Anaesthesiologist Assistant Program

[Trishla]

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Hi everybody,

I'm new here and just wondering if anybody could give some insight regarding future of anaesthesiologist assistant (AA) Program.

I did my research about the program and found out that this is a 2 - 2.25 year Master's program conducted at CWRU cleavland, ohio and Emory univ. Atlanta, just at 2 places in USA and after completing the course, one needs to clear National certification exam and then gradutates can start working in anaesthesia care team under supervision of an anaesthesiologist doctor. But the downside is that only few states like atlanta, alabama n few others allow them to practice.Also I've heard that CRNA's are kind of against this course bcoz as opposed to difficulty in becoming a CRNA, graduate of this course become equivalent to CRNA after just 2 yrs of study n certification.

So i would welcome any valuable suggestions from people already in related fields about the future n the growth or difficulties ahead........
Also i would like to hear how difficult is getting in to this course bcoz i'm not only new to the forum but new to this country too.That's all for now.
Thanks in advance.
Trishla

 

[wickliffe2]

check out www.physicianassociate.com. they'll probably have more info on this than SDN will

 

[timerick]

You may wish to check out Physician Assistant programs in addition to or instead of Anaesthesiologist Assistant programs, if you want a mid-level career in anaesthesiology. PA's can practice in all 50 states, and can do anything that an AA can do, and much more.

 

[jwk]

I am an AA in Atlanta - I want to jump in on some of these threads about AA's so I can provide you with correct information and clear up some common misconceptions about our profession.

An AA is a Master's Degree-trained professional who is a member of the Anesthesia Care Team, along with MD anesthesiologists and nurse anesthetists. On a day-to-day basis, the AA is giving anesthesia in the operating room. In hospitals that employ AA's, they do EXACTLY the same thing as a CRNA, and are paid EXACTLY the same as a CRNA with comparable experience.

An AA is sometimes referred to as an Anesthesia PA. When the PA profession was originally established more than 30 years ago, it was envisioned that there would be a "Type A" PA which is the "general" PA, and the "Type B" PA, which was a specialty PA. AA's fell into that second category, which is why Georgia licenses AA's as a PA. Georgia also licenses specially-trained critical care medicine PA's, although there are very few of those folks remaining. The difference is that AA's train specifically for anesthesia, not a more broad-based training of the general PA. We take coursework in anesthesia-related subjects - we don't take classes in gynecology, psychiatry, and other areas of a more general nature.

It is true that AA's currently practice in about 12-15 states, with half of those licensing them as either AA's or PA's, and the other half work under the umbrella of a physician's delegatory authority as authorized in that particular state's medical practice act. That number will expand. The Florida legislature voted yesterday in favor of AA legislation and practice. More will follow.

CRNA's (as a group / association) don't like us because we represent competition, plain and simple. They have many arguments against us - all of them are bogus. It is true that many AA's do not have clinical experience prior to entering their training. Neither do most PA's. Neither to most MD's and DO's. The only major difference is that we do not practice independent of an anesthesiologist, whereas a CRNA can go work for a dentist or a podiatrist or work in a surgeon's office. AA's will always be a member of the anesthesia care TEAM.

AA's are graduates of AMA and CAHEP approved programs. A third program will open at South University (in association with the Mercer University School of Medicine) in June, 2004. More programs are in the planning stages.

It is incorrect to state that a PA can do anything an AA can. Medicare, Medicaid, and private insurance companies specifically recognize AA's, and may not pay for PA's providing anesthesia. Even if a state would allow a PA to give anesthesia, most malpractice carriers will not, unless that PA has advanced, formal training in anesthesia.

Salary potential for AA's is at the high end of allied health professionals. This year's graduates can expect a first-year income of greater than $100,000 plus benefits, and most have several job offers from which to choose. Depending on the type of practice and compensation structure, the income potential can easily reach the mid-to-high $100's.

I'll go ahead and cut this short, but I'll be more than happy to answer questions you might have.

 

[PainDr]

I have some questions about this profession. If your training, abilities and compensation are identical to CRNA's, why the need for a different type of training program and job title? It seems unnecessary. Why not just go to CRNA school? Please don't flame me, I'm genuinely curious. 😕

 

[jwk]

There are many reasons why someone would choose the AA route instead of CRNA, but the short answer is this:

A person with a science-oriented bachelors degree (biology, physics, engineering, etc.) can go directly into the AA program and come out less than 2.5 years later with a master's degree in anesthesiology, and immediately go to work at a starting salary near or above $100k.

If that same person that already has a degree wants to become a CRNA, they must go back and earn a BSN, then work at least one year in critical care, and then go to CRNA school. That's at least a five-year stint. Obviously a CRNA would disagree, but being a nurse is not necessary to be an anesthetist.

It's a different way of accomplishing pretty much the same thing. We could debate endlessly about why one is better or worse than the other. I can refute every single argument the CRNA's use against AA's, and I'm sure they think their arguments are just as convincing. But in hospitals that use both types of providers, we are all simply anesthetists - same job, same responsibilities, just a different title and licensure.

 

[entpa]

Good info jw. I wasn't at all familiar with your career field, so it's nice to get the straight scoop. I personally haven't met any anesthesia PA's. Are any here? Would love to hear about your job. I've been a PA for 13 yrs now and did an 1yr ENT program three yrs ago. If anyone has questions about ENT give me a yell.

 

[jwk]

AA's are an AMA and CAHEP approved health care profession, but because we cannot sit for the NCCPA exam, we cannot be licensed under PA law in most states. Georgia licenses AA's as a PA. Ohio, Alabama, Missouri, New Mexico, and a couple others license us as AA's. The remaining ones usually operate under a physician's delegatory authority or some other formal arrangement with the state.

You will find large concentrations of AA's in Georgia and Ohio, since that is where the two initial schools are located. In addition to the states mentioned above, we can be found in Texas, South Carolina, Vermont, Michigan, and Colorado.

Assuming Gov. Bush signs the legislation, we will be able to be licensed in Florida in 2004, and are actively pursuing legislation in other states.

 

[JustaPA]

JWK, I'm sure you are aware that the nursing organizations fight the rest of us anytime we make some progress in our professional abilities. I hope that your national organization can work with ours to support each other in the future.

 

[jwk]

JWK, I'm sure you are aware that the nursing organizations fight the rest of us anytime we make some progress in our professional abilities. I hope that your national organization can work with ours to support each other in the future.

Fight? PA's against nurses? Surely you jest. The AANA fights us on an ongoing basis, and they fight the ASA as well. If they devoted more energy to taking care of patients, which is what I'm interested in, we'd get along a lot better.

We actually catch a little grief from the AAPA occasionally about AA's being referred to as PA's, but other than that, no problems. Those who have been doing this long enough know why we are licensed as PA's in Georgia.

 

[bestiller]

Hi everybody,

I'm new here and just wondering if anybody could give some insight regarding future of anaesthesiologist assistant (AA) Program.

I did my research about the program and found out that this is a 2 - 2.25 year Master's program conducted at CWRU cleavland, ohio and Emory univ. Atlanta, just at 2 places in USA and after completing the course, one needs to clear National certification exam and then gradutates can start working in anaesthesia care team under supervision of an anaesthesiologist doctor. But the downside is that only few states like atlanta, alabama n few others allow them to practice.Also I've heard that CRNA's are kind of against this course bcoz as opposed to difficulty in becoming a CRNA, graduate of this course become equivalent to CRNA after just 2 yrs of study n certification.

So i would welcome any valuable suggestions from people already in related fields about the future n the growth or difficulties ahead........
Also i would like to hear how difficult is getting in to this course bcoz i'm not only new to the forum but new to this country too.That's all for now.
Thanks in advance.
Trishla

Trishla, Go either the med school rote or the CRNA route. I know these options are much harder but will be far more worth it. You hit the nail on the head above, it is much easier becoming an AA than a CRNA. The down sides are many to the AA route 1. They are only stautorily licensed in 8 states, so you are really limited in practice locations. 2. Many hospitals in states where they (AAs) can practice write them out of their bylaws anyway forbidding their practice at that facility. 3. Many states currently have proposed legislation outlawing AA practice in those states for safety. 4. If you become an AA you are forever tied to practice w/ an MD anesthesiologist. 5. AAs aren't highly respected by surgeons, who prefer MDs or CRNAs to do their anesthesia. AAs are making the news right now b/c of an anesthesia provider shortage. MD anesthesiologist and CRNAs are being produced like crazy right now and their will soon be a saturated market. When the market saturation comes you will have far more options as an anesthesiologist or a CRNA. CRNAs have been providing anesthesia for over 100 years vs 30 by AAs. CRNAs can stautorily practice in all 50 states vs 8 by AAs. CRNAs can practice independent of anesthesiologist, this is huge, though AAs will tell you it's not. Thats my 2 cents worth

 

[jwk]

Trishla, Go either the med school rote or the CRNA route. I know these options are much harder but will be far more worth it. You hit the nail on the head above, it is much easier becoming an AA than a CRNA. The down sides are many to the AA route 1. They are only stautorily licensed in 8 states, so you are really limited in practice locations. 2. Many hospitals in states where they (AAs) can practice write them out of their bylaws anyway forbidding their practice at that facility. 3. Many states currently have proposed legislation outlawing AA practice in those states for safety. 4. If you become an AA you are forever tied to practice w/ an MD anesthesiologist. 5. AAs aren't highly respected by surgeons, who prefer MDs or CRNAs to do their anesthesia. AAs are making the news right now b/c of an anesthesia provider shortage. MD anesthesiologist and CRNAs are being produced like crazy right now and their will soon be a saturated market. When the market saturation comes you will have far more options as an anesthesiologist or a CRNA. CRNAs have been providing anesthesia for over 100 years vs 30 by AAs. CRNAs can stautorily practice in all 50 states vs 8 by AAs. CRNAs can practice independent of anesthesiologist, this is huge, though AAs will tell you it's not. Thats my 2 cents worth

Bestiller, you must be searching all the threads so you can flame AA's in each and every one where we are mentioned.

The only true statements above are #1 and #4 - AA's are currently limited in the number of states in which they may practice. AA's practice under the anesthesia care team practice model - always have, always will, and knew it going in. No new news here. The other statements are incorrect and/or unsubstantiated.

#2 - Cite me even one hospital in states where AA's are practicing that has them specifically prohibited in their bylaws. Obviously the hospital would have to have an anesthesiologist on staff for an AA to practice there.

#3 - One state has proposed banning AA's - Louisiana - with an entirely self-serving piece of legislation offered by our opponents. As of this writing, it has not been signed into law. It has nothing to do with patient safety and everything to do with competition. Can you name even one more state? Nope!

#5 - Where on earth did you come up with this statement? AA's are highly respected by the surgeons they work with. Again, cite me even one example where a surgeon who has actually worked with AA's (not just heard about them) prefers an MD or CRNA and specifically does NOT want an AA.

You're long on flaming and misrepresentations, and short on facts.

 

[Lonestar]

I will be a practicing anesthesiologist in the state of Georgia in the near future. I can tell from what I have seen in private practice that there is NO difference between nurse anesthetists and PAs in terms of getting job offers. I think in the future the PAs will be more of a wanted comodity simply because they want to be part of the anesthesia care team rather than trying to go it alone. I have worked with many anesthesiology assistants and I find them very knowledgeable and hardworking. I also got along with the nurses, but it seemed to me that there was definitely a "us vs them" mentality. Now, currently I am starting my residency, but once I get out I plan on joining a group that atleast hires PAs. They simply impressed me when I did an anesthsiology rotation in med school.

To jwk: where is this South university you are referring to. I know that Mercer Univ School of Medicine is in Macon.

 

[jwk]

To jwk: where is this South university you are referring to. I know that Mercer Univ School of Medicine is in Macon.

South University is in Savannah. The program is a cooperative effort with Mercer and South Univ. Much of the early clinical work will be at Memorial Hospital in Savannah, which is a major teaching affiliate of Mercer. Later clinical rotations in the senior year will be at several other facilities, much as the Emory and Case programs.

 

[bestiller]

I will be a practicing anesthesiologist in the state of Georgia in the near future. I can tell from what I have seen in private practice that there is NO difference between nurse anesthetists and PAs in terms of getting job offers. I think in the future the PAs will be more of a wanted comodity simply because they want to be part of the anesthesia care team rather than trying to go it alone. I have worked with many anesthesiology assistants and I find them very knowledgeable and hardworking. I also got along with the nurses, but it seemed to me that there was definitely a "us vs them" mentality. Now, currently I am starting my residency, but once I get out I plan on joining a group that atleast hires PAs. They simply impressed me when I did an anesthsiology rotation in med school.

To jwk: where is this South university you are referring to. I know that Mercer Univ School of Medicine is in Macon.

Lonestar, being a resident a can see that you have a handle on the politics, but I will tell you why there is a DIFFERENCE on the $money side for MDs b/t CRNAs & AAs. JWK is so busy blowing his equality horn he is missing the ugly truth. CRNAs are beating AAs in GA due to the ability of the MDA to bill for the CRNA as "non medically directed" which means the MDA does not have to adhere to those pesky TEFRA regulations for reimbursement, when billing in this manner when working w/ a CRNA. It may not make sense to you at the moment but, when you get out in the private sector the almighty $ rules and those TEFRA REGULATIONS are a bitch. Thats why AAs have had virtually no effect in GA. When an MDA supervises AAs they must be "medically directed", you would be amazed at how many anesthesiologists put their political views aside b/c of this $ money issue.

 

[jwk]

Lonestar, being a resident a can see that you have a handle on the politics, but I will tell you why there is a DIFFERENCE on the $money side for MDs b/t CRNAs & AAs. JWK is so busy blowing his equality horn he is missing the ugly truth. CRNAs are beating AAs in GA due to the ability of the MDA to bill for the CRNA as "non medically directed" which means the MDA does not have to adhere to those pesky TEFRA regulations for reimbursement, when billing in this manner when working w/ a CRNA. It may not make sense to you at the moment but, when you get out in the private sector the almighty $ rules and those TEFRA REGULATIONS are a bitch. Thats why AAs have had virtually no effect in GA. When an MDA supervises AAs they must be "medically directed", you would be amazed at how many anesthesiologists put their political views aside b/c of this $ money issue.

There are lots of true ACT practices in Georgia, and lots of AA's. I'm not sure where you figure "CRNA's are beating AA's in Georgia" and under what criteria you make that statement. And AA's have had "virtually no effect in GA" ? What does that even mean?

Emory graduates on the order of 25-30 new AA's each year, and the first South University class just started their coursework in Savannah

Many hospitals in Georgia have AA's. Most of the major hospitals in Atlanta, Columbus, Macon, Albany, Savannah, and Rome have several. AA's outnumber CRNA's in some practices, and some are MDA/AA only practices. AA's are chief anesthetists at several of the largest and busiest hospitals in Georgia.

 

[bestiller]

There are lots of true ACT practices in Georgia, and lots of AA's. I'm not sure where you figure "CRNA's are beating AA's in Georgia" and under what criteria you make that statement. And AA's have had "virtually no effect in GA" ? What does that even mean?

Emory graduates on the order of 25-30 new AA's each year, and the first South University class just started their coursework in Savannah

Many hospitals in Georgia have AA's. Most of the major hospitals in Atlanta, Columbus, Macon, Albany, Savannah, and Rome have several. AA's outnumber CRNA's in some practices, and some are MDA/AA only practices. AA's are chief anesthetists at several of the largest and busiest hospitals in Georgia.

That's all very nice JW but, the point of my post was "medically directed vs non-medically directed" as it relates to TEFRA Regulations and the $ money & time advantages to the MDA to bill "non-medically directed". Which is the AAs Achilles heel. Sure there are many fanatics who adhere to the ACT in Ga. afterall, it is the Mecca for AAs. As long as the money is good in anesthesia there will be an endless supply of ambulance drivers and PE coaches in Ga, who are tired of selling Amway on the side to make ends meet, and will jump at the chance to be AAs.

 

[deleted6669]

"As long as the money is good in anesthesia there will be an endless supply of ambulance drivers and PE coaches in Ga, who are tired of selling Amway on the side to make ends meet, and will jump at the chance to be AAs."

DUDE (dudette?)....that's a little harsh...why don't you guys just agree to disagree and settle on the fact that there are 2 different classes of midlevel provider who pass gas, each with their own advantages and disadvantages....
crna's have the independence option and aa's who were pa's first( as many are) can work outside of the anesthesia field to work inpt medicine,icu, etc

 

[jwk]

That's all very nice JW but, the point of my post was "medically directed vs non-medically directed" as it relates to TEFRA Regulations and the $ money & time advantages to the MDA to bill "non-medically directed". Which is the AAs Achilles heel. Sure there are many fanatics who adhere to the ACT in Ga. afterall, it is the Mecca for AAs. As long as the money is good in anesthesia there will be an endless supply of ambulance drivers and PE coaches in Ga, who are tired of selling Amway on the side to make ends meet, and will jump at the chance to be AAs.

Still waiting for responses from message #12 in this thread.

Update for AA legislation:

Louisiana governor signed legislation banning AA's for now. Trust me, that battle is far from over.

Florida governor signed legislation authorizing AA's effective July 1st.

TriCare approves AA's effective June 1st.

 

[bestiller]

Still waiting for responses from message #12 in this thread.

Update for AA legislation:

Louisiana governor signed legislation banning AA's for now. Trust me, that battle is far from over.

Florida governor signed legislation authorizing AA's effective July 1st.

TriCare approves AA's effective June 1st.

JW, It is a fact that in many states where AAs are licensed, there are many facilities that do not have MDAs in house 24/7, and hence, would not be available to watch an AA. As a result, AAs are not included in/or written out of the bylaws for those facilities. An MDA 24/7 can make for an expensive baby-sitter.
I noted both LA nd FL laws. I won't lose sleep over either one. Interesting that you see the LA law as self serving and not the FL. I see the FL law as an attempt by a group to legislate what they could not earn academically. If a state told me "we think your education is suspect, your a political pawn, and you suck," which is basically what the LA law says, I would say "fine you will never see 1 cent of my tax $dollars, we've been around 30 years and have already amassed 1000 AAs that will bring you to your knees by boycotting your state!"
Won't lose any sleep over the TRICARE ruling either, AAs can practice at VA/DOD facilities in states that they are already licensed in?(correct me if I'm wrong). I can definitely see how a fledgling profession would see that as a moral victory though. A good thing about the TRICARE ruling for AAs is that they will never have to be deployed to a combat zone. It's interesting who Uncle Sam chooses to send to the frontline. 🙂

 

[jwk]

JW, It is a fact that in many states where AAs are licensed, there are many facilities that do not have MDAs in house 24/7, and hence, would not be available to watch an AA. As a result, AAs are not included in/or written out of the bylaws for those facilities. An MDA 24/7 can make for an expensive baby-sitter.
I noted both LA nd FL laws. I won't lose sleep over either one. Interesting that you see the LA law as self serving and not the FL. I see the FL law as an attempt by a group to legislate what they could not earn academically. If a state told me "we think your education is suspect, your a political pawn, and you suck," which is basically what the LA law says, I would say "fine you will never see 1 cent of my tax $dollars, we've been around 30 years and have already amassed 1000 AAs that will bring you to your knees by boycotting your state!"
Won't lose any sleep over the TRICARE ruling either, AAs can practice at VA/DOD facilities in states that they are already licensed in?(correct me if I'm wrong). I can definitely see how a fledgling profession would see that as a moral victory though. A good thing about the TRICARE ruling for AAs is that they will never have to be deployed to a combat zone. It's interesting who Uncle Sam chooses to send to the frontline. 🙂

Funny, the AANA spent a TON of money fighting us on the TriCare issue, including that fancy ad in Stars and Stripes, so obviously someone was losing sleep over it.

I'm not sure how much was spent in Louisiana, but I'm sure it was significant. I'm sure some of the language of the bill was directly quoted from some of the propaganda fed to the legislature. There certainly weren't any original thoughts expressed in the bill.

Rules and laws can change. Legislation allowing AA practice didn't make it through this year, but it could next year. And don't be so sure about AA's being utilized in the military - sooner or later that will happen as well.

 

[r90t]

The Tricare ruling would be a significant victory for AA, since it would = $$$. To simplify Tricare pays civilian providers for outside of military facility health care services. Thus, if they recognize an AA as a provider, he/she can bill for services.

Tricare has nothing to do with picking providers for the military's frontline.

 

[jwk]

The Tricare ruling would be a significant victory for AA, since it would = $$$. To simplify Tricare pays civilian providers for outside of military facility health care services. Thus, if they recognize an AA as a provider, he/she can bill for services.

Tricare has nothing to do with picking providers for the military's frontline.

TriCare is accepting AA's as providers as of 6/1/04.