Awakened Anesthetist

Your Complete Guide to Understanding Certified Anesthesiologist Assistants Pt. 2 Why You Should NOT be a CAA

• Mary Jeanne, Certified Anesthesiologist Assistant • Season 4 • Episode 61

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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. 

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Speaker 1:

Welcome to the Awakened Anesthetist podcast, the first podcast to highlight the CAA experience. I'm your host, mary Jean, and I've been a certified anesthesiologist assistant for close to two decades. Throughout my journey and struggles I've searched for guidance that includes my unique perspective as a CAA, at one of my lowest one. I encourage you to stick around and experience the power of being in a community filled with voices who sound like yours, sharing experiences you never believed possible. I know you will find yourself here at the Awakened Anesthetist Podcast. Welcome in. Welcome to the next installment in this Understanding Certified Anesthesiologist Assistant mini series. This is part two. I will be discussing why you should not become a CAA, which is the type of conversation I really like having just a very straightforward sort of behind the scenes the things people aren't going to tell you but in a way that I think is going to be very helpful. If you are considering this profession, the CAA profession, I think it's great to see it from all angles and of course, there are pros and cons to every single job. There are so many wonderful things about being a CAA and I will absolutely list some of those at the end so we're not all feeling sort of sad and depressed about why this profession can be hard, but I just wanted to be really honest. Remember, I'm your big sister, your best friend in the CAA profession, who's just keeping it real and this is a safe space for us to be very open and honest. So let me pull up my document.

Speaker 1:

I, honestly, was prepping for this about three weeks ago and I was like, well, let me just get into my Google Docs and see what comes up. As I'm typing Google Docs right now, this is very unscripted. I sat down and in 10 minutes, came up with this list. And then I reread it a couple times and I'm like, yep, that's what I want to say, and I think it's because I've had this conversation before. I have been a first year clinical instructor, mostly for UMKC MSA program, but also have met several other students from several other schools. I also, you know, in the operating room there's usually a parade of high school students and shadow students a little bit less so now after the pandemic, but certainly I've had this conversation with people who are interested in health care. They really only know about being a doctor or a nurse and I'm like, hey, have you ever thought about being a CAA? And then I give them this spiel of sort of the things to know before you are choosing a healthcare profession, or if they know about the CAA profession. I give them some of this inside scoop on what it feels like and looks like in real time to be a CAA. So let's keep this short, which means 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 sort of in the moment here if I feel like it's necessary, and of course, you can DM me afterwards on Instagram at AwakendDenestitist, if you want any more follow up or you have questions or things to add. You can also just text me right in the show notes. There's a way to text. I think it says text or chat me and it sends me a direct message to my podcast provider. That's probably what's most pertinent here Sign up for my emails. You know, check the show notes. Basically, lots of good stuff, mindful connections. All of that will be in the show notes for season four. All right, let's start with part two of understanding.

Speaker 1:

Certified anesthesiologist assistance why you should not become a CAA. Here's my number one that I always say is that a CAA is not the boss and is never the boss. So if you have a lot of boss energy, if you think of yourself as struggling to take instruction from someone else or to be a member of a team, struggling to take instruction from someone else or to be a member of a team, then this career is not for you. As said by our name and as I described in part one of this series, we are an anesthesiologist assistant, so we are assistant to the anesthesiologist, which means we are not the boss, they are the boss and, yeah, probably more to say there, but we are not the boss. Number two is that the CAA profession is the minority profession in the anesthesia care team model. So, again, in the anesthesia care team, a physician anesthesiologist can supervise generally up to four CAAs or CRNAs, and I described those acronyms in part one. Again, go back. But of all the people who could be on an anesthesia care team, caas are by far the minority. We have about maybe 4,000 of us now at the time of this recording and there are, I believe, I want to say, 40,000 physician anesthesiologists and about the same number of CRNAs. Don't quote my numbers, but in terms of the stark difference of numbers I am correct.

Speaker 1:

Okay, here's another one that you may or may not know, depending on how involved you are in the healthcare system, but the healthcare system in the United States is largely broken. The healthcare system in the United States is largely broken. It has many moving parts that are broken, and it is not a system that is doing what we all think it is, which is serving our patients full-heartedly, without making money. You know no one's making money on this and that we're all there just to make patients feel better, to heal them, to cure them, to help them die. Well, you know, all the things you think happen at a hospital happen. However, there's also all of this insurance issues and bureaucracy of health care, and lots of people are making money off things, and so there's a whole lot more going on than just being there giving anesthesia to make this patient feel better or to be able to endure their surgery, and you come into contact with some of that ugliness, some of that brokenness, on daily, weekly, monthly, yearly basis, and it can be really challenging to feel like you are a cog in a broken wheel without a lot of power to make the big systemic change that needs to happen. Okay, another one is that, as a CAA, you will likely have to educate your work colleagues anesthesia groups, hospital administration on who a CAA is. So who you are and why you matter, why a CAA matters, why they should hire CAAs, why they should fight for our legislative efforts. Likely you're going to meet many, many people who do not know what CAAs are and you're going to have to do the hard work of educating them, which kind of sucks and is probably why I have so many things to say right now, because I've talked about what it means to be a CAA to so many people for so many years. I've been a CAA for almost 18 years and you get really good at sort of describing who you are and feeling like you have to defend yourself or at least stand up for yourself, and it can get kind of tiresome.

Speaker 1:

Here's one about AA school, which is very common. You'll hear people talk about AA school like it's drinking from a fire hose, meaning that it comes at you fast and furious. It is all consuming Relationships. Many relationships have been lost in AA school relationships. Many relationships have been lost in AA school. It's just a short period of time to learn a whole bunch of information and kind of pop you out at the end of this two and a half ish year process of fully formed CAA, you cannot be doing many other things and that can take a toll on someone and that's maybe not everyone's best way to learn.

Speaker 1:

Another thing about AA school and becoming an AA is that it is a very specialized education with no direct fallback option. So if you get into AA school and you begin paying for AA school and you do not love it and you get, you know, past the first year, it's really hard to say, okay, well, this was just like an experiment that went awry and I'm not going to see this as a failure and all the tens of thousands of dollars I lost. I'm just going to like it's okay, I'm just going to move on. It's hard to make that decision once you've gotten far enough along, because you basically have to start over if you're going to do anything else. Of course there's exceptions. Of course you can get a job with an undergraduate degree in whatever biology, chemistry, you know. If you have something a little bit more practical or applicable, like an accounting degree, it's a little easier, but it's tricky. It is expensive, which is another point. Aa school is very expensive and, unlike being a CRNA which every CRNA is also a nurse and if they keep their nursing license up, they can just go back to practicing nursing if they don't like doing anesthesia. We do not have that option and so 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 already in the program, you really have to. You know, sort of eat all the money that you spent and the time and go back and figure something else out. Obviously possible, obviously you can. It's just there's no direct fallback option.

Speaker 1:

I kind of touched on this, that there's a huge upfront financial investment to being a CAA. Personally, I came out of AA school in 2008. I went to Case Cleveland. I graduated in 2008. I also went to a private undergrad education, but I didn't have as many loans from undergrad and in total, I walked away with $160,000 of student loan debt. Now, remember this was 2008. I believe my first salary was about $160,000 or $170,000. Total package $170,000. And so, yes, you make enough money to pay off your debt and you can pay it off sort of efficiently or quickly, but it is still a large amount of financial risk to take on if you don't end up becoming a CAA or can't find a job that works for you because you want to work in a state that we can't work.

Speaker 1:

Which brings me to my next point, which is AAs are not licensed to deliver anesthesia in every state. We are licensed in around 20 states now, at the time of this recording, in what month is it? October of 2024. Any VA hospital, but I don't know many CAAs in VA hospitals and we can work in Guam, I believe. If anyone would like to work, probably on the military base in Guam, I think, is how that works out. But if it's not one of those places, then you can't work there. And even if we are licensed in a state. So let's take my state of Missouri. Even though the state of Missouri licensed and allows AAs to practice within the state, a particular hospital still has to accredit us and a particular anesthesia group, if it's a private group, still has to employ us. So there's still hurdles to jump through, which is why in the state of Missouri, not every single hospital, even though it's an open state, not every single hospital hires certified anesthesiologist assistants. So you're still fighting that battle on a hospital level, private anesthesia group level and, of course, state level If it's a state we're not licensed in. Wow, I have a few more. Let's keep going.

Speaker 1:

So another drawback to being a CAA is that due to our small numbers so remember, we're like a tenth of the size of physician anesthesiologists in this country and CRNAs in this country that means that every CAA has to be involved both politically and teaching AA students. Very, very rare that a CAA is just kind of free-floating out in the world, never touching an AA student and not being involved at all with any sort of quad A efforts, which is our national governing body, any legislative efforts. There are people like this that exist, but they are fewer and farther between than the people who are and honestly must be involved to keep this profession growing, and not everyone wants to have to do that. So that can be a definite drawback. Okay, let's do one more so we have time to get to the why you should become a CAA.

Speaker 1:

This is something that I've said in other podcast episodes. But because the CAA profession is very small, one person, one individual, one CAA can create great change and can cause major growth in our profession from just that one person's efforts. But that is a huge burden on that one person and also, on the flip side, could be seen as one of your life's biggest accomplishments, one of the biggest opportunities that you had to make impact. So it's one of those double-edged swords where it's something I embrace. I love the fact that I can have this podcast.

Speaker 1:

I can talk directly to CAAs who are sort of the movers and shakers in this community the Quad A presidents and the people who open states, like Sarah Brown, who just opened the state of Washington and the resonating truth when I talk to these people is that, yes, they're the movers and shakers and they're also just regular people who said, okay, if no one does anything, nothing's happened. So I'm going to do something. And that's a burden because they also have, you know, jobs and families and other things to do, and now they have to do this volunteer work to grow and expand our profession. And also it's something that they hold as one of their biggest accomplishments and something that they would never give back. Okay, so let's get to some good stuff why you should become a CAA, because, honestly, this list is just as long and I do think there's a few points I want to make, because people can see the money involved with being a CAA. They can see the starting salaries and how you only have to go to two and a half years of grad school and think, oh, this is definitely for me. But there are so many other amazing things about being a CAA, on top of the financial security that is possible, that I really want to highlight.

Speaker 1:

So I believe the most important benefit, or the biggest benefit of being a certified anesthesiologist assistant is that if you use the profession as a tool, you can have all the freedom you want in your life the freedom to choose. So when you have money, when you have more of a guaranteed job, when you can say, hey, I know that I can always fall back on giving anesthesia in the operating room, that allows you to make more risky choices, maybe follow different pursuits, maybe something entrepreneurial or something creative that you've always wanted to do, but you're not sure if you're ever going to be able to feed yourself if it was your full-time job. Being a CAA allows you to choose or try those things. It allows you to move to a new place and feel secure that you can have a job that's going to be stable and going to. You know, start your life off right. It just when you play the cards right and you see it as a tool towards freedom. It really gives you that freedom because it allows you to choose. You're in the driver's seat of your life as opposed to, you know, always a step behind. Number one absolute. My favorite thing about being a CAA is that it gave me the freedom to choose my own path and it's been awesome. It's led me here.

Speaker 1:

Okay, another thing about being a CAA that I think makes it really amazing is that I feel 100% valued every day that I work, not only from my patients, who see me as someone who's going to make them feel better or take their pain away or soothe their anxiety, but I feel valued through the anesthesia care team model. I feel valued by my coworkers. I feel valued by my supervisors so the physician, anesthesiologists. I feel valued by the system, meaning the hierarchy inside the culture of medicine. Caas are near the top where the physicians are, and so there are some perks to that and there's some reverence that an advanced practice provider enjoys like a physician enjoys.

Speaker 1:

In our culture, in the culture of medicine and honestly, in the larger culture in the United States, physicians are seen as fairly esteemed and APPs, and therefore CAAs, kind of get glommed into that and so very practically, this means that there is a doctor's lounge in the hospital that I work that also is open to advanced practice providers, including CAAs, and you can go in there and have free snacks, free sodas, all sorts of little foods and coffee bar, you know, 24-7, as well as a provided lunch every single day. But you have to be a physician or an advanced practice provider, like a CAA, to even be able to badge into that secure doctor's lounge and there are things like this all over the culture of medicine where there's this higher archical structure that I don't necessarily agree with but I do benefit from. So I'm very grateful for that benefit and I also see that as a little bit of a problem with why our healthcare system's broken. But again, caas have the benefit of being grouped into this higher level in the hierarchy of healthcare. Okay, let me read my list.

Speaker 1:

Oh, I said that a benefit of being a CAA, and why you should, is that, yes, we're not the boss, but we are always working in a team, so you can always phone a friend if you ever get into a sticky situation where you need a second pair of hands because the patient's requiring something a little bit more in depth or if you have a question about something that's going on with your patient, or if the surgeon or the surgical team is giving you a hard time or pressuring you in some way, you always have a pressure release valve to call your attending anesthesiologist, have them come in the room, back you up. They, in my experience, always take your side first and maybe you know it doesn't come out the way you were hoping, but your anesthesiologist always gives you the benefit of the doubt in my experience, and it just feels like this real team mentality where you have someone to rely on. Of course, not in every situation, of course there's outliers, but that team feeling really takes for me a burden off of me, that it's not all riding on my shoulders, that I always can ask for help and I unabashedly, unashamed, ask for help when I need it. And I think that's a perk of our job, so long as you have the right perspective on it.

Speaker 1:

Caas often are in the actual operating room delivering anesthesia, while those physician anesthesiologists are oftentimes doing pre-ops or post-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 more face-to-face time with awake patients than we do in a lot of situations. But that means that I'm in the operating room actually getting to deliver the anesthesia, which is very much seen as the fun part of my job and many anesthesia providers see that as the fun part and that is my role. I am meant to be in the operating room giving the anesthesia and the anesthesiologist, the physician, has sort of all of the extra ancillary responsibilities. Very much a typical way an anesthesia care team model runs in a hospital, not to say that the physicians can't do what I'm doing and I can't do what they're doing in many situations. But that's just the reality of it. That's just the model is that the anesthesiologist because they're supervising several rooms, they're out doing all the other things, while the mid-levels, the CAAs or the CRNAs, the advanced practice providers, are in the rooms delivering anesthesia the fun part.

Speaker 1:

I also see it as a benefit that I get to be right with the patients in what may be the worst day of their life or, you know, if they're having a baby, having their first baby, maybe it's the best day of their life. I get to be really intimately tied to human beings during their best and worst moments and that's something I really value about my job. This job as a CAA has helped me build my empathy muscle. I am so much more compassionate than I was in my younger years before I became a CAA, and then, over the course of my career, I can see how my empathy muscle has just grown and grown and grown. Because you are with human beings. You are with them in this really intimate way. You're watching over them while they're having surgery, you're keeping them alive for many, many intents and purposes and it's just a really powerful, cool, intimate experience that I really cherish and that's a huge benefit for me of being a CAA. Okay, let me see if I have any other ones. Oh, here's a big one.

Speaker 1:

This is a little bit more confusing if you're outside of medicine or healthcare to understand malpractice insurance and how that affects us as a CAA and how that is carried in an anesthesia care team model. But you'd likely know that patients can sue if something were to happen. They can sue rightfully or wrongfully. You're allowed to sue in the United States. It's a legal right and if a patient were to sue, the liability does not fall directly on the CAA. Just by the way the anesthesia care team model works, the way that the insurance model works, the anesthesiologist, sort of surprisingly, has all of that liability. So I'm not liable for my actions as much as the anesthesiologist is liable for my actions, much as the anesthesiologist is liable for my actions. Now, this is nuanced and there is, you know, you could come up with lots of situations where I'm liable. But I mean to say that if I'm doing my best and something bad happens, if there's an untoward outcome or a patient dies or something happens, the anesthesiologist, their insurance, will pay for me. If there's some sort of settlement. I cannot be personally sued under the anesthesia care team model. That's just the way malpractice insurance works. It's sort of confusing, but it's a great benefit as a CAA that we can't be directly sued in this model. Okay, here's my last one.

Speaker 1:

This may be also a little controversial, because we can take our work home emotionally and mentally, but we can't take anesthesia home physically. So I do feel like when I leave the operating room I leave 99.9% of my job there. I have learned over time and I've built resilience and skills to leave most of the emotional burden, most of the mental burden, there as well. That's not to say that I'm not tired and exhausted and, like you know, sort of tapped out when I get home oftentimes. But I can't stay up till midnight after my kids go to bed giving anesthesia because I didn't get it all done that day. I don't have computer work to do. There's not a ton of paperwork or bureaucracy that I have to do just to stay afloat in my job, and that is really really, really nice. I see many of my corporate friends working nights and weekends and you know, yes, we do that, but we're in the hospital doing that. I'm not in my home in my bed typing away at midnight because I didn't get my work done.

Speaker 1:

And that's not true for a lot of physicians. A lot of physicians now you'll hear, have to do charting and things and they have to take the work home. But that is not true for certified anesthesiologist assistants and I see that as a huge benefit. All right, that is the end of my list. I hope it was helpful. I hope you learned something new. Maybe you saw the profession in a new light or, if you're practicing CAA, maybe appreciate something about our profession that you've never really put into words before. My goal with this mini-series is just to spread more awareness and information about what it truly means to be a certified anesthesiologist assistant. Again, if you have anything to add or comments, you can DM me on Instagram at Awakened Anesthetist, or just chat me right there in the show notes. You can send me a direct message and, you know, maybe I'll have something to add or edit 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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Mary Jeanne Roberts, CAA

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