PA's doing Anesthesia??

  1. PA's doing Anesthesia??

    I was in the ER last night (my wife fell and fractured her radial head). The PA that saw her was asking me about Nurse Anesthesia and mentioned he was looking to do some more training to be a PA that could do Anesthesia. I have never heard of that. I asked him more about it he mentioned the school was in the East. I asked if it was a AA program (anesthesia assistant) but he said no, it was a PA program.

    Has anyone heard of that??? I thought it was weird, he couldn't give me a name of a program, he was very interested in Nurse Anesthesia, he wasn't real happy being a PA and wanted to try something else.
    Oh btw my wife is fine, (3 hrs, $60 and cheap looking sling later).
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  2. 20 Comments

  3. by   loisane
    I agree, sounds weird to me too.

    I know of two AA schools-Cleveland and Atlanta. As you indicate, AAs are not PAs.

    I don't know of any PA involvement in anesthesia, either.

    loisane crna
  4. by   DIPLOMATICRN4HIRE
    Well I cant think of one school either that would allow a PA to do any type of anesthesia. They arent trained in that much chemistry to be honest, and I dont see how they could just jump into a totally different area of medicine, without doing an entire set of classes just the same amount as a CRNA? The classes of a PA are only a 24 mo training and its not even as intense as a LPN, they are trained broad not specific. I dont think I would want a PA to administer my sucx , would you?
    Just my thoughts
    Zoe
  5. by   smiling_ru
    They are considered physicians assistants. This is from the Emory web site.


    Anesthesiologist Assistant (AA) was the name given to graduates of the first two programs (Emory University and Case Western Reserve University) that trained anesthetists of the Physician Assistant type, in a medical school environment utilizing the faculty of an academic department of anesthesiology. In 1970, the Board of Medicine of the National Academy of Sciences (NAS), produced a document that described multiple categories of physician assistants (PAs) which included the primary care/generalist Type A, and the specialist Type B. AA programs were designed to be prototypical examples of the Type B physician assistant according to the National Academy of Sciences definition:

    "The Type B assistant, while not equipped with general knowledge and skills relative to the whole range of medical care, possesses exceptional skill in one clinical sub-specialty or, more commonly in certain procedures within such specialty. In this area of specialty, he has a degree of skill beyond that normally possessed by a Type A assistant and perhaps beyond that normally possessed by physicians who are not engaged in the specialty. Because his knowledge and skill are limited to a particular specialty, he is less qualified for independent action."
  6. by   MICU RN
    Zoe:

    While I am not a PA but a RN trying to become a CRNA, don't you think your statement that PA school is not as intense as LPN school to be rather ridiculous. I looked at a PA program before I went to nursing school and it had more science classes than RN programs. IN addition, the PA programs follows a medical model which is more scientific based than a nursing program, LPN or RN.
    Last edit by MICU RN on Dec 24, '02
  7. by   TexasCRNA
    The difference to PAs to AAs is or would be the same as to trying to say that NPs and CRNAs are the same to which they are not. The training for each is different and so is the govering/regulations/clinical privilages of those jobs. If you wanted to do both you would have to train for both as in clinical hours, classes, etc..
  8. by   EmeraldNYL
    I was considering PA school before nursing school, and I heard of this while I was shadowing a PA. Apparently, there is a school in Georgia (forget which one?) that trains PAs to do anesthetia. However, I hear they are not very much in demand and to get accepted to the program you basically already have to have a sponsor (a hospital where you will work upon completion of the program).
  9. by   u-r-sleeepy
    This is probably more than you want to know... but it does shed some light on the subject and what's currently going on. Plus, many CRNAs and SRNAs (like myself) have decided to absolutely BOYCOTT any and all groups utilizing AAs in their practice. I would like to encourage YOU to adopt the same stance. It isn't merely "dealing with competition" - what about the safety of the patient and YOUR license to practice?

    from the article:

    AAs AAs AAs AAS


    Anesthesiologist Assistants (AAs)

    --------------------------------------------------------------------------------
    District of Columbia-The medical board has adopted guidelines to permit AAs
    to practice under the delegatory authority of anesthesiologists. The
    guidelines, as finalized by the board, have yet to be published.

    Florida-Florida H.B. 599, providing for the licensure of AAs, passed the
    House but failed to be considered by the full Senate prior to the end of the
    session. The House-passed bill would have allowed an anesthesiologist to
    supervise two AAs, although the Board of Medicine would have been permitted by
    rule to allow an anesthesiologist to supervise up to four AAs after July 1,
    2006. "Direct supervision" was defined as supervision by an anesthesiologist
    who is present in the same room as the AA or in an immediately adjacent room or
    hallway, such that the supervising anesthesiologist is able to monitor the
    ongoing anesthetic and be immediately available to provide assistance and
    direction while anesthesia services are being performed. The supervising
    anesthesiologist would have been required to personally begin the patient's
    preanesthetic assessment.

    Indiana-S.B. 370 would have prevented a physician assistant (PA) from
    prescribing, administering or monitoring general anesthesia, regional block
    anesthesia or deep sedation unless 1) a physician is physically present in the
    area and is immediately available to assist in the management of the patient,
    and 2) the PA is qualified to rescue patients from deep sedation and is
    competent to manage a compromised airway and provide adequate oxygenation and
    ventilation. The bill failed to pass.

    Kentucky-H.B. 617 was signed into law to provide for the continued practice
    of PAs who have been practicing as AAs. The law requires the individual to have
    completed a four-year PA program followed by a two-year program that consists
    of academic and clinical training in anesthesiology. Under the law, a PA
    practicing as an AA may administer or monitor general or regional anesthesia if
    the supervising anesthesiologist is physically present in the room during
    induction and emergence, is not concurrently performing any other anesthesia
    procedure and is available to be immediately present in the room.

    Louisiana-The governor has extended the time frame for the AA commission to
    develop legislation to license AAs until March 1, 2003.

    Maryland-The governor signed H.B. 533 to establish a commission to propose
    regulations or legislation regarding the approval of delegation agreements for
    the administration of anesthesia by PAs. The commission was to report to the
    legislature by December 1, 2002.

    New Jersey-A.B. 655 was introduced to license AAs. The bill states that an AA
    shall be under the direct supervision and medical direction of an
    anesthesiologist at all times. An AA may assist an anesthesiologist in
    developing and implementing an anesthesia care plan for a patient pursuant to a
    written practice protocol developed by the supervising anesthesiologist. The
    written protocol is to delineate all the services that the AA is authorized to
    provide and the manner in which the anesthesiologist will supervise and
    medically direct the AA. A supervising anesthesiologist shall not have more
    than two AAs under his or her supervision and medical direction or employment
    at any one time.

    Ohio-The Anesthesiologist Assistant Advisory Committee (AAAC), a group formed
    by the Board of Medicine to draft regulations for AAs, has issued its final
    report to the board. The board has finalized the proposed regulations and has
    begun the formal rules process. The proposed regulations require supervising
    anesthesiologists to establish a written practice protocol with AAs and to
    provide direct supervision in the immediate presence of the AA. During the
    first four years of an AA's practice, the supervising anesthesiologist shall
    provide "enhanced supervision." "Enhanced supervision" requires regular,
    documented quality assurance interactions between the supervising
    anesthesiologist and the AA. An AA shall be required, during the first two
    years of practice, to file monthly a separate record of cases of anesthetic
    management in which he or she participated. The record will be reviewed by a
    supervising anesthesiologist, who will then file a report of each quality
    assurance int
    eraction.

    AAs are permitted to practice only in hospitals and ambulatory surgical
    facilities and are prohibited from performing epidural and spinal anesthetic
    procedures and invasive monitoring techniques such as pulmonary artery
    catheterization, central venous catheterization and all forms of arterial
    catheterization with the exception of brachial, radial and dorsalis pedis
    cannulation.

    Oklahoma-The Board of Medical Licensure and Supervision adopted regulations
    to allow PAs to perform preanesthetic and postanesthetic assessment of patients
    and administer topical, local or regional anesthesia. PAs are prohibited from
    administering general anesthetics without the express approval of the Board.

    Pennsylvania-The Board of Medicine proposed regulations to codify criteria
    under which a physician may delegate the performance of medical services. While
    this regulation would apply to all physicians, anesthesiologists would be able
    to delegate authority to AAs.

    Texas-The Board of Medical Examiners amended the AA guidelines to allow an
    anesthesiologist to supervise up to four AAs at one time. Previously the
    guidelines allowed for a ratio of 1:2.

    This year-end summary will continue in January summarizing other activities in
    the states related to office-based anesthesia and tort reform.
  10. by   Tenesma
    i don't know what the ruckus is all about... it is clear that there is a shortage of anesthesia providers in this country... CRNAs and AAs are two different animals and aren't in conflict with each other. what are the threats that AAs pose to CRNAs? in my opinion there are none, just as the existence of CRNAs doesn't threaten me (MDA) - just as long as we are able to provide care to as many people in as safe a way possible.
  11. by   DIPLOMATICRN4HIRE
    Well thats why its based on opinion. I have looked into a few PA schools for the simple reason of my traveling internationaly like I do and have found that some schools were a yr long with pre reqs and were a base instructional of education. I have also looked into the programs which you can go from a RN , and complete a PA course in one yr. North Dakota. The year mainly consists of coding and insurance models, the rest of the time in clinicals , so they will be able to bill for thier services. The education on some of the programs not saying all, but some have very short A&P, biology and other sciences that last just a few weeks and are tested out from there. I would rather leave myself or a family member of mine to the SKILLED Care of a CRNA, or an Anesthetist.
    Just my thoughts
    Zoe
  12. by   u-r-sleeepy
    Thanks ITSJUSTMEZOE - your response is a good start.

    In my humble opinion... this is more an issue of monopoly and control of the practice of anesthesia and the $$$$$. I wonder how MDAs would react if the AANA proposed doing a "PA" type approach of training RNs with a 6-9 month program in anesthesia to the point to where CRNAs could "supervise them" and increase their pay? Let's see - how about being able to supervise at least 2 such RNs? That would allow CRNAs to start to "clean up" on the $$$ - like SOME MDAs do...!? Of course this could not happen - the control for such decisions is not made by the lower CRNA-class of practitioners.

    Sorry Tenesma - I have a LOT of respect for you and other MDAs I've worked with who are like you. I will continue to have a GREAT appreciation for you and your like-minded compatriates. I think the "threat" is to the patients - not me or my fellow CRNAs. I have a great deal of disagreement over this issue and I think it is primarily about above said "control and $$$$".

    When the numbers of Baby-Boomers retiring shifts the supply-demand ratios to the breaking point in medicine in general (and anesthesia in particular), I believe the cost vs benefit problem is going to have to be solved. I do NOT believe AAs are the best way to resolve this. I think managed care alone is going to force some changes with regard to MDAs vs CRNAs - eventually. Maybe not in the next year or three, but eventually, things are going to change. I am simply stating my opinion that AAs are NOT the way to go.

    To be fair-minded, yes, Tenesma, I am aware of a few "poor outcomes" of newly minted CRNAs out there in the recent year or two. I doubt you would appreciate me beginning to sight MDA "complications" and recent cases either. ;-)
  13. by   u-r-sleeepy
    PS - for a futher glimpse into the view and attitudes of MDs and their VALUE$: Take a peek at this article -->

    http://www.ama-assn.org/sci-pubs/amn...0/prsb0103.htm

    Now... who's feeling "threatened" by whom? ...and WHAT'$ most important about their concern$?
  14. by   Tenesma
    i disagree about the money issue... if this was about money, then there would be no incentive to add providers (or provider assistants) to the market as this would lead to decreased reimbursement.

    correct me if i am wrong but an AA is basically a bachelor's degree followed by specialized anesthesia education over 2 years... which sounds very similar to Physician Assistants (PA). and from what i hear on the inside is that preference is given to people with nursing degrees/respiratory therapy etc... in fact in canada where they have a similar model (as they don't have the luxury of CRNAs) only nursing degrees and respiratory therapy can apply for their AA programs.

    (by the way there is a huge difference between an MDA supervising CRNAs/AAs and a CRNA supervising an RN with 6-9 months of training... )

    bottom line, as less and less people go to nursing school there will continue to be a larger and larger shortage of CRNAs... why not help fill the void... plus remember these AAs don't practice independently at all, the requirement for the MDA is that he/she either be in the room, the room next door or in the hallway adjacent to the room... which is a lot more stringent then the supervision many CRNAs receive.

    i still don't understand what the AANA is concerned about... i could see your point if the market was shrinking and CRNAs/MDAs/AAs were all fighting for the same job.. which they aren't... for heaven's sake, salaries >120k for a CRNA is almost the norm nowadays.

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