Curious about what it truly means to be a Certified Anesthesiologist Assistant (CAA)? You're in the right place! From nearly two decades of experience, I share a clear and comprehensive breakdown of the CAA profession. Think of me as your older sister or best friend, guiding you step-by-step through the essentials—from what CAAs actually do to how much money we make, no topic is off limits. Whether you're an aspiring AA student or simply exploring a career in medicine, this guide equips you with the insights you need to understand the CAA profession.
In Part 2 we unravel the lesser-known complexities of this unique profession, painting a candid picture that challenges its conventional allure. Not to worry, we also explore the many good reasons why you should become a CAA. This is an honest deep dive you won't find anywhere else.
Helpful Resources:
- American Academy of Anesthesiologist Assistants (AAAA) -the CAA profession's national governing board
- AAAA statement on "What is a CAA"
- American Society of Anesthesiologists (ASA) on CAAs
- Looking for Day in the Life CAA content? find it HERE and HERE
- "What is a CAA?" YouTube video (produced by AAAA 2015)
You can now text me! Questions/Suggestions
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+Check out my Pre-AA Highlight on IG
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:04):
Welcome to the Awakened Anesthetist podcast,
the first podcast to highlightthe CAA experience.
I'm your host, mary Jean, andI've been a certified
anesthesiologist assistant forclose to two decades.
Throughout my journey andstruggles I've searched for
guidance that includes my uniqueperspective as a CAA, at one of
(00:42):
my lowest one.
I encourage you to stick aroundand experience the power of
being in a community filled withvoices who sound like yours,
sharing experiences you neverbelieved possible.
I know you will find yourselfhere at the Awakened Anesthetist
Podcast.
Welcome in.
Welcome to the next installmentin this Understanding Certified
(01:06):
Anesthesiologist Assistant miniseries.
This is part two.
I will be discussing why youshould not become a CAA, which
is the type of conversation Ireally like having just a very
straightforward sort of behindthe scenes the things people
aren't going to tell you but ina way that I think is going to
(01:28):
be very helpful.
If you are considering thisprofession, the CAA profession,
I think it's great to see itfrom all angles and of course,
there are pros and cons to everysingle job.
There are so many wonderfulthings about being a CAA and I
will absolutely list some ofthose at the end so we're not
all feeling sort of sad anddepressed about why this
(01:48):
profession can be hard, but Ijust wanted to be really honest.
Remember, I'm your big sister,your best friend in the CAA
profession, who's just keepingit real and this is a safe space
for us to be very open andhonest.
So let me pull up my document.
I, honestly, was prepping forthis about three weeks ago and I
(02:11):
was like, well, let me just getinto my Google Docs and see
what comes up.
As I'm typing Google Docs rightnow, this is very unscripted.
I sat down and in 10 minutes,came up with this list.
And then I reread it a coupletimes and I'm like, yep, that's
what I want to say, and I thinkit's because I've had this
conversation before.
I have been a first yearclinical instructor, mostly for
(02:34):
UMKC MSA program, but also havemet several other students from
several other schools.
I also, you know, in theoperating room there's usually a
parade of high school studentsand shadow students a little bit
less so now after the pandemic,but certainly I've had this
conversation with people who areinterested in health care.
(02:54):
They really only know aboutbeing a doctor or a nurse and
I'm like, hey, have you everthought about being a CAA?
And then I give them this spielof sort of the things to know
before you are choosing ahealthcare profession, or if
they know about the CAAprofession.
I give them some of this insidescoop on what it feels like and
(03:15):
looks like in real time to be aCAA.
So let's keep this short, whichmeans I need to get started,
and I have quite a lengthy list,so I'm going to just read them
off.
I'll give more information sortof in the moment here if I feel
like it's necessary, and ofcourse, you can DM me afterwards
on Instagram atAwakendDenestitist, if you want
(03:35):
any more follow up or you havequestions or things to add.
You can also just text me rightin the show notes.
There's a way to text.
I think it says text or chat meand it sends me a direct
message to my podcast provider.
That's probably what's mostpertinent here Sign up for my
emails.
You know, check the show notes.
Basically, lots of good stuff,mindful connections.
(03:55):
All of that will be in the shownotes for season four.
All right, let's start withpart two of understanding.
Certified anesthesiologistassistance why you should not
become a CAA.
Here's my number one that Ialways say is that a CAA is not
the boss and is never the boss.
So if you have a lot of bossenergy, if you think of yourself
(04:19):
as struggling to takeinstruction from someone else or
to be a member of a team,struggling to take instruction
from someone else or to be amember of a team, then this
career is not for you.
As said by our name and as Idescribed in part one of this
series, we are ananesthesiologist assistant, so
we are assistant to theanesthesiologist, which means we
are not the boss, they are theboss and, yeah, probably more to
(04:43):
say there, but we are not theboss.
Number two is that the CAAprofession is the minority
profession in the anesthesiacare team model.
So, again, in the anesthesiacare team, a physician
anesthesiologist can supervisegenerally up to four CAAs or
(05:03):
CRNAs, and I described thoseacronyms in part one.
Again, go back.
But of all the people who couldbe on an anesthesia care team,
caas are by far the minority.
We have about maybe 4,000 of usnow at the time of this
recording and there are, Ibelieve, I want to say, 40,000
(05:24):
physician anesthesiologists andabout the same number of CRNAs.
Don't quote my numbers, but interms of the stark difference of
numbers I am correct.
Okay, here's another one thatyou may or may not know,
depending on how involved youare in the healthcare system,
but the healthcare system in theUnited States is largely broken
.
The healthcare system in theUnited States is largely broken.
(05:47):
It has many moving parts thatare broken, and it is not a
system that is doing what we allthink it is, which is serving
our patients full-heartedly,without making money.
You know no one's making moneyon this and that we're all there
just to make patients feelbetter, to heal them, to cure
them, to help them die.
(06:07):
Well, you know, all the thingsyou think happen at a hospital
happen.
However, there's also all ofthis insurance issues and
bureaucracy of health care, andlots of people are making money
off things, and so there's awhole lot more going on than
just being there givinganesthesia to make this patient
(06:30):
feel better or to be able toendure their surgery, and you
come into contact with some ofthat ugliness, some of that
brokenness, on daily, weekly,monthly, yearly basis, and it
can be really challenging tofeel like you are a cog in a
broken wheel without a lot ofpower to make the big systemic
change that needs to happen.
(06:52):
Okay, another one is that, as aCAA, you will likely have to
educate your work colleaguesanesthesia groups, hospital
administration on who a CAA is.
So who you are and why youmatter, why a CAA matters, why
they should hire CAAs, why theyshould fight for our legislative
(07:14):
efforts.
Likely you're going to meetmany, many people who do not
know what CAAs are and you'regoing to have to do the hard
work of educating them, whichkind of sucks and is probably
why I have so many things to sayright now, because I've talked
about what it means to be a CAAto so many people for so many
years.
I've been a CAA for almost 18years and you get really good at
(07:39):
sort of describing who you areand feeling like you have to
defend yourself or at leaststand up for yourself, and it
can get kind of tiresome.
Here's one about AA school,which is very common.
You'll hear people talk aboutAA school like it's drinking
from a fire hose, meaning thatit comes at you fast and furious
.
It is all consumingRelationships.
(08:00):
Many relationships have beenlost in AA school relationships.
Many relationships have beenlost in AA school.
It's just a short period oftime to learn a whole bunch of
information and kind of pop youout at the end of this two and a
half ish year process of fullyformed CAA, you cannot be doing
many other things and that cantake a toll on someone and
that's maybe not everyone's bestway to learn.
(08:24):
Another thing about AA schooland becoming an AA is that it is
a very specialized educationwith no direct fallback option.
So if you get into AA schooland you begin paying for AA
school and you do not love itand you get, you know, past the
first year, it's really hard tosay, okay, well, this was just
(08:44):
like an experiment that wentawry and I'm not going to see
this as a failure and all thetens of thousands of dollars I
lost.
I'm just going to like it'sokay, I'm just going to move on.
It's hard to make that decisiononce you've gotten far enough
along, because you basicallyhave to start over if you're
going to do anything else.
Of course there's exceptions.
Of course you can get a jobwith an undergraduate degree in
(09:08):
whatever biology, chemistry, youknow.
If you have something a littlebit more practical or applicable
, like an accounting degree,it's a little easier, but it's
tricky.
It is expensive, which isanother point.
Aa school is very expensive and, unlike being a CRNA which
every CRNA is also a nurse andif they keep their nursing
(09:29):
license up, they can just goback to practicing nursing if
they don't like doing anesthesia.
We do not have that option andso it is a risk you run.
If you do not like AA school,if you don't like what it means
to be a CAA when you're alreadyin the program, you really have
to.
You know, sort of eat all themoney that you spent and the
(09:50):
time and go back and figuresomething else out.
Obviously possible, obviouslyyou can.
It's just there's no directfallback option.
I kind of touched on this, thatthere's a huge upfront financial
investment to being a CAA.
Personally, I came out of AAschool in 2008.
(10:13):
I went to Case Cleveland.
I graduated in 2008.
I also went to a privateundergrad education, but I
didn't have as many loans fromundergrad and in total, I walked
away with $160,000 of studentloan debt.
Now, remember this was 2008.
I believe my first salary wasabout $160,000 or $170,000.
Total package $170,000.
(10:34):
And so, yes, you make enoughmoney to pay off your debt and
you can pay it off sort ofefficiently or quickly, but it
is still a large amount offinancial risk to take on if you
don't end up becoming a CAA orcan't find a job that works for
you because you want to work ina state that we can't work.
(10:55):
Which brings me to my next point, which is AAs are not licensed
to deliver anesthesia in everystate.
We are licensed in around 20states now, at the time of this
recording, in what month is it?
October of 2024.
Any VA hospital, but I don'tknow many CAAs in VA hospitals
(11:20):
and we can work in Guam, Ibelieve.
If anyone would like to work,probably on the military base in
Guam, I think, is how thatworks out.
But if it's not one of thoseplaces, then you can't work
there.
And even if we are licensed ina state.
So let's take my state ofMissouri.
Even though the state ofMissouri licensed and allows AAs
(11:43):
to practice within the state, aparticular hospital still has
to accredit us and a particularanesthesia group, if it's a
private group, still has toemploy us.
So there's still hurdles tojump through, which is why in
the state of Missouri, not everysingle hospital, even though
it's an open state, not everysingle hospital hires certified
(12:06):
anesthesiologist assistants.
So you're still fighting thatbattle on a hospital level,
private anesthesia group leveland, of course, state level If
it's a state we're not licensedin.
Wow, I have a few more.
Let's keep going.
So another drawback to being aCAA is that due to our small
(12:27):
numbers so remember, we're likea tenth of the size of physician
anesthesiologists in thiscountry and CRNAs in this
country that means that everyCAA has to be involved both
politically and teaching AAstudents.
Very, very rare that a CAA isjust kind of free-floating out
(12:48):
in the world, never touching anAA student and not being
involved at all with any sort ofquad A efforts, which is our
national governing body, anylegislative efforts.
There are people like this thatexist, but they are fewer and
farther between than the peoplewho are and honestly must be
involved to keep this professiongrowing, and not everyone wants
(13:12):
to have to do that.
So that can be a definitedrawback.
Okay, let's do one more so wehave time to get to the why you
should become a CAA.
This is something that I've saidin other podcast episodes.
But because the CAA professionis very small, one person, one
individual, one CAA can creategreat change and can cause major
(13:38):
growth in our profession fromjust that one person's efforts.
But that is a huge burden onthat one person and also, on the
flip side, could be seen as oneof your life's biggest
accomplishments, one of thebiggest opportunities that you
had to make impact.
So it's one of thosedouble-edged swords where it's
(14:00):
something I embrace.
I love the fact that I can havethis podcast.
I can talk directly to CAAs whoare sort of the movers and
shakers in this community theQuad A presidents and the people
who open states, like SarahBrown, who just opened the state
of Washington and theresonating truth when I talk to
(14:22):
these people is that, yes,they're the movers and shakers
and they're also just regularpeople who said, okay, if no one
does anything, nothing'shappened.
So I'm going to do something.
And that's a burden becausethey also have, you know, jobs
and families and other things todo, and now they have to do
this volunteer work to grow andexpand our profession.
(14:44):
And also it's something thatthey hold as one of their
biggest accomplishments andsomething that they would never
give back.
Okay, so let's get to some goodstuff why you should become a
CAA, because, honestly, thislist is just as long and I do
think there's a few points Iwant to make, because people can
see the money involved withbeing a CAA.
(15:06):
They can see the startingsalaries and how you only have
to go to two and a half years ofgrad school and think, oh, this
is definitely for me.
But there are so many otheramazing things about being a CAA
, on top of the financialsecurity that is possible, that
I really want to highlight.
So I believe the most importantbenefit, or the biggest benefit
(15:30):
of being a certifiedanesthesiologist assistant is
that if you use the professionas a tool, you can have all the
freedom you want in your lifethe freedom to choose.
So when you have money, whenyou have more of a guaranteed
job, when you can say, hey, Iknow that I can always fall back
(15:51):
on giving anesthesia in theoperating room, that allows you
to make more risky choices,maybe follow different pursuits,
maybe something entrepreneurialor something creative that
you've always wanted to do, butyou're not sure if you're ever
going to be able to feedyourself if it was your
full-time job.
Being a CAA allows you tochoose or try those things.
(16:12):
It allows you to move to a newplace and feel secure that you
can have a job that's going tobe stable and going to.
You know, start your life offright.
It just when you play the cardsright and you see it as a tool
towards freedom.
It really gives you thatfreedom because it allows you to
choose.
You're in the driver's seat ofyour life as opposed to, you
(16:35):
know, always a step behind.
Number one absolute.
My favorite thing about being aCAA is that it gave me the
freedom to choose my own pathand it's been awesome.
It's led me here.
Okay, another thing about beinga CAA that I think makes it
really amazing is that I feel100% valued every day that I
(16:58):
work, not only from my patients,who see me as someone who's
going to make them feel betteror take their pain away or
soothe their anxiety, but I feelvalued through the anesthesia
care team model.
I feel valued by my coworkers.
I feel valued by my supervisorsso the physician,
anesthesiologists.
I feel valued by the system,meaning the hierarchy inside the
(17:23):
culture of medicine.
Caas are near the top where thephysicians are, and so there
are some perks to that andthere's some reverence that an
advanced practice providerenjoys like a physician enjoys.
In our culture, in the cultureof medicine and honestly, in the
larger culture in the UnitedStates, physicians are seen as
(17:46):
fairly esteemed and APPs, andtherefore CAAs, kind of get
glommed into that and so verypractically, this means that
there is a doctor's lounge inthe hospital that I work that
also is open to advancedpractice providers, including
CAAs, and you can go in thereand have free snacks, free sodas
(18:11):
, all sorts of little foods andcoffee bar, you know, 24-7, as
well as a provided lunch everysingle day.
But you have to be a physicianor an advanced practice provider
, like a CAA, to even be able tobadge into that secure doctor's
lounge and there are thingslike this all over the culture
(18:32):
of medicine where there's thishigher archical structure that I
don't necessarily agree withbut I do benefit from.
So I'm very grateful for thatbenefit and I also see that as a
little bit of a problem withwhy our healthcare system's
broken.
But again, caas have thebenefit of being grouped into
this higher level in thehierarchy of healthcare.
(18:55):
Okay, let me read my list.
Oh, I said that a benefit ofbeing a CAA, and why you should,
is that, yes, we're not theboss, but we are always working
in a team, so you can alwaysphone a friend if you ever get
into a sticky situation whereyou need a second pair of hands
because the patient's requiringsomething a little bit more in
(19:16):
depth or if you have a questionabout something that's going on
with your patient, or if thesurgeon or the surgical team is
giving you a hard time orpressuring you in some way, you
always have a pressure releasevalve to call your attending
anesthesiologist, have them comein the room, back you up.
They, in my experience, alwaystake your side first and maybe
(19:39):
you know it doesn't come out theway you were hoping, but your
anesthesiologist always givesyou the benefit of the doubt in
my experience, and it just feelslike this real team mentality
where you have someone to relyon.
Of course, not in everysituation, of course there's
outliers, but that team feelingreally takes for me a burden off
(20:00):
of me, that it's not all ridingon my shoulders, that I always
can ask for help and Iunabashedly, unashamed, ask for
help when I need it.
And I think that's a perk ofour job, so long as you have the
right perspective on it.
Caas often are in the actualoperating room delivering
anesthesia, while thosephysician anesthesiologists are
(20:24):
oftentimes doing pre-ops orpost-ops or a little bit more of
the paperwork.
They're seeing the patients,which can be a perk because they
get a little bit moreface-to-face time with awake
patients than we do in a lot ofsituations.
But that means that I'm in theoperating room actually getting
to deliver the anesthesia, whichis very much seen as the fun
(20:45):
part of my job and manyanesthesia providers see that as
the fun part and that is myrole.
I am meant to be in theoperating room giving the
anesthesia and theanesthesiologist, the physician,
has sort of all of the extraancillary responsibilities.
Very much a typical way ananesthesia care team model runs
(21:06):
in a hospital, not to say thatthe physicians can't do what I'm
doing and I can't do whatthey're doing in many situations
.
But that's just the reality ofit.
That's just the model is thatthe anesthesiologist because
they're supervising severalrooms, they're out doing all the
other things, while themid-levels, the CAAs or the
(21:26):
CRNAs, the advanced practiceproviders, are in the rooms
delivering anesthesia the funpart.
I also see it as a benefit thatI get to be right with the
patients in what may be theworst day of their life or, you
know, if they're having a baby,having their first baby, maybe
(21:47):
it's the best day of their life.
I get to be really intimatelytied to human beings during
their best and worst moments andthat's something I really value
about my job.
This job as a CAA has helped mebuild my empathy muscle.
I am so much more compassionatethan I was in my younger years
(22:09):
before I became a CAA, and then,over the course of my career, I
can see how my empathy musclehas just grown and grown and
grown.
Because you are with humanbeings.
You are with them in thisreally intimate way.
You're watching over them whilethey're having surgery, you're
keeping them alive for many,many intents and purposes and
(22:31):
it's just a really powerful,cool, intimate experience that I
really cherish and that's ahuge benefit for me of being a
CAA.
Okay, let me see if I have anyother ones.
Oh, here's a big one.
This is a little bit moreconfusing if you're outside of
(22:51):
medicine or healthcare tounderstand malpractice insurance
and how that affects us as aCAA and how that is carried in
an anesthesia care team model.
But you'd likely know thatpatients can sue if something
were to happen.
They can sue rightfully orwrongfully.
You're allowed to sue in theUnited States.
It's a legal right and if apatient were to sue, the
(23:15):
liability does not fall directlyon the CAA.
Just by the way the anesthesiacare team model works, the way
that the insurance model works,the anesthesiologist, sort of
surprisingly, has all of thatliability.
So I'm not liable for myactions as much as the
anesthesiologist is liable formy actions, much as the
(23:40):
anesthesiologist is liable formy actions.
Now, this is nuanced and thereis, you know, you could come up
with lots of situations whereI'm liable.
But I mean to say that if I'mdoing my best and something bad
happens, if there's an untowardoutcome or a patient dies or
something happens, theanesthesiologist, their
insurance, will pay for me.
If there's some sort ofsettlement.
I cannot be personally suedunder the anesthesia care team
(24:05):
model.
That's just the way malpracticeinsurance works.
It's sort of confusing, butit's a great benefit as a CAA
that we can't be directly suedin this model.
Okay, here's my last one.
This may be also a littlecontroversial, because we can
take our work home emotionallyand mentally, but we can't take
(24:27):
anesthesia home physically.
So I do feel like when I leavethe operating room I leave 99.9%
of my job there.
I have learned over time andI've built resilience and skills
to leave most of the emotionalburden, most of the mental
burden, there as well.
That's not to say that I'm nottired and exhausted and, like
(24:51):
you know, sort of tapped outwhen I get home oftentimes.
But I can't stay up tillmidnight after my kids go to bed
giving anesthesia because Ididn't get it all done that day.
I don't have computer work todo.
There's not a ton of paperworkor bureaucracy that I have to do
just to stay afloat in my job,and that is really really,
(25:12):
really nice.
I see many of my corporatefriends working nights and
weekends and you know, yes, wedo that, but we're in the
hospital doing that.
I'm not in my home in my bedtyping away at midnight because
I didn't get my work done.
And that's not true for a lot ofphysicians.
A lot of physicians now you'llhear, have to do charting and
(25:32):
things and they have to take thework home.
But that is not true forcertified anesthesiologist
assistants and I see that as ahuge benefit.
All right, that is the end ofmy list.
I hope it was helpful.
I hope you learned somethingnew.
Maybe you saw the profession ina new light or, if you're
practicing CAA, maybe appreciatesomething about our profession
(25:54):
that you've never really putinto words before.
My goal with this mini-seriesis just to spread more awareness
and information about what ittruly means to be a certified
anesthesiologist assistant.
Again, if you have anything toadd or comments, you can DM me
on Instagram at AwakenedAnesthetist, or just chat me
right there in the show notes.
(26:14):
You can send me a directmessage and, you know, maybe
I'll have something to add oredit out of this episode after I
hear from you all.
All right, that's all for me.
Let's talk soon, y'all.
Welcome to the Awakened Anesthetist podcast,
the first podcast to highlightthe CAA experience.
I'm your host, mary Jean, andI've been a certified
anesthesiologist assistant forclose to two decades.
Throughout my journey andstruggles I've searched for
guidance that includes my uniqueperspective as a CAA, at one of
(00:42):
my lowest one.
I encourage you to stick aroundand experience the power of
being in a community filled withvoices who sound like yours,
sharing experiences you neverbelieved possible.
I know you will find yourselfhere at the Awakened Anesthetist
Podcast.
Welcome in.
Welcome to the next installmentin this Understanding Certified
(01:06):
Anesthesiologist Assistant miniseries.
This is part two.
I will be discussing why youshould not become a CAA, which
is the type of conversation Ireally like having just a very
straightforward sort of behindthe scenes the things people
aren't going to tell you but ina way that I think is going to
(01:28):
be very helpful.
If you are considering thisprofession, the CAA profession,
I think it's great to see itfrom all angles and of course,
there are pros and cons to everysingle job.
There are so many wonderfulthings about being a CAA and I
will absolutely list some ofthose at the end so we're not
all feeling sort of sad anddepressed about why this
(01:48):
profession can be hard, but Ijust wanted to be really honest.
Remember, I'm your big sister,your best friend in the CAA
profession, who's just keepingit real and this is a safe space
for us to be very open andhonest.
So let me pull up my document.
I, honestly, was prepping forthis about three weeks ago and I
(02:11):
was like, well, let me just getinto my Google Docs and see
what comes up.
As I'm typing Google Docs rightnow, this is very unscripted.
I sat down and in 10 minutes,came up with this list.
And then I reread it a coupletimes and I'm like, yep, that's
what I want to say, and I thinkit's because I've had this
conversation before.
I have been a first yearclinical instructor, mostly for
(02:34):
UMKC MSA program, but also havemet several other students from
several other schools.
I also, you know, in theoperating room there's usually a
parade of high school studentsand shadow students a little bit
less so now after the pandemic,but certainly I've had this
conversation with people who areinterested in health care.
(02:54):
They really only know aboutbeing a doctor or a nurse and
I'm like, hey, have you everthought about being a CAA?
And then I give them this spielof sort of the things to know
before you are choosing ahealthcare profession, or if
they know about the CAAprofession.
I give them some of this insidescoop on what it feels like and
(03:15):
looks like in real time to be aCAA.
So let's keep this short, whichmeans I need to get started,
and I have quite a lengthy list,so I'm going to just read them
off.
I'll give more information sortof in the moment here if I feel
like it's necessary, and ofcourse, you can DM me afterwards
on Instagram atAwakendDenestitist, if you want
(03:35):
any more follow up or you havequestions or things to add.
You can also just text me rightin the show notes.
There's a way to text.
I think it says text or chat meand it sends me a direct
message to my podcast provider.
That's probably what's mostpertinent here Sign up for my
emails.
You know, check the show notes.
Basically, lots of good stuff,mindful connections.
(03:55):
All of that will be in the shownotes for season four.
All right, let's start withpart two of understanding.
Certified anesthesiologistassistance why you should not
become a CAA.
Here's my number one that Ialways say is that a CAA is not
the boss and is never the boss.
So if you have a lot of bossenergy, if you think of yourself
(04:19):
as struggling to takeinstruction from someone else or
to be a member of a team,struggling to take instruction
from someone else or to be amember of a team, then this
career is not for you.
As said by our name and as Idescribed in part one of this
series, we are ananesthesiologist assistant, so
we are assistant to theanesthesiologist, which means we
are not the boss, they are theboss and, yeah, probably more to
(04:43):
say there, but we are not theboss.
Number two is that the CAAprofession is the minority
profession in the anesthesiacare team model.
So, again, in the anesthesiacare team, a physician
anesthesiologist can supervisegenerally up to four CAAs or
(05:03):
CRNAs, and I described thoseacronyms in part one.
Again, go back.
But of all the people who couldbe on an anesthesia care team,
caas are by far the minority.
We have about maybe 4,000 of usnow at the time of this
recording and there are, Ibelieve, I want to say, 40,000
(05:24):
physician anesthesiologists andabout the same number of CRNAs.
Don't quote my numbers, but interms of the stark difference of
numbers I am correct.
Okay, here's another one thatyou may or may not know,
depending on how involved youare in the healthcare system,
but the healthcare system in theUnited States is largely broken
.
The healthcare system in theUnited States is largely broken.
(05:47):
It has many moving parts thatare broken, and it is not a
system that is doing what we allthink it is, which is serving
our patients full-heartedly,without making money.
You know no one's making moneyon this and that we're all there
just to make patients feelbetter, to heal them, to cure
them, to help them die.
(06:07):
Well, you know, all the thingsyou think happen at a hospital
happen.
However, there's also all ofthis insurance issues and
bureaucracy of health care, andlots of people are making money
off things, and so there's awhole lot more going on than
just being there givinganesthesia to make this patient
(06:30):
feel better or to be able toendure their surgery, and you
come into contact with some ofthat ugliness, some of that
brokenness, on daily, weekly,monthly, yearly basis, and it
can be really challenging tofeel like you are a cog in a
broken wheel without a lot ofpower to make the big systemic
change that needs to happen.
(06:52):
Okay, another one is that, as aCAA, you will likely have to
educate your work colleaguesanesthesia groups, hospital
administration on who a CAA is.
So who you are and why youmatter, why a CAA matters, why
they should hire CAAs, why theyshould fight for our legislative
(07:14):
efforts.
Likely you're going to meetmany, many people who do not
know what CAAs are and you'regoing to have to do the hard
work of educating them, whichkind of sucks and is probably
why I have so many things to sayright now, because I've talked
about what it means to be a CAAto so many people for so many
years.
I've been a CAA for almost 18years and you get really good at
(07:39):
sort of describing who you areand feeling like you have to
defend yourself or at leaststand up for yourself, and it
can get kind of tiresome.
Here's one about AA school,which is very common.
You'll hear people talk aboutAA school like it's drinking
from a fire hose, meaning thatit comes at you fast and furious
.
It is all consumingRelationships.
(08:00):
Many relationships have beenlost in AA school relationships.
Many relationships have beenlost in AA school.
It's just a short period oftime to learn a whole bunch of
information and kind of pop youout at the end of this two and a
half ish year process of fullyformed CAA, you cannot be doing
many other things and that cantake a toll on someone and
that's maybe not everyone's bestway to learn.
(08:24):
Another thing about AA schooland becoming an AA is that it is
a very specialized educationwith no direct fallback option.
So if you get into AA schooland you begin paying for AA
school and you do not love itand you get, you know, past the
first year, it's really hard tosay, okay, well, this was just
(08:44):
like an experiment that wentawry and I'm not going to see
this as a failure and all thetens of thousands of dollars I
lost.
I'm just going to like it'sokay, I'm just going to move on.
It's hard to make that decisiononce you've gotten far enough
along, because you basicallyhave to start over if you're
going to do anything else.
Of course there's exceptions.
Of course you can get a jobwith an undergraduate degree in
(09:08):
whatever biology, chemistry, youknow.
If you have something a littlebit more practical or applicable
, like an accounting degree,it's a little easier, but it's
tricky.
It is expensive, which isanother point.
Aa school is very expensive and, unlike being a CRNA which
every CRNA is also a nurse andif they keep their nursing
(09:29):
license up, they can just goback to practicing nursing if
they don't like doing anesthesia.
We do not have that option andso it is a risk you run.
If you do not like AA school,if you don't like what it means
to be a CAA when you're alreadyin the program, you really have
to.
You know, sort of eat all themoney that you spent and the
(09:50):
time and go back and figuresomething else out.
Obviously possible, obviouslyyou can.
It's just there's no directfallback option.
I kind of touched on this, thatthere's a huge upfront financial
investment to being a CAA.
Personally, I came out of AAschool in 2008.
(10:13):
I went to Case Cleveland.
I graduated in 2008.
I also went to a privateundergrad education, but I
didn't have as many loans fromundergrad and in total, I walked
away with $160,000 of studentloan debt.
Now, remember this was 2008.
I believe my first salary wasabout $160,000 or $170,000.
Total package $170,000.
(10:34):
And so, yes, you make enoughmoney to pay off your debt and
you can pay it off sort ofefficiently or quickly, but it
is still a large amount offinancial risk to take on if you
don't end up becoming a CAA orcan't find a job that works for
you because you want to work ina state that we can't work.
(10:55):
Which brings me to my next point, which is AAs are not licensed
to deliver anesthesia in everystate.
We are licensed in around 20states now, at the time of this
recording, in what month is it?
October of 2024.
Any VA hospital, but I don'tknow many CAAs in VA hospitals
(11:20):
and we can work in Guam, Ibelieve.
If anyone would like to work,probably on the military base in
Guam, I think, is how thatworks out.
But if it's not one of thoseplaces, then you can't work
there.
And even if we are licensed ina state.
So let's take my state ofMissouri.
Even though the state ofMissouri licensed and allows AAs
(11:43):
to practice within the state, aparticular hospital still has
to accredit us and a particularanesthesia group, if it's a
private group, still has toemploy us.
So there's still hurdles tojump through, which is why in
the state of Missouri, not everysingle hospital, even though
it's an open state, not everysingle hospital hires certified
(12:06):
anesthesiologist assistants.
So you're still fighting thatbattle on a hospital level,
private anesthesia group leveland, of course, state level If
it's a state we're not licensedin.
Wow, I have a few more.
Let's keep going.
So another drawback to being aCAA is that due to our small
(12:27):
numbers so remember, we're likea tenth of the size of physician
anesthesiologists in thiscountry and CRNAs in this
country that means that everyCAA has to be involved both
politically and teaching AAstudents.
Very, very rare that a CAA isjust kind of free-floating out
(12:48):
in the world, never touching anAA student and not being
involved at all with any sort ofquad A efforts, which is our
national governing body, anylegislative efforts.
There are people like this thatexist, but they are fewer and
farther between than the peoplewho are and honestly must be
involved to keep this professiongrowing, and not everyone wants
(13:12):
to have to do that.
So that can be a definitedrawback.
Okay, let's do one more so wehave time to get to the why you
should become a CAA.
This is something that I've saidin other podcast episodes.
But because the CAA professionis very small, one person, one
individual, one CAA can creategreat change and can cause major
(13:38):
growth in our profession fromjust that one person's efforts.
But that is a huge burden onthat one person and also, on the
flip side, could be seen as oneof your life's biggest
accomplishments, one of thebiggest opportunities that you
had to make impact.
So it's one of thosedouble-edged swords where it's
(14:00):
something I embrace.
I love the fact that I can havethis podcast.
I can talk directly to CAAs whoare sort of the movers and
shakers in this community theQuad A presidents and the people
who open states, like SarahBrown, who just opened the state
of Washington and theresonating truth when I talk to
(14:22):
these people is that, yes,they're the movers and shakers
and they're also just regularpeople who said, okay, if no one
does anything, nothing'shappened.
So I'm going to do something.
And that's a burden becausethey also have, you know, jobs
and families and other things todo, and now they have to do
this volunteer work to grow andexpand our profession.
(14:44):
And also it's something thatthey hold as one of their
biggest accomplishments andsomething that they would never
give back.
Okay, so let's get to some goodstuff why you should become a
CAA, because, honestly, thislist is just as long and I do
think there's a few points Iwant to make, because people can
see the money involved withbeing a CAA.
(15:06):
They can see the startingsalaries and how you only have
to go to two and a half years ofgrad school and think, oh, this
is definitely for me.
But there are so many otheramazing things about being a CAA
, on top of the financialsecurity that is possible, that
I really want to highlight.
So I believe the most importantbenefit, or the biggest benefit
(15:30):
of being a certifiedanesthesiologist assistant is
that if you use the professionas a tool, you can have all the
freedom you want in your lifethe freedom to choose.
So when you have money, whenyou have more of a guaranteed
job, when you can say, hey, Iknow that I can always fall back
(15:51):
on giving anesthesia in theoperating room, that allows you
to make more risky choices,maybe follow different pursuits,
maybe something entrepreneurialor something creative that
you've always wanted to do, butyou're not sure if you're ever
going to be able to feedyourself if it was your
full-time job.
Being a CAA allows you tochoose or try those things.
(16:12):
It allows you to move to a newplace and feel secure that you
can have a job that's going tobe stable and going to.
You know, start your life offright.
It just when you play the cardsright and you see it as a tool
towards freedom.
It really gives you thatfreedom because it allows you to
choose.
You're in the driver's seat ofyour life as opposed to, you
(16:35):
know, always a step behind.
Number one absolute.
My favorite thing about being aCAA is that it gave me the
freedom to choose my own pathand it's been awesome.
It's led me here.
Okay, another thing about beinga CAA that I think makes it
really amazing is that I feel100% valued every day that I
(16:58):
work, not only from my patients,who see me as someone who's
going to make them feel betteror take their pain away or
soothe their anxiety, but I feelvalued through the anesthesia
care team model.
I feel valued by my coworkers.
I feel valued by my supervisorsso the physician,
anesthesiologists.
I feel valued by the system,meaning the hierarchy inside the
(17:23):
culture of medicine.
Caas are near the top where thephysicians are, and so there
are some perks to that andthere's some reverence that an
advanced practice providerenjoys like a physician enjoys.
In our culture, in the cultureof medicine and honestly, in the
larger culture in the UnitedStates, physicians are seen as
(17:46):
fairly esteemed and APPs, andtherefore CAAs, kind of get
glommed into that and so verypractically, this means that
there is a doctor's lounge inthe hospital that I work that
also is open to advancedpractice providers, including
CAAs, and you can go in thereand have free snacks, free sodas
(18:11):
, all sorts of little foods andcoffee bar, you know, 24-7, as
well as a provided lunch everysingle day.
But you have to be a physicianor an advanced practice provider
, like a CAA, to even be able tobadge into that secure doctor's
lounge and there are thingslike this all over the culture
(18:32):
of medicine where there's thishigher archical structure that I
don't necessarily agree withbut I do benefit from.
So I'm very grateful for thatbenefit and I also see that as a
little bit of a problem withwhy our healthcare system's
broken.
But again, caas have thebenefit of being grouped into
this higher level in thehierarchy of healthcare.
(18:55):
Okay, let me read my list.
Oh, I said that a benefit ofbeing a CAA, and why you should,
is that, yes, we're not theboss, but we are always working
in a team, so you can alwaysphone a friend if you ever get
into a sticky situation whereyou need a second pair of hands
because the patient's requiringsomething a little bit more in
(19:16):
depth or if you have a questionabout something that's going on
with your patient, or if thesurgeon or the surgical team is
giving you a hard time orpressuring you in some way, you
always have a pressure releasevalve to call your attending
anesthesiologist, have them comein the room, back you up.
They, in my experience, alwaystake your side first and maybe
(19:39):
you know it doesn't come out theway you were hoping, but your
anesthesiologist always givesyou the benefit of the doubt in
my experience, and it just feelslike this real team mentality
where you have someone to relyon.
Of course, not in everysituation, of course there's
outliers, but that team feelingreally takes for me a burden off
(20:00):
of me, that it's not all ridingon my shoulders, that I always
can ask for help and Iunabashedly, unashamed, ask for
help when I need it.
And I think that's a perk ofour job, so long as you have the
right perspective on it.
Caas often are in the actualoperating room delivering
anesthesia, while thosephysician anesthesiologists are
(20:24):
oftentimes doing pre-ops orpost-ops or a little bit more of
the paperwork.
They're seeing the patients,which can be a perk because they
get a little bit moreface-to-face time with awake
patients than we do in a lot ofsituations.
But that means that I'm in theoperating room actually getting
to deliver the anesthesia, whichis very much seen as the fun
(20:45):
part of my job and manyanesthesia providers see that as
the fun part and that is myrole.
I am meant to be in theoperating room giving the
anesthesia and theanesthesiologist, the physician,
has sort of all of the extraancillary responsibilities.
Very much a typical way ananesthesia care team model runs
(21:06):
in a hospital, not to say thatthe physicians can't do what I'm
doing and I can't do whatthey're doing in many situations
.
But that's just the reality ofit.
That's just the model is thatthe anesthesiologist because
they're supervising severalrooms, they're out doing all the
other things, while themid-levels, the CAAs or the
(21:26):
CRNAs, the advanced practiceproviders, are in the rooms
delivering anesthesia the funpart.
I also see it as a benefit thatI get to be right with the
patients in what may be theworst day of their life or, you
know, if they're having a baby,having their first baby, maybe
(21:47):
it's the best day of their life.
I get to be really intimatelytied to human beings during
their best and worst moments andthat's something I really value
about my job.
This job as a CAA has helped mebuild my empathy muscle.
I am so much more compassionatethan I was in my younger years
(22:09):
before I became a CAA, and then,over the course of my career, I
can see how my empathy musclehas just grown and grown and
grown.
Because you are with humanbeings.
You are with them in thisreally intimate way.
You're watching over them whilethey're having surgery, you're
keeping them alive for many,many intents and purposes and
(22:31):
it's just a really powerful,cool, intimate experience that I
really cherish and that's ahuge benefit for me of being a
CAA.
Okay, let me see if I have anyother ones.
Oh, here's a big one.
This is a little bit moreconfusing if you're outside of
(22:51):
medicine or healthcare tounderstand malpractice insurance
and how that affects us as aCAA and how that is carried in
an anesthesia care team model.
But you'd likely know thatpatients can sue if something
were to happen.
They can sue rightfully orwrongfully.
You're allowed to sue in theUnited States.
It's a legal right and if apatient were to sue, the
(23:15):
liability does not fall directlyon the CAA.
Just by the way the anesthesiacare team model works, the way
that the insurance model works,the anesthesiologist, sort of
surprisingly, has all of thatliability.
So I'm not liable for myactions as much as the
anesthesiologist is liable formy actions, much as the
(23:40):
anesthesiologist is liable formy actions.
Now, this is nuanced and thereis, you know, you could come up
with lots of situations whereI'm liable.
But I mean to say that if I'mdoing my best and something bad
happens, if there's an untowardoutcome or a patient dies or
something happens, theanesthesiologist, their
insurance, will pay for me.
If there's some sort ofsettlement.
I cannot be personally suedunder the anesthesia care team
(24:05):
model.
That's just the way malpracticeinsurance works.
It's sort of confusing, butit's a great benefit as a CAA
that we can't be directly suedin this model.
Okay, here's my last one.
This may be also a littlecontroversial, because we can
take our work home emotionallyand mentally, but we can't take
(24:27):
anesthesia home physically.
So I do feel like when I leavethe operating room I leave 99.9%
of my job there.
I have learned over time andI've built resilience and skills
to leave most of the emotionalburden, most of the mental
burden, there as well.
That's not to say that I'm nottired and exhausted and, like
(24:51):
you know, sort of tapped outwhen I get home oftentimes.
But I can't stay up tillmidnight after my kids go to bed
giving anesthesia because Ididn't get it all done that day.
I don't have computer work todo.
There's not a ton of paperworkor bureaucracy that I have to do
just to stay afloat in my job,and that is really really,
(25:12):
really nice.
I see many of my corporatefriends working nights and
weekends and you know, yes, wedo that, but we're in the
hospital doing that.
I'm not in my home in my bedtyping away at midnight because
I didn't get my work done.
And that's not true for a lot ofphysicians.
A lot of physicians now you'llhear, have to do charting and
(25:32):
things and they have to take thework home.
But that is not true forcertified anesthesiologist
assistants and I see that as ahuge benefit.
All right, that is the end ofmy list.
I hope it was helpful.
I hope you learned somethingnew.
Maybe you saw the profession ina new light or, if you're
practicing CAA, maybe appreciatesomething about our profession
(25:54):
that you've never really putinto words before.
My goal with this mini-seriesis just to spread more awareness
and information about what ittruly means to be a certified
anesthesiologist assistant.
Again, if you have anything toadd or comments, you can DM me
on Instagram at AwakenedAnesthetist, or just chat me
right there in the show notes.
(26:14):
You can send me a directmessage and, you know, maybe
I'll have something to add oredit out of this episode after I
hear from you all.
All right, that's all for me.
Let's talk soon, y'all.
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