Physician Assistant Anesthesia Residency

[dfw6er]

A bunch of ADN RNs at my old ER have gotten/are getting their online BSNs at Grand Canyon University.   Kinda hard to have the serious inorganic/organic courses without having labs associated with them.  The majority of BSN programs I've seen have watered down inorganic/organic chem courses required of their students.

[LT_Oneal_PAC]

Lets get the thread back on the subject of an anesthesia residency. I don’t want it turn into a RN prerequisite discussion. Some schools have tough requirements and some don’t and a lot of it isn’t needed for clinical medicine. 
 

to bring the thread back, I will say an understanding of some physic concepts are essential, but you can teach all one needs to know about physics related to the machine and physiology pretty quickly. 

[VeryOldPA]

Why must PAs always turn every discussion into. A comparison to nurses?  Let’s stand on or own.

Now that I have that off my chest......

I see:no reason PA would not be interested in  practicing anesthesia.  Seems to me that the major barrier is lack of training in anesthesia, be it residency/fellowship or on the job training.

An anesthesia group could hit a PA and have an instant revenue stream. The PA could start out by doing pre-anesthesia evaluations and at the same time learn anesthesia just like a new PA learns Ortho or any other speciality. 

i believe MEDICARE only allows physicians, AAs and CRNAs to be reimbursed which is a problem that would need to be overcome

[EMEDPA]

Did not read the whole thread, but in answer to the OP I think this is a great idea. Early on, a few PAs actually did this. Shep Stone at Norwalk was allowed to fill an empty MD anesthesia residency slot has been doing operative anesthesia for over 30 years at this point.

https://pahx.org/assistants/stone-shepard-b/

I met him a few years ago. Impressive dude.

I think those drawn to this would already have some prior intubation/airway experience for the most part: paramedics, RTs, etc.

[MacLocal]

6 minutes ago, VeryOldPA said:

Why must PAs always turn every discussion into. A comparison to nurses?  Let’s stand on or own.

Now that I have that off my chest......

I see:no reason PA would not be interested in  practicing anesthesia.  Seems to me that the major barrier is lack of training in anesthesia, be it residency/fellowship or on the job training.

An anesthesia group could hit a PA and have an instant revenue stream. The PA could start out by doing pre-anesthesia evaluations and at the same time learn anesthesia just like a new PA learns Ortho or any other speciality. 

i believe MEDICARE only allows physicians, AAs and CRNAs to be reimbursed which is a problem that would need to be overcome

When I first graduated Medical School there were not many NP schools, and certainly NO DNP school. I had never even met a NP in medical school and that was exactly 20 years ago in the late 90s. There were PharmDs on rounds however.  And there were a number of PAs that I met.  Fast Forward, 20 years  there are over 400 NP schools granting DNP and you see how much legislative progress they have made. 

Same thing for this concept, there is no reason that there shouldnt be   at least 50-75 PA (Anesthesia) programs across the country supporting their physician colleagues in anesthesia with the right support.

And I agree, lets stay away from bashing CRNAs and AAs and nurses..

 

[VeryOldPA]

Agree Dr, But I believe it has to be physician driven

[CVTSPA]

Didn't read the whole thread but I would have been very interested in doing a PA Anesthesia residency prior to going back to medical school.  There is certainly a market for it.  It really just makes sense to me.  I even looked into the PA to AA program at Emory and seriously considered it.  However, it was just easier and made sense logistically to go back to med school for me rather than do a PA to AA bridge program since I don't believe AA's can practice in my current state and I didn't want to limit where I could work. 

In regards to the training during PA school to prepare one for anesthesiology, I can honestly say that I can't name a single person I know or have met that did an anesthesiology rotation during PA school.  There wasn't much training on the gases, the physiology of how anesthetics work, how to induce, or even the different types of blades during my PA school program so you would probably being starting mostly from scratch with a residency.  Obviously, the best candidates for such a program would be more experienced PA's.  I think a successful PA anesthesiology residency would involve an "anesthesia boot camp" at the beginning with anesthesia didactics for a few months to catch one up to speed followed by a year of clinical residency.  Totally do-able!  If you are designing such a program, PM me and I'd be happy to share my insights as I am starting anesthesia residency this July!  I would love to see such a program.

[ohiovolffemtp]

@MacLocal: Ohio has legislation explicitly prohibiting PA's from administering or maintaining general or regional anesthesia.  The definition of regional anesthesia is a little blurry.  While nerve blocks are considered local anesthesia, are ultrasound guided blocks?  Under Ohio law, a block done to relieve a painful condition is considered local, but it's unclear about something like a scalene block to reduce a dislocated shoulder.  Another inconsistency: as a paramedic I can and have used paralytics in the field to RSI but as a PA I can't order the same medications to RSI in the ED.

[dfw6er]

22 minutes ago, ohiovolffemtp said:

@MacLocal: Ohio has legislation explicitly prohibiting PA's from administering or maintaining general or regional anesthesia.  The definition of regional anesthesia is a little blurry.  While nerve blocks are considered local anesthesia, are ultrasound guided blocks?  Under Ohio law, a block done to relieve a painful condition is considered local, but it's unclear about something like a scalene block to reduce a dislocated shoulder.  Another inconsistency: as a paramedic I can and have used paralytics in the field to RSI but as a PA I can't order the same medications to RSI in the ED.

I wonder how long it'd take to successfully lobby CMS to allow newly-minted anesthesia-PAs (A-PAs) to be reimbursed for their services. 

[MacLocal]

On 3/28/2020 at 4:54 PM, dfw6er said:

I wonder how long it'd take to successfully lobby CMS to allow newly-minted anesthesia-PAs (A-PAs) to be reimbursed for their services. 

a-PA-c

I think it would be infinitely easier to introduce PAprofession to anesthesia especially since they are involved in almost every surgical specialty especially Cardiac Surgery. IN some places the PAs do a lions share of the operation. SO if they can do that, (the argument) they should be able to train and deliver anesthesia. 

Anesthesiologist should not be the only specialty deprived of hiring PAs.  

[okons212]

I am a soon to matriculate PA-S, I have always had interest in anesthesiology and plan on doing a rotation during my clinical year. Please do update us if this program ever develops. I will be interested. 

[rev ronin]

Has anyone approached the AAs and suggested merging them into the PA profession?  Maybe a 1 year bridge and PANCE?

[ERpa2014]

I would be interested.  This would give me much more capability in the ER and OR. After working in the ER for 5 years, my ceiling is hospital regulations, often anesthesia procedures.  However, I remind myself I don't need to be a one man show...it would be awesome to expand my understanding though. 

[ventana]

(Disclaimer here - this is a ranting post)

 

 

I think it would work

I seriously looked at the AA program a few years back and a neighboring state is one that you can work in

I just could not wrap my head around ANOTHER degree with more debt and still stuck to the whim of organized medicine

 

PA who has advanced training in anesthesia is the way to go - 

I have been startled and left feeling defeated when I have gone out and compared RN/NP (Admittedly not CRNA) to the education we PA's get.  It is not fair to say we are better educated because i truly don't believe you can draw this comparison due to the total lack of quality education an NP gets.  Seriously I have been hiring for a new job in my clinic and 1:10 ratio fo PA:NP and EVERY SINGLE NP applicant did an online course and SHADOWED for a total of a min of 500 hours - some made it all the way to 600 hours.  This is not an education or instruction - this is just a formalized observation period. To compare PA to NP is like comparing a Telsa to pedal bike.  Both get you down the road, but they are simply not the same (sorry that is my rant for today - and I have worked with some AMAZING NPs - but they have been life long RN's and returned to rigorous programs that FAR exceeded the NP min education standards - and that is NOT what the NP schools are now turning out)  

 

 

Good luck in this - I think it is a winning idea and very very do-able - and yup the nursing lobby will fight politically cause they know they loose on the education side.

[roundabout]

Would it really be that hard to lift restrictions on PA’s using certain medications? Paramedics have 1 year of education and give etomidate, propofol, succinylcholine, vecuronium, rocuronium and the list goes on. I can’t see not being able to remove restrictions on PA’s when you have individuals far less educated giving very similar meds. 

[LT_Oneal_PAC]

59 minutes ago, johncfl said:

Would it really be that hard to lift restrictions on PA’s using certain medications? Paramedics have 1 year of education and give etomidate, propofol, succinylcholine, vecuronium, rocuronium and the list goes on. I can’t see not being able to remove restrictions on PA’s when you have individuals far less educated giving very similar meds. 

It’s not the medications, other than volatile inhaled anesthetics, we can use all the same drugs that anesthesia can. It’s the method. Some states do not allow PAs to practice neuraxial or regional anesthesia. I totally get spinal anesthesia, but regional anesthesia is much safer now using US instead of stimulation techniques and is becoming a big portion of EM and should be allowed. As far as inhaled anesthesia, that needs probably near a year of education and hands on training to be proficient.

[roundabout]

2 hours ago, LT_Oneal_PAC said:

It’s not the medications, other than volatile inhaled anesthetics, we can use all the same drugs that anesthesia can. It’s the method. Some states do not allow PAs to practice neuraxial or regional anesthesia. I totally get spinal anesthesia, but regional anesthesia is much safer now using US instead of stimulation techniques and is becoming a big portion of EM and should be allowed. As far as inhaled anesthesia, that needs probably near a year of education and hands on training to be proficient.

Ah I see. Thank you for educating me in that. 

[ChemPhysicsInstructor]

On 3/27/2020 at 9:46 PM, 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. 

 

Actually, organic chemistry is the basis of many things in medicine, for example, how/why do the beta-lactam antibiotics work?  

Although organic chemistry is not usually used daily, an understanding is important to help make sense of things.  I try to pass this along to my students.  

 

[ChemPhysicsInstructor]

On 3/27/2020 at 9:03 PM, 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

A couple of things are operating here...(1.) Certain faculty (not me!) think of organic chemistry as a weed-out course.  (2.)  Organic chemistry is a pre-requisite for certain upper level courses such as biochemistry.  It causes trouble with accreditation when pre-requisite courses are removed.  The accrediting bodies do not like it.  

[VeryOldPA]

Back a thousand years ago my biochem professor said org chem was a waste of time. He taught us al the org chem we needed to know in 6 lectures. 
 

[LT_Oneal_PAC]

41 minutes ago, VeryOldPA said:

Back a thousand years ago my biochem professor said org chem was a waste of time. He taught us al the org chem we needed to know in 6 lectures. 
 

Agreed. It requires base level knowledge, nothing near mastery

[eze8923]

It has been a while since logging on to the PA forum, and I couldn't believe that this was a thread because it's a topic that I had wondered about as well. Having said that, I tremendously appreciate this discussion. I'm currently finishing up my 2nd year of anesthesia residency at a major academic institution. We do have EM PA residents rotate a few weeks with us getting their hands dirty with intubations and lines peri-operatively which is really great to see.

I would have to think how one might formulate a curriculum for this, but a 12-18 month training period I concur that it would be potentially doable. While my anesthesia exposure in PA school didn't really extend beyond local anesthetics, I agree that a large portion of medical school graduates (unfortunately) have fairly limited knowledge of what anesthesia actually entails.

One thought/concern is would the lack of exposure as a new PA graduate to general medicine and/or general surgery able to be overcome? I can honestly say that I didn't come out of PA school with a solid grasp of the management of many bread and butter medical (e.g. inner workings of different types of hemodialysis) and surgical interventions (e.g. trachs, chest tubes, etc.) vs. if a CRNA has a background as an ICU RN, I'm sure that there would be a much better working understanding of critical care and peri-operative management.

I would also imagine (as already mentioned), even if there is interest, the many legislative barriers that one might encounter during this process would be an uphill battle. "Why leave a profession plagued by ambiguity to pursue a position of guaranteed ambiguity? No thanks." - is a very valid point. The CRNA profession most definitely has a strong foothold.

In any case, I'll be continuing to advocate for EM, surgical, and critical care PAs to spend some time with the OR with me...

@MacLocal Please feel free to PM me - might be interested in brainstorming this more as well.

BTW - thank you @EMEDPA for sharing that PAHx link. I love learning and reading about these tremendous PAs.

 

Edited May 23, 2020 by eze8923

[Hope2PA]

1 hour ago, eze8923 said:

I. if a CRNA has a background as an ICU RN, I'm sure that there would be a much better working understanding of critical care and peri-operative management.

Sadly, what use to be a 3 year ICU RN requirement is no longer a requirement for CRNA.  But you are right, they have the foot hold and are not about to give it up.  Someone suggested they should fight against PA Anesthesia because they did it first.  Yet Family Med NP, APRN, etc have no problem moving into areas previously filled  by PA's, such as surgery. Why should PA and AA's keep of CRNA territory, if interested and have the experience.  Why couldn't an ICU PA be a darn good anesthesia PA or AA. Will not likely happen because money and numbers talk, not ability.  Please don't take that as suggesting CRNA do not have the ability, they just will not allow anyone else with the ability fill the need.

[eze8923]

50 minutes ago, Hope2PA said:

Sadly, what use to be a 3 year ICU RN requirement is no longer a requirement for CRNA.

That's too bad - yeah I'm not tremendously well versed in CRNA pre-requisites, but I had heard at one point that some sort of prior ICU RN experience was needed and have run into a few RNs in the ICU where I'm at who are looking to pursue CRNA training eventually. Definitely some overlap there into the OR for sure.

[iconic]

They all still require 1 year of CC experience at the time of application (3 years is still average at the time of matriculation) plus 3 years of DNP (required by 2022, 91/121 programs already transitioned to it) and 2000 clinical hours. By no means a cheap or fast path. If only other NP programs were as stringent.

Edited May 24, 2020 by iconic