there are a FEW pa's nationally who have been able to get credentialed to do operative anesthesia. most of the folks who do this have been doing it for > 25 yrs and probably could not get that credentialing today but as long as they stay at their current jobs they are grandfathered indefinitely. they bill under the #s of the anesthesia md's they work with.they all received intensive on the job training from md anesthesiologists in the early years of the pa profession when the rules were wide open.
JWK probably knows more about this history.
this guy is the most well known pa anesthetist out there. he has been doing it for decades:
Shepard B. Stone, MPS, PA
[email protected]
Associate Clinical Professor of Anesthesiology
Yale University School of Medicine
Physician Associate-Anesthesiologist
Yale-New Haven Hospital
Lieutenant Colonel
Aeromedical Physician Assistant
State Aviation Medicine Officer
Connecticut Army National Guard
and an article about pa's in anesthesia:
By STEVEN LANE, AAPA News
A continuing national shortage of anesthesiologists and nurse anesthetists could mean a new niche for PAs, but they ould require additional training, according to some of the handful of PAs nationwide who work in the specialty. "I do think PAs are natural for anesthesia," said Shepard Stone, a PA at Yale University Hospital and one of the few PAs in the country who administers general anesthesia in the operating room. But Stone, who received his initial training in anesthesiology while a member of the first class of the Norwalk/Yale postgraduate program in surgery, agrees with other PAs interviewed for this article that the generalist PA program does not by itself provide sufficient training to administer general anesthesia.
Very few PAs practice in the specialty. On a 2003 AAPA survey, about .5 percent (85 of 1,806) of responding PAs selected anesthesiology as their specialty. However, the majority of these are probably providing pre- and postoperative care or providing pain management care, not administering anesthetics in the operating room. About 50 PAs are on the mailing list of the fledgling Society of PAs in Anesthesiology, which had its first meeting at AAPA's annual conference in New Orleans last May. Most of the 50 do not practice in anesthesia but are interested in doing so, said society president Michael Champion, who was trained as a perfusionist — which has a lot of overlap with anesthesia, he said — and now practices at a government facility in San Antonio.
Demand for providers in the field is high, due to a shortfall of 1,400 to 4,000 anesthesiologists nationally, according to aan April 2001 article in the American Society of Anesthesiologists (ASA) newsletter. (Demand was calculated by the authors from the number of inpatient, short-stay hospital procedures reported by federal agencies.) The shortfall could grow to between 3,500 and 7,900 by 2005. The authors, anesthesiologists Gifford Eckhout and Armin Schubert, also claimed that the situation would be compounded by a shortage of nurse anesthetists, pointing to a decline in the number of nurse anesthesia programs and an increase in the proportion of nurse anesthetists close to retirement age.
The shortage of certified registered nurse anesthetists (CRNAs) is important, given that CRNAs administer the majority of anesthesia in the United States: about 65 percent of the 26 million general anesthetics administered nationally each year, according to the American Association of Nurse Anesthetists (AANA). CRNAs are the only anesthesia providers in about 70
percent of the country's rural hospitals, according to AANA. "Access to anesthesia care is a challenge that is growing, not shrinking, as an aging CRNA population is concentrated more in non-urban areas . . ." said Deborah Chambers, AANA president, in her 2001 testimony to an expert panel hearing public comments on funding allocation for the Division of Nursing, Health Resources and Services Administration.
And compounding the situation is the well-documented national shortage of nurses, from whose ranks CRNAs are drawn. Despite the potential demand, anesthesiology is difficult for PAs to break into. In most areas of medicine, Stone said, PAs can get use their generalist medical training to get a job and then build on that through training in the clinical setting, gradually specializing over time if they so desire. But the technical nature of anesthesiology, coupled with the immediacy and urgency of the operating room environment, make it difficult for PAs to get opportunities to learn on the job.
"Anesthesia is a very scientific practice, and there's not a lot of opportunity to learn it through on-the-job training,"
said Michael Swetman, a PA and administrator of the department of anesthesia at the University of Texas Health Science Center at San Antonio (UTHSCSA). "In surgery, you have the surgeon directly across the table from you." "If a physician has to sit there and hold my hand, there's no point in my being there," said Stone, drawing on his experience as a pilot to create a flying analogy. "There are normal emergencies and catastrophic emergencies. If a helicopter rotor stops turning, you have to
reduce power immediately. There's no time to check a checklist."
Most PAs who work in anesthesia are probably doing pre- and postop care of patients and peripheral tasks, like inserting catheters. "I was an H&P machine," said PA Ashley August, of her first job out of PA school, working for Anesthesia Services at Christiana Hospital in Newark, Delaware.
August saw patients coming in for surgery, explained to them what would happen as anesthesia was administered, and checked their cardiac history. "I could read an EKG like the back of my hand," she said. But "I wouldn't want to do what they do," August said of her CRNA colleagues.
Faculty at UTHSCSA, where there is an entry-level PA program, are exploring the possibility of setting up a postgraduate program to train PAs in anesthesiology. The course would probably be at least two and half years long, said Champion, who is involved in developing the program. An informal survey of Texas PAs found significant interest in attending an anesthesia training program, especially among new graduates, and local physicians have been supportive of the program, Champion said.
Swetman explained that the UTHSCSA program would probably be based on curriculum used by anesthesiologist assistant training programs, of which there are only two — at Case Western Reserve University in Cleveland and Emory University in Atlanta.
Many PAs who have successfully broken into anesthesia have done it after being trained as perfusionists through the military, said Champion, who is one of them. And it is certainly possible for PAs to be successful in the specialty, as Stone's 25-year career indicates. When members of his department have required surgery, Stone has been requested more than any of his colleagues, he said, and a senior faculty member twice asked him to handle the anesthesia for his surgeries. "I was
so nervous I didn't sleep the night before," Stone said.
"Anesthesia has been good to me and I think I've been good to it," Stone added.
