Considering a Career as an Anesthesiologist Assistant

Making a Difference in Health Care
Considering a Career as an Anesthesiologist Assistant

36-year old Richard Bassi was a navy pilot for ten years and absolutely loved it. But he was unsure what he would do after his military career.

"The one thing I did know is that I didn't want to sit behind a desk," says Bassi. A fellow Naval Academy graduate had a suggestion for Richard. Gary Jones was an anesthesiologist assistant (AA), and highly recommended the profession.

"From the minute I talked to Gary about the AAs, I could see he loved it," Bassi recalls. "In fact, I saw some similarities between my military service and the AAs."

In the Navy, Bassi flew a helicopter off a carrier, leaving the glory for the jet fighter pilots. "And for AAs in the operating room, it doesn't matter who gets the credit, everybody's job is important when you are taking care of the patient. You are a part of the anesthesia care team and each person's responsibility is critical."

Bassi is currently an AA student at Emory University in Atlanta.

"The students tell me that entering AA school is the best decision they made in their lives," says Joe Rifici, Academic Director for the Master of Science in Anesthesia Program at Case Western Reserve University in Cleveland, Ohio.

As in Richard Bassi's case in Atlanta, where the program was recommended by Gary Jones, "Our program's best way to advertise is by word of mouth," says Rifici. "When graduates tell their brother, sister or friend to check out our program, it makes me feel good because they are recommending us and the AA profession to people close to them."

Challenging Educational Program

The AA training programs are intense. There are three programs across the country, and another in development. The established programs are at Emory, Case Western, and South University in Savannah Georgia. The new school will be at Nova Southeastern University in Ft. Lauderdale, Florida.

Admission requirements for AAs are:

• Baccalaureate Degree (BA is acceptable as well)
• premedical curriculum
• grade point average of at least 3.0
• completion of a Medical College Admissions Test (MCAT) or Graduate Record Examination (GRE)

During the program, there are more than two thousand hours of hands-on clinical training, the intensity of which draws another comparison by Bassi. "My hands-on training with the Navy was flying. The best way to learn is to actually do it. The same for anesthesia."

"The quality of the instructors is very high. I will be ready when I graduate."

Don Biggs, an instructor in the Emory AA program for 25 years, Chief Anesthetist at Emory, and President of the American Academy of Anesthesiologist Assistants (AAAA, www.anesthetist.org), says, "Because we have set up our programs to be very intense in didactic (classes) and clinical training, it is possible to get into the clinical realm with little background in that area. If you have a strong science and academic background, we can put you into the proper clinical training setting."

Biggs adds, "At our annual meeting, one of the anesthetists whom I had taught fifteen years ago shook my hand and said he wanted to thank me for the mountain of material that I had insisted that he learn, because over the years he needed every bit of it. None of the material was trivial. It made me feel pretty good."

The education does not stop at graduation. Other educational opportunities come at the AAAA annual conference. "There is the chance to travel and learn in a nice setting when attending our meetings," says Claire Chandler, AA-C, and Secretary of AAAA " The educational seminars are state-of-the-art, and the conferences offer an opportunity to relax, even take a vacation when the meeting is over." In 2005, the annual conference was in St. Petersburg Beach, Florida.

Keeping Pace with a High Demand

One of the biggest draws to an AA career today is the demand. Rifici says the students who stay in Ohio see an average of three job offers when they graduate. At Emory, Biggs says there are at many as ten offers per graduate, and three standing offers for practicing AAs.

Rifici says, "Although nobody can guarantee jobs for anyone who graduates, since 1991 when I began my association with the Case Western program, 100 percent of the students have been placed in a job before they graduated. That's a striking percentage."

It is all about the shortage of anesthesia providers in the work force. Rifici points to three reasons for the huge demand.

1. There are more interventional procedures being done. Patients are being treated in ways that are less invasive, which increases the number of procedures performed, and a subsequent need for more anesthesia care. Things are much more streamlined, safe, and cost effective because of minimally invasive procedures, such as Nissen fundoplication for hiatal hernias, endoscopies for children (who need anesthesia care), and cardiac interventional procedures.

2. There is a lot more off-site anesthesia now. "Earlier it was all in the operating room," says Rifici. "Now five to ten percent of anesthesia care may be for off-site procedures like MRIs. If a child is having an MRI and can't hold still, we get called. The increase in off-site anesthesia, and the corresponding growth of AAs, parallels the advancement of medicine.

3. The population is aging. As the baby boomer population matures, the need for surgical intervention increases, and so does the need for anesthesia care.

All of this has contributed to a tremendous shortage of anesthesia providers.

Biggs adds, "The choices for AA jobs grows monthly and yearly, monthly because of the shortage, and yearly because the opening up of states where AAs can practice."

There are currently 700 AAs working in 16 states. They are licensed in ten states and are granted practice privileges through physician delegation (the physician delegates to an AA the duties specific to implementation of the anesthesia care plan) in the other states. AAs continue to get licensed in new states. In 2004 Florida's legislature passed AA licensure. In 2005, AAs began working in Washington, DC.

The states in which AAs work by a license, regulation, and/or certification are:

• Alabama
• Florida
• Georgia
• Kentucky
• Missouri
• New Mexico (university hospital settings)
• Ohio
• South Carolina
• Vermont
• North Carolina

The states in which AAs are granted practice privilege through physician delegation (meaning the anesthesiologist can delegate specific anesthesia tasks to an AA):

• Colorado
• District of Columbia
• Michigan
• New Hampshire
• Oklahoma
• Texas
• West Virginia
• Wisconsin

Involvement in Political Process

Chandler says the political effort by AAs to get licensed in new states offers even more opportunity for students. "It is important now that we get involved politically. We need more representatives to help us in more and more states and the students can take advantage of that."

In the recent Florida effort, students testified before the legislature about their desire to work in that state, which was home for some of them. It sent a powerful message to lawmakers, who like to make sure the jobs they help create are high-paying. AAs certainly fall into that category. Rifici says that the most recent graduating class at Case Western University averaged a low-end salary of $95-100 thousand per year, and a high-end of $120 thousand.

The Lifestyle Advantage

Those salaries have obvious advantages for an AA with a family

Student Richard Bassi says, "With two infant children, the plan is for my wife to stay home for as long as she wants. She is also a former Navy pilot but our priorities have changed. The AA salary allows us that freedom.

"Another difference is, I'm not gone for months now like I was in the Navy. for my last deployment, I was gone for nine months. I was single then so it didn't matter. Now it will be good to go home at night."

Claire Chandler points out the advantages for women who want a professional career balanced with family time. "Some anesthesiology groups and hospitals allow you to limit your schedule to three or four times a week."

Bassi adds another point about lifestyle, "You can live comfortably in Atlanta, Georgia on this salary. And I think that says a lot."

Fulfillment on the Job

Although salary and opportunity are significant when choosing a career, job satisfaction is also a priority.

"Anytime I have a patient under my care they are a critical care patient," says Don Biggs. "Because of that it keeps your interest up. There has never been a week when I have been bored with my job. It forces you to be constantly aware of what is going on with your patient."

Chandler echoes that, "You work with critical patients, healthy patients, ladies having babies, heart patients. Even though an AA is a specialty, you still have a variety. Every day is different, a new problem to solve."

And while solving those problems, AAs see their intensive training pay off.

"The operating room can be a pressure-cooker environment," says anesthesiologist Joel Zivot, MD, Medical Director of the Master of Science in Anesthesia program at Case Western. "AAs work well in this setting. For my assistant, I want somebody who is well trained and will work with me collaboratively, not somebody who is going to give me a hard time and be negative. I have never had a negative experience with an AA, because they are trained to be part of a team."

"I have seen AAs do things that nobody else in the room could do," Dr. Zivot continues. "For example, in a difficult intubation (the placement of a breathing tube through the mouth and throat into the windpipe) it has to be done in a matter of moments, or it could lead to injury or death. It requires a technical ability. I've seen AAs be masterful at this."

Rifici adds that a benefit from challenges like that is an instantaneous, positive outcome. "If you work in a lab and do research, you might not see the effect for months, even years. But if you are providing anesthesia, you see immediate results."

Another example of a beneficial consequence is the opportunity an AA has to consult with families of patients under their care. "Nothing is more satisfying than making the family of a sick child feel comfortable with their anesthesia provider. You make not just the child, but the entire family feel good about their medical care."

Bassi agrees, "Money can only buy you so much, but it feels cool to come home and know that you made a difference."