Anesthesiologist Assistant (AA) questions

core0 · Jun 19, 2010

HenryH said:
core0 said:

But you'd need both an AA degree and a PA degree and not an AA degree combined with an NP degree, right?

Click to expand...

In theory you could do it with a AA and ACNP degree. The issue could be with the BON. I could easily see a complaint against your nursing license because the practice of anesthesia is in the scope of the CRNA. There are a few PA/NPs out there and they usually choose either the PA or NP in a given state so they don't have to worry about both boards.

David Carpenter, PA-C

pakster429 · Oct 21, 2010

I just got done reading almost ALL the posts on these 3 pages - I really appreciate all the useful info memebers are posting here.

However I still have some further questions that I couldn't really find answers to from sources on the internet (or in the previous posts). Anyone with actual insight, please take few minutes to answe them =]

1. Do AAs take out malpractice insurance? (I know this was asked on the first page, but no one really gave a definitive answer). If so, how much do they normaly pay for it?

2. How much of a difference does volunteering makes? I mean in terms of lenght. Does volunteering for a year at a hospital really have a significant advantage compare o volunteering for lets say 3 months?

3. How do u exactly go about job shadowing? Do u contact the anesthesia department of the hospital? I recently contacted 3 hospitals in my area and neither one of them had a job shadowing program for anesthesia. So I'm having a hard time finding a hospital in my area to job shadow.

4. Lastly, and this is particularly for someone who was/is an administrator in one of the AA programs, or is/was contacted to an AA program in any of the schools - can you please give an honest assesment as to what my chances are of getting into an AA program? Here's a snap shot of my profile...
-graduated with a BS in 07 with a 2.5 gpa (I know, i was a extremly bad student. I made mistakes... but I learned)
-currently i'm taking the pre-reqs for the AA programs and i'm done with all except biochem and cell bio. my current gpa in all the pre-reqs is 3.7
-I just took my GRE a month ago and scored 1130 (its my 2nd try. my previous, a year go, was 1050)
-I don't have any healthcare PAID experience but I have been volunteering at a hospital for almost 4 months now.

Sorry, I know the post is kind of long, but any honest insight would be much appreciated.

Denatured · Oct 21, 2010

pakster429 said:
I just got done reading almost ALL the posts on these 3 pages - I really appreciate all the useful info memebers are posting here.

However I still have some further questions that I couldn't really find answers to from sources on the internet (or in the previous posts). Anyone with actual insight, please take few minutes to answe them =]

1. Do AAs take out malpractice insurance? (I know this was asked on the first page, but no one really gave a definitive answer). If so, how much do they normaly pay for it? Yes, and it is usually paid for by the group as part of a benefit package.

2. How much of a difference does volunteering makes? I mean in terms of lenght. Does volunteering for a year at a hospital really have a significant advantage compare o volunteering for lets say 3 months? Can't help you on that one. Don't know enough about it. But I imagine it's of minor significance.

3. How do u exactly go about job shadowing? Do u contact the anesthesia department of the hospital? I recently contacted 3 hospitals in my area and neither one of them had a job shadowing program for anesthesia. So I'm having a hard time finding a hospital in my area to job shadow. You either have to find someone you know or just make cold calls/emails to anesthesia departments and people in those departments.

4. Lastly, and this is particularly for someone who was/is an administrator in one of the AA programs, or is/was contacted to an AA program in any of the schools - can you please give an honest assesment as to what my chances are of getting into an AA program? Here's a snap shot of my profile...
-graduated with a BS in 07 with a 2.5 gpa (I know, i was a extremly bad student. I made mistakes... but I learned)
-currently i'm taking the pre-reqs for the AA programs and i'm done with all except biochem and cell bio. my current gpa in all the pre-reqs is 3.7
-I just took my GRE a month ago and scored 1130 (its my 2nd try. my previous, a year go, was 1050)
-I don't have any healthcare PAID experience but I have been volunteering at a hospital for almost 4 months now.

Sorry, I know the post is kind of long, but any honest insight would be much appreciated.

answer in bold

AegriSomnia · Oct 22, 2010

pakster429 said:
I just got done reading almost ALL the posts on these 3 pages - I really appreciate all the useful info memebers are posting here.

However I still have some further questions that I couldn't really find answers to from sources on the internet (or in the previous posts). Anyone with actual insight, please take few minutes to answe them =]

1. Do AAs take out malpractice insurance? (I know this was asked on the first page, but no one really gave a definitive answer). If so, how much do they normaly pay for it?

2. How much of a difference does volunteering makes? I mean in terms of lenght. Does volunteering for a year at a hospital really have a significant advantage compare o volunteering for lets say 3 months?

3. How do u exactly go about job shadowing? Do u contact the anesthesia department of the hospital? I recently contacted 3 hospitals in my area and neither one of them had a job shadowing program for anesthesia. So I'm having a hard time finding a hospital in my area to job shadow.

4. Lastly, and this is particularly for someone who was/is an administrator in one of the AA programs, or is/was contacted to an AA program in any of the schools - can you please give an honest assesment as to what my chances are of getting into an AA program? Here's a snap shot of my profile...
-graduated with a BS in 07 with a 2.5 gpa (I know, i was a extremly bad student. I made mistakes... but I learned)
-currently i'm taking the pre-reqs for the AA programs and i'm done with all except biochem and cell bio. my current gpa in all the pre-reqs is 3.7
-I just took my GRE a month ago and scored 1130 (its my 2nd try. my previous, a year go, was 1050)
-I don't have any healthcare PAID experience but I have been volunteering at a hospital for almost 4 months now.

Sorry, I know the post is kind of long, but any honest insight would be much appreciated.

The only problem I see is that you undergrad GPA is low. Even with doing well on your premed classes I don't think that it would pull up your overall GPA to a 3.0. Most graduate schools require at least a 3.0 overall GPA for admissions. You may have to retake some of your classes to pull that GPA up to the 3.0 mark and then hope that the programs will look at your recent coursework as evidence of your motivation to be an AA and to be able to complete the program.

pakster429 · Oct 22, 2010

Thanks Denatured and AegriSomnia for replying.

Denatured, when you said "paid for by the group as part of a benefit package" - by group do you mean the employer? And if it's part of the benefits, the money isn't taken out of your net pay right?

Aegrisomnia, that's what really concerns me too. You actually reminded me of something that me and a buddy of mine were talking about the other day. Do you know how exactly schools count your overall gpa? Do they take alll the classes you have ever taken in college, put em in one pile and get the overall gpa that way?
His case is also similar to mine, (as far as the undergrad gpa) but he did go to graduate school and got a masters in business (gpa 3.4) - Can't find a job for almost a year now so he's also seriously looking into AA programs.

And to your second point, I don't think i can go back and take any of the classes over again since I already have my degree. I mean, once you graduate, isn't that your final gpa?
I'm really hoping that all the time and effort I'm putting towards this now will bring my overall gpa to 3.0 or above

Anyone else with any helpful input, please feel free to jump in.

Denatured · Oct 23, 2010

Yes, paid for by the employer. I'm not sure what you mean by "taken out of your net pay." all benefits reduce your pay. If you work 1099 instead of W2 then you get no benefits but a much more significant pay.

BTW, i know of one AA school that takes 2.75 gpa.

AegriSomnia · Oct 23, 2010

Pakster, you're going to have to bring that GPA up to a 3.0 just to be considered for admissions as there is a cut off at that point. It shouldn't be a problem to retake some courses that you did particularly bad in during your undergrad to lift your GPA. I think most schools only consider the newer grade. You are really going to have play up that you're really motivated to be an AA by doing lots of volunteer work and that maybe you had some extenuating circumstances during your undergrad. I'm not exactly sure what the average GPA for my class is but its probably around the 3.4 to 3.5 area.

AegriSomnia · Oct 23, 2010

Denatured said:
Yes, paid for by the employer. I'm not sure what you mean by "taken out of your net pay." all benefits reduce your pay. If you work 1099 instead of W2 then you get no benefits but a much more significant pay.

BTW, i know of one AA school that takes 2.75 gpa.

Really? When I applied to schools everyone wanted a minimum of a 3.0 and everyone that was accepted was well over that, at least at my program. If someone got in with a 2.75 they must've had some other big things going for them.

PharmBound2011 · Oct 23, 2010

Denatured said:
BTW, i know of one AA school that takes 2.75 gpa.

umm...what school, care to elaborate? are you an NP or CRNA?

pakster429 · Oct 23, 2010

AegriSomnia said:
Pakster, you're going to have to bring that GPA up to a 3.0 just to be considered for admissions as there is a cut off at that point. It shouldn't be a problem to retake some courses that you did particularly bad in during your undergrad to lift your GPA. I think most schools only consider the newer grade. You are really going to have play up that you're really motivated to be an AA by doing lots of volunteer work and that maybe you had some extenuating circumstances during your undergrad. I'm not exactly sure what the average GPA for my class is but its probably around the 3.4 to 3.5 area.

Yea I realize that. I'm trying to figure out where my overall gpa stands.
Are you currently in a AA school?
Can I ask you what your gpa and GRE/MCAT scores were when you applied? And which schools you got into?

Denatured · Oct 23, 2010

PharmBound2011 said:
umm...what school, care to elaborate? are you an NP or CRNA?

Nova and Emory both state a 2.75 GPA is the minimum requirements. Maybe more but those are just the first ones on a google search. The preferred is 3.2 and 3.1 respectively.

I am neither. Why would you ask that? Just because I said the minimum is a 2.75? Its just a fact and trying to help the guy out. I've researched alot of careers. PA, NP, AA, CRNA. Whatever I become, I remain unbiased. I've seen every profession in healthcare talk out of both sides of their mouth and I just go with my own research. I'm sure there are a couple of CRNA schools that have a 2.75 GPA minimum with the preferred being much higher as well, if that makes you feel better.

AegriSomnia · Oct 24, 2010

Denatured said:
Nova and Emory both state a 2.75 GPA is the minimum requirements. Maybe more but those are just the first ones on a google search. The preferred is 3.2 and 3.1 respectively.

I am neither. Why would you ask that? Just because I said the minimum is a 2.75? Its just a fact and trying to help the guy out. I've researched alot of careers. PA, NP, AA, CRNA. Whatever I become, I remain unbiased. I've seen every profession in healthcare talk out of both sides of their mouth and I just go with my own research. I'm sure there are a couple of CRNA schools that have a 2.75 GPA minimum with the preferred being much higher as well, if that makes you feel better.

That minimum preferred GPA is the key here as the 2.75 is the grad schools cut off point for admissions while the preferred GPA is the real cutoff. There may be individual exceptions here and there but I go to one of those programs and I don't know anyone in my class that has below a 3.3.

pakster429 · Oct 24, 2010

If someone doesn't know what the required and the preferred gpas are for each one of the handful of AA schools, and aren't able to find it on the school's website, they probably don't belong in a graduate program.

Secondly, Aegrisomina, just as you are being quite stingy about giving any details regarding everything from your school, gpa, gre scores, i'm pretty everyone that you know there isn't being the most honest when they tell you their gpa.

Regardless, if anyone wants to find out the average gpa for the last couple of classes that got accepted to an AA program - some schools do lists those stats.

I'm simply trying to find out how AA schools look at your gpa. Do they look at your graduate gpa too (for those who have a graduate degree) or is it just the undergrad that they care about?
For someone who didn't take most of the prereqs for AA programs in their undergrad degree, and is taking them now, how do they calculate the gpa you have in those classes with your undergrad gpa?

I would directly contact the AA programs but they aren't much help either with answering these type of question. So anyone with HELPFUL insight would be really appreciated.

AegriSomnia · Oct 24, 2010

pakster429 said:
If someone doesn't know what the required and the preferred gpas are for each one of the handful of AA schools, and aren't able to find it on the school's website, they probably don't belong in a graduate program.

Secondly, Aegrisomina, just as you are being quite stingy about giving any details regarding everything from your school, gpa, gre scores, i'm pretty everyone that you know there isn't being the most honest when they tell you their gpa.

Regardless, if anyone wants to find out the average gpa for the last couple of classes that got accepted to an AA program - some schools do lists those stats.

I'm simply trying to find out how AA schools look at your gpa. Do they look at your graduate gpa too (for those who have a graduate degree) or is it just the undergrad that they care about?
For someone who didn't take most of the prereqs for AA programs in their undergrad degree, and is taking them now, how do they calculate the gpa you have in those classes with your undergrad gpa?

I would directly contact the AA programs but they aren't much help either with answering these type of question. So anyone with HELPFUL insight would be really appreciated.

I don't know how much more helpful I can be. You NEED above a 3.0. Because the school has a 2.75 minimum just means that the program can technically admit someone with that low of a GPA. IT doesn't mean they will. Check it out:

http://www.anesthesiaprogram.com/admissions.htm

http://www.emoryaaprogram.org/General Track/admission reqs.htm

They don't give you a SD so you don't know how much variation is in the GPA. My program is somewhere between these two. There could be some with below a 3.0, but if there are they have something making up for it big time, like years of healthcare experience or the know someone. There probably aren't many (if any.) I know people that I interviewed with were rejected with above 3.0.

They do take previous grad work into consideration, mine helped, and I'm pretty sure that all undergrad classes that you take are calculated into your overall GPA.

If you have research experience Nova really takes that into consideration.

Denatured · Oct 24, 2010

AegriSomnia said:
That minimum preferred GPA is the key here as the 2.75 is the grad schools cut off point for admissions while the preferred GPA is the real cutoff. There may be individual exceptions here and there but I go to one of those programs and I don't know anyone in my class that has below a 3.3.

I know the preferred GPA is higher, which is why I listed it. However the applicant will be allowed to apply with a 2.75 GPA once he gets there. If the OP makes, say a 36, on the MCAT, then the they might not look as harshly on that 2.75.

jwk · Oct 25, 2010

Just like with college admissions, many of these numbers are screening tools. Fall below a certain GPA/MCAT/GRE etc. and your application probably won't get more than a cursory look. However, all the schools look at the whole applicant - undergrad grades, grad school grades, work experience, research, volunteer work, test scores, LOR's, etc. Applicants from some undergrad programs will get some benefit if their program is considered more rigorous - for example, someone who graduates with an engineering degree from Georgia Tech or a biology degree from Duke with a 2.75 is probably going to get a look, whereas someone from a school that has a far less rigorous reputation may not get a look at all even with a 3.25.

To say that you automatically won't get in because your GPA is under a 3.0 or some other magical number is simply incorrect and uninformed. There have been plenty of applicants who probably had marginal GPA's from many years ago, have gone back to school to do their pre-reqs, and have been accepted, and others with fair GPA's but outstanding previous work experience and LOR's.

Probably the least reliable source for this info are students. If you're really concerned, call the program office (one, two, or all of them) and talk to someone there and explain your situation. A GPA of < 3.0 doesn't automatically rule out anyone, but you'd have to make up for it in other areas. If this is what you want to do, figure out how to make yourself the best possible applicant, minimize your weaknesses, maximize your positive points, and go for it.

HenryH · Oct 25, 2010

AegriSomnia -- you mentioned that Nova looks favorably upon applicants with research experience. Do you/anyone else know what (if any) attributes Emory is particularly receptive to regarding applicants?

MRW · Oct 27, 2010

As a student who has entered an AA program with a sub par undergraduate GPA, I can say that it can definitely happen.

However, with 20 years of relevant work experience, very high GRE score and a 3.9 GPA in another Masters Program, I can assure you I had something else for the admissions committee to think I might be worth admitting.

AAanesthetist · Nov 4, 2010

AegriSomnia -- you mentioned that Nova looks favorably upon applicants with research experience. Do you/anyone else know what (if any) attributes Emory is particularly receptive to regarding applicants?

They like a lot of experience before you apply. Not necessarily research, but just a lot of OR exposure time. Make sure you are comfortable with very basic anesthesia concepts for your interview as they might ask you questions on them.

HenryH · Nov 5, 2010

AAanesthetist said:
They like a lot of experience before you apply. Not necessarily research, but just a lot of OR exposure time. Make sure you are comfortable with very basic anesthesia concepts for your interview as they might ask you questions on them.

Thanks for the info. Do they prefer applicants to have had formal OR exposure (i.e., have held a job in the OR)? The reason I ask is because I have only shadowed AA's at a few facilities but haven't actually held a job in the OR. Will this essentially make my application to Emory a write-off?

Also, do you know if they ask about anesthesia concepts deeper than the basic concept of airway management, induction/emergence, different masks, intubating, etc.? Do they actually ask about how these concepts should be applied, or do they just make sure you're familiarized with them?

jwk · Nov 8, 2010

HenryH said:
Thanks for the info. Do they prefer applicants to have had formal OR exposure (i.e., have held a job in the OR)? The reason I ask is because I have only shadowed AA's at a few facilities but haven't actually held a job in the OR. Will this essentially make my application to Emory a write-off?

Also, do you know if they ask about anesthesia concepts deeper than the basic concept of airway management, induction/emergence, different masks, intubating, etc.? Do they actually ask about how these concepts should be applied, or do they just make sure you're familiarized with them?

Again - a lot of this varies by program and by individual. I know many recent grads with zero pre-program clinical experience that are excellent anesthetists. The shadowing requirements of the various programs are intended to get you into the OR so you can see what AA's or anesthesiologists actually do on a day to day basis, not to teach you skills or concepts that you can be quizzed on in your interview.

Potential123 · May 1, 2013

How difficult is it to get into an AA program?

jwk · May 1, 2013

Potential123 said:
How difficult is it to get into an AA program?

The programs are all very competitive.

allsop21 · May 18, 2013

I've recently been advised to consider this field as a backup. I currently live in Michigan and I've checked Henry Ford and Beaumont and it does not seem as if they have 'Anesthesiologist Assistant' as a career path. I say this because I would like to practice here in MI once I graduate and also, I need at least 8 hours of shadowing to satisfy the application requirements.

My next step would be to physically go to the hospitals and ask if they have such careers and if I can shadow them.

One last thing, in another thread, I was reading about this field being saturated but wasn't covered enough. Would anyone shed light on this matter?

pamac · May 18, 2013

allsop21 said:
I've recently been advised to consider this field as a backup. I currently live in Michigan and I've checked Henry Ford and Beaumont and it does not seem as if they have 'Anesthesiologist Assistant' as a career path. I say this because I would like to practice here in MI once I graduate and also, I need at least 8 hours of shadowing to satisfy the application requirements.

My next step would be to physically go to the hospitals and ask if they have such careers and if I can shadow them.

One last thing, in another thread, I was reading about this field being saturated but wasn't covered enough. Would anyone shed light on this matter?

I'd be wary of a field that at this point hasn't penetrated into every state in the US, let alone a majority of them. There isn't going to be much more creativity in roles extended to fields that dont have a significant foothold at this point. Nurse anesthetists have considerable presence everywhere. There might be jobs and opportunities for AAs, but I'd have a hard time believing that they hold an advantage over NAs, even in the few markets there they can be found. The fact that you have to look hard to find them to shadow would give me pause before I plunked down 100k and two years of my time. Go get an accelerated bsn in 12-18 months, a year of critical care experience, and go to NA school. Then practice anywhere in the nation. That gives you more bargaining power than finding facilities that are willing to use you as an AA, and know you have fewer options. That's just how I look at it. I'd never invest heavily in something that wasn't recognized broadly, because it things ever get tight, the niche areas are the first to get neglected. And try to think of a program of any type (let alone the price) that has that kind of lack of presence across the board.... 16 states. At any time, the regulatory environment may change, and only independance providers may be welcome. And in most places, you have to have an md on site to supervise. Cost measures may make that prohibitive. You just can't count on things getting more favorable, especially with a field of only 3k providers.

allsop21 · Jul 26, 2013

pamac said:
I'd be wary of a field that at this point hasn't penetrated into every state in the US, let alone a majority of them. There isn't going to be much more creativity in roles extended to fields that dont have a significant foothold at this point. Nurse anesthetists have considerable presence everywhere. There might be jobs and opportunities for AAs, but I'd have a hard time believing that they hold an advantage over NAs, even in the few markets there they can be found. The fact that you have to look hard to find them to shadow would give me pause before I plunked down 100k and two years of my time. Go get an accelerated bsn in 12-18 months, a year of critical care experience, and go to NA school. Then practice anywhere in the nation. That gives you more bargaining power than finding facilities that are willing to use you as an AA, and know you have fewer options. That's just how I look at it. I'd never invest heavily in something that wasn't recognized broadly, because it things ever get tight, the niche areas are the first to get neglected. And try to think of a program of any type (let alone the price) that has that kind of lack of presence across the board.... 16 states. At any time, the regulatory environment may change, and only independance providers may be welcome. And in most places, you have to have an md on site to supervise. Cost measures may make that prohibitive. You just can't count on things getting more favorable, especially with a field of only 3k providers.

sorry for the delayed response. thanks for the insight, I really appreciate it!

psychMDhopefully · Jun 18, 2018

A couple of things about this thread, started in 2007 and 11 years later AAs can still only practice in only under half of states. If AAs have to buy malpractice insurance how much are the premiums usually, that was never answered. There are AA jobs listed on gas work that are 220-230k for 1099, besides the contractor having to pay for their own insurance and all taxes, I guess a good portion of that ~225k would go to malpractice insurance premiums.

pamac · Jun 21, 2018

Thats interesting to look back on this thread for sure. I was the last poster just over 5 years ago, and I still feel the same about the AA field. Since it was posted in 2010 on this thread that they had a presence in 16 states and DC, AAs still only practice in 16 states and DC seven years later.

Meanwhile, CRNAs practice independently in 18 states.

I think that the profession is intrigueing, but it feels like a niche field that hasn’t caught fire. I don’t see anything that compels any kind of change to that. Health care dollars are only going to be getting more scarce, and I don’t think there is a political appetite to take on nurses and physicians with a new mode of entry into the world of anesthesia. I’m not running into many fellow nurses that are gunning for CRNA school much either. Everyone wants their online FNP.

seanfrommemo · Jun 29, 2018

pamac said:
Thats interesting to look back on this thread for sure. I was the last poster just over 5 years ago, and I still feel the same about the AA field. Since it was posted in 2010 on this thread that they had a presence in 16 states and DC, AAs still only practice in 16 states and DC seven years later.

Meanwhile, CRNAs practice independently in 18 states.

I think that the profession is intrigueing, but it feels like a niche field that hasn’t caught fire. I don’t see anything that compels any kind of change to that. Health care dollars are only going to be getting more scarce, and I don’t think there is a political appetite to take on nurses and physicians with a new mode of entry into the world of anesthesia. I’m not running into many fellow nurses that are gunning for CRNA school much either. Everyone wants their online FNP.

I'm an AA. More jobs are opening up for us and data and outcomes research has shed light on our competency as anesthesia providers. Moreover, recent job market data has shown exponential increases in AA hiring opportunities in the last 2-3 years. We are gaining traction.

psychMDhopefully · Jun 29, 2018

seanfrommemo said:
I'm an AA. More jobs are opening up for us and data and outcomes research has shed light on our competency as anesthesia providers. Moreover, recent job market data has shown exponential increases in AA hiring opportunities in the last 2-3 years. We are gaining traction.

Really? The only place I can track AA jobs is Gaswork, and there are only a few listed there that fluctuate between 50-60. I am applying to AA school this year for the entering class of 2019, and there is so little info out there about AA admissions I don't know where to begin. For instance, if you were previously in another healthcare field, and failed no classes, would they hold that against you?

pamac · Jun 30, 2018

seanfrommemo said:
I'm an AA. More jobs are opening up for us and data and outcomes research has shed light on our competency as anesthesia providers. Moreover, recent job market data has shown exponential increases in AA hiring opportunities in the last 2-3 years. We are gaining traction.

You would be more in the loop than I am since you are in that industry. But I think the problem still exists that since I'm in one of the 34 states where AA's have no presence whatsoever, the profession might as well be a million miles away, because they have no hope of expanding to anywhere that they already don't have a toehold. I also seriously doubt that AA's are making headway at the expense of CRNA's. There are 40,000 anesthesiologists, and 40,000 CRNA's vs 8,000 AA's, so there is a long way to go, especially with no new practice states coming online in the last 10 years. Workforce trends show a decline in numbers of anesthesiologists, and a surplus of CRNA's. My guess is that if AA's are seeing exponential growth, CRNA's are as well.

seanfrommemo · Jul 11, 2018

pamac said:
You would be more in the loop than I am since you are in that industry. But I think the problem still exists that since I'm in one of the 34 states where AA's have no presence whatsoever, the profession might as well be a million miles away, because they have no hope of expanding to anywhere that they already don't have a toehold. I also seriously doubt that AA's are making headway at the expense of CRNA's. There are 40,000 anesthesiologists, and 40,000 CRNA's vs 8,000 AA's, so there is a long way to go, especially with no new practice states coming online in the last 10 years. Workforce trends show a decline in numbers of anesthesiologists, and a surplus of CRNA's. My guess is that if AA's are seeing exponential growth, CRNA's are as well.

AAs can actually work in 17 states, Guam and the VA system. Many groups preferentially hire AAs over CRNAs because we don't compete for physician jobs. At the end of the day, with the backing of the ASA, our legislative efforts are likely to open more states sooner rather than later. Like I said, that new outcomes paper that came out is game changing.

seanfrommemo · Jul 11, 2018

psychMDhopefully said:
Really? The only place I can track AA jobs is Gaswork, and there are only a few listed there that fluctuate between 50-60. I am applying to AA school this year for the entering class of 2019, and there is so little info out there about AA admissions I don't know where to begin. For instance, if you were previously in another healthcare field, and failed no classes, would they hold that against you?

3 years ago there wasn't half as many AA job postings on gasworks. To answer your question, no they wouldn't. There are current AAs who are in their second career.

pamac · Jul 12, 2018

seanfrommemo said:
AAs can actually work in 17 states, Guam and the VA system. Many groups preferentially hire AAs over CRNAs because we don't compete for physician jobs. At the end of the day, with the backing of the ASA, our legislative efforts are likely to open more states sooner rather than later. Like I said, that new outcomes paper that came out is game changing.

Two things.... CRNA groups exist on their own and compete with anesthesia groups. Who do you think has bids that come in lower? Additionally, hospital administration is taking over physician groups or choosing to do their own hiring now. This is happening everywhere, and you see proof of that in the fact that well over half of all physicians are hospital system employees rather than joining into practices. This is especially true of anesthesia. This keeps more of the profits in house. Anesthesia is profitable, and hospitals and surgical centers want that money coming in for them, so they hire folks to pass gas, then they bill, and pay a salary. No need to share profit, cover other expenses, pay bonuses, etc. The docs they hire may find it in them to care, but even if they do, they might not have a voice, and the hospital might like the flexibility of an independent gas provider that doesn’t need a physician on site to supervise them in the middle of the night.

Legislatively, there’s no place where legislators want to cross 3 million nurses in favor of 6,000 AA’s. And anyone who thinks that physicians will go to bat for anyone that isn’t a physician is kidding themself. That’s the kind of deal that even an AA wouldn’t want because it’s like making a deal with a cobra.... how much money do you think an anesthetist group wants to pay an AA? A: as little as possible. The fastest way for an AA to be found making $75,000 per year is to be the mid level provider of choice at the exclusion of CRNAs. The only reason AAs are making the kind of money that they are making is entirely because of CRNAs and the ground they gained. They make the big money because “why not pay them like they would pay an NA”? But without that counterbalance in place, you guys will be lucky to break $100k.

The medical world is consolidating. I don’t see where a niche provider gains ground. I thought about AA for myself once upon a time, but they weren’t coming to my neck of the woods anytime soon. And with an oversupply of CRNAs predicted over the next few years, I don’t see market pressures for a third provider to take hold. Not to mention the fact that doctorates for NAs are now the trend. Who comes off as more capable in a PR battle...the CRNA doctorate, or the assistant?

The people taking anesthesiologist jobs aren’t CRNAs, it’s the hospital and surgical center administrators and other physicians in charge of groups that hand the jobs to CRNAs. A lot of physicians would like to help their peers, but they would more like to have the money their peers would have to be paid. I’ve seen this played out quite frequently, where a physician medical director gets to choose between a fat bonus payout for cost savings by using mid levels, or the expensive peer. They choose the payout.

psychMDhopefully · Jul 12, 2018

pamac said:
Two things.... CRNA groups exist on their own and compete with anesthesia groups. Who do you think has bids that come in lower? Additionally, hospital administration is taking over physician groups or choosing to do their own hiring now. This is happening everywhere, and you see proof of that in the fact that well over half of all physicians are hospital system employees rather than joining into practices. This is especially true of anesthesia. This keeps more of the profits in house. Anesthesia is profitable, and hospitals and surgical centers want that money coming in for them, so they hire folks to pass gas, then they bill, and pay a salary. No need to share profit, cover other expenses, pay bonuses, etc. The docs they hire may find it in them to care, but even if they do, they might not have a voice, and the hospital might like the flexibility of an independent gas provider that doesn’t need a physician on site to supervise them in the middle of the night.

Legislatively, there’s no place where legislators want to cross 3 million nurses in favor of 6,000 AA’s. And anyone who thinks that physicians will go to bat for anyone that isn’t a physician is kidding themself. That’s the kind of deal that even an AA wouldn’t want because it’s like making a deal with a cobra.... how much money do you think an anesthetist group wants to pay an AA? A: as little as possible. The fastest way for an AA to be found making $75,000 per year is to be the mid level provider of choice at the exclusion of CRNAs. The only reason AAs are making the kind of money that they are making is entirely because of CRNAs and the ground they gained. They make the big money because “why not pay them like they would pay an NA”? But without that counterbalance in place, you guys will be lucky to break $100k.

The medical world is consolidating. I don’t see where a niche provider gains ground. I thought about AA for myself once upon a time, but they weren’t coming to my neck of the woods anytime soon. And with an oversupply of CRNAs predicted over the next few years, I don’t see market pressures for a third provider to take hold. Not to mention the fact that doctorates for NAs are now the trend. Who comes off as more capable in a PR battle...the CRNA doctorate, or the assistant?

The people taking anesthesiologist jobs aren’t CRNAs, it’s the hospital and surgical center administrators and other physicians in charge of groups that hand the jobs to CRNAs. A lot of physicians would like to help their peers, but they would more like to have the money their peers would have to be paid. I’ve seen this played out quite frequently, where a physician medical director gets to choose between a fat bonus payout for cost savings by using mid levels, or the expensive peer. They choose the payout.

@jwk

I don't agree with a lot of what you said but the red part I do, I'm applying to AA school this year and I've been hesitant to fully pull the trigger because I can't see what protections AAs have. Like why do they get paid so much? Pretty much because CRNAs get paid so much and they do the same job, so the people paying both see it as fair to pay them the same ( for now). Generally employers wants to get away with paying as little as possible so I don't see whats stopping them from paying AAs 75k a year, AAs have to work under a physician and would have 6 figure loans to pay back, so they would have to take the job and they have no leveraging power. CRNAs can practice independently in a lot of places and they have lots of political power so they have leverage. A lot of AAs think groups hire AAs preferentially to CRNAs because AAs have a better attitude, but still I don't see what income security AAs have, thy cannot opt out and practice independently, neither can PAs, but PAs can practice in all 50 states so they have more security in that regard.

pamac · Jul 13, 2018

You seem to have a grasp of some of the theoretical pitfalls of the AA field. A point that I think is important to focus on is the fact that if they do become the anesthesia “midlevel” provider of choice, that opens up a new set of pitfalls for them. If they muscle out CRNAs, then they are screwed, because then they will get paid what the market allows, and that becomes problematic if they don’t have CRNAs out there driving wages higher by competition with physicians. If they latch themselves too tightly to the physician bandwagon, then they have to leave the party WITH the physicians if the physicians lose out to CRNAs. Here’s a case study.... Anesthesioligists take on only AAs to work under them in a group, and they bid for a contract at a surgical center. Each Anesthesiologist can supervise 4 AAs. The bid provides $400,000 salary for the MD, and $150,000 salary for the AAs. That’s a total of $1,000,000. They compete against a group with 5 CRNAs that make $150,000 each, for a total of $750,000. Who gets their pay cut in the Anestesiologist led group to make the bid more competitive? The AAs start making $90,000 and the physician makes $390,000 per year, and that puts them at the same rate as 5 CRNAs. Or the hospital decides that it’s better for the money to have 5 CRNAs tat can work unsupervised for call, and go with them.

The point of the above exercise is that there could be unintended consequences of AAs becoming the choice provider of MDs. And it might even make Md groups even more uncompetitive if they latch on to that idea and try to work against CRNAs because they are “competing for jobs”.

As for why AAs make around what CRNAs do, the answer is because nobody has gotten around to screwing them over yet, and folks still believe in the adage that you get what you pay for, and they know that CRNAs work out well for the relatively high price, so nothing has been tinkered with yet.

Another thing about AAs is liability. When one messes up (or is accused of messing up), a lawyer is more excited about it because they can go after the big money physician for not “supervising” as well as they think they should have. CRNAs, not so much. If you think that won’t be an issue over time, you aren’t paying attention to the fact that PA malpractice insurance is around $7,000 per year vs $1000 to $1500 for NPs. That’s that way for the same reason.... PA mistakes can easily lead to a physician being roped into the lawsuit, and physicians are insured well, and tend to make much more money.

I always get a kick out of folks that live together and don’t get married because a marriage license is “just a piece of paper”. Well if it is just a piece of paper, then why not get one so you can reap the rewards and enjoy the protection that one provides. Likewise, if AAs were interchangable with CRNAs, then why would independence be valuable? Because it just is. When you need it, then nothing else will do. Every place where a CRNA or an NP lobby wants to expand independence for their patrons, they can point to almost half of all states and say “look at how well it’s working in those places.” AAs and PAs aren’t independent anywhere, and can’t say the same. And in states where they aren’t present, they won’t make up ground because the nurse lobby will halt them in their tracks by pointing to CRNA oversaturation.

I don’t disdain AAs or PAs, and personally considered both of those fields for myself. I would have gotten into those field a lot easier than the roundabout way I’ve taken to become an NP. But the reason I took that route to NP is because I looked carefully at the fundamentals of the industry and where it was headed, as well as the freedom I wanted to have professionally. I probably would have loved to be an AA, and appreciated the fact that I could have accomplished that goal in 2 years, but I don’t want to be at the mercy of trends that I can’t control. If the market pushes AAs into $90,000 per year territory, then they just have to oblige because they are dependent providers. Everything they have going for them is a gift that is contingent on someone else allowing them to practice. They have no real safe haven. To practice in my state would require them begging for a foothold, and that just isn’t going to be provided to them.

There is the possibility that he market won’t sway towards cost savings, and AAs will go ahead and become the midlevel of choice for anesthesiologists who feel disaffected. And maybe AAs will continue to make good wages under the authority of their physicians....but you have yourself why. If the world is bending to the will of greater cost savings and efficiency, why wouldn’t AAs be the canary in the coal mine? Do you think that CRNA groups won’t be better positioned to adapt to lower bids by anesthesiologist led groups? How will AAs stand up to MDs when MDs start paying AAs less? They aren’t as mobile as CRNAs, and they form a much smaller community. They will have to take the lower wages that are offered. But the groups that employ them will still have to deal with being underbid by CRNAs. And with an oversupply of CRNAs coming over the next decade, CRNAs will have the upper hand. The more CRNAs out there, the lower the wage offers that CRNAs will take. That will mean they will become the more appealing providers due to cost savings. So in my case study, CRNA groups could make themselves even more appealing by taking $140,000 salaries to underbid physician led groups. That’s a minor adjustment for a group of 5 CRNAs to make in order to beat out the 4 AAs and 1 MD group. But there is a point where an MD just won’t go lower, and it’s well beyond where they are willing to squeeze every penny from an AAs salary. And where would the AAs go if all the anesthesia groups are pulling the same trick on them?

pamac · Jul 13, 2018

Five reasons that anesthesiologist assistants limit anesthesia flexibility and profitability

Then you have CRNAs working on shooting AAs down as a hobby (which I think is a bit much, but it shows that there is a target painted on AAs, and that some folks are indeed paying attention to them).

jwk · Jul 17, 2018

psychMDhopefully said:
Really? The only place I can track AA jobs is Gaswork, and there are only a few listed there that fluctuate between 50-60. I am applying to AA school this year for the entering class of 2019, and there is so little info out there about AA admissions I don't know where to begin. For instance, if you were previously in another healthcare field, and failed no classes, would they hold that against you?

Gaswork is a horrible resource to track jobs. MOST of the jobs out there are not on Gaswork. And, in states where AA practice is allowed, many of the groups that advertise for CRNAs will also hire AAs.

Dude, you have fretted about this ad nauseum for ages. Apply, good luck, hope you get in, get accepted, get started, and move on. Don't worry about everyone else. If you have decent grades (particularly in pre-reqs), decent test scores, and have real interest in the profession, you will likely do just fine. Why would a program hold ANY previous employment in ANY field against you? I like seeing applicants with work experience - of any sort. I'm much more concerned about someone who looks great on paper with great grades and test scores that has never, ever, had a job. People want to talk about lazy millenials - it's absolutely true. Not all of them, but it's amazing that some of them seem shocked they actually have to work to get paid.

jwk · Jul 17, 2018

pamac said:
Two things.... CRNA groups exist on their own and compete with anesthesia groups. Who do you think has bids that come in lower? Additionally, hospital administration is taking over physician groups or choosing to do their own hiring now. This is happening everywhere, and you see proof of that in the fact that well over half of all physicians are hospital system employees rather than joining into practices. This is especially true of anesthesia. This keeps more of the profits in house. Anesthesia is profitable, and hospitals and surgical centers want that money coming in for them, so they hire folks to pass gas, then they bill, and pay a salary. No need to share profit, cover other expenses, pay bonuses, etc. The docs they hire may find it in them to care, but even if they do, they might not have a voice, and the hospital might like the flexibility of an independent gas provider that doesn’t need a physician on site to supervise them in the middle of the night.

Legislatively, there’s no place where legislators want to cross 3 million nurses in favor of 6,000 AA’s. And anyone who thinks that physicians will go to bat for anyone that isn’t a physician is kidding themself. That’s the kind of deal that even an AA wouldn’t want because it’s like making a deal with a cobra.... how much money do you think an anesthetist group wants to pay an AA? A: as little as possible. The fastest way for an AA to be found making $75,000 per year is to be the mid level provider of choice at the exclusion of CRNAs. The only reason AAs are making the kind of money that they are making is entirely because of CRNAs and the ground they gained. They make the big money because “why not pay them like they would pay an NA”? But without that counterbalance in place, you guys will be lucky to break $100k.

The medical world is consolidating. I don’t see where a niche provider gains ground. I thought about AA for myself once upon a time, but they weren’t coming to my neck of the woods anytime soon. And with an oversupply of CRNAs predicted over the next few years, I don’t see market pressures for a third provider to take hold. Not to mention the fact that doctorates for NAs are now the trend. Who comes off as more capable in a PR battle...the CRNA doctorate, or the assistant?

The people taking anesthesiologist jobs aren’t CRNAs, it’s the hospital and surgical center administrators and other physicians in charge of groups that hand the jobs to CRNAs. A lot of physicians would like to help their peers, but they would more like to have the money their peers would have to be paid. I’ve seen this played out quite frequently, where a physician medical director gets to choose between a fat bonus payout for cost savings by using mid levels, or the expensive peer. They choose the payout.

For someone who is not an AA, you sure purport to know a lot about my profession. You're clearly under a lot of misconceptions or have partaken of the CRNA koolaid. Almost too many to list - and your nursing bias shines through quite brightly.

I've been in this profession nearly 40 years. It has been a long road, made much longer by the CRNAs and other nursing groups that oppose us at every turn. Despite all the lies, and despite CRNA opposition, AAs have continued to expand and prosper. AA job placement is, has been, and will continue to be essentially 100% upon graduation. Unfortunately, that means CRNAs, like the author of the one in the article you just posted, push back that much harder. Why? Because they are scared to death of competition. They want it all for their greedy selves. Look, there is a TON of work to go around for EVERY anesthesia provider of every type. Why they can't just shut up and move on is beyond me. They fight the docs. They fight us. They fight amongst themselves. The market is and always has been supply and demand. Right now the demand is not being met. It's an aging population. There are more procedures being done. There is more demand for services. It's a great time to be an AA.

Although there are quite a few hospitals that hire their own anesthetists, there are far more that are employed by groups. Increasingly, those groups are owned by corporations. Look at Gaswork - Envision, TeamHealth, Mednax, USAP, and others have ads for providers all over the country. Anesthesia groups get their contracts by providing a service the hospital requires. Some groups get stipends from the hospital, some do not. Regardless, those groups do what they have to do to keep their hospitals and surgeons happy. They will pay providers whatever it takes to do all the cases. Supply and demand rules - always has, always will. Nearly 40 years in, I have seen nothing but upward movement for AAs. There are plateaus in hiring and compensation, but it's never gone backwards. As CRNAs shoot themselves in the foot moving to the DNP (an extra year in school, 50% higher tuition, no additional clinical time or skills) AAs will continue to benefit. The same thing happened when anesthesia increased from a 3 to a 4 year residency. A lack of new anesthesiologists for a couple years back in the 80's started the real upward trend for anesthetist salaries. AAs are one of the highest earning potential masters degree careers out there. I don't see that changing.

pamac · Jul 18, 2018

Here's the thing... the conversation is about the fundamentals of the career, not the immediate environment. The points that I make are that essentially AA's aren't in the driver seat for their future. If that fact is something that someone can be comfortable with, then that's the direction they should go. For myself, I wasn't interested in the restrictions, geographically or otherwise.

I'm not an AA. But what I do know about the AA workforce is that they are not able to function in ANY capacity in my state, or in any state around me, and won't be practicing in any more states any time soon, nor have they expanded outside of their existing states for well over a decade... since before this thread emerged. So to me, that's the most important thing to know about the profession. AA's thrive in areas where midlevel providers have some of the least influence and independence. What that means is that they are tailor made dependent providers, with fortunes that can change on a whim (the whim of supply and demand, bean counters, physician supervisors).

As far as the doctorate for CRNA's, I personally wouldn't want to have to deal with the extra school, but I think that it has been made the entry point as a way to put some limitations on the supply, and also to add some prestige to the field where they are competing with physicians. It definitely gives potential applicants to CRNA school some pause to have some artificial limitations placed on the speed with which they can enter the field and work, but with a predicted oversupply on the market, it might prove to be a good way for them to limit supply while still adding some respect to their "brand". But for AA's to call it "shooting themselves in the foot" is whistling past the graveyard in terms of AA's losing the marketing battle. They can see what its like trying to argue who has the better image when they have two competing fields with "doctor" in the professional degree title. I'm not saying it should be that way, just that it is. I think the DCRNA is more about paving the way for further state by state independence expansion rights than anything else, and its probably going to work well.

jwk · Jul 19, 2018

pamac said:
Here's the thing... the conversation is about the fundamentals of the career, not the immediate environment. The points that I make are that essentially AA's aren't in the driver seat for their future. If that fact is something that someone can be comfortable with, then that's the direction they should go. For myself, I wasn't interested in the restrictions, geographically or otherwise.

I'm not an AA. But what I do know about the AA workforce is that they are not able to function in ANY capacity in my state, or in any state around me, and won't be practicing in any more states any time soon, nor have they expanded outside of their existing states for well over a decade... since before this thread emerged. So to me, that's the most important thing to know about the profession. AA's thrive in areas where midlevel providers have some of the least influence and independence. What that means is that they are tailor made dependent providers, with fortunes that can change on a whim (the whim of supply and demand, bean counters, physician supervisors).

As far as the doctorate for CRNA's, I personally wouldn't want to have to deal with the extra school, but I think that it has been made the entry point as a way to put some limitations on the supply, and also to add some prestige to the field where they are competing with physicians. It definitely gives potential applicants to CRNA school some pause to have some artificial limitations placed on the speed with which they can enter the field and work, but with a predicted oversupply on the market, it might prove to be a good way for them to limit supply while still adding some respect to their "brand". But for AA's to call it "shooting themselves in the foot" is whistling past the graveyard in terms of AA's losing the marketing battle. They can see what its like trying to argue who has the better image when they have two competing fields with "doctor" in the professional degree title. I'm not saying it should be that way, just that it is. I think the DCRNA is more about paving the way for further state by state independence expansion rights than anything else, and its probably going to work well.

The only one's in the drivers seat for their future are the insurance companies.

AAs have never made a secret of the fact that we are required to work with an anesthesiologist. Nor has it been a secret that we are geographically limited, although it hasn't been more than ten years since a state came on board. There are always other states in the works, but getting legislation passed for anything, for any purpose, anywhere, is no small task. I have been hearing gloom and doom since I finished school in 1981, before the title "anesthesiologist assistant" was even used. The profession grew very slowly the first 25 years, but has grown significantly in the last 20 or so with the addition of a dozen new programs. The number of states has grown. The employment numbers within those states have taken some big jumps in the last few years, no doubt some of that due to the repeated "shoot themselves in the foot" moves of CRNA "professional" organizations and individuals. You may not like the characterization - but it's entirely accurate, given my nearly 40 years in my profession watching them. AAs all have jobs. Most students have multiple job offers when they leave school. My salary is more than 6 times what it was in the early 80's. Ask most physician anesthesiologists who they'd rather have working with them - for those that have the option, AAs come out on top.

You don't get respect by buying an online degree, something many NPs (including CRNAs) have been doing. Most current DNPs got their degree through some sort of distance learning format - in-person DNP programs are in their infancy, and still not even a requirement for another seven years. Precious few have received any additional clinical education as part of their programs. Clinical capabilities and expertise are what gain respect in the OR, not online classes in nursing theory, nursing business, and nursing propaganda.

Makati2008 · Jul 20, 2018

JWK- Please keep the conversation professional and on track.

pamac · Jul 20, 2018

CRNAs have not taken the online route at all. There is no CRNA program out there that does that. There is also no state where CRNA numbers are diminishing to the extent that switching to the doctorate has created holes for other CRNAs or AAs, or anesthesiologists are stepping in to fill them. Most of the labor reports show a future oversupply of CRNAs. If AAs are becoming the preference of physicians, do you think it has more to do with them being the better provider, or the least threatening, more controllable provider that will always be attached to a supervisor? That’s my only point. I don’t doubt the quality of the product put out by AA schools, but I have my doubts about the fundamental nature of the profession (which is direct involvement with a physician). That’s the same drawback that kept me from wanting to be a PA, which I could have used my biology degree and pre med prerequisites to pursue. I actually believe that PAs and AAs should be independent providers if they choose to be, and I always have felt that way. I see no reason for the current structure of professional subservience to exist, except to benefit physicians. We’ve seen CRNAs and NPs function independently in half of states with no detriment, so the evidence is there that it works well.

As for online education, that’s an entirely different discussion, but the future isn’t in brick and mortar, and long ago we crossed the threshold of efficient remote education delivery. Anyone who drives through busy traffic to hunt for nonexistent parking on a large campus where you walk through the elements and put up with delays ( that can add an hour of travel to every hour of class ) can attest to the fact that simply logging in in the comfort of your own home on your own schedule is preferable to the “respect” of sitting through class and suffering at the speed of the least prepared student that distracts the professor with the questions that most of the rest of the students know the answer to. My Np program provides on campus time for the hands on skills, and the rest of the time we telecommute like the rest of the human workforce is moving towards. I get more out of pausing a lecture and looking up the answer to my question than I ever got from raising my hand and grinding my class to a halt. It’s older folks who can’t adapt, or missed the revolution in online education that are the most ardent critics of not sitting around the professor.... as if most of our classes resembled those in “the dead poets society” rather than the intimately appointed grand lecture halls and accompanying death by PowerPoint. Instead, I’ll sit in my lazy boy at 1 AM and broadcast tapes lectures to my 46 inch screen on the wall (or to my tablet when I’m on the road), eat a snack, skip the commute, and get much more out of the experience.

“But the respect of the brick and mortar cannot be matched!” Here’s a short story:

I worked as a TA for a professor who taught a large medical profession prereq course. He emphasized the in person experience, and thought there was no substitute. The course is now an online course because it was more efficiently delivered in that format. The major university we worked for decided on the change. I knew this was coming when most of the students did as I did the previous term and skipped class and mastered the material in the PowerPoints and the chapters.when I took his class previously, I went to one day of class and that was it.

Yale PA school, THE pre eminent PA program on Earth, operates two programs... an in person traditional program, and a newer remote learning option with a minimal on campus immersion portion. Argue with them about the respect gained by “buying an online degree”. The parchment they hand out to graduates upon graduation doesn’t differentiate the folks who lived in New Haven, and those that lived in Alaska. The on campus students protested when it first came out, but I’m sure if given the option of not getting into Yale, and getting into the Yale Online program, those same whiners would have chosen the online program so they could still use the name because they seem to care so much about it. Tuition to both programs is the same, but like Yale needs to care about profits. Anyway, I think I made my point.

jwk · Jul 20, 2018

pamac said:
CRNAs have not taken the online route at all. There is no CRNA program out there that does that. There is also no state where CRNA numbers are diminishing to the extent that switching to the doctorate has created holes for other CRNAs or AAs, or anesthesiologists are stepping in to fill them. Most of the labor reports show a future oversupply of CRNAs. If AAs are becoming the preference of physicians, do you think it has more to do with them being the better provider, or the least threatening, more controllable provider that will always be attached to a supervisor? That’s my only point. I don’t doubt the quality of the product put out by AA schools, but I have my doubts about the fundamental nature of the profession (which is direct involvement with a physician). That’s the same drawback that kept me from wanting to be a PA, which I could have used my biology degree and pre med prerequisites to pursue. I actually believe that PAs and AAs should be independent providers if they choose to be, and I always have felt that way. I see no reason for the current structure of professional subservience to exist, except to benefit physicians. We’ve seen CRNAs and NPs function independently in half of states with no detriment, so the evidence is there that it works well.

As for online education, that’s an entirely different discussion, but the future isn’t in brick and mortar, and long ago we crossed the threshold of efficient remote education delivery. Anyone who drives through busy traffic to hunt for nonexistent parking on a large campus where you walk through the elements and put up with delays ( that can add an hour of travel to every hour of class ) can attest to the fact that simply logging in in the comfort of your own home on your own schedule is preferable to the “respect” of sitting through class and suffering at the speed of the least prepared student that distracts the professor with the questions that most of the rest of the students know the answer to. My Np program provides on campus time for the hands on skills, and the rest of the time we telecommute like the rest of the human workforce is moving towards. I get more out of pausing a lecture and looking up the answer to my question than I ever got from raising my hand and grinding my class to a halt. It’s older folks who can’t adapt, or missed the revolution in online education that are the most ardent critics of not sitting around the professor.... as if most of our classes resembled those in “the dead poets society” rather than the intimately appointed grand lecture halls and accompanying death by PowerPoint. Instead, I’ll sit in my lazy boy at 1 AM and broadcast tapes lectures to my 46 inch screen on the wall (or to my tablet when I’m on the road), eat a snack, skip the commute, and get much more out of the experience.

“But the respect of the brick and mortar cannot be matched!” Here’s a short story:

I worked as a TA for a professor who taught a large medical profession prereq course. He emphasized the in person experience, and thought there was no substitute. The course is now an online course because it was more efficiently delivered in that format. The major university we worked for decided on the change. I knew this was coming when most of the students did as I did the previous term and skipped class and mastered the material in the PowerPoints and the chapters.when I took his class previously, I went to one day of class and that was it.

Yale PA school, THE pre eminent PA program on Earth, operates two programs... an in person traditional program, and a newer remote learning option with a minimal on campus immersion portion. Argue with them about the respect gained by “buying an online degree”. The parchment they hand out to graduates upon graduation doesn’t differentiate the folks who lived in New Haven, and those that lived in Alaska. The on campus students protested when it first came out, but I’m sure if given the option of not getting into Yale, and getting into the Yale Online program, those same whiners would have chosen the online program so they could still use the name because they seem to care so much about it. Tuition to both programs is the same, but like Yale needs to care about profits. Anyway, I think I made my point.

You missed my point. There are very few full three year DNP CRNA programs at the moment. For the most part, they are just cranking up. Many have not even graduated their first class. MOST of the CRNAs that have a DNP were already CRNAs and did their DNP online. The rest of my statement was correct - Precious few have received any additional clinical education as part of their programs. Clinical capabilities and expertise are what gain respect in the OR, not online classes in nursing theory, nursing business, and nursing propaganda. Sure - online classes are fine for a lot of things. Clinical education is not one of them, and pretending that the DNP somehow confers additional clinical expertise is disingenuous at best.

psychMDhopefully · Jul 20, 2018

Makati2008 said:
JWK- Please keep the conversation professional and on track.

He is keeping the conversation professional and on track, just because you don't like the truth of what he is saying doesn't make it unprofessional.

pamac · Jul 21, 2018

There are actually plenty of entry level DNAP programs up and running. I feel like the push for practice doctorates is not for me at all (see one of the other threads where I commented heavily on it). I don't think that the push for the transition to DNAP has had an impact on slowing numbers down any, and it might not even have that much of an effect because I imagine all the seats in programs will still be filled to the brim like they are now, just that matriculating students will have the joy of an extra year of school to clutter up their lives. But as I've said before, the practice doctorates are a way of enhancing image and making inroads into policy, boardrooms, and practice management. I'll lay out again how that translates to increased "voice" for the nursing world:

Folks with DNP's (and the subsequent "fluff" courses) enter leadership roles in public health systems, hospital systems, nonprofits, and clinical practices where they can do the hiring, and hire nursing based providers. That was always the biggest part of the agenda vs. advancing clinical skills. So the DNAP's that will be cranked out will have all the training that AA's have, plus their critical care nursing experience that they had in a previous career as an RN, plus additional coursework in practice management, research methods, diversity of care, process improvement, etc... which on paper makes them look more impressive. This coursework, like the coursework that DNP's have tacked on to their degree, is a head-scratcher for most folks like PA's, AA's, and even many NP's who don't read between the lines to see what the overall goal is from the nursing lobby... after all, there are no further clinical skills being foisted upon NPs and CRNA's, nor much more added to the employ ability in the workforce. But what I've seen is that folks who want to make the case that their DNP gives them the insight into management can do so more readily. I imagine that the DNAP's in independent states can make the case that they are in a good position to manage. For the folks that really do drink the coolaid and believe in elevating nurses to the level of physicians (or at least above that of other "midlevels") the DNP and DNAP does that because nobody else has the equivalent. PA's and AA's are in a checkmate situation because if they get any more education, they might as well put their academic acumen to use to become a physician.

I'm convinced that the nursing world envisions DNP's taking management roles in large hospital systems as they consolidate and gobble up small practices. They want them putting together the employee schedules, doing the hiring, and running the administrative angles of the provider world. They want them in board rooms and executive councils, steering funding, and advocating to politicians, etc. That's what folks should be most aware of when they talk about what the doctorates are meant to do for the nursing world. I'm not interested in that, and want to fully avoid being required to be a DNP, but I know thats what its all about.

jwk · Jul 22, 2018

pamac said:
I'm convinced that the nursing world envisions DNP's taking management roles in large hospital systems as they consolidate and gobble up small practices. They want them putting together the employee schedules, doing the hiring, and running the administrative angles of the provider world. They want them in board rooms and executive councils, steering funding, and advocating to politicians, etc. That's what folks should be most aware of when they talk about what the doctorates are meant to do for the nursing world. I'm not interested in that, and want to fully avoid being required to be a DNP, but I know thats what its all about.

Just a couple observations -

If every CRNA has a doctorate, then not every one will be in a management role. You/they are fooling themselves. It's total degree creep/inflation. There will always be a need for someone to actually take care of patients. This is the problem with nursing in general. So many nurses want to move up the ladder that there is a shortage of nurses to actually take care of patients - you know, what y'all are supposedly all about. Someone counted up the levels of nursing management at one of the hospitals I've been associated with. From staff nurse to Director of Nursing, there are 17 layers of management. Seventeen! How absurd is that?

Also - keep in mind that there are still CRNAs out there with NO degree whatsoever. None. Nada. Nursing diploma, anesthesia certificate, done. There are still plenty of them around, even with the current masters programs, and now DNPs. But again, it mimics regular nursing. There are TONS of 2 year ADN programs out there cranking out RNs, 30 years after the BSN was supposedly going to be the "entry level" for RNs. LPNs are still being produced. They were supposed to be non-existent by now, but reality sets in.

pamac · Jul 23, 2018

While I don’t doubt that administration could find a way to burden the world with 17 levels of admin to the chain of command, someone is being creative and adding in a few things while not knowing that a certain position is seperate from the chain. There are a lot of layers in nursing organizational structure, (just like any large organization), and maybe too many, but no, there aren’t nearly that many to wade through, and many can be bypassed. What certain folks may be thinking of is that due to regulatory requirements, there are several layers in the chain of command, and several departments that oversee irnreview actions and compliance etc, but a lot of that is in place due to government regulations. And the fact that nursing dominates that environment just proves my point that nurses have carved out niches for themselves where none existed before. All around it’s bad news for folks that aren’t nurses. But yes, when someone falls or gets a restraint these days, several people show up to check documentation, but none of those folks is a nurse’s boss that is part of the leadership structure in the way to the CNO. The structure actually has a fairly flat architecture compared to much of the world.

The nursing shortage... sigh. There is only a shortage of nurses willing to put up with what administrations want them to put up with for the price that admin wants to pay them. It’s in the best interest of nursing schools and hospital facilities to play up the suggested shortage. Things aren’t tight because if they were, nurses would be showered with incentives like they used to be.

A while ago I actually met one of those folks who were nurse anesthetists with only a nursing degree and a certificate. This person was actually quite old and long retired. But it’s been a long time since there were “plenty” of them around with only certificates like you say. Since 1998, the masters degree has been fully implemented, so I guess maybe a handful of folks here and there are still around, but it’s disingenuous to imply that folks without degrees are all over the place. 1998 was when 100% of programs were all onboard and it’s not like all of them switched over the year before... that’s when the final stragglers finished up. Most places moved over to requiring masters many years before. And over 50% of CRNA programs have transitioned fully to the DNAP at this point which stands in contrast to what you said here before where you implied that it was a rare thing to have schools cranking out DNAPs.

Let’s talk about folks that should be somewhere else instead of trying to be something they are not, since you brought that up. There’s something like 2 million nurses out there and less than 200,000 NPs, and around 40,000 CRNAs, so advanced practice nursing isn’t taking much away from nurses doing “what we’all are all about”. I fully understand why someone wouldn’t want to stay in bedside nursing, but here’s the thing.... we showed up to do it, even the folks that only stay a little while before moving into advanced practice. But since you seem to be suggesting that nurses are jumping on a bandwagon that we don’t belong on, where exactly does that put AA’s... you know, the folks that can move into a position within healthcare that involves heavy responsibility, without anything so much as obtaining the 2 years of critical care RN experience that is the MINIMUM that CRNAs have before CRNA school. Yeah, you guys who go to AA school to get a taste of the good life when none of you have been required to participate in even one code blue before you jump into AA school? At least RNs making the transition to CRNA have taken some steps on the ladder before they reach the top. ANesthesiologist assistant is a career based on jumping ahead on a ladder that they’ve never been on. You can say what you want about AA training, but there’s nothing more magical about it that makes you more capable than a CRNA. But the CRNA went through nursing school, and spent some time actually touching patients. For AAs, having any kind of healthcare degree before hand is optional, and having significant and worthwhile healthcare experience where a patient’s life is in your hands is optional for them as well.

From the perspective of the forces that are trying to implement the DNAP as a universal requirement (which actually seems to be catching fire with over 50% of programs implementing it), they could probably care less if most folks don’t go into management. And yes.... it is degree creep pure and simple. But nothing you have said counters what I have said, and that is that moving to a doctorate puts the pressure on everyone else that would compete against CRNAs. If every CRNA has a doctorate, that means that every CRNA could potentially be in management, rather than just a few folks in the applicant pool. But AAs should be concerned because the CRNAs with doctorates can come along and say that they have doctorates, and previous health care experience in a significant role, and are cheaper than doctors, but also practice independent of any oversight in over half of states. That’s more than a mouthful, and AAs can say that they have a masters and their profession may or may not have folks with health care experience, and that they aren’t independent in any states, and can only practice in a handful of states.

I’m not trying to troll you, I’m pointing out pitfalls and hang ups that surround a field if very capable AA providers. I don’t drink the coolaid, I’m just laying out things that make me hesitant to assume anything about the AA field is a given.

jwk · Jul 23, 2018

pamac said:
I’m not trying to troll you, I’m pointing out pitfalls and hang ups that surround a field if very capable AA providers. I don’t drink the coolaid, I’m just laying out things that make me hesitant to assume anything about the AA field is a given.

Don't sell yourself short. Of course you drank the koolaid - or you're a CRNA. The diatribe is too specific.

pamac · Jul 23, 2018

If I drank the coolaid, then ther wouldn’t be posts on other threads as recent as two weeks ago where I’ve been a critic of the DNP. I’ve also got a paper trail showing this is one of the few times I’ve had much to say about anesthesia vs NP topics. But nobody has ever tried to suggest that nurses stick to floor nursing vs becoming CRNAs. To take it a step further and suggest that it is a gold rush for nurses, when at least they have background with patients vs AAs touching their first patient in AA clinicals is disingenuous. Nurses have been delivering anesthesia since the earliest days of anesthesia. AAs are a recent invention of folks that are trying to jump several steps in patient care responsibility to find the pot of gold. Kind of puts things in perspective, doesn’t it.

When I was considering AA (before the geographic constraints proved too onerous for me) I took note of the fact that almost half of AA programs were consolidated between two programs (Case Western and Nova... who have several campuses between the two of them). And no AA programs have any requirements for health care experience posted.

My big hesitation about PA and AA careers is the dependent nature, and not the quality of the providers, and there are trends that are hard to ignore regarding what independence will yield for a profession. For instance, in my field of psyche, psyche Nps in independent NP states do much better in terms of salary and benefits than psyche Nps in states that require being dependent on a physician. And by extension, AAs that practice in states where CRNAs are independent reap the reward of better wages than AAs in states where CRNAs are dependent to physicians. So they should probably go hug a CRNA rather than be jealous of what their rising tide has done for AAs boats.

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