
important to work as a team under the supervision of a qualified
anesthesiologist who has received a medical degree. Being able to work independently is proof of
successful lobbying, rather than exceptional ability.
-The AA education is inferior to that of Certified Registered Nurse
Anesthetists (CRNAs)
The AA curriculum
is taught by both practicing AA's as well as anesthesiologists at an accredited
medical school and includes both didactic and clinical programs. The curriculum
is reviewed by the CAAHEP and must pass stringent requirements. Program lengths can vary from 24-27 months and include a minimum of 2,500 clinical hours. Clincial rotations include cardiac, pediatric, obstetrics, regional anesthesia, trauma, etc.
AA’s have proven to be safe and efficient mid-level
healthcare providers (you can look at the link below to see a study that proves as much). Our purpose is not to suggest that CRNA's are not qualified to administer anesthesia. We know and are friends with many CRNA's and they do a fantastic job. We are expressing our concern that some people are spreading false perceptions (to our lawmakers) of AA's as being unqualified to administer anesthesia and keeping them out of Utah because of job competition.
http://www.lrc.ky.gov/lrcpubs/RR337.pdf