The Perfect Storm is coming....

[rev ronin]

Um, in 2012 when I was doing my primary care rotation in Forks, WA (yeah, yeah, Twilight jokes...) there were two CRNAs that worked 2 weeks on, 2 off, and that was it for the CAH's anesthesia department.  Independent CRNAs are not a new development.

[EMEDPA]

all 4 of the rural hospitals I work for in OR and WA staff only CRNAs, Have never seen an MD anesthesiologist at any of them. 

[CookiePA]

I am not too aware of the curriculum differences between the two. What is the point that CRNAs are using: is the  needing ICU bedside experience??

I am assuming alot of is just politics and not the actual study material? If we are allowing NPs to practice freely out the door why cant AA use that same example and “learn on the job” under supervision and be independent after? 
 

[LT_Oneal_PAC]

34 minutes ago, CookiePA said:

I am not too aware of the curriculum differences between the two. What is the point that CRNAs are using: is the  needing ICU bedside experience??

I am assuming alot of is just politics and not the actual study material? If we are allowing NPs to practice freely out the door why cant AA use that same example and “learn on the job” under supervision and be independent after? 
 

Agree that AA is a equivalent provider to CRNA. I’ve not been involved in AA curriculum, but I have been for CRNA. They likely could be an independent provider similar to CRNA. 
 

we can’t draw direct comparisons to NP/PA legislation as they were created at approximately the same time and came up together. Nurse anesthesia however was around before even MDs were doing anesthesia. AAs didn’t come around until the 70s and one could make an argument they were created as a tool to disrupt the CRNA hold on the market for a provider that could be more controlled by MD anesthesia. I’m don’t think that was the original intent, but I think in a way they have become that. If they were to give more autonomy to AAs, as they cannot practice without a anesthesiologist outside the building, I’d be more inclined to believe they were actually promoting their use for better access to care. As it is, there is not a shortage of anesthesia providers in the areas they allow AAs to practice, which is typically large or academic centers that have an MD in house 24/7. It’s the rural areas that are having the shortages. Unfortunately I do not think any AAs have advocated for this.

this is why I have been hesitant to “bring them into the fold,” so to speak, as they do not seem to share our passion for expanded practice. It wasn’t but a few years ago they tried to squeeze in AAs under PA legislation in Texas, which would have actually increased supervision of PAs there. I remember @sas5814 being against it as well and may remember better being his state. This is similar to the rift between CRNAs and NPs back in the day. NPs, even as recent as my time in anesthesia, were not wanting to push for expanded practice like CRNAs. In fact, I believe in the 80s they actively fought with CRNAs and undermined them legislatively. There was bad blood between them for a long time and CRNAs broke off into the AANA instead of being part of the larger NP groups.

 

as far as the ICU experience, this is also a point of contention amongst themselves. The requirement is actually 1 year “acute care” experience. Schools are allowed to determine this and have accepted ER nurses and other experiences. The military pulls from an even broader range. The former program director for the Army CRNA program, Michael Benton, was a high risk OB nurse. 

[CookiePA]

Thank you for the detail post and pointing out facts throughout history! Much appreciated!

[KpsPac]

11 hours ago, LT_Oneal_PAC said:

this is why I have been hesitant to “bring them into the fold,” so to speak, as they do not seem to share our passion for expanded practice. It wasn’t but a few years ago they tried to squeeze in AAs under PA legislation in Texas, which would have actually increased supervision of PAs there. 

I don’t blame you. I help initiate the grassroots efforts in Texas to keep AAs from being governed by the PA board. Our endeavors help successfully defeat the bill. 

Of course, AAs took offense, or were defensive, whichever way you look at it.  I was quite surprised at how much the AAs feel if they are “just like us“ yet feel they are true “assistants”. 

[bldavi2]

On 4/14/2020 at 10:02 PM, bobuddy said:

Cideous - I agree with your post.    

I am the current President of KAPA - and have been on the board for 5 years.   In KY we have less than 10% membership to KAPA and struggle to do the basic things - like pay a lobbyist.    This past year, we were finally successful in getting privileges for prescribing controlled medications but only III-V.  We were the last state to get CS prescriptions and it took us over 10 years to accomplish this.     

Eight years ago, our rural private practice joined with a larger corporate clinic in a larger city.    I saw the writing on the wall with our profession at that time and looked into going back to school for the NP.     I could not justify the cost and the time away from the job (making a paycheck) to do exactly what I was already doing.    I chose to join the board of KAPA to see how to make a difference.  

I was furloughed several weeks ago along with about 100 other APP's at our clinic.   There is no time limit on the furlough ending and all other job leads have dried up.    I am even having trouble finding places to work that are in the thick of COVID - they want nurses but not APP's.    At least the NP's can fall back on nursing jobs.   I am at a crossroads of what to do/where to go from here.   I am currently back to researching taking a year off - doing an accelerated second degree BSN and then working as a PA (if I can find a job) while doing online NP degree.      I am 53 years old - too young to retire, too old to go to medical school and take on a ridiculous amount of debt.    

 

I am a PA practicing in KY since graduation and I agree it has been rough. I am totally for making membership to KAPA mandatory. The most common response I get when I ask people why they aren’t members is because “they forgot or haven’t gotten around to it”. And the cost is irrelevant. It is reimbursed by employers. These same ppl never forget to Renew their state license or certification fees because they would no longer be able to practice...and they as well are reimbursable by employer. There needs to be a “campaign” of sorts because if I didn’t  seek out KAPA on my own I wouldn’t have known it existed. The organization needs to be more visible, in our faces then people would forget. Maybe develop a relationship with the state universities and largest hospital groups and have a KAPA liaison with an employed PA of those respective places. Hell the hospital I work as a hospitalist won’t even allow PAs to work in the ICU and I am one of the first three PAs to work in the hospitalist service cuz I opened my big mouth and applied for an “NP” position.

 

otherwise let’s quit kicking the mandatory ideas around and do it already.

 

we really appreciate the hard work and time it took to get us this far but to see that our own president is about to give up and become an NP is scary!

[bobuddy]

6 hours ago, bldavi2 said:

I am a PA practicing in KY since graduation and I agree it has been rough. I am totally for making membership to KAPA mandatory. The most common response I get when I ask people why they aren’t members is because “they forgot or haven’t gotten around to it”. And the cost is irrelevant. It is reimbursed by employers. These same ppl never forget to Renew their state license or certification fees because they would no longer be able to practice...and they as well are reimbursable by employer. There needs to be a “campaign” of sorts because if I didn’t  seek out KAPA on my own I wouldn’t have known it existed. The organization needs to be more visible, in our faces then people would forget. Maybe develop a relationship with the state universities and largest hospital groups and have a KAPA liaison with an employed PA of those respective places. Hell the hospital I work as a hospitalist won’t even allow PAs to work in the ICU and I am one of the first three PAs to work in the hospitalist service cuz I opened my big mouth and applied for an “NP” position.

 

otherwise let’s quit kicking the mandatory ideas around and do it already.

 

we really appreciate the hard work and time it took to get us this far but to see that our own president is about to give up and become an NP is scary!

Bldavi2 -  Thank you for your support with KAPA and I love hearing your conviction and energy.    I do think your idea of having a liaison for every large hospital/group is great.  Now we just need to identify the people that can take on this responsibility.   

 It might sound easy to make membership mandatory - but what we are finding is that is is not so simple.    This is an ongoing discussion.    

 When I was a student - UK made it mandatory for their students to join and participate in the annual CME conference.  They stopped this requirement although several other schools in the state do make it mandatory for their students.  This year, the UK students had a scheduling conflict with Lobby Day - and they actually made such a stink - they got things changed around so they could attend.   We were very grateful for their determination and they actually got to see our/their  bill pass on the House floor the same day.   

  KAPA is very active on social media and at least in central KY (Lexington area) - we try to do dinner programs at least once a month.     If you are not receiving emails from us  - please, please, please let me know.     In our last board meeting, we had a discussion of cutting down the monthly dinner programs due to poor attendance ( only a handful of practicing PA's would attend) and every time we sent out invitations - we would get back 5 or 6 "unsubscribe" responses.     I am not sure what more KAPA can do to be in people's faces.  If you have ideas, we would love to have you on our board or any of the open committees that we have.    We are currently taking nominations for board positions - you can even self nominate!     If you have not received information regarding open positions - again, please let me know.  

Laurie

 

 

[bldavi2]

On 4/20/2020 at 9:19 PM, bobuddy said:

Bldavi2 -  Thank you for your support with KAPA and I love hearing your conviction and energy.    I do think your idea of having a liaison for every large hospital/group is great.  Now we just need to identify the people that can take on this responsibility.   

 It might sound easy to make membership mandatory - but what we are finding is that is is not so simple.    This is an ongoing discussion.    

 When I was a student - UK made it mandatory for their students to join and participate in the annual CME conference.  They stopped this requirement although several other schools in the state do make it mandatory for their students.  This year, the UK students had a scheduling conflict with Lobby Day - and they actually made such a stink - they got things changed around so they could attend.   We were very grateful for their determination and they actually got to see our/their  bill pass on the House floor the same day.   

  KAPA is very active on social media and at least in central KY (Lexington area) - we try to do dinner programs at least once a month.     If you are not receiving emails from us  - please, please, please let me know.     In our last board meeting, we had a discussion of cutting down the monthly dinner programs due to poor attendance ( only a handful of practicing PA's would attend) and every time we sent out invitations - we would get back 5 or 6 "unsubscribe" responses.     I am not sure what more KAPA can do to be in people's faces.  If you have ideas, we would love to have you on our board or any of the open committees that we have.    We are currently taking nominations for board positions - you can even self nominate!     If you have not received information regarding open positions - again, please let me know.  

Laurie

 

 

I get most of the emails but unfortunately have only ever worked night shift so it can be tough to make it to some things. I do encourage and remind all my PA friends and colleagues  to join KAPA and I’m pretty sure I’m responsible for at least 15 memberships lol. I go to the KAPA conference every year and I donate yearly with my chapter renewal. I however know and understand little about the legislative side of things and feel like I’m under qualified to fill any of those positions...and I think that is the sentiment of A LOT of people. Lastly, I wonder if there is a way to reach non KAPA members and explain to them the dire need of membership? I have a lot of questions and random ideas but would feel like I lack the insight or knowledge of logistics to carry those things out. Keep fighting the fight and if there’s anything for the very  inexperienced to help with please let us know. I have faith that once this calms down you will find employment as a PA!!

Edited April 25, 2020 by bldavi2