Physician Assistant Anesthesia Residency

[MacLocal]

 

 

I am an Anesthesiologist and had some thoughts about the PA profession and was asking myself why PAs were not involved in the anesthesia profession save for the AAs that are practicing in a limited amount of states and to get the AAs licensed in all 50 states would take a huge legislative battle.  My question to the group is: 

 

Do you think there would be interest in graduating and practicing PAs to enter  a 12-18 month intensive anesthesia (residency) training program to supplement the CRNA staff. Training PAs vs (trying to get AAs licensed in every single state)  would be a lot easier since PAs are licensed in all 50 states. 

 

My thoughts would be the Large Academic anesthesia residency programs could take this on. Certainly it would be only available to qualified PAs who have a solid interest in the profession . The job description would be identical to the current AAs and Crnas.

What are your thoughts?

[PAtoMD]

I can only speak for myself but I know my education had zero anesthesiology management in it. I would find it difficult for a new grad PA to enter a 12 month residency with no prior experience to anesthesiology. That being said I have seen PA students rotate in anesthesiology. As well anecdotes of former PAs who worked in anesthesiology. Maybe a more veteran PA will be able to help answer this.

I just find it to be a large obstacle for PAs given our education. 

[MacLocal]

51 minutes ago, PAtoMD said:

I can only speak for myself but I know my education had zero anesthesiology management in it. I would find it difficult for a new grad PA to enter a 12 month residency with no prior experience to anesthesiology. That being said I have seen PA students rotate in anesthesiology. As well anecdotes of former PAs who worked in anesthesiology. Maybe a more veteran PA will be able to help answer this.

I just find it to be a large obstacle for PAs given our education. 

How is it different from Physicians who have little initiation in ANesthesiology before residency?  

It would be an 12-18 month program..   

 

Believe me it is totally doable. The question is, whether there would be any interest.

[PAtoMD]

1 minute ago, MacLocal said:

How is it different from Physicians who have little initiation in ANesthesiology before residency?  

It would be an 12-18 month program..   

 

Believe me it is totally doable. The question is, whether there would be any interest.

Fair enough. Is anesthesiology basics taught in medical school and is a rotation required of students? 
 

is 12-18 months adequate without any prior experience to be on par with a CRNA or AA?

 

I suppose you could argue there would be a lack of desire because if you liked anesthesiology you would have pursued a MD/DO, CRNA or AA already.

[Hope2PA]

45 minutes ago, PAtoMD said:

I can only speak for myself but I know my education had zero anesthesiology management in it. I would find it difficult for a new grad PA to enter a 12 month residency with no prior experience to anesthesiology. That being said I have seen PA students rotate in anesthesiology. As well anecdotes of former PAs who worked in anesthesiology. Maybe a more veteran PA will be able to help answer this.

I just find it to be a large obstacle for PAs given our education. 

I am not extremely familiar with all requirements for CRNA, however I recently looked into Case Western AA and CRNA programs. RN’s are not required to have, as previously,  the few years of critical care experience.  CRNA coursework/clinical was almost half of AA’s. I do not see why a PA who worked in critical care with a strong science background, couldn’t do an awesome job. It is my understanding that any residency type training includes a lot of didactic education.  As is AA’s are having a hard time getting opportunity to practice because Nursing flat out fights against them. I’ve seen letters saying they do not have appropriate education, wrong, or that the state doesn’t need them, AA’s, , they just need to give CRNA more freedom and independence. 

[Hope2PA]

8 minutes ago, PAtoMD said:

Fair enough. Is anesthesiology basics taught in medical school and is a rotation required of students? 
 

is 12-18 months adequate without any prior experience to be on par with a CRNA or AA?

 

I suppose you could argue there would be a lack of desire because if you liked anesthesiology you would have pursued a MD/DO, CRNA or AA already.

Maybe not, AA is great in theory but They are having more trouble than PA’s because they can only work in a few states. Sometimes your ideas and goals change after exposure to various work sites. I do believe I have read in a thread somewhere about PA’s actually questioning how to possibly get into anesthesia.

MacLocal, Just out of curiosity, in what part of the country is this “residency idea” ?

Edited March 27, 2020 by Hope2PA

[LT_Oneal_PAC]

I believe I’ve answered your same question on reddit. 
 

as possibly the only person who has attended nurse anesthesia (that I left because I didn’t want to only do anesthesia any more) and a PA program, I think I can provide a lot of insight on this.

first, absolutely you could take a PA straight out of school and put them in a 18 month program to create a good anesthesia clinician. I think this would make a pretty awesome clinician.

i think there would be great interest. I would certainly be interested, so I could do the OR and ER at my CAH, both very low volume and hard to attract good clinicians. I mean, this would be way better than going back to school and spend even more tuition money, instead getting paid a stipend. I mean, who wouldn’t be interested.
 

there are many problems to this. First, many states specifically prohibit PAs from performing anesthesia. This would have to be overturned and CRNAs would fight tooth and nail. You probably would have AAs fighting this too.

I also worry about the intention behind this. Could you explain the reasoning? Is this a way to undermine CRNAs and have an “assistant” that you aren’t competing with? Would you allow these anesthesia trained PAs to work at CAH that don’t have anesthesiologists? Otherwise we won’t be able to compete with CRNAs and admin won’t hire us. I’m fine with competing against CRNAs, I’m not okay with being a political tool.
 

lastly, you probably know this, you’re going to find a lot of physician pushback. Anesthesiologists in particular feel pretty burnt on CRNAs. I think you would find it difficult to have them on board

[LT_Oneal_PAC]

20 minutes ago, Hope2PA said:

I am not extremely familiar with all requirements for CRNA, however I recently looked into Case Western AA and CRNA programs. RN’s are not required to have, as previously,  the few years of critical care experience.  CRNA coursework/clinical was almost half of AA’s. I do not see why a PA who worked in critical care with a strong science background, couldn’t do an awesome job. It is my understanding that any residency type training includes a lot of didactic education.  As is AA’s are having a hard time getting opportunity to practice because Nursing flat out fights against them. I’ve seen letters saying they do not have appropriate education, wrong, or that the state doesn’t need them, AA’s, , they just need to give CRNA more freedom and independence. 

You aren’t looking at the right places if you think CRNA coursework is half of AA. I’ve been in it, and it is one of the toughest programs around. 
 

The problem with getting AAs implemented in a state is because there isn’t a shortage where AAs can practice. It’s true. Currently an AA can only practice with an anesthesiologist in the building and the shortages are primarily where there are not anesthesiologists. This is why many rural hospitals only have CRNAs because either a) it’s hard to attract an anesthesiologist to a rural area b) the volume might be too low to support a market competitive salary. So if you can’t attract an anesthesiologist, then you can’t hire an AA. Which if this residency doesn’t allow for more remote work, then it’ll run into the same problems.

[dfw6er]

32 minutes ago, PAtoMD said:

Fair enough. Is anesthesiology basics taught in medical school and is a rotation required of students? 
 

 

Yes, basic anesthesia is taught in preclinical portion of med school.   I've been tested on it a couple of times already and need to go back and study it again before boards in May (If Prometric is reopened by then).  

No, anesthesia is not a core (required) rotation in medical schools...it can be an elective rotation though.

[dfw6er]

8 minutes ago, LT_Oneal_PAC said:

You aren’t looking at the right places if you think CRNA coursework is half of AA. I’ve been in it, and it is one of the toughest programs around. 
 

The problem with getting AAs implemented in a state is because there isn’t a shortage where AAs can practice. It’s true. Currently an AA can only practice with an anesthesiologist in the building and the shortages are primarily where there are not anesthesiologists. This is why many rural hospitals only have CRNAs because either a) it’s hard to attract an anesthesiologist to a rural area b) the volume might be too low to support a market competitive salary. So if you can’t attract an anesthesiologist, then you can’t hire an AA. Which if this residency doesn’t allow for more remote work, then it’ll run into the same problems.

Yeah, the CRNAs and nursing lobby will fight any attempt to bring more competition to the table.  And yes, there's tons of anesthesia doctors who are threatened by CRNA encroachment....so I agree 100% that this will be difficult.  I echo your concern that this could be an attempt on Anesthesiologist's parts to use PAs as a tool to fight the CRNAs.  

[kidpresentable]

1 hour ago, MacLocal said:

The question is, whether there would be any interest.

The answer to this question is “yes.”

Lots of other good points have been made here too.

[SirScottric]

I would most definitely be interested in an anesthesia residency for PAs

[ANESMCR]

At first glance, I would be interested as well. I was a tech for several years prior to PA school and while obviously serving in a lower capacity, I loved being in anesthesia. But the LT brings up some very valid points. Why leave a profession plagued by ambiguity to pursue a position of guaranteed ambiguity? No thanks. 

[Hope2PA]

4 hours ago, LT_Oneal_PAC said:

You aren’t looking at the right places if you think CRNA coursework is half of AA. I’ve been in it, and it is one of the toughest programs around.

I have no doubt it is a challenging program. I only looked at Case Western CRNA and AA program curriculums. CRNA didactic and clinical equals 42 graduate hours(which includes what appears to be about 5 hours of leadership, finance and legislative issues). Same University, Case Western AA curriculum equals 70 grad hours for didactic and clinical(no leadership, legislative and financial courses included). Maybe I am missing something, but based on Case Western requirements, AA is nearly double CRNA. 

[MacLocal]

Lt meant to say that CRNAs  have an RN degree prior to attending CRNA school, and to obtain an RN degree very rigorous science courses are NOT required. I would venture to say less than 10 percent of RN schools require Gen Chem with a lab (a full year) never mind physics or orgo.  That is all anesthesia is, is chemistry

Anesthesiologists want to expand AA education and opportunities but politically it is difficult based on the foregoing reasons. (push back from crna lobby etc etc). PAs are licensed in every state if I am not mistaken, why would not an argument made to have an academic center train PAs over 18 months to deliver anesthesia not be a a good idea.

I am not familiar with laws specifically prohibiting PAs to deliver anesthesia. Please enlighten me LT.  

And certainly it would be easier to rescind than introducing AAs.

 

Edited March 27, 2020 by MacLocal

[LT_Oneal_PAC]

3 hours ago, Hope2PA said:

I have no doubt it is a challenging program. I only looked at Case Western CRNA and AA program curriculums. CRNA didactic and clinical equals 42 graduate hours(which includes what appears to be about 5 hours of leadership, finance and legislative issues). Same University, Case Western AA curriculum equals 70 grad hours for didactic and clinical(no leadership, legislative and financial courses included). Maybe I am missing something, but based on Case Western requirements, AA is nearly double CRNA. 

I was surprised to hear this since my old program was about 75 hours. It look to me that some school are not including the clinics credit hours in their calculations, which is definitely the case for case western when I looked. My old program is now a DNP program and requires >100 credit hours. Random google search shows many programs >80 hours.

1 hour ago, MacLocal said:

Lt meant to say that CRNAs  have an RN degree prior to attending CRNA school, and to obtain an RN degree very rigorous science courses are NOT required. I would venture to say less than 10 percent of RN schools require Gen Chem with a lab (a full year) never mind physics or orgo.  That is all anesthesia is, is chemistry

Anesthesiologists want to expand AA education and opportunities but politically it is difficult based on the foregoing reasons. (push back from crna lobby etc etc). PAs are licensed in every state if I am not mistaken, why would not an argument made to have an academic center train PAs over 18 months to deliver anesthesia not be a a good idea.

I am not familiar with laws specifically prohibiting PAs to deliver anesthesia. Please enlighten me LT.  

And certainly it would be easier to rescind than introducing AAs.

 

correct. Very few RN programs require higher level science, though many if not most CRNA programs do. 
 

oh I don’t think it would be a bad idea. I think it would be a very good idea. I just think you’re going to run into some of the same road blocks. Don’t misunderstand my lack of optimism And concerns for opposition.
 

I can’t remember which states specifically bar it, but this article notes eleven that do not allow for sedation or general anesthesia. It is slightly outdated as we having prescribing rights in Florida and Kentucky now. Maybe it has changed slightly, but doubt all eleven have significantly changed. I remember recently in Washington an expansion of scope bill was shot down by CRNAs because it MIGHT let us do anesthesia. They will make an argument that they are already filling that void and that there isn’t a need for more providers where anesthesiologists already practice.

https://pubmed.ncbi.nlm.nih.gov/25453855/

I agree, with the backing of specialty groups it would be easier to remove these regulations rather than introduce a new profession. 

A similar but was tried in Texas, labeling AAs as PAs in legislation. It was blocked however as we were afraid that restrictions placed on AAs, limiting them to practice with physician in house would ultimately be applied to us. They, in Texas, didn’t want to get in the middle of a turf war that may come back to bite us. @sas5814 probably remember me this better than me. So some assurances would have to be made that rural providers wouldn’t be affected by stringent supervisory requirements. 
 

like I said, I’m all for it if implemented correctly. Would be happy to help overcome barriers, which I just want to highlight at this juncture.

[sam619]

2 hours ago, MacLocal said:

Lt meant to say that CRNAs  have an RN degree prior to attending CRNA school, and to obtain an RN degree very rigorous science courses are NOT required. I would venture to say less than 10 percent of RN schools require Gen Chem with a lab (a full year) never mind physics or orgo.  That is all anesthesia is, is chemistry

Anesthesiologists want to expand AA education and opportunities but politically it is difficult based on the foregoing reasons. (push back from crna lobby etc etc). PAs are licensed in every state if I am not mistaken, why would not an argument made to have an academic center train PAs over 18 months to deliver anesthesia not be a a good idea.

I am not familiar with laws specifically prohibiting PAs to deliver anesthesia. Please enlighten me LT.  

And certainly it would be easier to rescind than introducing AAs.

 

You are so very mistaken, it’s almost disrespectful. For my BSN (and for many school’s in California) you are REQUIRED to have general, inorganic, and organic chemistry. Also required was cell and molecular biology, Microbiology, Anatomy, Calculus,  Physiology, Pathophysiology, medical surgical (which includes the pathophysiologic mechanisms of disease, fully body assessments by system, respiratory/vent care, etc). I went to a UC school. 

Before I got into PA school I basically had all my pre-reqs done from my undergrad nursing degree besides physics. And please tell me when we use advanced physics in clinical practice anyways. LOL. 

PA’s have amazing training, but I’m tired of our profession putting down another profession to make ourselves feel better. Superiority complex much?

Edited March 28, 2020 by sam619

[MacLocal]

16 minutes ago, sam619 said:

You are so very mistaken, it’s almost disrespectful. For my BSN (and for many school’s in California) you are REQUIRED to have general, inorganic, and organic chemistry. Also required was cell and molecular biology, Microbiology, Anatomy, Calculus,  Physiology, Pathophysiology, medical surgical (which includes the pathophysiologic mechanisms of disease, fully body assessments by system, respiratory/vent care, etc). I went to a UC school. 

Before I got into PA school I basically had all my pre-reqs done from my undergrad nursing degree besides physics. And please tell me when we use advanced physics in clinical practice anyways. LOL. 

PA’s have amazing training, but I’m tired of our profession putting down another profession to make ourselves feel better. Superiority complex much?

Im sorry to offend, didnt mean to and it was not meant to denigrate nursing. There is really no need for BSN to have Organic Chemistry  but i could be wrong. At any rate,   can you please post the curriculum for BSN when you got it or just tell me the school so i can review it.. Thanks

[rev ronin]

22 minutes ago, MacLocal said:

Im sorry to offend, didnt mean to and it was not meant to denigrate nursing. There is really no need for BSN to have Organic Chemistry  but i could be wrong. At any rate,   can you please post the curriculum for BSN when you got it or just tell me the school so i can review it.. Thanks

My experience is that when I took an RN-prerequisite "Intro to Organic and Biochemistry" at the local community college it didn't count towards my PA school admission requirements.  It did, however, equip me to succeed at the UNE distance learning OChem course (!) later.

I had no idea OChem was even a recommended elective in a BSN program, so I'm sure you're not alone.

[MyNameWasUsed]

25 minutes ago, MacLocal said:

Im sorry to offend, didnt mean to and it was not meant to denigrate nursing. There is really no need for BSN to have Organic Chemistry  but i could be wrong. At any rate,   can you please post the curriculum for BSN when you got it or just tell me the school so i can review it.. Thanks

I don't think you're being offensive at all. From what I know of RN education, they don't require those rigorous courses. I mean you can practically look up BSN requirements and each school is different but overall, across the board, the required courses to enter a BSN program are pretty basic.

I'm not where what sam619 is talking about, most BSN school's dont require organic chemistry, cell biology, molecular biology, CALCULUS??

Hell even some med school doesn't require organic chem or anatomy.

here's an example from my college: https://www.unr.edu/main/pdfs/verified-accessible/colleges-schools/nursing/fall2020-spring2021-prerequisite-checklist.pdf

[sam619]

Degree requirements for my BSN at UCLA, straight from the website:

 

1. 1. Chemistry 14A, Atomic and Molecular Structure, Equilibria, Acids, and Bases (4)
   2. Chemistry 14B, Thermodynamics, Electrochemistry, Kinetics, and Organic Chemistry (4)
   3. Chemistry 14C, Structure of Organic Molecules (4)
   4. Communication Studies 1, Principles of Oral Communication (4), or Communication Studies 10,  Introduction to Communication Studies (5)
   5. Life Sciences 7A, Cell and Molecular Biology (4)
   6. Life Sciences 7C, Physiology and Human Biology (4)
   7. Microbiology, Immunology and Molecular Genetics 10, Medical Microbiology (4)
   8. Psychology 10, Introductory Psychology (4)
   9. Nursing 3, Human Physiology (5)
   10. Nursing 13, Human Anatomy (5)
   11. Nursing 10, Introduction to Nursing/Social Justice (2)
   12. Nursing 20, Introduction to Nursing/Social Justice (2)
   13. Nursing 50, Fundamentals of Epidemiology (4)
   14. Nursing 54A, Pathophysiology I (3)
   15. Nursing 54B, Pathophysiology II (2)
2. Major courses 94 units
   1. Biostatistics 100A, Introduction to Biostatistics (4)
   2. Nursing 115, Pharmacology and Therapeutics (5)
   3. Nursing 150A, Fundamentals of Professional Nursing (4)
   4. Nursing 150B, Fundamentals of Professional Nursing (4)
   5. Nursing 152W, Human Development/Health Promotion in Culturally Diverse Populations (5)  
   6. Nursing 160, Secondary Prevention (4)
   7. Nursing 161, Psychiatric Mental Health Nursing (5)
   8. Nursing 162A, Foundational Concepts for Tertiary Prevention and Care of Medical-Surgical Patients and Families (4)
   9. Nursing 162B, Tertiary Prevention and Care of Medical-Surgical Geriatric Patients and Families (5)
   10. Nursing 162C, Tertiary Prevention and Care of Medical-Surgical Patients and Families (9)
   11. Nursing 162D, Human Responses to Critical Illness: Introduction to Critical Care (4)
   12. Nursing 164, Maternity Nursing (5)
   13. Nursing 165, Pediatric Nursing (5)
   14. Nursing 168, Advanced Leadership and Role Integration (5)
   15. Nursing 169, Clinical Internship: Integration (12)
   16. Nursing 171, Public Health Nursing (6) 
   17. Nursing 173, Introduction to Research (4)
   18. Nursing 174, Physical Assessment (4)

 

[MyNameWasUsed]

Oh but to address your post, I would have loved to go into anesthesiology but that wasn't an option. I would have done the 1 year residency considering how much AA and CRNA's make. 

[sam619]

4 minutes ago, MyNameWasUsed said:

I don't think you're being offensive at all. From what I know of RN education, they don't require those rigorous courses. I mean you can practically look up BSN requirements and each school is different but overall, across the board, the required courses to enter a BSN program are pretty basic.

I'm not where what sam619 is talking about, most BSN school's dont require organic chemistry, cell biology, molecular biology, CALCULUS??

Hell even some med school doesn't require organic chem or anatomy.

here's an example from my college: https://www.unr.edu/main/pdfs/verified-accessible/colleges-schools/nursing/fall2020-spring2021-prerequisite-checklist.pdf

Dude the first course on the second page is ochem, lol. 

“Organic Chemistry and associated lab:
CHEM 220A
CHEM 220L
Prerequisite(s): CHEM 121A and CHEM 121L“

[MyNameWasUsed]

Just now, sam619 said:

Dude the first course on the second page is ochem, lol. 

“Organic Chemistry and associated lab:
CHEM 220A
CHEM 220L
Prerequisite(s): CHEM 121A and CHEM 121L“

Oh yeah they took "easy ochem". I remember now. All the pre-med majors (biochemistry) took real ochem and the pre nursing took easy ochem. 

I took chem 341 (ochem 1) and 342 (ochem 2) over the span of 2 semesters while pre nursing majors took easy ochem over 1 semester. 

Not that any of this matters because nobody uses ochem in medicine. 

[sam619]

4 minutes ago, MyNameWasUsed said:

Oh yeah they took "easy ochem". I remember now. All the pre-med majors (biochemistry) took real ochem and the pre nursing took easy ochem. 

I took chem 341 (ochem 1) and 342 (ochem 2) over the span of 2 semesters while pre nursing majors took easy ochem over 1 semester. 

Not that any of this matters because nobody uses ochem in medicine. 

Interesting...

Edited March 28, 2020 by sam619