Physician Assistant in Anesthesia

[PieOHmy]

If I were the ASA I would advocate for training of PAs in anesthesia to supplement the AAs and CRNAs. The benefit of having PAs is their well rounded clinical skills, indepth science backround and a national certification exam.
I would take these PA graduates and open up a 12-16 month intensive anesthesia intra-op training program to get them certified in anethesia. And the certification would be from the ABA. ABA would love it.. because of the new revenue stream. Same with the ASA. throw in some anesthesia re cert requirements. A whole new revenue stream.
Moreover, PAs already are licensed in 50 states so that hurdle wouldnt have to be jumped over.

I think it is a bad idea to be fighting publicly with the CRNAS. In any fight regardless who wins both parties get injured
Advocate for PAs in anesthesia.

BTW I am not PA. Iam a boarded Anesthesiologist. (the physician kind) not the nurse kind.

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[Endee]

I was the President of the American Academy of Anesthesiologist Assistants (AAAA) in 2018, so let me offer some of my insight about this idea:

1) There was an Emory PA-to-AA program for a while that ended. I think it was lack of enrollment, but I defer to jwk for the scoop on that.

2) At least over the last several years of my involvement at the national level, the AAPA and its state components have expressed little interest in being involved with us or with anesthesia at all--in fact, they specifically have said they DONT want to be involved.

3) The AAPA is having an independent practice push. AAs want nothing to do with that.

4) We can barely get anesthesiologists/groups/facilities on board with introducing AAs into their practices and AAs have been around for 50 years. You'd be surprised how much of a fight it is to get groups to bring in AAs in states where we can already work, or to introduce AAs into new states.

5) Every state statute would have to be amended to allow PAs to practice anesthesia. Currently, anesthesia can only be practiced by an anesthesiologist, a nurse anesthetist, or (in 17 jurisdictions) an anesthesiologist assistant.

I don't think its a bad idea to fight. The problem has been not fighting. You wouldn't believe how many anesthesiologists I've talked to who are completely beholden to their nurse anesthetists. It makes me wonder who employs who. People are paralyzed with fear at the idea of standing up for physician led or physician performed anesthesia care just at the thought of what their CRNAs will do. The ASA and anesthesia groups across the country need to see the declaration of war that has been laid on the table by the AANA and respond with appropriate strength.

 

[2.0%]

3) The AAPA is having an independent practice push. AAs want nothing to do with that.

For now...
The way things have been going in my neck of the woods with PAs, I can't help but thing AAs may follow suit. I realize their smarter play is to continue to work with the ASA on pushing for their expansion first though. Once they can work throughout the country, the AAAA will follow in the AAPAs footsteps. By that time, PAs will have succeeded and it will be even easier for AAs.

 

[Endee]

For now...
The way things have been going in my neck of the woods with PAs, I can't help but thing AAs may follow suit. I realize their smarter play is to continue to work with the ASA on pushing for their expansion first though. Once they can work throughout the country, the AAAA will follow in the AAPAs footsteps. By that time, PAs will have succeeded and it will be even easier for AAs.

Not happening. I don’t understand how this idea keeps persisting. I led the revision of the AAAA statement on the anesthesia care team affirming the profession’s commitment to physician leadership, referencing the WHO statement that every anesthetic should be performed or supervised by a physician.

The difference between AAs and every other non physician clinician (NP, PA, etc) is that throughout education and practice we are trained to value and appreciate the immense expertise that physicians bring to the anesthesia team. We know the extent of what we don’t know and even though we are very well trained, no AA presumes to think that they can do it without a physician’s leadership. It’s across the board philosophical buy in. We enjoy being members of a team and we appreciate our role in that team.

Compare that to most DNP programs that educate their students from the get go that physicians are superfluous and increasingly unnecessary in 21st century medicine.

 

[PieOHmy]

I was the President of the American Academy of Anesthesiologist Assistants (AAAA) in 2018, so let me offer some of my insight about this idea:

1) There was an Emory PA-to-AA program for a while that ended. I think it was lack of enrollment, but I defer to jwk for the scoop on that.

2) At least over the last several years of my involvement at the national level, the AAPA and its state components have expressed little interest in being involved with us or with anesthesia at all--in fact, they specifically have said they DONT want to be involved.

3) The AAPA is having an independent practice push. AAs want nothing to do with that.

4) We can barely get anesthesiologists/groups/facilities on board with introducing AAs into their practices and AAs have been around for 50 years. You'd be surprised how much of a fight it is to get groups to bring in AAs in states where we can already work, or to introduce AAs into new states.

5) Every state statute would have to be amended to allow PAs to practice anesthesia. Currently, anesthesia can only be practiced by an anesthesiologist, a nurse anesthetist, or (in 17 jurisdictions) an anesthesiologist assistant.

I don't think its a bad idea to fight. The problem has been not fighting. You wouldn't believe how many anesthesiologists I've talked to who are completely beholden to their nurse anesthetists. It makes me wonder who employs who. People are paralyzed with fear at the idea of standing up for physician led or physician performed anesthesia care just at the thought of what their CRNAs will do. The ASA and anesthesia groups across the country need to see the declaration of war that has been laid on the table by the AANA and respond with appropriate strength.

Thanks for your input. I wonder why that PA-AA program closed. I am wondering if it was strictly political and a aturf battle between the AA and PA.
Anesthesiologists are physicians. IT would follow normal course that we could have Physician Assistants in the Operating Room. I am not against AAs at all. In fact I advocate getting them licensed in all 50 states, just like PAs are. BUt the legal battle in 50 states recognizing you is uphill. THis is where the ASA has dropped the ball completely.

I am wondering how much of an interest PAs have in anesthesia. Im pretty sure it would be a robust interest. Im sure the AANA would be against this idea citing lack of icu experience etc etc but PAs open and closed chests with the surgeon in another room. WHy wouldnt they be allowed to function as anesthetists?

 

[PieOHmy]

Thanks for your input. I wonder why that PA-AA program closed. I am wondering if it was strictly political and a aturf battle between the AA and PA.
Anesthesiologists are physicians. IT would follow normal course that we could have Physician Assistants in the Operating Room. I am not against AAs at all. In fact I advocate getting them licensed in all 50 states, just like PAs are. BUt the legal battle in 50 states recognizing you is uphill. PAs are already recognized in all 50 states. THis is where the ASA has dropped the ball completely.

I am wondering how much of an interest PAs have in anesthesia. Im pretty sure it would be a robust interest. Im sure the AANA would be against this idea citing lack of icu experience etc etc but PAs open and closed chests with the surgeon in another room. WHy wouldnt they be allowed to function as anesthetists?

 

[Endee]

Thanks for your input. I wonder why that PA-AA program closed. I am wondering if it was strictly political and a aturf battle between the AA and PA.
Anesthesiologists are physicians. IT would follow normal course that we could have Physician Assistants in the Operating Room. I am not against AAs at all. In fact I advocate getting them licensed in all 50 states, just like PAs are. BUt the legal battle in 50 states recognizing you is uphill. THis is where the ASA has dropped the ball completely.

I am wondering how much of an interest PAs have in anesthesia. Im pretty sure it would be a robust interest. Im sure the AANA would be against this idea citing lack of icu experience etc etc but PAs open and closed chests with the surgeon in another room. WHy wouldnt they be allowed to function as anesthetists?

I don't have any details on why the program closed, really. I do know from my experience that as an organization we have tried to improve our relationship with the AAPA and PA groups nationally due to our similar characteristics. They have rebuffed us on multiple occasions and in multiple areas. They really don't like that in Georgia, AAs are under the PA statute and considered specialist PAs.

AAs are akin to physician assistants in the operating room. I just think this is duplicative. If you really wanted to try to open the door, you could argue to get new state AA bills to fall under the state's PA practice act, like in Georgia. But like I said, AAPA fights that. They don't want any AA/PA overlap.

The average PA would see a decent salary jump by becoming an AA, and we have some AAs in my state and others that are dual AA/PA. But like I said, I think the Emory program just didn't have enough applicants to keep it going. So it's already been tried and didn't gain any traction.

I don't mind those programs existing. But I'd rather see a PA go to a program to allow them credentials as an AA, rather than allow PAs to practice anesthesia without respect to being an AA. Just like I also don't mind seeing any AA-to-PA programs that allow AAs to gain PA credentials and maybe let them work in states where AAs cannot yet practice. But I don't think AAs should just start being able to practice general medicine nor should PAs start being allowed to practice anesthesia. Like I said, all of that would require statutory revision anyway. So that's just as hard as getting AAs into a state in the first place.

 

[PieOHmy]

I don't have any details on why the program closed, really. I do know from my experience that as an organization we have tried to improve our relationship with the AAPA and PA groups nationally due to our similar characteristics. They have rebuffed us on multiple occasions and in multiple areas. They really don't like that in Georgia, AAs are under the PA statute and considered specialist PAs.

AAs are akin to physician assistants in the operating room. I just think this is duplicative. If you really wanted to try to open the door, you could argue to get new state AA bills to fall under the state's PA practice act, like in Georgia. But like I said, AAPA fights that. They don't want any AA/PA overlap.

The average PA would see a decent salary jump by becoming an AA, and we have some AAs in my state and others that are dual AA/PA. But like I said, I think the Emory program just didn't have enough applicants to keep it going. So it's already been tried and didn't gain any traction.

I don't mind those programs existing. But I'd rather see a PA go to a program to allow them credentials as an AA, rather than allow PAs to practice anesthesia without respect to being an AA. Just like I also don't mind seeing any AA-to-PA programs that allow AAs to gain PA credentials and maybe let them work in states where AAs cannot yet practice. But I don't think AAs should just start being able to practice general medicine nor should PAs start being allowed to practice anesthesia. Like I said, all of that would require statutory revision anyway. So that's just as hard as getting AAs into a state in the first place.

This sounds like a nomeclature issue.
AAs are PAs.
THe legal battle is very very difficult in getting AAs recognized in states where they are not recognized. I am not certain the ASA has that on their top agenda which they should.

Physician Assistants ARE licensed in all 50 states so that legal battle is not an issue. All that would have to be done is to present evidence what PAs are and are not. and point out how long they have been in the Operating Room and their safety records with regards to specialties like ER, CT surgery etc etc. where they have a robust presence. MOreover a 12-18 month intensive anesthesia program at medical centers like columbia hopkins Upenn Pitt etc .
Have them take a 1000 dollar written board exam (administered by the ABA of course) at the end of 18 months and the ANesthesiologist would supervise them.

Obviously this idea is very crude at this point but with time I think it could work and patients everywhere would benefit from clinicians who WANT to work as a team.
The way the specialty is going, the future is NOT BRIGHT for folks going into it now.

Disclosures: I am NOT a PA. I am boarded anesthesiologist (not the nurse variety) with 10 years exp.

 

[Endee]

This sounds like a nomeclature issue.
AAs are PAs.
THe legal battle is very very difficult in getting AAs recognized in states where they are not recognized. I am not certain the ASA has that on their top agenda which they should.

Physician Assistants ARE licensed in all 50 states so that legal battle is not an issue. All that would have to be done is to present evidence what PAs are and are not. and point out how long they have been in the Operating Room and their safety records with regards to specialties like ER, CT surgery etc etc. where they have a robust presence. MOreover a 12-18 month intensive anesthesia program at medical centers like columbia hopkins Upenn Pitt etc .
Have them take a 1000 dollar written board exam (administered by the ABA of course) at the end of 18 months and the ANesthesiologist would supervise them.

Obviously this idea is very crude at this point but with time I think it could work and patients everywhere would benefit from clinicians who WANT to work as a team.
The way the specialty is going, the future is NOT BRIGHT for folks going into it now.

Disclosures: I am NOT a PA. I am boarded anesthesiologist (not the nurse variety) with 10 years exp.

AAs are not PAs. We are analogous, we are similar, but we are not PAs and we cannot identify ourselves as PAs. The PA laws and regulations of any state do not apply to us (exception: Georgia).

PAs are indeed licensed in 50 states. But you can't just train them in anesthesia in a one year course and then let them function as AAs do now. State and federal laws and regulations including CMS billing rules say that anesthesia services can only be performed by an anesthesiologist, nurse anesthetist, or anesthesiologist assistant.

To allow PAs to practice anesthesiology, you would have to change every single state's PA statute to allow it (meaning laws that have to be passed & signed), and also change federal CMS regulations. None of that is easy and it is extremely expensive. ASA isn't going to do that. AAPA has other things to worry about as far as their agenda.

 

[PieOHmy]

To allow PAs to practice anesthesiology, you would have to change every single state's PA statute to allow it (meaning laws that have to be passed & signed), and also change federal CMS regulations. None of that is easy and it is extremely expensive. ASA isn't going to do that. AAPA has other things to worry about as far as their agenda.

I think this is worthwhile endeavor, even though you say how hard it is.

Putting a PA to 2500hours of anesthesia training over 18 months is not a big issue and I think the interest would be there. Moreover, it would probably save the viability of anesthesiology as a speciatly.

 

[deleted171991]

Not happening. I don’t understand how this idea keeps persisting.

Because people are greedy and stupid, not necessarily in that order. It's just human nature.

Just look at what the PAs are doing, another group that used to swear that they didn't want independent practice.

 

[PieOHmy]

Because people are greedy and stupid, not necessarily in that order. It's just human nature.

Just look at what the PAs are doing, another group that used to swear that they didn't want independent practice.

Having them certified under the same umbrella by THE ABA as "Assistant" status would mitigate any claims of equivalence or independence. HAving said that, the PA movement for independence is doomed to fail.

This needs to happen.

 

[Endee]

Because people are greedy and stupid, not necessarily in that order. It's just human nature.

Just look at what the PAs are doing, another group that used to swear that they didn't want independent practice.

I can understand your skepticism. But there are layers after layers of cultural, institutional, statutory, and regulatory controls that would make this so unlikely that it's essentially not possible.

Anesthesiologists are involved in every step of AA education and practice:
Medical directors of AA educational programs
Clinical educators during AA training
Every AA training program trains its students to support physicians and work within the physician led team.
Members of the accreditation review committee for new AA programs
Members of the board of the organization that administers the certification exam
AAs are members of ASA, ASAPAC donors, and state component societies and their PACs. (I am currently on the ASAPAC executive board.)
Dozens of AAs actively participate every year at the ASA legislative conference in DC, advocating for physician issues, not our own.
AAAA and ASA leaders meet multiple times per year to keep our goals aligned.
ASA has a representative on the AAAA board of directors.
All AA statutes require supervision by an anesthesiologist and defines anesthesiologist as a physician (our statutes actually help you in states where nurses are trying to codify "nurse anesthesiologist." It makes it a lot harder when state statute defines anesthesiologist as a physician.)
AA billing regs at CMS require anesthesiologist supervision.
AAs serve on multiple ASA committees and AAs participate at the ASA's board of directors meetings multiple times per year.

With a relationship that intertwined, I just don't see how it could completely unravel. It's built into our profession. With PAs, you had a profession that was dispersed between all of the medical specialties. It didn't have an identity with any particular one, because it was a facet of all of them..therefore, its identity was its own, and that fosters the independent practice mindset.

The AA professional identity is joined with anesthesiologists. That can't be separated out.

 

[btbam]

We had a guy in my AA program who was a PA, but this was back in 2011. I was unaware the Emory program stopped the PA to AA transition. This guy came in a semester later, since he had all the prerequisite anatomy/physiology stuff. He ended up quitting anesthesia after a few years and went back to being a PA last I heard.

 

[AdmiralChz]

PA independent practice doomed to fail? Not so fast. There is a growing small, but vocal, part of the AAPA quite well interested in it.

There’s several things they are doing to slowly make this a reality:

1) The growth of PA “fellowships” for subspecialty training. Very common in CCM and EM.
2) Formally changing PA to “Physicians Associate” with an emphasis on collaborative rather than supervisory practice (sound familiar?).
3) Offering doctorate programs. This is the most laughable of all, like seriously just go to medical school. But they are popping up, and the past 2 years in my state the PA society pushed for those grads to get formal recognition by the Board of Medicine with minimal supervisory requirements. It’s been soundly defeated each time, but the momentum appears to be there.

Don’t be so dismissive of AAPA independent practice goals. They are very real. The organization isn’t as nasty as a national nursing org like AANA, but they appear to be heading in that direction slowly.

 

[PieOHmy]

PA independent practice doomed to fail? Not so fast. There is a growing small, but vocal, part of the AAPA quite well interested in it.

There’s several things they are doing to slowly make this a reality:

1) The growth of PA “fellowships” for subspecialty training. Very common in CCM and EM.
2) Formally changing PA to “Physicians Associate” with an emphasis on collaborative rather than supervisory practice (sound familiar?).
3) Offering doctorate programs. This is the most laughable of all, like seriously just go to medical school. But they are popping up, and the past 2 years in my state the PA society pushed for those grads to get formal recognition by the Board of Medicine with minimal supervisory requirements. It’s been soundly defeated each time, but the momentum appears to be there.

Don’t be so dismissive of AAPA independent practice goals. They are very real. The organization isn’t as nasty as a national nursing org like AANA, but they appear to be heading in that direction slowly.

that is exactly what i am advocating for. fellowship for PAs n anesthesia (14-18monts) so they can become anesthetists.
This is what the ASA should be advocating for.
We are physicians, we should be able to have physician assistants at our disposal.
Why should rely on nurses only? the nursing agenda has been revealed.
I am dismissive of PA independence because they are licensed through us.

 

[deleted480308]

It seems weird to ask for additional midlevels

 

[Neopolymath]

We had a guy in my AA program who was a PA, but this was back in 2011. I was unaware the Emory program stopped the PA to AA transition. This guy came in a semester later, since he had all the prerequisite anatomy/physiology stuff. He ended up quitting anesthesia after a few years and went back to being a PA last I heard.

I also know of at least one individual who has done this. I know several more who were some other type of advanced practioner as well. I don't think it would be that uncommon if more people knew how good of a gig being an AA is in comparison to these other fields.

 

[jwk]

that is exactly what i am advocating for. fellowship for PAs n anesthesia (14-18monts) so they can become anesthetists.
This is what the ASA should be advocating for.
We are physicians, we should be able to have physician assistants at our disposal.
Why should rely on nurses only? the nursing agenda has been revealed.
I am dismissive of PA independence because they are licensed through us.

Sorry to be late to this particular party.

The PA > CAA bridge program failed/closed for lack of interest and likely the costs involved in getting a second masters degree. CAA education isn't an OJT fellowship, and it's not just learning clinical procedures, which is essentially what you're proposing for PAs in anesthesia. It's a full-fledged masters degree curriculum in a university setting. While undergrad students can test out of certain classes, graduate programs are a different animal. You can't use undergrad classes to satisfy graduate school requirements. The PAs that did the bridge program already had a masters PA degree - but they only got one semester knocked off because of the graduate level physiology and pharmacology they'd already taken. Everything else was new material and/or anesthesia-specific. There weren't, nor should there have been, any shortcuts. There have been a few PAs come through the CAA programs over the years. Although their PA certification may allow them to work in states that don't have CAA-enabling legislation, by and large they have stayed in CAA states due to issues with insurance reimbursement and credentialing.

Endee has outlined the reasons the PA in anesthesia just isn't going to happen. He's absolutely correct. The costs of changing legislation on the state level are quite onerous - we know - we're in the middle of it every year as we try to get CAAs in more states. The costs on the federal level, which is where the real fight would be, would be staggering. Who do you think is going to foot the bill for millions of dollars in lobbying costs? It's certainly not the ASA or the AAPA or their members. Why would the ASA, who has spent countless hours and dollars over the last three decades supporting CAAs, suddenly throw all that away? And if you think there's CRNA opposition now - what do you think would happen if you try and add PAs into the mix of compensable anesthesia providers? Remember - PAs cannot be reimbursed for anesthesia services, only MD, CRNA, and CAA. Do you think insurance companies will pay anesthesia PAs if the federal government won't? Nope.

The "dismissive of PA independence" comment is wishful thinking at best. That movement is gaining steam quickly.

 

[PieOHmy]

Sorry to be late to this particular party.

The PA > CAA bridge program failed/closed for lack of interest and likely the costs involved in getting a second masters degree. CAA education isn't an OJT fellowship, and it's not just learning clinical procedures, which is essentially what you're proposing for PAs in anesthesia. It's a full-fledged masters degree curriculum in a university setting. While undergrad students can test out of certain classes, graduate programs are a different animal. You can't use undergrad classes to satisfy graduate school requirements. The PAs that did the bridge program already had a masters PA degree - but they only got one semester knocked off because of the graduate level physiology and pharmacology they'd already taken. Everything else was new material and/or anesthesia-specific. There weren't, nor should there have been, any shortcuts. There have been a few PAs come through the CAA programs over the years. Although their PA certification may allow them to work in states that don't have CAA-enabling legislation, by and large they have stayed in CAA states due to issues with insurance reimbursement and credentialing.

Endee has outlined the reasons the PA in anesthesia just isn't going to happen. He's absolutely correct. The costs of changing legislation on the state level are quite onerous - we know - we're in the middle of it every year as we try to get CAAs in more states. The costs on the federal level, which is where the real fight would be, would be staggering. Who do you think is going to foot the bill for millions of dollars in lobbying costs? It's certainly not the ASA or the AAPA or their members. Why would the ASA, who has spent countless hours and dollars over the last three decades supporting CAAs, suddenly throw all that away? And if you think there's CRNA opposition now - what do you think would happen if you try and add PAs into the mix of compensable anesthesia providers? Remember - PAs cannot be reimbursed for anesthesia services, only MD, CRNA, and CAA. Do you think insurance companies will pay anesthesia PAs if the federal government won't? Nope.

The "dismissive of PA independence" comment is wishful thinking at best. That movement is gaining steam quickly.

PAs work and are licensed in every state. i think it wouls be easier and more palatable to states to get introduced PAs who they know already to AAs who are largely unknown.

PAs have exposure in every surgical specialty why should ours be different?
I am not advocating short cuts. Those Pas who have a masters already should be allowed to spend an extra 14-18 months in an OR to get anesthesia certification.

You have NP independence in 50 states passed easily in the past ten years why would mh idea be preposterous?

 

[jwk]

PAs work and are licensed in every state. i think it wouls be easier and more palatable to states to get introduced PAs who they know already to AAs who are largely unknown.

PAs have exposure in every surgical specialty why should ours be different?
I am not advocating short cuts. Those Pas who have a masters already should be allowed to spend an extra 14-18 months in an OR to get anesthesia certification.

You have NP independence in 50 states passed easily in the past ten years why would mh idea be preposterous?

You're comparing apples to oranges.

Understand that nurses practice in every state under the Board of Nursing and the Nurse Practice Act of that state. In almost every state, the Board of Nursing determines the scope of practice for nurses. That's why they are increasingly practicing independently - because the Board of Nursing says they can. Increasingly, they are at odds with the Boards of Medicine in each state, who, by the way, generally control PA and CAA practice in their state.

Again - and again - PAs CANNOT be reimbursed for anesthesia services under CMS. Changing federal regulations and adding an additional provider for anesthesia services is a virtual impossibility due to the costs involved and vehement opposition from the CRNAs. And no reimbursement for services = hard stop for that concept.

 

[PieOHmy]

You're comparing apples to oranges.

Understand that nurses practice in every state under the Board of Nursing and the Nurse Practice Act of that state. In almost every state, the Board of Nursing determines the scope of practice for nurses. That's why they are increasingly practicing independently - because the Board of Nursing says they can. Increasingly, they are at odds with the Boards of Medicine in each state, who, by the way, generally control PA and CAA practice in their state.

Again - and again - PAs CANNOT be reimbursed for anesthesia services under CMS. Changing federal regulations and adding an additional provider for anesthesia services is a virtual impossibility due to the costs involved and vehement opposition from the CRNAs. And no reimbursement for services = hard stop for that concept.

i will lookninto this and get back to uou

 

[Dr. Doctor MD]

PAs work and are licensed in every state. i think it wouls be easier and more palatable to states to get introduced PAs who they know already to AAs who are largely unknown.

PAs have exposure in every surgical specialty why should ours be different?
I am not advocating short cuts. Those Pas who have a masters already should be allowed to spend an extra 14-18 months in an OR to get anesthesia certification.

You have NP independence in 50 states passed easily in the past ten years why would mh idea be preposterous?

I am having trouble believing that you are actually an MD Anesthesiologist, especially with the account that is barely 2 weeks old.

Also, no anesthesiologist would EVER support midlevels practicing anesthesia with 1-1.5 years of anesthesia training. At least CRNA's do a 3 year program, which sure is crappy compared to an MD, but it's still some amount of time dedicated to specifically anestheisa. I'm confident that they are significantly better than a PA with 2 years of non-anesthesia completing a 12-18 month transition/fellowship program.

Let's not try to lessen the requirements even further for how minimally competent anesthesia providers can be; 3 years of training is minimalistic enough. AA are one thing, training PAs to do anesthesia in a year is deadly.

 

[PieOHmy]

I am having trouble believing that you are actually an MD Anesthesiologist, especially with the account that is barely 2 weeks old.

Also, no anesthesiologist would EVER support midlevels practicing anesthesia with 1-1.5 years of anesthesia training. At least CRNA's do a 3 year program, which sure is crappy compared to an MD, but it's still some amount of time dedicated to specifically anestheisa. I'm confident that they are significantly better than a PA with 2 years of non-anesthesia completing a 12-18 month transition/fellowship program.

Let's not try to lessen the requirements even further for how minimally competent anesthesia providers can be; 3 years of training is minimalistic enough. AA are one thing, training PAs to do anesthesia in a year is deadly.

Thats 18 months AFTER earning a masters degree.
The AA program is 29 months fresh out of college.
SO PA would have significant more or at least on par training with 18 months in the OR full time
and I am a boarded anesthesiologist.
residents with 2-6 months experience are routinely left alone in the OR and safely i might add.
I think it would work, alleviate the burden to have to deal with CRNAs who DONT want to work in a team.

 

[Dr. Doctor MD]

Thats 18 months AFTER earning a masters degree.
The AA program is 29 months fresh out of college.
SO PA would have significant more or at least on par training with 18 months in the OR full time
and I am a boarded anesthesiologist.
residents with 2-6 months experience are routinely left alone in the OR and safely i might add.
I think it would work, alleviate the burden to have to deal with CRNAs who DONT want to work in a team.

But the master's degree is completely useless as far as anesthesia goes. Medical students may have 0-2 months of Anesthesia their whole 4 years of medical school, PAs will have none, neither should be out practicing alone or unsupervised after such little training. Thats why residents do 3 years of nonstop anesthesia before they are out on their own.

I would take an AA with "29 months" fresh out of college any day over 12-18 months on top of an irrelevant 2 year masters program anyday.

No one should be doing anesthesia at all without a minimum of three years of direct anesthesia training.

 

[deleted162650]

No one should be doing anesthesia at all without a minimum of three years of direct anesthesia training

Uhhh, you know it wasn’t that long ago that anesthesia residency was only 2 years long right?

 

[Splenda88]

But the master's degree is completely useless as far as anesthesia goes. Medical students may have 0-2 months of Anesthesia their whole 4 years of medical school, PAs will have none, neither should be out practicing alone or unsupervised after such little training. Thats why residents do 3 years of nonstop anesthesia before they are out on their own.

I would take an AA with "29 months" fresh out of college any day over 12-18 months on top of an irrelevant 2 year masters program anyday.

No one should be doing anesthesia at all without a minimum of three years of direct anesthesia training.

I am not an anesthesiology resident, but I think 18 months might be OK if they will be working in a team with anesthesiologists being the leaders... The 28-month PA curriculum is not completely useless since they take advanced classes like pharm, pathology, clinical diagnosis etc... and they rotate thru IM/FM/Surgery/EM etc...

 

[AdmiralChz]

Uhhh, you know it wasn’t that long ago that anesthesia residency was only 2 years long right?

Plus an internship year. And that changed in the early 90s I believe.

 

[jwk]

Plus an internship year. And that changed in the early 90s I believe.

That's "long ago" to most folks.

 

[nimbus]

Plus an internship year. And that changed in the early 90s I believe.

The transition occurred in the mid 1980s. I’m old enough to remember that a CA-3 year was required by the late 1980s. Not sure of the exact year.

History and Evolution of Anesthesia Education in United States

Resident education is both, a science and an art. Quality and homogeneity of resident education has a considerable correlation with patient safety. This article appraises how for..

www.omicsonline.org

Comparing Anesthesiology Residency Training Structure and Requirements in Seven Different Countries on Three Continents - PMC

Little has been published comparing the graduate medical education training structure and requirements across multiple countries. The goal of this study was to summarize and compare the characteristics of anesthesiology training programs in the USA, ...

www.ncbi.nlm.nih.gov

 

[blockstar]

ASA needs to get AAs in all 50 states. Im not old enough to remember but I hear Clinton stopped it from happening federally now they/we have to fight for them in every state.

 

[zero0]

ASA needs to get AAs in all 50 states. Im not old enough to remember but I hear Clinton stopped it from happening federally now they/we have to fight for them in every state.

I dunno man

Fighting for rights for a whole new group of midlevels gives me deja vu. If there's one thing history has proven is that they will never be happy where they're at and will always be trying to push their scope of practice. Midlevels as a whole, especially the male ones I've noticed, have a big ol chip on their shoulders and want that doctor title with none of the work.

We're better off pushing for a doctor sitting in every case and leaving well enough alone. For God's sake just take the 100k hit to your salary and leave some anesthesia for the next generation of docs

 

[PieOHmy]

I dunno man


We're better off pushing for a doctor sitting in every case and leaving well enough alone.

Listen, I hear you. Totally. I sit my cases. I love it. I dont listen to ANYONE elses opinion on the anesthestic. I do it MY WAY and my way only.
But.... for every anesthesiologist to sit their own cases we would need 1/2 the medical graduates to go into anesthesia per year every year.
Is that going to happen?
NOPE. Nor will anyone ever let it happen SO we are stuck with mid levels.
IThe current crop CRNAS have already voiced their opinion on us and how lazy we are and useless we are publicly.
THey do now want to do their jobs and function at their level. So we have to answer that by finding a group that does and will. Enter PA in anesthesia,

 

[blockstar]

I dunno man

Fighting for rights for a whole new group of midlevels gives me deja vu. If there's one thing history has proven is that they will never be happy where they're at and will always be trying to push their scope of practice. Midlevels as a whole, especially the male ones I've noticed, have a big ol chip on their shoulders and want that doctor title with none of the work.

We're better off pushing for a doctor sitting in every case and leaving well enough alone. For God's sake just take the 100k hit to your salary and leave some anesthesia for the next generation of docs

No one will take 100k hit and there will never be enough md anesthesiologists. You cant turn back the clock and put 55000 crnas out of work. Surgeries are going to happen.

AAs have never in their 50 year history been anything other than pro MD run anesthesia. The nurses in this field (at least their national organization) are not. They also have no competition for jobs in the majority of states. AAs are just as competent as CRNAs and if licensed in all 50 states the nurses would have a much more difficult road to dumping MDs from the specialty.

 

[PieOHmy]

No one will take 100k hit and there will never be enough md anesthesiologists. You cant turn back the clock and put 55000 crnas out of work. Surgeries are going to happen.

AAs have never in their 50 year history been anything other than pro MD run anesthesia. The nurses in this field (at least their national organization) are not. They also have no competition for jobs in the majority of states. AAs are just as competent as CRNAs and if licensed in all 50 states the nurses would have a much more difficult road to dumping MDs from the specialty.

It is absolutely brutal directing CRNAS. I do it on a perdiem basis on my weeks off and they simply want complete independence. They DO NOT want to be part of a team. So it is NOT just their national organizations. They DO NOT WANT TO TAKE DIRECTION.
So the answer is , give them some competition.

Physician Assistants in the OR. We need that NOW.