Seeking advice: Clinician Career Change at 45?

[Paseo Del Norte]

I must be the first person in the U.S. going into healthcare for other than altruistic reasons.

Not at all.

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[foreverLaur]

No offense to the AAs, but no AA is putting one of my family members or me down.

When my kids had anesthesia, I barely let CRNAs, which I first interviewed (after I interviewed and spoke with the anesthesiologists that would be supervising) touch my kids, and I am a RN. I wanted to know their experiences, how many cases they did per week, month, and year. You name it. If they had a problem with it, it was bye, bye. Didn't matter if I liked the surgeons. They knew how I felt. Let me tell you, those anesthesiologists I interviewed first were so on the ball and very attentive. Anesthesia is very risky business. I know this because of the kind of nursing I do.

I have to agree that some of this moving of boundaries by mid-levels is very scary stuff. I am loyal to my profession; but thank you no. It's getting out of control.
What I have learned first hand is that mostly clinical time and experience makes the most difference in effectiveness and safety.

What do the CRNAs have over the AAs? Why let them barely touch your kid while you won't let an AA anywhere near them? I understand the hesitation about midlevels assuming such a role in general, but why are the CRNAs better than the AAs?

 

[foreverLaur]

Like I said, worry less about me, and more about nurses in the profession today with criminal backgrounds.

Hey now... not everyone with a "criminal background" did anything to deserve that title and doesn't always need to be worried about...

 

[deleted6669]

but why are the CRNAs better than the AAs?

they are not.
the curriculum is very similar. the difference is the nursing background (for crna's) and harder sci prereqs(for aa's).
md anesthesiologists were never nurses and they seem to do ok.....

 

[Paseo Del Norte]

I'd rather be put down by an AA or CRNA that had some real life xp, kids, etc.

Irrelevant IMHO. I want the most qualified person working on me or Mrs. Del Norte. CRNA's and AA's are fine, with the caveat being, a physician at the head of the team.

 

[jl lin]

We have a relative that is an anesthesiologist - MD - in her early 30s.

I'd rather be put down by an AA or CRNA that had some real life xp, kids, etc.

People that don't know her like we do may trust her, but we know her all too well....

That's not a basis for anything. The truth is anesthesiology residents and fellows get more and better supervised training, and they receive better education overall.

I've worked in many surgical recovery units and ICUs. I know well of what I speak.

I am also sick of people going into fields like medicine or nursing as mere stepping stones or because they pay better than working at McDonalds.


My question to you is, with your degree and experience, why aren't you networking within your own profession? In any area networking is key. Since you have no passion for any one particular thing other than what you think is "floating" right now, why not stay in your own field?

As an example back to you, I submit the following:

I've worked in level III NICUs. You better believe that NM in a busy NICU is going to need a Masters in Nursing and closer to ten years of direct level III NICU experience to be in the running. With Magnet, many nurses take full part in the hiring of direct leadership for their units. Good luck with that.

 

[Paseo Del Norte]

The OP actually has my respect. Many people would be dishonest and make up some BS story about wanting to be a nurse to save the world. At least the OP is honest about their intent and looking at options for making a living.

 

[jl lin]

Irrelevant IMHO. I want the most qualified person working on me or Mrs. Del Norte. CRNA's and AA's are fine, with the caveat being, a physician at the head of the team.

I know PDN. The problem with that is in some places the poor anesthesiologist is running from room to the next room and having to supervise the more critical cases. Another easier case, say with a kid, can also go bad VERY quickly. They can't be everywhere at once, and that is part of the problem. So an anesthesiologist may be at the head of the team, but he or she may NOT be able to be in that particular OR when things get hairy. That's reality.

I have a serious problem with this blase' attitude from those that aren't in acute or critical healthcare, like fire. They have not lived to see what horrors can go on. I have, many times. Things get tricky fast.

 

[FireCloud9]

That's not a basis for anything. The truth is anesthesiology residents and fellows get more and better supervised training, and they receive better education overall.

I've worked in many surgical recovery units and ICUs. I know well of what I speak.

I am also sick of people going into fields like medicine or nursing as mere stepping stones or because they pay better than working at McDonalds.

My question to you is, with your degree and experience, why aren't you networking within your own profession? In any area networking is key. Since you have no passion for any one particular thing other than what you think is "floating" right now, why not stay in your own field?

As an example back to you, I submit the following:

I've worked in level III NICUs. You better believe that NM in a busy NICU is going to need a Masters in Nursing and closer to ten years of direct level III NICU experience to be in the running. With Magnet, many nurses take full part in the hiring of direct leadership for their units. Good luck with that.

You may know HC, but you don't know our MD relative, if you did, you'd faint at the thought of her putting you under.

I have over 500+ contacts in my industry with a couple of hundred having been laid off. We're all networking, have been for over a year. Our industries don't like people over 40. Our industries have been devastated by automation, offshoring, outsourcing, H1B holders, etc.

Thus, we're looking for alternatives.

Lets not be children about it. I get all of your objections. Duly noted. Now lets move on. Don't want to provide advice, fine, but that nor your objections will dissuade me.

And yes, people pursue better jobs than McDonalds, why the hell shouldn't they? Perhaps if your industry was devastated you'd be happy with McDonald's, sorry, that won't work for me.

So back to the original point of this thread. It's not whether I should be a clinician or not, and your opinions have already been noted. So lets move on.

Alternative healthcare mid-level clinician career suggestions, alternatives are more than welcome.

 

[jl lin]

The OP actually has my respect. Many people would be dishonest and make up some BS story about wanting to be a nurse to save the world. At least the OP is honest about their intent and looking at options for making a living.

I can't respect it; because I don't believe it is sound practice. This is about people's lives. It's about efficacy as well as safety, and it is also about level-headed compassion.

If a person is just interested in making a "good" living, that is NOT a good enough reason to go into nursing OR medicine, end of story.

When you are ill, you want someone that is there because they are pretty much into it and truly care about you and what they are doing and how it will affect you. Sure physicians and nurses have bad days. Those that make a point of going the extra mile in learning, understanding, doing the extra things, and knowing the value of empathy, which is quite different from sympathy, these are the people you want in charge of your care.

Our field has enough problems and issues, and there's already enough crazy politics and promotion of people by way of the Peter Principle in it.

I say cut the patients and the people actually committed to health care a break. I have had the "pleasure" of working with people that should be tinkering with computers or something further removed from the life, death, and wellness affecting actual people.

I'm not OK with it. I never will be. People should be thankful for those like fab or physicians and nurses like me that speak out against this kind of thing.

 

[jl lin]

You may know HC, but you don't know our MD relative, if you did, you'd faint at the thought of her putting you under.

That is completely irrelevant to the point. Everyone knows idiots that work in one capacity or another.

I have over 500+ contacts in my industry with a couple of hundred having been laid off. We're all networking, have been for over a year. Our industries don't like people over 40. Our industries have been devastated by automation, offshoring, outsourcing, H1B holders, etc.

Thus, we're looking for alternatives.

I know five people in the last year in business that were given severance packages (S&A reductions) and sent packing. Due to their reputation and networking, they all found jobs very close to their salaries, the same, or greater within five months.

Nursing or medicine are not fields for those simply looking for alternatives that pay better than McDonalds, period. So scary.

Lets not be children about it. I get all of your objections. Duly noted. Now lets move on. Don't want to provide advice, fine, but that nor your objections will dissuade me.

I am now hoping that you do get into a nursing program somewhere. I so know why. I do, however, feel for the patients and others that will have to work with someone that simply cares about making a buck and is so blase about it all. I also feel for those poor people that will have to work under you if you do move into administration.


Nursing school should be a trip for you. You may find it will really kick your butt big time before you get to the state boards, and I am not talking about the mere didactics. You know what they say. Be careful what you wish for.

 

[chimichanga]

... With Magnet, many nurses take full part in the hiring of direct leadership for their units. Good luck with that.

Please...

We all know how most acquire "magnet status"

We are not impressed...

Good management (magnet or not) knows how to hire a leader...

Anyway,

As a current nursing instructor, I see many second (third or fourth) career entry level students...They seem to worry some of my (older) colleagues...

Not me...

I say go for it...I was a nurse manager 6 months out of school (2nd degree, 5+ years prior management exp.)

Go for the CNO, but NOT the ANP...

I want to see a PHYSICIAN, not some hot shot, 2nd career midlevel...

I can lead the troops (CNO) w/ minimal RN experience...

But I cannot diagnose them...That, I leave to my more educated (not smarter) brethren (and sistern)

 

[chimichanga]

You may know HC, but you don't know our MD relative, if you did, you'd faint at the thought of her putting you under.

We ALL have a horror story of: docs, nurses, AAs, other midlevels...

Whatever...

Anectodal evidence means nothing (except in your world)

 

[chimichanga]

...If a person is just interested in making a "good" living, that is NOT a good enough reason to go into nursing OR medicine, end of story.

When you are ill, you want someone that is there because they are pretty much into it and truly care about you and what they are doing and how it will affect you...

I disagree...

I went into nursing: accidentally, at the urging of other RNs (with whom I worked alongside), and at the promise of a "guaranteed job"

I knew it would be stable, and safe...

I have made GREAT money...

Turns out I am good at it...Better than most...

I work to take care of my family...

I'd rather be running a backhoe (long story); See "Medicine sucks" thread in "gen residency" forum;

Anyway... I am here, and will give the best that I can

I was not born to be a nurse, but I will do it to the best of my ability

FYI, I teach it now, and can say (as can my students), that I do it well

 

[jl lin]

I disagree...

I went into nursing: accidentally, at the urging of other RNs (with whom I worked alongside), and at the promise of a "guaranteed job"

I knew it would be stable, and safe...

I have made GREAT money...

Turns out I am good at it...Better than most...

I work to take care of my family...

I'd rather be running a backhoe (long story); See "Medicine sucks" thread in "gen residency" forum;

Anyway... I am here, and will give the best that I can

I was not born to be a nurse, but I will do it to the best of my ability

FYI, I teach it now, and can say (as can my students), that I do it well

So it turned out OK for you and I hope your patients and colleagues. But the fact that you'd rather be running a backhoe is a bit disturbing.

This is a huge part of the problem in the field of nursing. It is precisely why the "profession" is stuck. It wants to believe with certain programs and advanced education, it is going places. That's all smoke and mirrors.

At least medicine uses multiples means of evaluating potential medical professionals. The objective means are far better in my opinion, and the subjective means use a panel. Hopefully on those panels there are people that can see past superficial motivations.



About the Magnet point, it had nothing to do with the virtues of Magnet or even its actual legitimacy. It had to do with the fact that staff clinical nurses are directed to be part of the hiring of those that would seek to manage them.

As far as being a nursing instructor, no offense, but schools and those that work for them are hopped up on excellerated programs for those with undergrad or grad degrees. The reason is that it keeps the schools and programs and the instructors in business, period.
So for someone that would rather be working a backhoe, although instructing is a pain in its own way, it beats working in the trenches, huh? Sorry but this is but one major reason nursing has so many problems.
​

What matters is not whether someone can BS their motivation and perhaps ethics and commitment towards a profession to get into a program. Some will always get through. The idea is to try to limit them for the sake of the profession and for those for which it advocates.​

 

[foreverLaur]

So this is why there are 2 year waitlists at all the nursing programs and I'm stuck in limbo...

 

[jl lin]

So this is why there are 2 year waitlists at all the nursing programs and I'm stuck in limbo...

There are a number of reasons for that.

The truth is, a good number of graduate nurses can't find jobs right now. Hiring freezes abound. Those people that post the "go nursing" articles in a down economy do not understand the business end of things where hospitals are concerned.


I am curious about you being waitlisted for a nursing program, since next to your avatar it says future PA. So I am curious about why nursing.

I mean you could easily take a course and become a telemetry tech, have far less aggravation, responsibility, and potential liability, and be able to study on the job while you are going to school. Also, you could take a unit secretary position. With the later, however, you will be much busier. Great unit secretaries are worth their weight in gold and keep things moving along.

Getting back to your queston though, almost all programs are showing a need for Masters and Phd prepared nursing instructors and professors. Also a lot of programs have limted funding for the programs right now. There are also programs that have their accreditation in jeopardy or taken away and have to work to get it back. So they have to bring in enough people that are potentially going to be successful on the NCLEX in order to keep the school's pass rate up. Like I said, there are many reasons for waitlisting.

 

[chimichanga]

I teach at a CC, which has had the RN program since the '60s...Only one around, has served the local hospitals well...No need for an accelerated program in these parts...

It does beat working in the trenches, as I have 20+ years of bedside care...

And the backhoe thing. Not sure why that is so disturbing...
Bedside nursing can suck the life right out of you...Being alone in a backhoe cab actually sounds appealing (after endless ODs, violence, ETOH, etc.)

I (unlike many career RNs) can recognize when I've had an *****full of ED nursing (or wherever), and want to take my experiences and knowledge, and pass them on to students...

Not sure why that's a bad thing...

And instructing is NOT a pain...It's possibly the best career move I've ever made...

Personally we need more good ones...With RECENT clinical experience...I continue to work as an RN, on a regular basis...

 

[fab4fan]

No offense to the AAs, but no AA is putting one of my family members or me down.

When my kids had anesthesia, I barely let CRNAs, which I first interviewed (after I interviewed and spoke with the anesthesiologists that would be supervising) touch my kids, and I am a RN. I wanted to know their experiences, how many cases they did per week, month, and year. You name it. If they had a problem with it, it was bye, bye. Didn't matter if I liked the surgeons. They knew how I felt. Let me tell you, those anesthesiologists I interviewed first were so on the ball and very attentive. Anesthesia is very risky business. I know this because of the kind of nursing I do.

I have to agree that some of this moving of boundaries by mid-levels is very scary stuff. I am loyal to my profession; but thank you no. It's getting out of control.
What I have learned first hand is that mostly clinical time and experience makes the most difference in effectiveness and safety.

I have to agree with you on this. I used to work a lot with CRNAs. The ones I really trusted were all nurses a long, long time before they became CRNAs.

To be fair, I didn't exactly trust all the younger 'ologists either. (One in particular comes to mind. ) Had I needed surgery, I probably would have requested one of the older 'ologists. (Except for one; he bugged me as well. )

 

[bradt9881]

.
If there are any PAs out there I have a question. Since PAs work closely with doctors, but don't make anywhere near as much, how does a PA work when the doctor does not? Some of the doctors by me only work 2-3 days.

Not sure I fully understand the question, but it sounds like you are asking how do we work if the MD is not in the office? If thats the question, then the answer is that access to call the MD for a telephone consult is adequate to satisfy supervision requirements of a PA.

 

[FireCloud9]

I can't respect it; because I don't believe it is sound practice. This is about people's lives. It's about efficacy as well as safety, and it is also about level-headed compassion.

If a person is just interested in making a "good" living, that is NOT a good enough reason to go into nursing OR medicine, end of story.

When you are ill, you want someone that is there because they are pretty much into it and truly care about you and what they are doing and how it will affect you.

I'm not OK with it. I never will be.

Apologies for the lengthy delay in response, but I was busy looking for work that'll sustain us while I retrain....

We get it, noone other than you is worthy to be in your field.

You do realize that people enter the profession all the time don't you? That the nurses 50yrs from now haven't even been born yet, and like all that went before them, they'll get an education and proceed to learn along the way.

Sorry to burst your naivete bubble, but people enter all sorts of professions including medicine in large part to make a good living. Hence the advice of parents to their kids to go be doctors, lawyers, engineers, etc.

I've venture a guess and say that if at the end of medical school and residency the best one could hope for was $50k /yr we'd have about 10% of the doctors that we have today (if that).

When I've been ill and needed care, I want the best and brightest. I don't want their empathy, I don't want them to "care", I don't want any emotional mumbo jumbo. I want them to be smart, good at solving whatever the problem is, and available when I need them.

Nursing school should be a trip for you. You may find it will really kick your butt big time before you get to the state boards, and I am not talking about the mere didactics.

Oooh, I'm shaking in my 11B boots. Maybe it'll be like Benning or worse! Really now, you're going to whip out the whiny "it's hard" card?

I can't tell you how many times I've heard that in my life. Going to school full-time while working full-time? That's crazy, you'll never make it, exactly how long do you think you can keep that up?

Applying for a top MBA program while working? That's crazy, you have to quit your job to do such an intense program! You're what??? Going to quadruple major!?! While working? That's insane!

Lets get real. It's very clear, even to someone who just started looking into healthcare what the pecking order is - MD -> PA/AA/CRNA ->RN (and salaries, length of education and training reflect that).

Of the clinician options, RN looks to be the easiest by far. Which is why even someone with an Associates degree can be an RN. I just figure why spend 2yrs with 18yr olds out of H.S. to get an Associates, take the NYCLEX and get the RN, when there is a ABSN option that takes less time?

This is a huge part of the problem in the field of nursing. It is precisely why the "profession" is stuck. It wants to believe with certain programs and advanced education, it is going places. That's all smoke and mirrors.

What matters is not whether someone can BS their motivation and perhaps ethics and commitment towards a profession to get into a program.
​

I find it interesting that the PA / AA candidates/professionals commenting here are secure enough in their professions to offer advice. Only complaints from the RNs.

I have to admit that just yesterday each option had a 33% chance, but given all the responses, I'm definitely leaning towards RN now... it's at least 50% RN / 30% PA / 20% AA.

Back to the subject!

Any AAs here that know something about the AA programs / job options in NC, CO and TX? Looked through the websites below

http://www.anesthetist.org/factsaboutaas/
http://www.anesthesiologistassistant.com/

(Discussed with wife and those are the only 3 states that would work for us - actually, I'd have to do some persuading for NC and CO).

Anyone know of AA programs collaborating with hospitals that have loan forgiveness programs (there's a CRNA program here that has that arrangement with a major provider)?

Also enjoyed the story of a navy pilot that got into it.

"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."
Read more..."

"My hands-on training with the Navy was flying. The best way to learn is to actually do it. The same for anesthesia."

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.

What a concept!? Actually be trained in school. Like the military trains its pilots and other soldiers. Or perhaps people should practice with their Harrier Jet at home before applying to join the military to become a military pilot.

For the PAs what are some of the better programs in CA, NY, TX, and AZ (states where we are most likely to find ourselves).

 

[chimichanga]

... If a person is just interested in making a "good" living, that is NOT a good enough reason to go into nursing OR medicine, end of story.

Diagree wholeheartedly...Are you telling me every good nurse out there had an epiphany at 7 years of age that she wanted to be an RN?



When you are ill, you want someone that is there because they are pretty much into it and truly care about you and what they are doing and how it will affect you. Sure physicians and nurses have bad days. Those that make a point of going the extra mile in learning, understanding, doing the extra things, and knowing the value of empathy, which is quite different from sympathy, these are the people you want in charge of your care.

At the bedside, I am always "into it" and I know most nurses are as well...It's not noble, it's our job...Again, just because I wasn't "born to be a nurse" doesn't mean I can't excel at it... Your logic is flawed...Ever heard of doctors that used to have previous,non medical careers...Sometimes timing is the answer, not desire...Sometimes you just grow out of a career, and decide to change...Some call that GROWTH




I say cut the patients and the people actually committed to health care a break. I have had the "pleasure" of working with people that should be tinkering with computers or something further removed from the life, death, and wellness affecting actual people.

Then their nursing school, and individual instructors dropped the ball...Though I do agree w/ your point about some accelerated programs...Some are just diploma mills (mostly online) and should be more closely monitored...But the demand is there...



I'm not OK with it. I never will be. People should be thankful for those like fab or physicians and nurses like me that speak out against this kind of thing.

Awful full of yourself, eh?

 

[deleted6669]

for the pas what are some of the better programs in ca, ny, tx, and az (states where we are most likely to find ourselves).

ca: Sjvc, usc, rcc, stanford, uc davis
az: Atsu
ny: Stony brook, cornell
tx: Utmb

 

[chimichanga]

When I've been ill and needed care, I want the best and brightest. I don't want their empathy, I don't want them to "care", I don't want any emotional mumbo jumbo. I want them to be smart, good at solving whatever the problem is, and available when I need them.

Actually, you do want their empathy and caring (not sure what you implied with the quotes)...

And connecting w/ a patient on an emotional level, can be quite beneficial to the patient...

They should be "smart, good at solving whatever the problem is, and available when I need them" AND have those other "mumbo jumbo" qualities...

Especially the emapthy...A nurse/doc (let alone human being) without the ability to try and see the world from someone else's perspective is not someone I want looking after me...

Good luck in school...It is the best bang for your buck these days...Some Phoenix hospitals, for example, are doing some sporadic hiring of new grads (will likely be better in 2-4 years) @ ~ 27/hour

 

[FireCloud9]

Not sure I fully understand the question, but it sounds like you are asking how do we work if the MD is not in the office? If thats the question, then the answer is that access to call the MD for a telephone consult is adequate to satisfy supervision requirements of a PA.

Thanks Brad, that's exactly what I meant. I wondered if the MD on his/her "days off" had another MD as access for telephone consult or provided that access even on their "days off".

ca: Sjvc, usc, rcc, stanford, uc davis
az: Atsu
ny: Stony brook, cornell
tx: Utmb

Thanks emedpa! You've given me some homework to do now.

I've checked out some of the TX curriculum for RN and came across a bunch of religious classes that are part of the program. I have little interest in spending my time on that. Here's hoping UTMB isn't the same.

Actually, you do want their empathy and caring (not sure what you implied with the quotes)...

And connecting w/ a patient on an emotional level, can be quite beneficial to the patient...

They should be "smart, good at solving whatever the problem is, and available when I need them" AND have those other "mumbo jumbo" qualities...

Especially the emapthy...A nurse/doc (let alone human being) without the ability to try and see the world from someone else's perspective is not someone I want looking after me...

Good luck in school...It is the best bang for your buck these days...Some Phoenix hospitals, for example, are doing some sporadic hiring of new grads (will likely be better in 2-4 years) @ ~ 27/hour

Chimichanga,

I suppose different strokes for different folks is applicable here. My preference has always been the bottom line (fix the problem). That is, I'll take the best and brightest that can solve the problem over an empathetic type that can't.

I've been in emergency care more times than I can count and emergency surgery 3 times. I've come across too many of the empathetic types that solved nothing and relied on their cold, non-empathetic, skilled and competent peers.

People may want both (who doesn't want it all), but my experience has been that few healthcare providers meet both criteria.

To me, seeing the world from other's perspective and empathy are two different things. I can easily see other perspectives, but I'm not the emotional type that "feels" empathy (with perhaps children being an exception).


By the way, in CA the RN to patient ratio seems to be around 4:1 and they get paid 1.5X for any work beyond 8hrs. How do other states compare? I can tell you that as a patient, there's no way the RN to patient ratio was 4:1 more like 500:1 That seems to be why CA nurses are so much happier than NY nurses.

 

[chimichanga]

People may want both (who doesn't want it all), but my experience has been that few healthcare providers meet both criteria...

In all fairness, you have only that: your anectodal experience...It's yours only, and in the overall context, is limited...

We have many years of working alongside and supervising empathic and non empathic...Your assessment that empathy doesn't go hand in hand w/ clinical competence, is an unfair one, and only formed from your own experiences, as a patient, from the non-health care world...

Dude, I WAS the technical ,skill hound nurse, who could "manage" a slew of patients in the ED, without ever making a connection with them...I had contempt for the average ED pt, and was at the top of my game (clinically)...

But turns out, I was a general azshole in pt relations...I now (many years later) see the error of my ways...
A good nurse can and will do it all well...

 

[chimichanga]

In AZ, no ratios (mandated), and OT is after 40/week, not per shift...

 

[FireCloud9]

Got it Chimichanga. By the way, that experience and perception isn't mine alone. My family reports much of the same with their own experiences.

So anyway, back to topic.

I go to http://gasworks.com and it's an interesting difference between AA and CRNA...

So the pros of AA seem to be relatively quick entry 2-3yrs vs. 3-5yrs (though seems to be less income for similar work) and "pigeonholed" as my wife points out. If a CRNA doesn't like the gas business after a while, he/she can go to other areas of nursing whereas that would be it for an AA.

Also limited to 1-3 states (for me). Though I like that it seems to be more of the medical model and more intense training.

Pretty wild that prereqs for CRNA is RN, but not necessarily BSN. Though I suspect BSNs get preference for admissions.

"First, you must be a Registered Nurse, and you must have a bachelor’s degree. Not all programs require a BSN. In many cases, being an RN with an unrelated bachelor’s degree is sufficient for admission. Check with programs where you intend to apply for this information."
Source: http://www.nurse-anesthesia.org/showthread.php?t=34

And only 5-7yrs RN xp.
"average CRNA applicant has 5-7 years of experience as an RN before admission"

Given CRNAs making more than PCPs!
http://mdsalaries.blogspot.com/2007/08/nurse-anesthetists-still-earn-more-than.html

"How long does it take to become a CNRA in USA? About 7 Years

How long does it take to become a primary care physician in USA ? 4 years Pre-med + 4 years Med school + 3 years Residency = 11 years and about 120,000$ in medical school debt !"

I don't suppose many RNs go the AA route since they can go the CRNA route? Would it be shorter ABSN to RN to AA (just in case gas doesn't work out)?

Then again if the local community college accepts most undergrad transfer credits that 2yr Associates can probably be done in a couple of fully loaded semesters vs. a little over a year in a ABSN program, to RN skip ICU and go to AA program or work 1yr ICU and go CRNA. Hmm....

RN certainly seems to have many more paths, options, alternatives, fallbacks, etc. and one still leaves the AA / PA options open with an RN.... unlikely I'd go RN if I went PA / AA first.

Besides, I haven't seen many PA+MBA jobs, but plenty of RN+MBA. That can pay quite well as I maneuver towards a PA / AA / CRNA program.

 

[deleted6669]

re: crna vs aa: scope of practice is the same.
states that use both typically pay them the same. in some places that use both the head anesthetist is an aa. aa's can now work in 18 states and in govt service with new states added every few yrs..
there is a trend with anesthesiologists prefering aa> crna as aa's must work for an md while in some states crna's can be independent(ie competition for docs). aa to md is a much easier transition later if desired than crna to md.
lots of midlevels make more than some lower paid primary care docs so that isn't much of a benchmark.
em, derm, ortho, neurosurg, trauma, and surgical pa's can all easily make > 125k/yr with less student debt than an md.

 

[core0]

Snip bunch of stuff

For the PAs what are some of the better programs in CA, NY, TX, and AZ (states where we are most likely to find ourselves).

CA I'll defer but Most of the programs have good reps. The CCs especially.
In AZ both Midwestern and ATSU have good reputations.
TX Baylor is the big daddy. All of the UT programs have a pretty good rep. UTSouthwestern probably the best.
NY is the promised land for PA students. It has the most PA programs of any state in the nation. Touro and the SUNY programs are the ones I've heard the most about. Sophie Davis and Cornell has a good rep too.

As to your previous question, I've been doing medicine for most of my life in one form or another. My experience has been as an observer in hospitals and medical schools for the last 20 years. Lots of people that thought this was an easy way to some good money. Some are still here.

There's nothing wrong with wanting to make good money. The thing about medicine is you have to want to be there. The consequences of not paying attention or phoning it in are higher than in most other professions. That being said there are more than a handful of people in medicine/nursing that don't want to be there but don't have a skillset that will make them the same money elsewhere. Basically don't come in and think that even if you hate it you can still do the job.

David Carpenter, PA-C

 

[core0]

re: crna vs aa: scope of practice is the same.
states that use both typically pay them the same. in some places that use both the head anesthetist is an aa. aa's can now work in 18 states and in govt service with new states added every few yrs..
there is a trend with anesthesiologists prefering aa> crna as aa's must work for an md while in some states crna's can be independent(ie competition for docs). aa to md is a much easier transition later if desired than crna to md.
lots of midlevels make more than some lower paid primary care docs so that isn't much of a benchmark.
em, derm, ortho, neurosurg, trauma, and surgical pa's can all easily make > 125k/yr with less student debt than an md.

Actually the scope of practice is not the same. My understanding is that AAs must practice in the ACT setting and CRNAs may or may not (although this may be particular to the institution). Even my institution which is almost exclusively AA has a few CRNAs to do things like conscious sedation in the clinics and radiology. Pay is the same though.

David Carpenter, PA-C

 

[Endee]

Gaswork is in no way anywhere near an indication of anything approaching reality.

I know of some RN's who went to AA school. There is one in our class. I know there are some in the other schools. For some it was a philosophical choice. Maybe others didn't want to do the time in the ICU. CRNA gives more flexibility, honestly, because they can work in 50 states and in settings without an anesthesiologist. However, the majority of CRNA's work in the ACT model which is exactly the same as AA's.

 

[deleted6669]

Actually the scope of practice is not the same. My understanding is that AAs must practice in the ACT setting and CRNAs may or may not (although this may be particular to the institution). Even my institution which is almost exclusively AA has a few CRNAs to do things like conscious sedation in the clinics and radiology. Pay is the same though.

David Carpenter, PA-C

let me rephrase: at places that use both scope of practice is typically the same.
as long as there is an anesthesiologist on site there is no reason an aa could not run a procedural sedation case in the er for example.
pm jwk for a discussion if desired. he is head of his anesthetist group in georgia that uses both aa's and crna's interchangeably.
yes, crna's in some(15?) states can work under the direction of a surgeon, not an anesthesiologist, and therefore have some degree of independence.

 

[Endee]

let me rephrase: at places that use both scope of practice is typically the same.
as long as there is an anesthesiologist on site there is no reason an aa could not run a procedural sedation case in the er for example.
pm jwk for a discussion if desired. he is head of his anesthetist group in georgia that uses both aa's and crna's interchangeably.
yes, crna's in some(15?) states can work under the direction of a surgeon, not an anesthesiologist, and therefore have some degree of independence.

CRNAs can work under the direction of any physician in all states. I think you are thinking of the opt-out states which means the state can opt out of the federal supervision requirement which if my understanding is correct is mostly a billing issue. That is only in place in 15 states.

 

[jl lin]

I teach at a CC, which has had the RN program since the '60s...Only one around, has served the local hospitals well...No need for an accelerated program in these parts...

It does beat working in the trenches, as I have 20+ years of bedside care...

And the backhoe thing. Not sure why that is so disturbing...
Bedside nursing can suck the life right out of you...Being alone in a backhoe cab actually sounds appealing (after endless ODs, violence, ETOH, etc.)

I (unlike many career RNs) can recognize when I've had an *****full of ED nursing (or wherever), and want to take my experiences and knowledge, and pass them on to students...

Not sure why that's a bad thing...

And instructing is NOT a pain...It's possibly the best career move I've ever made...

Personally we need more good ones...With RECENT clinical experience...I continue to work as an RN, on a regular basis...

Not saying your are altogether wrong on that at all. Actually I hear what you are saying.

You, however, are part of the exception list to this general attitude of "What's the quickest way I can make more than $50,000 or so" list.

In general, whether it is stated openly or not; it's a bad idea.

 

[jl lin]

Awful full of yourself, eh?

Not at all chimi. . . lol. It really isn't a reason to go into the field, period.

And to fire, who truly does seem full of himself and who will learn a lot, one can only hope,
look at the use of the conjunction "and."

It's NOT one thing. . .empathy VS. brightness, knowledge, commitment, ethics. If a person is committed to what they are doing on a deeper level, they will work hard and see to it that they are the BRIGHTEST AND THE BEST. Those are the people that are most vigilant and go the extra mile.

Also, empathy and compassion do go along with it--ESPECIALLY in nursing. It makes be sad when people miss the boat on this.

See, either or thinking is part of the problem. It's not one or the other; it's both, period.

Is nursing school hard? I didn't find it hard. Sometime it was a bit of pain in the butt; but others went home or left the program crying or were shown the door. I went in with my eyes wide open; but that's another story.

There can be a weed-out factor. I used to think this was an altogether bad thing. I've since learned otherwise.

LOL, if you get by a wise clinical instructor, OK. No worries. There are enough in the field that aren't at all easy. In fact, I feel that nursing can really be downright raw at times to the point of being unfair to many within its own profession. I'll just say it can be a very eye-openning field.
Even Chimi knows this.

People can try to pursue what they want. But karma, or however you want to refer to it, is a potent force.

Remember Socrate's guiding rule: "Know thyself."


So fire, what exactly makes YOU think you will be a worthwhile nurse?

 

[jl lin]

in all fairness, you have only that: your anectodal experience...it's yours only, and in the overall context, is limited...

We have many years of working alongside and supervising empathic and non empathic...your assessment that empathy doesn't go hand in hand w/ clinical competence, is an unfair one, and only formed from your own experiences, as a patient, from the non-health care world...

Dude, i was the technical ,skill hound nurse, who could "manage" a slew of patients in the ed, without ever making a connection with them...i had contempt for the average ed pt, and was at the top of my game (clinically)...

But turns out, i was a general azshole in pt relations...i now (many years later) see the error of my ways...
A good nurse can and will do it all well...

-->

 

[deleted6669]

crnas can work under the direction of any physician in all states. I think you are thinking of the opt-out states which means the state can opt out of the federal supervision requirement which if my understanding is correct is mostly a billing issue. That is only in place in 15 states.

yup, what he said....(thanks)

 

[FireCloud9]

All objections duly noted.

there is a trend with anesthesiologists prefering aa> crna as aa's must work for an md while in some states crna's can be independent(ie competition for docs). aa to md is a much easier transition later if desired than crna to md.
lots of midlevels make more than some lower paid primary care docs so that isn't much of a benchmark.
em, derm, ortho, neurosurg, trauma, and surgical pa's can all easily make > 125k/yr with less student debt than an md.

While surgery sounds interesting, it's probably not the route I'll go, but who knows?

You made 2 interesting and key points.

1st, AA to MD being easier transition. I got that impression from comparing the AA and CRNA curriculums and pre-reqs. While AA is shorter, it just seems to me that it's more scientific / challenging. Not to say that there isn't a lot of overall, just that it seems a lot closer to MD type training than CRNA.

http://www.southuniversity.edu/anethesiologist-assistant-program.aspx and
http://www.usc.edu/schools/medicine...gy/education/assets/SRNAProgramCurriculum.pdf

The other thing I noticed is that there seems to be little variance in requirements or curriculum among AA programs whereas CRNA program requirements and curriculum seem to have higher variance though tend to be longer with the ICU requirement.

And as Endee pointed out RN or CRNA seems more flexible.

The other point about mid-levels is range (vs. depth). AA has lots of depth, but no breadth. RN and PA provide a broader view into healthcare. Who knows? I may come across an area that's really interesting.

Ok, Endee, the gig is up. AA is out (for now). Looks like it'll be either RN or PA (though for PA I'll need a start somewhere - EMT on weekends? ) Thanks a lot for your help though!

CA I'll defer but Most of the programs have good reps. The CCs especially.
In AZ both Midwestern and ATSU have good reputations.
TX Baylor is the big daddy. All of the UT programs have a pretty good rep. UTSouthwestern probably the best.
NY is the promised land for PA students. It has the most PA programs of any state in the nation. Touro and the SUNY programs are the ones I've heard the most about. Sophie Davis and Cornell has a good rep too.

Good to know.

I know of some RN's who went to AA school. There is one in our class. I know there are some in the other schools. For some it was a philosophical choice. Maybe others didn't want to do the time in the ICU.

CRNA gives more flexibility, honestly, because they can work in 50 states and in settings without an anesthesiologist. However, the majority of CRNA's work in the ACT model which is exactly the same as AA's.

CRNA does provide for greater flexibility. Besides, RN is the pre-req for CRNA but can serve as entry to AA path (once supplemented with additional coursework).

ICU comment is exactly the discussion my wife and I were having over dinner.

So after RN, instead of ICU I can head to AA or PA routes.

OR

Go RN to ICU to CRNA

In the meantime, I can use the RN+MBA combo to do other work.

Now that I've put AA to rest I can focus on EMT - Para - PA route or RN to xxxx route.

More to think about tonight...

 

[tbone0217]

Gaswork is in no way anywhere near an indication of anything approaching reality.

I know of some RN's who went to AA school. There is one in our class. I know there are some in the other schools. For some it was a philosophical choice. Maybe others didn't want to do the time in the ICU. CRNA gives more flexibility, honestly, because they can work in 50 states and in settings without an anesthesiologist. However, the majority of CRNA's work in the ACT model which is exactly the same as AA's.

If gaswork.com is a bad example of typical AA jobs... Could you elaborate on the different options for AA's? Namely: hours/call schedules and typical new grad salary ranges. I, like the OP, am trying to decide between pursuing PA school or AA school. One big factor for me would be the ability to get a "regular schedule" (rarely having to work nights, weekends, holidays). I am unsure if AA can provide this, and thus I'm leaning towards PA. Any thoughts?

 

[Endee]

Ok, Endee, the gig is up. AA is out (for now). Looks like it'll be either RN or PA (though for PA I'll need a start somewhere - EMT on weekends? ) Thanks a lot for your help though!

Haha, well the door is always open. I'm glad your path is becoming clearer. In your position, I would probably do the same thing.

If gaswork.com is a bad example of typical AA jobs... Could you elaborate on the different options for AA's? Namely: hours/call schedules and typical new grad salary ranges. I, like the OP, am trying to decide between pursuing PA school or AA school. One big factor for me would be the ability to get a "regular schedule" (rarely having to work nights, weekends, holidays). I am unsure if AA can provide this, and thus I'm leaning towards PA. Any thoughts?

I'm still a student, so I can only say from what I've heard and not from personal experience. My professors have said that work schedules are just the same as CRNA's. So, average 40 hours a week. Call or no call depending on the employer. Possibility for overtime if you choose. Shift work is possible, so you can do maybe 5 eight hour shifts or 4 ten hour shifts or 3 twelve/thirteen hour shifts. Nights and weekends are probably rare unless you take call or overtime.

 

[facetguy]

How about those salary ranges? What are you hearing?

 

[Endee]

How about those salary ranges? What are you hearing?

The lowest I heard was 100 and the highest I've heard was 200 with call and overtime. Average was probably 120.

Although, don't expect that in some markets, like Atlanta.

 

[facetguy]

The lowest I heard was 100 and the highest I've heard was 200 with call and overtime. Average was probably 120.

Although, don't expect that in some markets, like Atlanta.

Is Atlanta a supply/demand issue?

 

[Endee]

Is Atlanta a supply/demand issue?

Yes. jwk is the man to discuss that. He's an AA working in Atlanta.

Although, some rural Georgia towns still seem to be vigorously hiring, so it may be confined to the metro area.

 

[facetguy]

Yes. jwk is the man to discuss that. He's an AA working in Atlanta.

Although, some rural Georgia towns still seem to be vigorously hiring, so it may be confined to the metro area.

Can we extrapolate to all metro areas (in the 18 states, that is)?

 

[Endee]

Can we extrapolate to all metro areas (in the 18 states, that is)?

No. In some of the 18 states there are no AA's currently working. In some, only a handful (less than 10) are employed. Georgia and Ohio are the highest, because they have had schools the longest. Florida opened up like 6 years ago, but now we have two schools in the state and almost 100 graduates a year coming out of the two of them. However, the Florida job market still seems to be great. Certain regional areas, though, will not hire AA's, usually because of CRNA political influence (for example, Orlando). This is probably true of many other states, that is, you have a better chance working in certain cities/areas than others within the same state.

Georgia is the worst, and an oversupply has been the topic of a few recent articles in the AAAA's quarterly publication. I guess a lot of Emory grads want to stay in Atlanta.

 

[facetguy]

When you say only 10 or so AAs are employed in some states, is that just a numbers thing, or have AAs tried and failed to get jobs?

 

[Endee]

When you say only 10 or so AAs are employed in some states, is that just a numbers thing, or have AAs tried and failed to get jobs?

People have to want to blaze a trail into a new state when it opens. If a state like Utah opens up it is going to take a while for there to be a significant population of AA's in that state.

A couple years ago North Carolina opened and there was only 1 AA there for a while. Slowly some more moved there and got jobs, and now in my class there are several students from NC, and some or many of them might go back, increasing the population more. With more in the state, awareness becomes higher among college students interested in the career, they enroll in the schools, they go back to their states, and the process continues.

So no, it isn't a failure issue. Graduates just have to want to go find jobs in those states.

 

[facetguy]

People have to want to blaze a trail into a new state when it opens. If a state like Utah opens up it is going to take a while for there to be a significant population of AA's in that state.

A couple years ago North Carolina opened and there was only 1 AA there for a while. Slowly some more moved there and got jobs, and now in my class there are several students from NC, and some or many of them might go back, increasing the population more. With more in the state, awareness becomes higher among college students interested in the career, they enroll in the schools, they go back to their states, and the process continues.

So no, it isn't a failure issue. Graduates just have to want to go find jobs in those states.

Makes sense. Thanks. Off-topic, would you say AA school so far has been more, less or just about as challenging as you expected going in?