Anesthesiologist Assistant program

[hmc0291]

Hello All,

Sorry if this topic has already been posted. I've been researching all week for news about this career path but haven't been able to find any recent information, even on SDN.

I am going through a bit of a life crisis and could really use some insight. Here's my situation:

I graduated in 2013 with my B.S. in Business Administration. Long story short, I worked for a year and decided to go back to school to pursue a healthcare degree. I set my sights on DPT - completed all my prerequisites with a 4.0 gpa, 80th+ percentile on all sections of GRE, 250 observation hours, etc. I was accepted into a program in FL and decided to go for it. I am tentatively set to move in 3 weeks to begin.

However... earlier this week, I ran into a major roadblock that I naively seem to have neglected to realize until now. In determining my loan options, I've come to face the overwhelming reality that I'm going to graduate with a heinous amount of debt. Close to $180,000, not including interest accrued (does include all undergrad debt). I crunched the numbers, and my future monthly payment looks to be well over $2000/month for 10 years. I assessed the average salary for PT in the areas I would consider (~$80,000, before taxes), and figured I will be living a rather frugal, substandard life if I'm solely supporting myself at that point (which I should assume) and for years to come.

That being said, I do enjoy PT and think it is a great career choice for me. And I've worked really hard to get where I am now. BUT, I think there are other healthcare professions that I could enjoy just as well without putting myself in a debilitating financial state. Considering I do not have a nursing degree (and prefer not to go back for another B.S.), I found that the masters program for anesthesiologist assistants may be a good alternative for me. I would only need 2 more prereqs and I could work for another year to save up extra $$$ to help pay for school (which will end up being significantly less than PT school).

My only concern with this field is the job outlook/availability. I've read that there are a limited number of states that allow AA's to practice (still unsure how many at this point, most recent news I could find is years old). Even the states that do allow it have sparse opportunities. It seems to be all dependent on whether the hospital/anesthesiologist is willing to sponsor AA's and whether the market is already saturated. Plus the competition with CRNAs will likely be an issue. What I do like is the salary data I was able to find and having schedule options. I wouldn't mind working weekends and call the first couple years to gain experience if I'm able to score a position with more regular 7am-3pm workday later. I hope to have a family within a few years of graduating and I just don't see that being possible with the amount of debt I would leave PT school with.

I'm hoping someone here can provide me more information on the relevance of the AA career as of today. Also, any updates on legislation for which states allow practice.

Thanks!

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[jwk]

Have you checked into the cost of AA school? It's anywhere from $65k-95k depending on the school. Not sure what your undergrad debt is, but going the AA route is not necessarily cheap either, but at least it's 2+ years instead of 3+. A "doctorate" in anything means more time in school and more money, although not necessarily an enhanced scope of practice (I have no knowledge of the DPT's) - advanced practice nursing is going the doctorate route with zero increased scope of practice but a lot more debt. Rather pointless IMHO. They're looking for the same jobs as someone with a masters, but they're not getting any more money because they can't do any more.

AA's are in 18 states at last count plus DC. Opportunities may seem hard to find on the outside looking in, but most anesthesia practices do not advertise their positions. We don't - we don't need to. We get plenty of students coming through on clinical rotations that we can talk to, and we get lots of applications from those willing to do their homework and hunt for a job. There is virtually 100% job placement for graduating AA students. Like any other profession, it may or may not be in the place you want to be, but that's the reality. One thing you should understand is that anesthesia in general is not usually a 7-3 job, and the places that do have that type of schedule, usually outpatient centers, are extremely popular and limited. Hospitals, especially larger ones, are a 24-7 operation and that includes the anesthesia department. We pay OT outside the usual 7-3 hours, including weekends, so we don't hire people to work weekends only. But every group is different according to the specific needs of their hospital and practice. Some are straight salary and everyone works the same amount - even if that includes nights and weekends. Some are salary plus OT, others might be straight hourly.

Competition with CRNA's is an issue - they don't like others playing in their sandbox and are scared to death of there being an alternative provider besides them. Again, our job placement success kind of speaks for itself.

 

[pamac]

Doctorates for advanced practice nurses wont cost much more than the masters, but the cost will be in terms of not being able to practice for the extra time spent completing the program. I'm not a big fan of degree creep, but the nursing world has their eye set on ever increasing their influence, and the DNP is a big part of that. They want to walk to the negotiating tables with doctorates to their name, and heck if it won't work, because those kinds of things add prestige. The image it confers is what they are after because they are successfully setting policy with their nurse PhDs as lobbyists. If one thinks it's about being called a "doctor" in the exam room, then the point is being missed. The DNP is about gaining influence in the boardroom, or in the committee room in legislatures. If nurses wanted clout in the exam room, they would add clinical time and beefy science to the DNP instead of coursework on influencing public policy. So many people seem focused on the notion of the infamous "noctor" who wants to take sandwiches from the physicians lounge. It's about churning out folks that don't seem out if place as faculty at universities. Who has more clout walking in a door to a deans office... A masters degree PA professor, or a nurse with a PhD and/or an NP with a doctorate? Like it or not, the DNP is a wise choice to obtain a louder voice as to where scarce funding will be allocated. I'll tie in my view on AAs later to that.

You could forgo PT school for AA school and probably come out well right now. There is a demand for providers in anesthesia, and current parity with CRNAs for wages. I agree that if going to PT school costs you 100k, then certainly that is far too much. But you are lumping in your undergrad with what PT would cost you, so it's hard to compare head to head. Your undergrad may make up the lion share there. But AA school will cost you close to 100k. But you have to do something with your life and it sounds like you paid too much for undergrad, so pick what you want to do, and do so with the knowledge that both routes involves paying back large amounts of debt. No matter which route you take, it will be beans and rice.

The cons are that you are restricted to a handful of states (16). Personally, I don't see that changing significantly. CRNAs are seeing the very beginnings of saturation in some places, and they are politically connected enough to hold the line against any intrusion by AAs into new states. There are entities that would love to have competition to CRNAs (groups that basically want to profit from their work and pay them reduced wages), but the road block to expansion will be legislative bodies. Physician groups are even losing their ability to own the day when they walk into legislatures seeking to have their way. Even if AAs got them on board, physicians groups aren't going to work hard to pull anyone across the finish line than themselves. Insurers won't care who provides anesthesia between AAs and nurses because any savings won't be passed on to them. Hospitals, surgical centers and anesthesia practices would love to make the dependent AAs take less wages than independent CRNAs would, but they would have to make the case to legislatures in the face of relentless opposition from the nursing lobby. People have an image in their head thanks to media of them as fat cats driving BMWs and living like princes. But nursing has numbers, rabid lobbies, and a public image of blue collar working women out doing selfless work. They have a voice. I don't see a new provider gaining wide traction at this point. Like it or not, AAs are a niche in a career with only about about 800 (!) peers in 16 states. That's vs 45,000 CRNAs. A group of 800 in a field isn't going to have a voice in today's atmosphere. It's probably a great job if you are fine with the restrictions on you.

 

[totter2]

I seriously considered DPT, AA, and PA when trying to decide which career would be right for me. I also eliminated DPT due to the debt:salary ratio, that was pretty easy for me.

AA vs PA was harder. I seriously *wanted* to pick AA. The salary is great and after shadowing both AAs and PAs, I liked AA work better. But in the end I couldn't bring myself to choose AA. PA means ability to work in all fifty states plus significantly more freedom when it comes to choosing where I want to work (a city vs. rural). I want a degree that lets me get a job anywhere. AA graduates still have pretty much 100% job placement, but like jwk said, it's not always where you want. There will always be the threat of CRNAs and their much more powerful lobby. I have kept tabs on AA legislation, and it's an extremely slow and laborious process that is fought tooth and nail by the nurses. IMO AA will be a niche provider so many years to come. For people who are flexible, I think AA is great. I am actually a bit jealous of people who choose AA.

I'm not saying PAs don't face competition, either, but it pales in comparison to the AA vs. CRNA stuff that goes on.

 

[jwk]

pamac - some of your info is a little outdated. there are over 2000 practicing AA's - and with 10 programs, it means there are more graduates coming out, double what there were even five years ago, somewhere between 200-250/yr. Where the CRNA market is very saturated in a lot of places, the AA market isn't nearly so stuffed. Even in places like Atlanta that has lots of AA's, groups are hiring, but of course we can't hire every single one that wants to be in Atlanta. Of course we don't have the size of the AANA - but if they're really a better and more cost-effective provider, one has to ask why they spend untold millions of dollars nationwide fighting the AA concept. The open market will decide IF the playing field is level, which they fight every day because they're scared of the competition.

Other areas are hiring as well, and in many cases, AA's are the preferred hire because of the hostile political climate between anesthesiologists and nurse anesthetists. Indiana opened this year, Colorado has a new program just graduating it's first class, and New Mexico just relaxed some of their restrictions. Nobody in any profession can guarantee anyone in a place of their choice - CRNA's certainly are having to hunt far and wide, especially those coming out of states that are grossly overloaded with CRNA programs like Florida and North Carolina.

AA's are not designed to be a less expensive provider - but they end up being less expensive than independently practicing CRNA's, because the dirty little secret is that CRNA's will charge the same as anesthesiologists. They're certainly not cheaper, although they are dying to have the public believe that they are. And while CRNA's would have you believe they are all independent practitioners that are equal or better than an anesthesiologist, the reality is that most still work in anesthesia care team practices and are supervised by anesthesiologists to some degree or another. Big hospitals with big surgery demand anesthesiologists be on staff, period. DNP is a smokescreen, and intelligent administrators know this. Zero increased scope of practice = degree creep in most cases, especially with the add-on degree that can be had online. That doesn't impress anyone.

AA's know a lot about CRNA's because we work with them every day. The same cannot be said of most CRNA's - they only know what they've been spoonfed by the AANA.

 

[MyNameWasUsed]

CRNA>AA

 

[Makati2008]

When I was a RN, I went through a hospital orientation with a guy who'd been an AA in another state. He said he earned more than most Americans in his previous job. Life required he and his wife move to my state where we don't recognize AAs. He did get a job working around the OR - mostly straightening up and cleaning after helping set up stuff. Kind of sad really. I felt sorry for the guy.

For the OP, when your debt to income ratio is going to be that skewed I think the DPT route would be a bad choice. Sorry for the negative opinion.

That's a sad case. He would have been better off commuting even if it was via plane...

 

[CaliforniaDreamingAA]

Ill be the first to advocate for AAs everywhere! But The AA reality is that "open" state does not mean u can work in any hospital or clinic in that state. Theres only a few specific hosPitals in those open states where u can work and even if u hv "established" urself that means nothing. The group where i used to work in Houstonwent frm hiring AAs to firing all of them bc the new MD chief didnt really like AAs. Luckily i transitioned out in time and i didnt have a mortgage or kids either yet. And abt 10 years ago AAs in ohio were suddenly out of a job too due to CRnA shenanigans. If u wanna stay in Atlanta ur prob pretty safe but being an AA is not as stable as some wd lead u to believe. And Ive worked at several hospitals in two states so ive seen more than those AAs who hv stayed in the same hospital or in the same city their whole entire career. Everyone is healthcare is struggling, and there r pros cons to all professions. there is no easy job in healthcare unless ur a pharma or med dev rep

 

[CaliforniaDreamingAA]

Doctorates for advanced practice nurses wont cost much more than the masters, but the cost will be in terms of not being able to practice for the extra time spent completing the program. I'm not a big fan of degree creep, but the nursing world has their eye set on ever increasing their influence, and the DNP is a big part of that. They want to walk to the negotiating tables with doctorates to their name, and heck if it won't work, because those kinds of things add prestige. The image it confers is what they are after because they are successfully setting policy with their nurse PhDs as lobbyists. If one thinks it's about being called a "doctor" in the exam room, then the point is being missed. The DNP is about gaining influence in the boardroom, or in the committee room in legislatures. If nurses wanted clout in the exam room, they would add clinical time and beefy science to the DNP instead of coursework on influencing public policy. So many people seem focused on the notion of the infamous "noctor" who wants to take sandwiches from the physicians lounge. It's about churning out folks that don't seem out if place as faculty at universities. Who has more clout walking in a door to a deans office... A masters degree PA professor, or a nurse with a PhD and/or an NP with a doctorate? Like it or not, the DNP is a wise choice to obtain a louder voice as to where scarce funding will be allocated. I'll tie in my view on AAs later to that.

You could forgo PT school for AA school and probably come out well right now. There is a demand for providers in anesthesia, and current parity with CRNAs for wages. I agree that if going to PT school costs you 100k, then certainly that is far too much. But you are lumping in your undergrad with what PT would cost you, so it's hard to compare head to head. Your undergrad may make up the lion share there. But AA school will cost you close to 100k. But you have to do something with your life and it sounds like you paid too much for undergrad, so pick what you want to do, and do so with the knowledge that both routes involves paying back large amounts of debt. No matter which route you take, it will be beans and rice.

The cons are that you are restricted to a handful of states (16). Personally, I don't see that changing significantly. CRNAs are seeing the very beginnings of saturation in some places, and they are politically connected enough to hold the line against any intrusion by AAs into new states. There are entities that would love to have competition to CRNAs (groups that basically want to profit from their work and pay them reduced wages), but the road block to expansion will be legislative bodies. Physician groups are even losing their ability to own the day when they walk into legislatures seeking to have their way. Even if AAs got them on board, physicians groups aren't going to work hard to pull anyone across the finish line than themselves. Insurers won't care who provides anesthesia between AAs and nurses because any savings won't be passed on to them. Hospitals, surgical centers and anesthesia practices would love to make the dependent AAs take less wages than independent CRNAs would, but they would have to make the case to legislatures in the face of relentless opposition from the nursing lobby. People have an image in their head thanks to media of them as fat cats driving BMWs and living like princes. But nursing has numbers, rabid lobbies, and a public image of blue collar working women out doing selfless work. They have a voice. I don't see a new provider gaining wide traction at this point. Like it or not, AAs are a niche in a career with only about about 800 (!) peers in 16 states. That's vs 45,000 CRNAs. A group of 800 in a field isn't going to have a voice in today's atmosphere. It's probably a great job if you are fine with the restrictions on you.

 

[CaliforniaDreamingAA]

I think you are right. Being an AA is pretty sweet but its not the answer for everyone. Lots of cons. Especially w CRNAs. Some of my best friends hv been CRNAs (yikes!lol!) its a tough market. Yeah, there are prob more like 2000 AAs now but compared to 50k crnas, thats a drop in the propofol bucket. And 2000/16-18 states=125 AAs max per state. Not good odds in terms of lobbying.

 

[pamac]

I looked into AA at one point, but quickly realized the geographic limitations would be really hard on me. It seems reasonable to have an analog in the gas world to the role PA's have. The argument CRNA's might make is that they typically recruit nurses from ICU's who are familiar with managing critical patients, and maybe there's something to that, but the fact that they are in force and practicing speaks well to how well AA's can function. But... numbers. At this point in time in the healthcare industry, when things tighten up, if you don't have an edge on the market, I don't see inroads forming around an obscure profession. I feel like PA's are at or beyond the critical mass to hold their ground decently, but AA's don't have a champion. In one size fits all bureaucratic, top down healthcare, the fat will get trimmed, and I didn't want to be in something that wasn't on solid ground.

pamac - some of your info is a little outdated. there are over 2000 practicing AA's - and with 10 programs, it means there are more graduates coming out, double what there were even five years ago, somewhere between 200-250/yr. Where the CRNA market is very saturated in a lot of places, the AA market isn't nearly so stuffed. Even in places like Atlanta that has lots of AA's, groups are hiring, but of course we can't hire every single one that wants to be in Atlanta. Of course we don't have the size of the AANA - but if they're really a better and more cost-effective provider, one has to ask why they spend untold millions of dollars nationwide fighting the AA concept. The open market will decide IF the playing field is level, which they fight every day because they're scared of the competition.

Other areas are hiring as well, and in many cases, AA's are the preferred hire because of the hostile political climate between anesthesiologists and nurse anesthetists. Indiana opened this year, Colorado has a new program just graduating it's first class, and New Mexico just relaxed some of their restrictions. Nobody in any profession can guarantee anyone in a place of their choice - CRNA's certainly are having to hunt far and wide, especially those coming out of states that are grossly overloaded with CRNA programs like Florida and North Carolina.

AA's are not designed to be a less expensive provider - but they end up being less expensive than independently practicing CRNA's, because the dirty little secret is that CRNA's will charge the same as anesthesiologists. They're certainly not cheaper, although they are dying to have the public believe that they are. And while CRNA's would have you believe they are all independent practitioners that are equal or better than an anesthesiologist, the reality is that most still work in anesthesia care team practices and are supervised by anesthesiologists to some degree or another. Big hospitals with big surgery demand anesthesiologists be on staff, period. DNP is a smokescreen, and intelligent administrators know this. Zero increased scope of practice = degree creep in most cases, especially with the add-on degree that can be had online. That doesn't impress anyone.

AA's know a lot about CRNA's because we work with them every day. The same cannot be said of most CRNA's - they only know what they've been spoonfed by the AANA.

I seriously doubt "millions" are being spent to counter AA's specifically. You might get to the millions of dollars in advocacy for the CRNA profession as a whole.