Physician Assistant Anesthesia Jobs, Employment & Career Center

Hi Bill. 

Thanks for getting back with me.  To give you a little history on my background, I worked in a medical intensive care unit for 5 years as a Physician Assistant.  I loved the experience that I gained with diagnostic dilemmas, airway management, and central line placement.  I also gained a great knowledge of physiology and pathophysiology, as well as having the time to interact with families on a daily basis.  However, my big issue was that on average my fellow Physician Assistants and I  were required to work 70-80 hour work weeks.  This included alternating every two weeks between nights and days and working 3 out of 4 weekends, as well as every other holiday.  After 5 years of this kind of work load my family life started to suffer and I realized that I needed to make a change in my life.  At that time I started looking for another job as a Physician Assistant.  I wanted to find a job that would require the use of all the skills that I’d learned over the last number of years, but could not put my finger on a job that could fulfill all those categories for me. 

I then started looking on the internet for jobs for Physician Assistants and came across your website, which talked about Physician Assistants in anesthesia.  This field has always interested me ever since my rotation as a physician assistant in general surgery.  During that rotation, I had the opportunity to spend some time with the anesthesia group learning about intubations and their ability to keep the pt asleep during the surgery. 

  After coming across your website, my interest to pursue an opportunity to practice in this field grew.  I then came across a website called anesthesiaassistant.com which explained that with additional training that I could actually practice in the delivery of anesthetics.  Looking through the different programs, I discovered that Emory University had just started a special track for Physician Assistants to become certified to deliver anesthesia.  I applied to the program and was accepted and relocated my family from Michigan to Atlanta, Georgia.  So I became part of the very first physician assistant track of anesthesia assistants in January 2007.

I found the program very intense and rewarding.  I love learning new aspects of medicine.  It was hard after 6 years going back to school and becoming a graduate student again, but the experience was well worth it.  I found many aspects of anesthesia very comparable to things that I had already learned and been performing in an ICU setting.  I felt that as a physician assistant in the anesthesia program, you really have an enormous edge on the general track students as far as knowledge of medicine, patient interaction, pharmacology, and in communicating with surgeons as well as anesthesiologist.  For me, going into this program, I thought that it was going to be fairly easy, since I've already been practicing airway management and advanced hemodynamics.  Once I started the program I found out quickly that there was a lot more to anesthesia than I realized.  I learned through the program more about the actual practice of anesthesia, anesthesia pharmacology, the anesthesia machine, the physics involved in anesthesia, complications of anesthesia, as well as an even better understanding of the physiology of the body and interactions with surgery and anesthetics.  After spending 18 months in the program and graduating, I've come to realize what a great job Emory's Anesthesia Program had done to prepare me to practice in anesthesia.  I think without this training it would have been very difficult to practice anesthesia, outside of pre and post operative follow ups.  I would highly recommend this type of program to anyone that wishes to practice in the field of anesthesia. 

Compensation after graduating from an anesthesia assistant program is equal to that of a nurse anesthetist ranging from $105,000 to $180,000 a year along with many of the same benefits that you receive as a practicing PA.  Your job title after you graduate is a Physician Assistant Anesthetist.

As a Physician Assistant Anesthetist, your job description is that you will provide anesthesia under supervision of an anesthesiologist.  You get to practice in the anesthesia care team model, just as Physician Assistants do with their supervising physician.  This differs from our CRNA counterparts which practice independently, under any physician’s license such as the surgeon’s license.  The CRNA’s are trained under the nursing model, whereas Physician Assistant Anesthetists are trained under the medical model.  Physician Assistant Anesthetists become involved in every aspect of anesthesiology such as placing epidurals, spinal anesthesia, general anesthesia cases, monitored anesthesia cases, placing invasive lines, monitoring/interpreting and treating hemodynamics, airway management, ventilator management, etc.

I’m very excited to be able to participate and practice in the field of anesthesia.  I look forward to continuing to learn the practice of anesthesia as well as help educate other providers in anesthesia. I have recently accepted a position as part of the program faculty at Emory University and get to help educate students both in the class room and in the operating room.  Feel free to contact me with any questions anyone might have about the practice of anesthesia as well as any of the training programs in anesthesia.  I would be happy to be a resource for you and your go to team at any time.

Thank you very much for your time and interest in my experiences as a Physician Assistant and as a Physician Assistant Anesthetist.

Michael P. Merren MSM, MMSc, AA-C, PA-C
Program Faculty
Master of Medical Science in Anesthesiology
Emory University School of Medicine
Phone: 770 713-0822
E-mail: merrenpac@hotmail.com

QUESTION:  I am a practicing PA with 14 years of both Family Practice as well as Orthopedics. I have been approached by a local Anesthesia group about adding a PA to their group. Duties are not clear as of yet, but may include providing sedation for endoscopy cases. In Iowa we are allowed to administer all but class II depressents. I would appreciate any information you could provide me to share with this group about the utilization of PA'S in anesthesia. Thank you for your assistance. 

ANSWER:

  PA could very easily provide sedation for endoscopy. Frankly, in many institutions physician-directed nurses provide this care. You should make clear to your anesthesiologists that, as physicians, they can delegate to you anything within their scope of practice that you are trained to do as long as it is within the institution's (and state's) rules, regulations and guidelines).
 

I think that our training in the basic and clinical sciences provide us the background to do much more. For example, pre-anesthetic assessments are a critical part of the anesthetic continuum and (once one acquired the pertinent knowledge relevant to anesthesia) can be done by PA's. Post-anesthetic care to include the critical care units and pain services are also within our purview. The real challenge is to find a mechanism to enable one to participate in intraoperative anesthetic care and thereby be a full-member of the anesthesia care team. If your anesthesia group is willing to give you on-the-job training (and it is not prohibited in your state), that is one option. Some PA's have atttended anesthesiologist assistant programs to get that training. I believe there are four programs now. It would take two years (and tuition) to acquire the AA credential. I don't know if this is a viable option. I hope that we can develop post-graduate training programs (residencies) in anesthesiology for PA's. We are not there yet.
 

I hope this helps.

Best of luck.
Shepard Stone
Shepard B. Stone, MPS, PA
Associate Clinical Professor of Anesthesiology
Yale University School of Medicine
Physician Associate-Anesthesiologist
Yale-New Haven Hospital
Lieutenant Colonel
State Aviation Medicine Officer
Connecticut Army National Guard"
 

EXAMPLE OF PAs in ANESTHESIA:

source: http://www.unmc.edu/anesthesia/APEU%20Guidelines.htm
THE FOLLOWING GUIDELINES APPLY TO ALL PROCEDURAL AND SURGICAL PATIENTS:

Kevin L. McNabb, MPAS,  PA-C
University of Nebraska Medical Center
Anesthesiology Pre-Op Dept.
402- 559-7497/9228

Anesthesia Preop Evaluation Unit Guidelines

The Department of Anesthesiology encourages all patients who are anticipating a surgical procedure at The Nebraska Medical Center, who are ASA II-IV (see attached), to have an Anesthesia screening in the Anesthesia Preop Evaluation Unit as part of their preoperative workup. The patients will be evaluated by a combined team of Staff Anesthesiologists, Residents and Physician Assistants focusing on potential cardiac, pulmonary and airway problems that may be encountered perioperatively. The Anesthesia Team then will work in conjunction with the Clinics, Consults, Primary Care Providers, and Ancillary Support Teams to assure that the patient is maximized prior to the day of surgery. Preoperative screening is an attempt to help alleviate problems, optimize patients, while minimizing unnecessary and costly delays or cancellations and making patient safety a number one priority. The Anesthesia Preop Evaluation Unit is located on the first floor of the South Tower in room number 1467. The APEU is currently open from 9:00 a.m. to 5:45 p.m. Patients are seen in the pre-screening area on a first come–first serve basis and patients should be informed that they may have a wait prior to being seen. The possibility of scheduling patients for appointments in the APEU is currently being considered. With clinic visits, Diagnostic Center workups, and APEU screening, patients should be informed that their preoperative workup may take half of a day to a full day to complete. That way, they will make appropriate arrangements and be prepared to complete what is required (diabetic patients and patients on oxygen should make arrangements for food, insulin, or adequate oxygen).

The patient should have a History and Physical exam completed by the primary team or patient’s primary care physician. All appropriate labs, chest x-rays, EKG’s, and cardiac or pulmonary workups should be completed prior to the Anesthesia Preop Evaluation Unit visit. These should be made available at the time of the patient’s preoperative visit to help avoid last minute problems the day prior to or morning of surgery, i.e., hyperkalemia, abnormal EKG’s, or abnormal cardiac workups that may require further recommendation from Internal Medicine or Cardiology for monitoring or optimizing the patient. If the patient has had any previous cardiac workup, i.e., cardiac catheterization, stress test, ECHO, EKG (in the case of abnormal preop EKG) or a previous CABG, this information/records should be enclosed in the surgical packet. Pulmonary function tests, pulmonary consultations and sleep studies are important information to include for evaluation of potential respiratory complications that might develop during the patient’s procedure.

In order to facilitate the preoperative screening by the Anesthesia Department, patients should be scheduled for surgery with the OR scheduling desk at 559-9900 prior to the APEU visit, have completed appropriate labs, chest x-ray, and EKG as suggested in the Healthy Patient Guidelines and Beta Blocker Guideline and page 73 of the Anesthesia Evaluation booklets, and have a completed surgical packet. This packet should include a History and Physical from the primary team, written order sheet, and signed consent. All orders should be placed in Carecast by the clerks in the Surgical clinics. APEU clerks do not put in clinic orders. Any workup (labs, CXR, EKG, ECHO, STRESS, CATH, PFT, etc.) ordered by the surgeon must be on the chart prior to the patient being taken to the OR.

Any questions or concerns regarding these guidelines should be addressed to:
Barbara J. Hurlbert, M.D., Anesthesiology, Medical Director APEU, 559-4081
Barbara Sink, P.A.C., Anesthesiology APEU, 559-9228 

source: http://www.asahq.org/career/aa.htm#14
Although Anethesiology Assistants (AAs) and physician assistants (PAs) are both allied health professionals, they do not perform the same functions. Each has its own separate educational curriculum, standards for accreditation, and its own agency for certification. PAs receive a generalist education and may practice in many different fields under the supervision of a physician in that field. The scope of practice of a PA is much broader than that of an AA, and in some states the PA works under less supervision than the AA. An AA may not practice outside of the field of anesthesia or without the supervision of an anesthesiologist. An AA may not practice as a physician’s assistant unless the AA has also completed a PA training program and passed the National Commission for the Certification of Physician Assistants (NCCPA) exam. Likewise a PA may not identify him- or herself as an AA unless he or she has completed an accredited AA program and passed the National Commission for the Certification of Anesthesiologist Assistants (NCCAA) exam. The exact scope of practice authority for AAs and PAs in any individual state can only be ascertained by referring to the laws or board of medicine guidelines of the state in question.
 

Physician Assistant
     source: http://www.mshealthcareers.com/careers/physicianassistant.htm
Physician Assistants (PAs) Work under the direction and supervision of a physician to provide a variety of medical care services. They are called upon to take detailed medical histories, perform physical examinations, and order diagnostic laboratory tests and X-rays. They then identify and report any abnormalities that they find after conducting these tests and examinations. Physician assistants can also care for minor injuries by suturing wounds, applying and removing casts, and splinting and bandaging. They may also be in charge of making rounds at a hospital in an effort to observe and record the progress of patients. A key role in the physician-PA relationship is assisting with counseling patients on preventative care, medical problems, and prescribed medications and treatments. PAs may choose to specialize in areas such as surgery, geriatrics, public health, anesthesiology, obstetrics, neonatology, occupational medicine, or orthopedics. The physician assistant is a vital member of the medical profession because they allow physicians to handle more complex patient problems. Individuals interested in this line of work should enjoy working with people, have good oral and written communication skills, and be able to make decisions quickly. 

CHARACTER and VALUE: Physician Assistants are by character compassionate advanced medical providers and team builders through individual professional excellence in collaboration and partnership with physicians, consultants, fellows / residents, nursing and other medical staff, achieving high quality outpatient and inpatient care, through medical problem solving, working interdependently and assuming responsibility for their patients. PAs are cost effective medical providers for patients, businesses, and insurance plans, contributing to a solid financial foundation for the whole health care system. 

MISSION and SERVICE: The Physician Assistant's mission serves in all medical and surgical specialties, operating as established medical authorities with their physician colleagues, hospitals, practices, and clinics. PAs are extended Hospital medical credentials and privileges.

MEDICAL COMPETENCY: Physician Assistants are trained in the same medical model as are physicians. PA's medical training advances their expertise in all areas of medicine in a condensed time frame-raining is roughly two-thirds the length of medical school with 108 weeks of general primary care education. PAs further enhance their chosen medical specialty in a structured residency program and/or hand in hand with their physician colleagues. Physician Assistants must also pass a national medical certification board and recertify every six years. In many cases, experienced PAs bring their patients a level of experience and care that often exceeds that of medical residents and less experienced physicians.  Frequently MDs in one area of medicine defer judgment to a Physician Assistant in another specialty.

PHYSICIAN ASSISTANTs: Are rigorously medically trained and are licensed medical professionals as advanced medical providers who establish and build a medical practice diagnosing and treating their own patient roster, medically trained to serve in a variety of clinical settings, in all medical specialities including Cardiac care, Orthopaedics and Sports medicine, Pediatrics, Internal Medicine, Emergency Medicine, Occupational Health, Pulmonary Care, Neurology, Gastroentology, Neonatology, Family Medicine, Urology, Obstetrics and Gynecology, in primary care practices, geriatric long-term care facilities, hospitals, correctional institutions, Federal and community-based clinics. In short, PAs are trained and certified advanced medical practitioners giving complete and outstanding patient care. 

DEGREES OF AUTONOMY: Physician Assistants are generally excellent team builders respecting the limits of their Physician colleague's medical professional relationships and state laws.  It's vitally important that the PA and MD are similar in their team approach!  This successful continuum includes Physician Assistants practicing significant autonomy in their medical practice, exclusive of a physician's presence, while other PAs want a much closer professional relationship with a consulting MD who is more, often than not, physically present for practical direction and oversight.

PHYSICIAN ASSISTANT'S MEDICAL PRACTICE includes:

1. Physician Assistants Provides comprehensive physical assessment.
2. Physician Assistants Evaluate, diagnose, and treat new and existing patient's medical and surgical conditions. 
3. Physician Assistants Initiate and interpret labs and x-ray studies including CTs & MRIs.
4. Physician Assistants Perform medical and surgical procedures.
5. Physician Assistants Prescribe and refer patients for specialized consultation. 
6. Physician Assistants Assist Physicians in medical and surgical procedures.
7. Physician Assistants Use prescriptive authority to write prescription medicines for patients. 
8. Physician Assistants Write/Dictate medical notes in patients' charts indicating patient status, treatment & procedures.
9. Physician Assistants Conduct follow-up patient care.
10. Physician Assistants Provide health education to patients and families. 
11. Physician Assistants Supervise and/or coordinate the activities of patient care and support staff within the clinic. 
12. Physician Assistants Train and supervise medical residents engaged in specific clinical activities. 
13. Physician Assistants Teach and train illness prevention.
14. Physician Assistants Actively participate in community health education. 
15. Physician Assistants Perform emergency life saving procedures including cardiac arrest, respiratory arrest, massive hemorrhage.
16. Physician Assistants Are among front line medical providers in emergency disaster services.

 

• Physician Assistants have Excellent interpersonal and communication skills.
• Physician Assistants Give the patient quality compassionate and empathetic caring.
• Physician Assistants Give the patient more time through Active listening.
• Physician Assistants Give the patient more easily understood feedback and instructions,
• Physician Assistants Promote greater patient health and wellness.

resulting in patients often preferring medical treatment by physician assistants-associates...

"Consumers seek a broader array of health services than physicians have time, inclination, or expertise to address. Interdisciplinary care is a more efficient and effective strategy for providing care of high quality since all providers contribute what they do best." Linda H. Aiken, PhD, RN Jan. 14, 2002 http://www.medscape.com/viewarticle/447839

For patients with chronic illness, treatment by a multidisciplinary team represents the state of the art, with nonphysicians providing most of the routine care and ancillary services while physicians and PAs manage more acute and complex problems.

1. Physician Assistants have the ability to perform medical examinations using standard medical procedures. 
2. Physician Assistants have knowledge of drugs and their indications, contraindications, dosing, side effects, and proper administration. 
3. Physician Assistants have expertise in clinical operations and procedures. 
4. Physician Assistants have expertise in primary care principles and practices. 
5. Physician Assistants have expertise in patient care charts and patient histories. 
6. Physician Assistants have expertise in Surgery, pre-op and/or post-op procedures. 
7. Physician Assistants have expertise in CPR and emergency medical procedures. 
8. Physician Assistants have expertise in current and emerging trends in technologies, techniques, issues, and approaches in area of expertise. 
9. Physician Assistants have expertise in clearly communicating medical information to professional practitioners and the general public. 
10. Physician Assistants have expertise in  maintaining quality, safety, and/or infection control standards. 
11. Physician Assistants have expertise to observe, assess, and record symptoms, reactions, and progress. 
12. Physician Assistants have expertise to make administrative and procedural decisions.
13. Physician Assistants have expertise in related accreditation and certification requirements. 
14. Physician Assistants are professionals in reacting calmly and effectively in emergency situations. 
15. Physician Assistants have expertise in supervising and training staff, including organizing, prioritizing, and scheduling work assignments. 
16. Physician Assistants have expertise in preparing and maintaining patient records. 
17. Physician Assistants have expertise in educating patients and/or families as to the nature of disease and to provide instruction on proper care and treatment.

• American Academy of Pain Management
• The American College of Obstetricians and Gynecologists
• American Pain Society
• American Academy of Hospice and Palliative Care
• American Chronic Pain Association
• American Academy of Pain Medicine
• American Pregnancy Association
• American Society of Anesthesiologists
• American Society of Regional Anesthesia and Pain Medicine
• Anesthesia & Analgesia (Journal)
• Anesthesiology (Journal)
• Anesthesia Patient Safety Foundation
• Association of Women's Health, Obstetric & Neonatal Nurses
• California Society of Anesthesiologists
• Canadian Association of Anesthesiologists
• City of Hope Pain/Palliative Care Resource Center 
• Confidential Enquiries into Maternal Deaths
• Employment Opportunities
• Foundation for Anesthesia Education and Research
• The Society for Pain Practice Management 
• Hospital & University Links
• International Anesthesia Research Society
• International Journal of Obstetric Anesthesia
• International Society of Obstetric Medicine
• MedLine
• Medscape
• National Pain Education Council (NPEC)
• North American Society of Obstetric Medicine 
• Obstetric Anaesthetist's Association(UK)
• Obstetric Anesthesia Digest
• Pain Relief for Labor: A Patient's Guide
• Pain Management in Nursing
• Society for Maternal-Fetal Medicine

Boston University, Department of Anesthesiology
California, Davis, Department of Anesthesiology
California, Irvine, Department of Anesthesiology 
California, San Diego Department of Anesthesiology
Chicago, Department of Anesthesia and Critical Care
Cincinnati, Department of Anesthesia Pain Management and Perioperative Medicine
Florida College of Medicine, Deptartment of Anesthesiology
Iowa, Department of Anesthesia
Kansas Medical Center, Department of Anesthesiology
Kentucky, Anesthesia Department
Kentucky, Louisville Department of Anesthesiology
Maryland, Department of Anesthesiology
Miami, Department of Anesthesiology
Missouri-Columbia, Anesthesiology & Perioperative Medicine
Missouri, Kansas City
North Carolina at Chapel Hill Department of Anesthesiology
New York University Pain Management
Ohio State University Medical Center - Department of Anesthesiology 
Puerto Rico, Department of Anesthesiology
Rochester, Anesthesiology Department
Rush University Department of Anesthesiology
South Florida, Department of Anesthesiology
Southern California,, Department of Anesthesiology
Tennessee Medical Center, Department of Anesthesiology
Texas Health Science Center at San Antonio, Department of Anesthesiology
Texas Medical Branch-Galveston, Anesthesiology
University at Buffalo, Department of Anesthesiology 
University of Colorado Health Sciences Center, Dept. of Anesthesiology
University of Michigan Department of Anesthesiology
University of North Carolina PainManagement
University Hospitals of Cleveland at Case Western Reserve University
University of Washington Pain Trainning
Washington, Department of Anesthesiology