Anesthesiologist assistant

[FutureDoc2001]

The intent of this post is to briefly introduce you to the Certified Anesthesiologist Assistant (CAA) profession.

In the 1960s—concerned with the shortage of anesthesiologists throughout the United States —a group of academic anesthesiologists came together to outline the role of a new mid-level anesthesia provider. This provider—the Anesthesiologist Assistant (AA)—was designed to alleviate a portion of the direct care burden facing perioperative physicians while, importantly, always remaining under the supervision of the anesthesiologist. This model of care is now called the Anesthesia Care Team (ACT) Model—often deploying four mid-level anesthetists under the direction of one supervising anesthesiologist.

Although CAAs practice as physician extenders, similar to the PAs of other specialties, anesthesiologists chose to establish the AA profession with a distinct education and certification track—one focused solely on the unique demands of anesthesia practice.

In 1969, Case Western Reserve University (Cleveland, OH) and Emory University (Atlanta, GA) accepted their first cohorts into Master of Science in Anesthesia and Master of Medical Science in Anesthesia programs. After decades of producing competent and caring providers, these programs were joined by South University (Savannah, GA) in 2004.

Since then, the AA profession has picked up some serious steam! Applicants will be accepted into THIRTEEN programs across the country this cycle, with more programs in development. At the bare minimum, every AA applicant has: a premedical background leading to a bachelor’s degree, shadowing experience in the operating room, and a competitive score on the MCAT or GRE.

Upon graduating from intense 24-28 month masters’ curricula, new AAs can expect to earn between $140-180K. Then, with experience, salaries can rise to >$220K before overtime pay. AAs work in a wide variety of practice settings, with responsibilities and schedules identical to any CRNAs within the same practice.

Despite the excellent clinical record of AAs—and the rising number of patients that thrive under the Anesthesia Care Team Model—anesthesia assistants are not yet able to practice in all 50 states due to their independent licensure requirements. State governments are gradually realizing the positive impact that fully-licensed CAAs can have on the lives of their physicians, healthcare systems, and—of course—patients.

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[pamac]

So if you live in one of the 14 states that even allow Anesthesiologist Assistants to practice at all, you are in luck.

However, CRNAs can practice in ALL states, and are FULLY independent providers in at least 30 states, which is more than double the number that AA’s can even practice in. Getting involved in AA means one would have to look forward to essentially a professional lifetime of advocacy ahead of them in order to expand the landscape, if it even happens at all. As seductive at it may be to look at the field, anyone going into it is taking a huge gamble.

 

[deleted6669]

Pretty sure that AAs can work at federal facilities(VA, prison, etc) in any state at this point. It is only private hospitals that are limited to the 14.
I agree that CRNA is a great way to go for a non-physician provider in anesthesia. You do have to have a BSN and ICU experience beforehand, however. From start to finish AA is a lot faster for those not desiring to become a nurse. AA path: BS degree in science + 2 yr anesthesia program= 6 years.
CRNA path: BSN + 2-3 years ICU experience + 2 year program= 8+ years.
In facilities that use both they are used interchangeably. There is a longtime poster here from Georgia who is the lead anesthetist at a facility that uses both so he is in charge of the AA and CRNA group. Do a search for posts by JWK. Very reasonable fellow. He has been an AA for 40 years.

 

[pamac]

The problem isn’t whether they should be able to work in more states, it’s whether they can. That’s the aspect of AA that gives me pause. It’s a big deal to invest in a career. Investing in an AA career involves accepting the limitations in place on the ground now, and that includes the fact that you have 14 states to practice in, and only in a directly supervised capacity. It should make someone nervous to have that patchwork of limitations, because those limitations come with other limitations. You might have the federal government as an option... if you are fine with the pay, the location, the environment, etc.... and then IF there is a job available. People like options, especially for the substantial time and effort of school. It involves more risk to have a career that boxes one in.

 

[deleted6669]

The problem isn’t whether they should be able to work in more states, it’s whether they can. That’s the aspect of AA that gives me pause. It’s a big deal to invest in a career. Investing in an AA career involves accepting the limitations in place on the ground now, and that includes the fact that you have 14 states to practice in, and only in a directly supervised capacity. It should make someone nervous to have that patchwork of limitations, because those limitations come with other limitations. You might have the federal government as an option... if you are fine with the pay, the location, the environment, etc.... and then IF there is a job available. People like options, especially for the substantial time and effort of school. It involves more risk to have a career that boxes one in.

Not everyone wants to become a nurse if their end goal is anesthesia. It is an extra 2 years (at least) to go the CRNA route. It is a great career with lots of flexibility. No argument here. I work with great CRNAs at all 4 of my rural jobs.

 

[jwk]

The problem isn’t whether they should be able to work in more states, it’s whether they can. That’s the aspect of AA that gives me pause. It’s a big deal to invest in a career. Investing in an AA career involves accepting the limitations in place on the ground now, and that includes the fact that you have 14 states to practice in, and only in a directly supervised capacity. It should make someone nervous to have that patchwork of limitations, because those limitations come with other limitations. You might have the federal government as an option... if you are fine with the pay, the location, the environment, etc.... and then IF there is a job available. People like options, especially for the substantial time and effort of school. It involves more risk to have a career that boxes one in.

Multiple states in play for legislation this year. And more new schools coming as well. The demand for CAAs is pretty significant right now. In the states where CAAs can work, they've become the preferred provider for a lot of anesthesia groups. Anesthesiologists have wised up and are tired of utilizing, as well as training, CRNAs who actively work against physician anesthesia practice. The majority of AA students receive multiple job offers, and many have job commitments lined up many months prior to graduation.

 

[pamac]

Multiple states in play for legislation this year. And more new schools coming as well. The demand for CAAs is pretty significant right now. In the states where CAAs can work, they've become the preferred provider for a lot of anesthesia groups. Anesthesiologists have wised up and are tired of utilizing, as well as training, CRNAs who actively work against physician anesthesia practice. The majority of AA students receive multiple job offers, and many have job commitments lined up many months prior to graduation.

Again.... in the limited number of states where CRNAs work.

AAs might be the natural preferred provider for anesthesia groups who want to employ them, because they would, by definition, be DEPENDENT providers.... providers who are DEPENDENT upon another provider for their job. They would never be any kind of threat to them. How does that work out in the end? Who does that work out best for? So IF what you say is the case that they are preferred by many groups owned by physicians, then that would not surprise me. For the student who is deciding what they want to be, I’ll throw this out there.... how many anesthesia practices are owned by CRNAs vs AAs? How many states allow AA to practice? How many states allow AAs that even can practice to practice independently? How much geographic mobility do you get from your very expensive investment vs the investment in becoming a CRNA. Will the physicians who you are dependently attached to be promoting AAs be doing that for the benefit of AAs, or for their own edge over CRNAs? Will physicians groups that supposedly are excited to hire AAs be paying top dollar, or do they have you backed into a corner because they know that an AA working for them has fewer options and latitude than a CRNA?

Even IF an AA currently makes about as much as a CRNA, which career is more likely to have that be the case for longer? Which career has more options?

And consider this.... who is more likely to be the most cost effective provider for a cost cutting health system.... anesthesiologist owned groups who would be employing AAs and doctors, or CRNA groups? When cost cutting occurs for anesthesiologist owned practices, who will be the first folks getting pay cuts? Let’s math this out:

Practice 1 ( a physician owned practice): 2 doctors making $400,000 each, and 1 AA making $200,000 make a payroll of $1 million.

Practice 2 (a CRNA group with 5 CRNAs making $200,000 each) has a $1 million payroll.

Who’s salary gets cut before the physicians salary when the hospital wants a cheaper contract?

I don’t know if being tied to physicians is really what AAs or PAs want, and as evidence I point to the movement of PAs to push for independence and name change for their career field. Is AA sting enough to survive without the backing of physicians that they work for? Would they still survive if they push for more daylight and independence?

 

[Startingover123]

Multiple states in play for legislation this year. And more new schools coming as well. The demand for CAAs is pretty significant right now. In the states where CAAs can work, they've become the preferred provider for a lot of anesthesia groups. Anesthesiologists have wised up and are tired of utilizing, as well as training, CRNAs who actively work against physician anesthesia practice. The majority of AA students receive multiple job offers, and many have job commitments lined up many months prior to graduation.

What states?

 

[DownJonesIndustrial]

I believe my state passed AA legislation in recent sessions. I have no ideas what AAs do if they're analogous to CRNAs, etc. I will say that CRNA was an appealing option for me, but I didn't like the total care nursing that came with critical care so chose not to work in that area and DQ'd myself from CRNA training. (I also don't like going to work early.) I submit that the typical person dislikes being told what to do, and everyone hates when their economic liberty is tied to the whims of a higher pecking order. I would not advocate for anyone to enter into a career like this without knowing for certain that your job function and income isn't going to be regulated by the personalities or opinions of a workplace accessory like a physician. For the optometrists pushing to become eye surgeons, the psychologists pushing to become evaluative prescribers, or pharmacists looking to do whatever it is pharmacists would rather be doing it's a long road ahead.

 

[Startingover123]

I believe my state passed AA legislation in recent sessions. I have no ideas what AAs do if they're analogous to CRNAs, etc. I will say that CRNA was an appealing option for me, but I didn't like the total care nursing that came with critical care so chose not to work in that area and DQ'd myself from CRNA training. (I also don't like going to work early.) I submit that the typical person dislikes being told what to do, and everyone hates when their economic liberty is tied to the whims of a higher pecking order. I would not advocate for anyone to enter into a career like this without knowing for certain that your job function and income isn't going to be regulated by the personalities or opinions of a workplace accessory like a physician. For the optometrists pushing to become eye surgeons, the psychologists pushing to become evaluative prescribers, or pharmacists looking to do whatever it is pharmacists would rather be doing it's a long road ahead.

May I ask what state?