PA vs AA

[EMEDPA]

you have to really like anesthesia to be a crna or AA. it's hours of boredom interspersed with minutes of panic.

ABCs of anestheia:

airway, book, coffee.....8-12 cases/day of the same thing...again, and again, and again, and again, oh look the pt aspirated and has no airway option and needs a crich!...back to the boredom......

[cemetra]

@EMEDPA my literal only concern with AA is the boredom. I have a big fascination with just watching surgeries unfold, though. I'll have to shadow an AA sometime to see how it really is. I always see that "airways, book, coffee" quote now! The more I research it, the more common it pops up. Haha. I actually enjoy reading and have quite the library myself. If only one could read in the OR... *shrugs*

[EMEDPA]

there is a curtain between the anesthesia provider and the surgery. you can't see the surgical field typically. 

[LT_Oneal_PAC]

You can see the surgical field when standing, but that’s not anesthesia’s style ;) 

i found my time in anesthesia fascinating. I was never bored personally. But God did I hate working with surgeons every damn day, all day. 

[EMEDPA]

4 minutes ago, LT_Oneal_PAC said:

You can see the surgical field when standing, but that’s not anesthesia’s style ;) 

i found my time in anesthesia fascinating. I was never bored personally. But God did I hate working with surgeons every damn day, all day. 

didn't you leave as soon as you got the tube in? 

[LT_Oneal_PAC]

22 minutes ago, EMEDPA said:

didn't you leave as soon as you got the tube in? 

I’m talkng about the 1.5 years I spent as a nurse anesthesia student before I left for greener pastures. I didn’t gel with OR personality types, especially surgeons. Honestly I was also pretty unhappy that my job was a)highly specialized b) really just allowed surgery to treat people. There is no therapeutic benefit to anesthesia itself. I started it for the money and then realized there was more to life.

[cemetra]

@LT_Oneal_PAC I thought the AA had to stand like in a ready position the entire time, but I'm still new to this, so I had no idea they were like kind of separated from the surgery. That's a bit of a bummer. So when you sit next to the patient, what's the scene like? Do they literally have the opportunity to read in the OR? I just read an article on the "controversy" between it, and it's surprising to me it's even a thing. I don't see how it would be considered sterile. 

[LT_Oneal_PAC]

Not everything is sterile,  nor does it need to be. I’ve seen LOTS of people read, play apps, crosswords. Personally I think it’s terrible. I mean, I would glance at something on my phone like a text message or google something I was curious about that would take 30 seconds, but to actively engage my mind off of the surgery I think it is poor form.

the scene is like this in the pictures.

See patient, maybe you preop to screen for problems the day before. Check airway, give versed, maybe preop opioid if that’s your thing. Roll them back. Surgery is at whatever body part, there’s a drape separating you from the surgery, and you are at the patients head to manage the airway/administer IV drugs/adjust volatile gas anesthetic with all your monitors. Obviously you may not have access immediately to airway due to positioning for some surgeries. You give some drugs, intubate, let them prep the patient with antiseptic, set up your drape, watch them do surgery so you can time giving opioids/paralytic/adjust gas/give pressors based on more/less stimulating portions of surgery. Complete your chart. See them getting ready to finish, back off gas, give whatever finishing cocktail of opioids/antiemetics/reversal you prefer, let them wake up or sleep while breathing depending on practice pattern, roll them to PACU, chart some more, rinse, repeat. Do this until surgeries are done, go home to big house, count money to deal with stress over the 12,000 times a surgeon complained/was pissed off about something.

if you’re an AA (or a CRNA in a ACT model, I only saw one), then just add wait for anesthesiologist to show up  so he can push drugs and you intubate and then wait for him to show up so you can extubate (or pull the tube and both lie saying the MD was present like I saw most people do).

 

[cemetra]

@LT_Oneal_PAC That just doesn't seem very boring to me. I'll definitely have to shadow both to see, though. How do you feel about the future of AA's? The more I look into forums, the moor "doomsday" it seems with the usage of CRNA's. How do you feel about it?

[LT_Oneal_PAC]

9 minutes ago, cemetra said:

@LT_Oneal_PAC That just doesn't seem very boring to me. I'll definitely have to shadow both to see, though. How do you feel about the future of AA's? The more I look into forums, the moor "doomsday" it seems with the usage of CRNA's. How do you feel about it?

it’ll probably be fine. I think it’s the least secure of PA, NP, CRNA, Midwife, etc. It’s definitely the most restrictive, which would bother me. Add to that anesthesia is getting safer each day. I worried a bit that one day that would come up with some marvelous perfect anesthetic that would eliminate the need for a provider at all. But let’s just say there was something that caused a need for cut backs. Who is going to be out of a job first: the CRNAs at solo hospitals or functioning the same as MDs side by side with them (plenty of those places), the MDs who run the departments at major medical centers, or the AA who is under the thumb of the anesthesiologist?

Nothing against AAs, just wouldn’t be for me. If you just want money and never want to work outside big cities in only half the states, go for it.

[EMEDPA]

12 minutes ago, LT_Oneal_PAC said:

 I worried a bit that one day that would come up with some marvelous perfect anesthetic that would eliminate the need for a provider at all.

You know what most of the developing world uses? Ketamine 100 mg/valium 10 mg/BVM. repeat prn. I have seen radiologists used to do anesthesia in this fashion. I would be more afraid about an intubating robot. RN starts IV. just hook in a line to the robot that is preloaded with propofol, lidocaine, fentanyl, etc and it uses its fiberoptic camera and grasping arms to pass the tube and hook up the gas. surprised it doesn't already exist. it would probably start as a remotely operated robot like a da vinci, then over time they would phase out the tele-anesthesiologists...:)

[scott079]

You asked how I switched? I just finished the PA pre-reqs except microbio, now all I need to do is take org chem, physics and calc. There are more pre-reqs to AA than PA if you plan to apply to the bulk of the programs. I just liked anesthesia better than the PA first assist work I saw and the money was better. I already have my HCE, research, letters of rec, etc. 

You asked what the catch is, no lateral mobility, your in anesthesia probably for good. Also, if there becomes a surplus of providers then yes the AA will be tougher.

You asked about boredom. I spoke with a married couple who are both AA's in Ohio, she was bored, he wasn't and they both said its what you make of it. He worked more with trauma surgeries. what LT_Oneal described sounds identical to what I saw. You can see the surgery but most of the CRNA's preferred to sit down and do their work/ shop on their phone. I did not find anesthesia boring, I really enjoyed what I saw and heard. 

I have called 6 AA schools and asked all of them what the job market was like. All have said the current job market is strong and all programs post 100% employment upon graduation. This matched up with the response from the AA's I have spoken with. When I first considered AA was like 8 years ago and I backed off because I saw all the "doomsday" predictions, not only did they never come to pass, but more states opened up and more schools opened. 

I suggest shadowing, alot. You will get a much better idea when you spend a couple shifts with a CRNA or AA. If your close to one of the programs I suggest calling and they might help you shadow, case western offered that for me. Its crazy, PA schools are so competitive you have to beg for 10 minutes of guidance. AA schools were more than happy to help an applicant. 

 

[scott079]

I think a few other people here have noted the need to shadow and keep your options open. Three years from now a lot will probably change by the time you finish on the undergrad work. Furthermore, while you are getting your healthcare experience you will learn about what types of patients and what types of people you do and do not want to work with. This insight typically does not come from being in a classroom or from shadowing. Shadowing is an incredible tool to give you an idea if something feels right and if it peaks your interest. If you shadow a variety of different roles you be able to compare and contrast them and see what you like and don't like.

Don't get me wrong there are plenty of boring or mediocre jobs out there, and there is an ocean of people who would be happy to do them if they paid 200K. Happiness is extremely relative.

[AAinTexas]

Very old thread, but times have changed, and AA will probably make close to double a PA. Starting salaries are around 170k-190k and most having singing bonuses that I’ve seen from 30k-60k. Once you add taking call AA’s easily make over 300k

[BLM8867]

Hypothetical scenario/question for open discussion: A PA-C decides to go to AA School. Would this individual be allowed to do both roles? 

[PAtoMD]

47 minutes ago, BLM8867 said:

Hypothetical scenario/question for open discussion: A PA-C decides to go to AA School. Would this individual be allowed to do both roles? 

An AA may not practice outside of the field of anesthesia or apart from the supervision of an anesthesiologist. A CAA may not practice as a physician's assistant unless the CAA has also completed a PA training program and passed the National Commission for the Certification of Physician Assistants (NCCPA) exam.

 

source

[BLM8867]

Interesting. So based on the last paragraph of the 3rd FAQ it seems like it is possible (granted you'd need 2 SPs) and is worded in such a manner that gives me the impression that it has been done in the past. Anyone have or have heard of this experience from someone else regarding work life, salary, work-life balance? 

[AAinTexas]

It sounds to me like a lot of extra schooling (and debt) for no real benefit. There is only so much time in a day so I’d pick one or the other. If u change your mind and you don’t like one, then decide to go back to school. You won’t make any more money being double certified. Also if u think also being a PA will get you a better AA job that’s not true either. Anesthesia is anesthesia and it’s pretty much the same all over the country. In reality OR’s just need to be covered. It’s a very highly demanded career right now so most every group that I know of all over the country is looking to hire anyone. Be it CRNA, AA, Anesthesiologist, whatever. Burnout is quite high because there are so many cases and not enough staff.

[AAinTexas]

Work like balance is awesome btw. U can choose to work 7-3 every day. U can do call or not. You can work 4 10’s, 3 12’s. Nights only. Etc etc etc. And a not thought of often benefit is you spend 99% of your time actually in procedures or waiting for them. We don’t have to round on patients, we don’t have clinic hours, we don’t make phone calls to patients or their families. Keep in mind that a negative for AA is that every program is private and will set u back 150k+ in loans. Your salary will be high, but just keep that in mind. I think Pa schools might be less. Both are worth it in my opinion 

[AAinTexas]

Also one last thing a PA cannot continue to practice while in AA school if they think that would work to pay for school or whatnot. AA school is 100% of your time, and most programs makes u sign that u will not be working during this period. 2nd year is all clinical mostly so you are working anyhow just not getting paid.

[EMEDPA]

I don't know of any dual AA/PA folks out there, but I know they exist. There is, or at least used to be a bridge program  from PA to AA at one of the programs that credited a semester of overlapping coursework. I have a friend who is a dual NP/CRNA. He was a long time ICU nurse, went to one of the better NP programs, worked in the ER for years, then became a CRNA. He covers the OR, ICU, pain clinic, L+DS, etc and makes bank. This wasn't his plan from the start, he just ended up liking anesthesia when a former job made us all spend time in the OR getting intubations to do procedural sedation. 

[EMEDPA]

On 8/1/2022 at 6:59 AM, AAinTexas said:

Very old thread, but times have changed, and AA will probably make close to double a PA. Starting salaries are around 170k-190k and most having singing bonuses that I’ve seen from 30k-60k. Once you add taking call AA’s easily make over 300k

That is great money. I know very few PAs making 300k. A few, but not many, and they have their hands in lots of different pies and work crazy hours. I am not one of them.