Over the years many Anesthesiologist Assistants (AAs) have contacted us about a possible AA to CRNA bridge program. Though this option does not currently exist the idea has been bantered around the CRNA community now for many years and the discussion is often heated.
Recently the AANA President mentioned there would be an investigation to decide if and how it can be done. This has reignited the discussion among CRNAs about putting the time and work into such an endeavor. However, there is more acceptance than ever about the idea.
CRNAs as a group believe in the value of previous healthcare experience, it is why we require CRNAs to have been Critical Care RNs prior to application for Nurse Anesthesia programs. While AAs do not often come with RN experience they gain experience during their program and working as an AA which would be valuable in a Nurse Anesthesia program. Many feel that this experience and their masters degree should allow them the opportunity to bypass basic bachelors and masters classes and go right into the nurse anesthesia classes. The benefit of the bridge it that they get credit for what they have already done but then learn and expand their capabilities to include skills and critical thinking required to become an independent anesthesia provider. A well designed bridge would do just that.
Not to mention the future of anesthesia care will result in a massive glut in providers as the baby boomers age and become medicare recipients. However it isn't enough to have dependent practitioners. We will need more practitioners who can perform anesthesia to the full scope of practice. Dependent practitioners and those who watch other qualified practitioners work will have a limited place in the future of healthcare.
Many CRNAs have asked, would the benefit be worth the work? The answer is often an individual one but some of the benefits of being a CRNA over being an AA are:
- Ability to work anywhere in the USA (as opposed the few states they can work in currently)
- Ability to work in any facility as opposed to the ones in states that allow AAs to practice which use them. Often it is a limited number of facility options.
- Flexibility to work independently outside of Anesthesiologists. This not only opens up hospitals but ASC and offices where CRNAs work independently today.
- Increased earning potential. Although AAs are often paid the same as CRNAs when working in the same restrictive practice, CRNAs generally make more in practices where AAs are not AND they have better scope of practice.
- Ability to work to full scope of practice as an anesthesia provider
- Ability to work where Anesthesiologists are not.
But it is also worth hearing what some AAs have said to us about why they would consider becoming a CRNA in the first place or bridging after the fact. Here are some of their comments and advice.
- Consider your decision to become an AA. Some have had friends attempt to talk them out of AA school. One AA student noted that they hadalso been accepted to an accelerated RN program but didn't attend because it would take longer than the AA route. Had they went that route they would be done now.
- You have to be aware of the AAs in your area and what options for employment are. Is it just in one or two large hospitals? Would this limitation of workplace be enough for your career? Would it be enough for you? If not this could be a serious concern.
- AAs do not have the flexibility CRNAs do. An AA misses out on lucrative and flexible opportunities that CRNAs have due to their restrictive practice an inabiility to work without MDs. One AA relates that there is only one facility near him that uses AAs, yet all of the hospital network's outpatient surgery centers, GI/endo clinics, ophthalmology clinics exclusively use CRNAs. He also relates that the entire OB department is run by CRNA without Anesthesiologists, something AAs can never do. In addition contracts with plastic surgeons often only use CRNAs in their ORs not to mention all the opportunities where the pay is higher in other states for CRNAs and where AAs cannot work.
- Some practices pay CRNAs int he same practice more than AAs. One AA relates that a group in his area that hires AAs starts their AAs out 10-20K a year less than CRNAs.
- There are 3 main things an AA has to consider.
- Are you OK working in a small number of facilities for the rest of your career in an employee capacity?
- Are you willing to move to find a job? This may be required for many as well as possibly never being able to work in your home state
- If you ever see yourself aspiring to work in a more independent role can you handle never having that happen? More and more CRNAs are doing exactly this and due to that option (which AAs do not have) make a much higher income.
- It may take an extra 3-4 years to become a CRNA but are you really willing to give up these opportunities to take the shorter easier route?
These are the perspectives of a number of individual AAs about choosing to be an AA. However, once an AA many have stated that they would consider a bridge for these very same benefits.
You can read about one AAs experience here