Anesthetist Assistant

[dqbanrn]

rn29306, you are correct. in order for a university to have an accredited crna program, the admission requirements for the program must include a minimum of 1 year of ACUTE care ecperience. Acute care is more or less defined by each university. However, this requirment is in place to assure the student has experience with invasive lines, hemodynamic monitoring and titrated medication drips. Typically, this type of experience is only found in the ICU, but need not be restricted to there.

I really dont know of any "easy" crna programs. Unfortunately, there are some less than stellar nurse practitioner programs, but that is true of the medical and every other profession also. Any reputable school will have rigorous admission requirements and a difficult cirriculum. Ultimately, the roles of PA and NP are very similar in practice. The main differences between the two have more to do with the individual than with the education they recieved. This is basically the truth when concerning AA and crna also.

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[dqbanrn]

rn29306, you are correct. in order for a university to have an accredited crna program, the admission requirements for the program must include a minimum of 1 year of ACUTE care ecperience. Acute care is more or less defined by each university. However, this requirment is in place to assure the student has experience with invasive lines, hemodynamic monitoring and titrated medication drips. Typically, this type of experience is only found in the ICU, but need not be restricted to there.

I really dont know of any "easy" crna programs. Unfortunately, there are some less than stellar nurse practitioner programs, but that is true of the medical and every other profession also. Any reputable school will have rigorous admission requirements and a difficult cirriculum. Ultimately, the roles of PA and NP are very similar in practice. The main differences between the two have more to do with the individual than with the education they recieved. This is basically the truth when concerning AA and crna also. the problem with AA is that they are not quite as widely accepted as crna, so depending on where you live, you may not be able to practice with that title.

 

[Josh L.Ac.]

Pain management by non-physicians is an extremely controversial subject right now. There are CRNA's practicing "pain management" under the guise of "we're only doing procedures that we've been requested to do by an orthopedist, neurologist, or other physician". Several states and/or state medical boards have ruled that "pain management" by CRNA's is beyond their scope of practice and constitutes the practice of medicine. The debate rages on.

UMKC's program is being developed as we speak. They have indicated they would like to accept students next summer, but they have to hire a director and take care of a few logistical issues first.

Thanks for the information. If the CRNAs are having legal issues with doing pain management procedures, it is unlikely that the AAs will have an easier lobbying for it.

But I'll still keep looking out for new information on the UMKC website.

 

[Baylee]

I attended a traditional program with none of this direct entry fluff and the majority of our class had 3-7 years experience, with only 3 accepted with one year.

THAT I can respect!

 

[jwk]

I have a good friend who's an anesthesiologist and he actually convinced his son to go to nursing school and then on to a nurse anesthetist program. His kid could have easily gone the medical route, because the little guy is a genius. At first, I was appalled that he would encourage his son to go into NURSING of all things, but after he explained that CRNA's are pulling down 150K per year and have less responsibility, less school debt, etc, it made perfect sense. He specifically mentioned that he wouldn't want his son going the AA route, because the nursing/CRNA lobbies are so strong and the AA organizations will never be able to compete.

Your anesthesiologist friend should spend some time reviewing the current state of politics of his own profession with CRNA's. AA's are here to stay.

 

[jwk]

HOLY S***! I'M DROPPING OUT OF MED SCHOOL AND SIGNING UP FOR NURSING SCHOOL! PLEASE don't tell me that these nurses are allowed to do ESI's! If so, there goes the profession.

uh, yep - that's what I'm telling you.

 

[jwk]

Thanks for the information. If the CRNAs are having legal issues with doing pain management procedures, it is unlikely that the AAs will have an easier lobbying for it.

But I'll still keep looking out for new information on the UMKC website.

AA's aren't looking to perform pain management procedures.

 

[core0]

AA's aren't looking to perform pain management procedures.

Lots of PA's are working in pain management now. An interesting combination would be PA/AA. You would have the ability to work both inpatient and outpatient. The Emory program has an entry for PA's. I'm suprised no one has put up a dual program. Could probably get both in about three years.

David Carpenter, PA-C

 

[jwk]

Lots of PA's are working in pain management now. An interesting combination would be PA/AA. You would have the ability to work both inpatient and outpatient. The Emory program has an entry for PA's. I'm suprised no one has put up a dual program. Could probably get both in about three years.

David Carpenter, PA-C

Are PA's performing the blocks used in chronic pain management?

 

[MSc44]

Lots of PA's are working in pain management now. An interesting combination would be PA/AA. You would have the ability to work both inpatient and outpatient. The Emory program has an entry for PA's. I'm suprised no one has put up a dual program. Could probably get both in about three years.

David Carpenter, PA-C

First, why cant PA's go into anesthesology, SInce t hey can go into any other field?????


Isnt A CRNA just a NP with a speciality degree -training in anesthesia?, and if they choose not to do anes any more couldent they do say primary care????

and


Since CRNA's can do anes, can they also handle critical care medicine?


all this why one but not the other stuff seems so confusing

 

[deleted6669]

Are PA's performing the blocks used in chronic pain management?

yes-blocdoc over at physicianassistant.com is a pa in pain medicine who does the full scope of practice.

 

[rn29306]

Isnt A CRNA just a NP with a speciality degree -training in anesthesia?, and if they choose not to do anes any more couldent they do say primary care????

No, a CRNA is not 'just an NP'. We don't focus on anything other than diseases and perioperative management. CRNAs are not taught primary care. The education is drastically different. There is no crossing over. If an NP wants to go to CRNA school, he or she gets to start over with everyone else.
There are NPs in the class that are currently seniors and there is no shortcut.

Same for PAs and AAs. AAs are not taught primary care or any hint of it. The two tracts are entirely different with no crossing over. I've got a buddy from Atlanta that was a vascular PA and he is in Florida training as an AA. And yes he started over just like everyone else.

 

[MSc44]

No, a CRNA is not 'just an NP'. We don't focus on anything other than diseases and perioperative management. CRNAs are not taught primary care. The education is drastically different. There is no crossing over. If an NP wants to go to CRNA school, he or she gets to start over with everyone else.
There are NPs in the class that are currently seniors and there is no shortcut.

Same for PAs and AAs. AAs are not taught primary care or any hint of it. The two tracts are entirely different with no crossing over. I've got a buddy from Atlanta that was a vascular PA and he is in Florida training as an AA. And yes he started over just like everyone else.

so then can PA's NOT go into anesthesology????????

 

[rn29306]

so then can PA's NOT go into anesthesology????????

Sure, a PA can go into anesthesia. Go to AA school like everyone else.

It is insulting (for those AAs and CRNAs here that trained for 2-3 years solely in anesthesia) for you to think that a generalist trained PA can do an anesthesia rotation in school and then go and do anesthesia to the equivalent that a CRNA or AA can. Even within the ACT environment, these two providers are expected to be as independent as possible. It is laughable that a generalist trained PA can perform this to the level of an AA or CRNA. Could a PA be trained to do anesthesia...sure with additional time. But it does not work that way.
JWK or emedpa please correct me if I am wrong on any of the PA information here.

It just doesn't happen, and for good reason too.

Why do you even care? Your a MS right?

 

[jwk]

so then can PA's NOT go into anesthesology????????

No, they can't - there are several reasons.

Anesthesiology as a specialty has it's own subset of physiology and pharmacology. It's not something that can be learned on the job.

Also, CMS and private insurors recognize three types of anesthesia providers - physicians, CRNA's, and AA's. Period. The flip side is that AA's and CRNA's don't do surgery, or derm, or any of the other specialties that PA's are involved with every day.

There is a currently a PA to AA bridge program just getting going at Emory in Atlanta. PA's with master's level coursework in the appropriate subjects can knock two semesters off their AA program. At $8-9k per semester or whatever the cost is currently, that's a big chunk of change.

 

[MSc44]

Sure, a PA can go into anesthesia. Go to AA school like everyone else.

It is insulting (for those AAs and CRNAs here that trained for 2-3 years solely in anesthesia) for you to think that a generalist trained PA can do an anesthesia rotation in school and then go and do anesthesia to the equivalent that a CRNA or AA can. Even within the ACT environment, these two providers are expected to be as independent as possible. It is laughable that a generalist trained PA can perform this to the level of an AA or CRNA. Could a PA be trained to do anesthesia...sure with additional time. But it does not work that way.
JWK or emedpa please correct me if I am wrong on any of the PA information here.

It just doesn't happen, and for good reason too.


Why do you even care? Your a MS right?

settle down, it was a simple question, that i did not know the answer too.

if by ms u mean med student........no im not

 

[jwk]

settle down, it was a simple question, that i did not know the answer too.

if by ms u mean med student........no im not

The way you phrased your statement/questions and the multiple ???????? gave your post a certain "tone" which you may not have intended. No one knows who you are (empty profile) so no one knows where you're coming from - legitimate question vs trolling.

 

[core0]

No, they can't - there are several reasons.

Anesthesiology as a specialty has it's own subset of physiology and pharmacology. It's not something that can be learned on the job.

Also, CMS and private insurors recognize three types of anesthesia providers - physicians, CRNA's, and AA's. Period. The flip side is that AA's and CRNA's don't do surgery, or derm, or any of the other specialties that PA's are involved with every day.

There is a currently a PA to AA bridge program just getting going at Emory in Atlanta. PA's with master's level coursework in the appropriate subjects can knock two semesters off their AA program. At $8-9k per semester or whatever the cost is currently, that's a big chunk of change.

OK I'll play devil's advocate here. While I agree with you that anesthesia has it's own subset of physiology and pharmacology. I also agree that these skill should not be learned on the job.

That being said, in most states there is nothing to stop a PA from doing anesthesia. The PA's practice is defined by his supervising physician (in most states). So if a PA had an SP that practices anesthesiology and was willing to supervise a PA practicing anesthesiology then in theory that PA could practice anesthesiology. Is this good practice - no and it is unlikely that a PA could get credentialled by a hospital to do this.

David Carpenter, PA-C

 

[jwk]

That being said, in most states there is nothing to stop a PA from doing anesthesia. The PA's practice is defined by his supervising physician (in most states). So if a PA had an SP that practices anesthesiology and was willing to supervise a PA practicing anesthesiology then in theory that PA could practice anesthesiology. Is this good practice - no and it is unlikely that a PA could get credentialled by a hospital to do this.

David Carpenter, PA-C

You're incorrect - a PA can only perform those functions that he has the education and training to do, and they don't get the 2-3 years of anesthesia training in PA school that AA's and CRNA's get. A malpractice insuror won't write coverage for a PA doing anesthesia because they simply don't have the education to back it up, hospitals won't allow you privileges to do it, and insurance companies and CMS won't pay for a PA doing anesthesia anyway. If you don't get paid or reimbursed for what you do and can't even be insured for doing it anyway, you won't be able to practice in that field.

This debate comes around every couple of years with the same end result.

 

[Josh L.Ac.]

AA's aren't looking to perform pain management procedures.

Thanks for the direct answer. I didn't see any pain management in the curriculum of 2 of the AA schools I looked at, but I thought I would ask anyway.

 

[core0]

You're incorrect - a PA can only perform those functions that he has the education and training to do, and they don't get the 2-3 years of anesthesia training in PA school that AA's and CRNA's get. A malpractice insuror won't write coverage for a PA doing anesthesia because they simply don't have the education to back it up, hospitals won't allow you privileges to do it, and insurance companies and CMS won't pay for a PA doing anesthesia anyway. If you don't get paid or reimbursed for what you do and can't even be insured for doing it anyway, you won't be able to practice in that field.

This debate comes around every couple of years with the same end result.

As someone practicing as a PA I can tell you that you are incorrect. The actual answer depends on the state of course, but in my state the only restriction is things that my SP won't let me do and things that my SP can't do. For example I couldn't do anesthesia if working for a FP, but I could if working for an anesthesiologist.

Here is the appropriate part of the medical practice act:
"Delegation of Medical Services. Delegated services must be consistent with the delegating physician’s education, training, experience and active practice. Delegated services must be of the type that a reasonable and prudent physician would find within the scope of sound medical judgment to delegate. A physician may only delegate services that the physician is qualified and insured to perform and services that the physician has not been legally restricted from performing. Any services rendered by the physician assistant will be held to the same standard that is applied to the delegating physician."

Notice it says nothing about the PA training, but speaks to the MD training. The part about prudent physician within scope of sound medical judgement to delegate would be a high hurdle to overcome but not impossible. As far as malpractice, my policy does not prohibit anesthesia and other policies are tied to the SP. I would agree on accredidation although a physician owned surgery center would be possible. As far as payment, I can't speak to that since I don't bill for anesthesia (although once again most private insurance is billed under the supervising physician).

I am not advocating this, simply stating that in the right circumstances it could be possible. One scenario I could see is a PA that was trained in anesthesia in a no liability situation such as VA taking this into private practice (this is the situation that we see with procedures such as colonoscopy).

David Carpenter, PA-C

 

[jwk]

As someone practicing as a PA I can tell you that you are incorrect. The actual answer depends on the state of course, but in my state the only restriction is things that my SP won't let me do and things that my SP can't do. For example I couldn't do anesthesia if working for a FP, but I could if working for an anesthesiologist.

Here is the appropriate part of the medical practice act:
"Delegation of Medical Services. Delegated services must be consistent with the delegating physician’s education, training, experience and active practice. Delegated services must be of the type that a reasonable and prudent physician would find within the scope of sound medical judgment to delegate. A physician may only delegate services that the physician is qualified and insured to perform and services that the physician has not been legally restricted from performing. Any services rendered by the physician assistant will be held to the same standard that is applied to the delegating physician."

Notice it says nothing about the PA training, but speaks to the MD training. The part about prudent physician within scope of sound medical judgement to delegate would be a high hurdle to overcome but not impossible. As far as malpractice, my policy does not prohibit anesthesia and other policies are tied to the SP. I would agree on accredidation although a physician owned surgery center would be possible. As far as payment, I can't speak to that since I don't bill for anesthesia (although once again most private insurance is billed under the supervising physician).

I am not advocating this, simply stating that in the right circumstances it could be possible. One scenario I could see is a PA that was trained in anesthesia in a no liability situation such as VA taking this into private practice (this is the situation that we see with procedures such as colonoscopy).

David Carpenter, PA-C

The simple fact still remains that PA's cannot do anesthesia. Again, this concept has come up before and is shot down every time, including by the AAPA as I recall. You can't get insured for it, you can't get paid for it, a hospital won't give you privileges to do it, and you're not trained to do it in the first place. A physician can't delegate medical acts to an untrained individual, and your education most certainly plays into that situation. Anesthesiology is so much more than intubation and art lines. That's why the programs are more than two years in length even for those individuals with previous healthcare experience. An anesthesiologist that would allow a PA to practice anesthesiology puts his patients at risk, and wouldn't have a medico-legal prayer to stand on if an untoward event happened.

There are a number of PA's who have tried to practice anesthesia. They are
universally unsuccessful for the above reasons. You may think as a practicing PA you understand this in theory, but as a practicing AA for more than 25 years, I can tell you that you clearly don't understand the reality.

 

[Baylee]

Sure, a PA can go into anesthesia. Go to AA school like everyone else.

It is insulting (for those AAs and CRNAs here that trained for 2-3 years solely in anesthesia) for you to think that a generalist trained PA can do an anesthesia rotation in school and then go and do anesthesia to the equivalent that a CRNA or AA can. Even within the ACT environment, these two providers are expected to be as independent as possible. It is laughable that a generalist trained PA can perform this to the level of an AA or CRNA. Could a PA be trained to do anesthesia...sure with additional time. But it does not work that way.
JWK or emedpa please correct me if I am wrong on any of the PA information here.

It just doesn't happen, and for good reason too.

Why do you even care? Your a MS right?

I'm a "MS" and I care. We just had this same discussion on another thread regarding the generalized training of PA's (4 wks each specialty - YIKES!). There is no where, no how, no WAY a PA can legally perform anesthesia in any frigging state in the union. A Third World Country, maybe, but not in the USA! If I'm going under, it will be by a 1st choice: Anesthesiologist 2nd choice: CRNA.

 

[deleted6669]

I'm a "MS" and I care. We just had this same discussion on another thread regarding the generalized training of PA's (4 wks each specialty - YIKES!). There is no where, no how, no WAY a PA can legally perform anesthesia in any frigging state in the union. A Third World Country, maybe, but not in the USA! If I'm going under, it will be by a 1st choice: Anesthesiologist 2nd choice: CRNA.

you need to stop this "4 weeks in each specialty" crap. most of us get more than that in our area of interest. ever heard of electives? I had 27 weeks of em/trauma in pa school following 10 years in ems. after graduation I did an additional 1 yr postgraduate program in em. the only doc who knows more em than me is an em doc. I teach em to fp residents.
get over yourself baylee

 

[jwk]

I'm a "MS" and I care. We just had this same discussion on another thread regarding the generalized training of PA's (4 wks each specialty - YIKES!). There is no where, no how, no WAY a PA can legally perform anesthesia in any frigging state in the union. A Third World Country, maybe, but not in the USA! If I'm going under, it will be by a 1st choice: Anesthesiologist 2nd choice: CRNA.

You should amend that and say CRNA or AA. In fact, if you're in Georgia or Ohio in any major medical facility, your chances of meeting an AA are very high.

And truth be told, there are many anesthesiologists that have not "put someone to sleep" in years. In my group, 95% of the anesthetics are administered by an anesthetist (AA or CRNA) being medically directed or supervised by an anesthesiologist covering up to 4 OR's. All of our MD's all still personally do cases on a regular basis, but this is not the case everywhere. About 65-70% of anesthetics in the US are done within the "Anesthesia Care Team" mode of practice - meaning the person who is actually personally doing the case is probably an anesthetist that is covered by an anesthesiologist. There's nothing wrong with this - perfectly legal and legit way of practicing anesthesia found throughout the US. You will occasionally find all-MD practices or all-CRNA practices) as well. AA's are always within an anesthesia care team type of practice.

 

[deleted6669]

there are pa's working for anesthesia groups but most of them do preop and postop evals or pain management and not intraoperative airway management.
http://www.paanesthesiaworld.us/

as a pa who has done graduate level research in emergent airway management I would still go back to an AA program if I ever wanted to deliver anesthesia in the o.r. setting. I am comfortable intubating patients emergently but there is a big difference between intubation and maintaining o.r. level anesthesia for hours. I know a few AA's and respect the work they do and the training they undertake to do it.