Which Anesthesia Career Is Right for You? Anesthesiologist, CRNA or CAA

Wondering which anesthesia career is right for you? Anesthesiologist, CRNA, or CAA are all great options. This in-depth guide breaks down everything you need to know to choose the right anesthesia career path for YOU.

In this video, I compare Certified Registered Nurse Anesthetists (CRNAs), Certified Anesthesiologist Assistants (CAAs), and physician anesthesiologists (MD/DOs) across every major category:
✔️ Education & training timelines
✔️ Scope of practice
✔️ Salary and job outlook
✔️ Work-life balance
✔️ Geographic and legal limitations

Whether you're pre-med, a nursing student, or just exploring careers in healthcare, this video gives you the clarity you need to decide between anesthesiologist, CRNA and CAA, so you can be clear which anesthesia career is right for you between these highly respected (and highly paid) anesthesia careers.

🧠 Timestamps:
00:00 - Introduction to Anesthesia
00:50 - Overview: Anesthesia Careers
01:24 - What is Anesthesia?
04:18 - What do Anesthesiologists do?
07:41 - Types of Anesthesia Providers: Anesthesiologist vs. CRNA, vs. CAA
12:31 - Physician Anesthesiologist (MD/DO): Pathway & Training
15:04 - Physician Anesthesiologist: Scope, Salary, Pros & Cons
21:01 - CRNA (Certified Registered Nurse Anesthetist): Pathway, Training, and ICU Experience
24:22 - CRNA: Scope, Independence, Salary, Pros & Cons
30:43 - CAA (Certified Anesthesiologist Assistant): Pathway, Training, and Scope
36:15 - CAA: Salary, Limitations, and Job Market
38:45 - Political Landscape & Provider Animosity
46:45 - Anesthesiologist Training Differences: Real-World Anesthesia Experience vs. Anesthesia Simulation
54:10 - The Importance of Vigilance in Anesthesia
01:01:10 - Head-to-head Comparison of All Three Anesthesia Careers
01:08:33 - Advice for Choosing Your Career Path. Which Anesthesia career path is right for you?
01:13:39 - Final Thoughts

📈 Average Anesthesia Salary Estimates (2024):
• MD/DO Anesthesiologist: $450K–$470K+
• CRNA: $210K–$250K+
• CAA: $140K–$180K

💬 Comment below: Which anesthesia career are you leaning toward and why? If you're already practicing anesthesia, share your perspective and insight to help students decide which anesthesia career is right for them.

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Chapters

• 0:00 Introduction to Anesthesia Careers
• 3:12 Understanding the Role of Anesthesiologists
• 13:24 Pathways and Training for Anesthesia Professionals
• 34:55 Understanding the Role of CAAs
• 37:29 The Political Landscape of Anesthesia Providers
• 56:47 The Importance of Proper Training and Vigilance

Transcript

Speaker 1: 0:00

Today is the day, guys. You're going to take your future into your own hands. You're going to dominate, you're going to be successful. No excuses, just dominate. What is up, guys? Dr Pineset here, and today we're talking about careers in anesthesia. I thought it'd be kind of cool. I saw an article recently talking about great careers for 2025. And, as always, I'm trying to give you guys career advice, help shape your careers, help you get there, and so I always like to introduce you guys to career opportunities. In talking to pre-meds, a lot of times people become pre-meds. They're like I gotta be a doctor, I wanna be a doctor, and they feel this burning need to be a doctor because people say they have to be a doctor. They get it set in their mind but they really haven't explored all of their options, and so I always think it's great to introduce you guys to some careers, and so I'm going to be doing some careers in medicine, outside of medicine, that you guys should consider, and we're going to talk about it Today. We're talking about anesthesia, because I do anesthesia as an anesthesiologist as an MD physician anesthesiologist and we're going to talk about CRNA, which is Certified Registered Nurse and Assistant. We're going to talk about Certified Anesthesiologist Assistance, which is another anesthesia pathway, and I talked about this briefly on my Instagram and it went crazy gangbusters with all these different comments and a lot of animosity, a lot of different confusion about it. So I thought let's clear it up right, like in 30 seconds you can't create clarity, but I figure in 30 minutes can we create clarity. So, if you are here, if you are excited, if you're ready to talk anesthesia, if you've considered your career in anesthesia or you're like what are my options out there, this is a great video for you. We're going to talk about salary expectations, we're going to talk about training. We're going to talk about different practice, settings and authority and how the team dynamics work in anesthesia and what I think the job market is going to be in the future, because this is really big for you guys who are entering training or in training. You want to know, not what is it right now, but what is it going to be in the future when I get there. And so watch this video and figure out what your best career fit is in anesthesia or if anesthesia is not for you at all. So I'm going to hit the intro If you have any questions, guys, this is live action. Live right now, live. So if you have any questions, put them in the box right now and we'll get to them. If you have any comments about things that I say hey, listen, dr Pinty, give me some additional clarity about that. Or you know what? Tell me more about that, put it in the box. If you have something to get it right, then me be right, but I know I'm right, but we get it right together. You know what I'm saying? Right, right, right, right right. All right, intro, and let's get right into it. Today is the day, guys. You're going to take your future into your own hands. You're going to dominate, you're going to be successful. No excuses, Just dominate. All right, guys. Like I said, I'm Dr Pineset, I'm the pre-med productivity expert.

Speaker 1: 2:49

My website is premedproductivitycom. If you guys want to get better, if you want to level up, get over to my website, get into a course, get into a program. I'm very excited. I have a new course launching this week, all about reading. It's my radical reading routine, so I'm excited to put that out. Also, have a podcast that hits on all of your podcast networks, and today we're talking about anesthesia careers, as you guys go into medicine and anesthesia is funny because I feel and again I'm biased, maybe because I'm an anesthesiologist but anesthesia is an extremely important specialty.

Speaker 1: 3:24

What anesthesiologists do is critical. It is a critical care specialty. It is critical to excellent patient outcomes and to safety. But so few people know what anesthesiologists do. And it's hilarious because, as an anesthesiologist, pre-meds don't know what it is, medical students don't really know what it is. Even the surgeons I work with don't fully grasp what I do and the complexities of what I do, because, as an anesthesiologist, I'm a smooth playa type. We make it look smooth. That's our job as anesthesiologists to make it look like we ain't doing nothing, like we're doing the crossword puzzle or whatever. And so, because it's our job to remain calm, you guys think we ain't doing nothing.

Speaker 1: 4:02

So let's start with what is anesthesia. Let's get clarity on what anesthesia actually is. And anesthesia, if I were to kind of make it simple, is that throughout your life you will experience a trauma, you will have to undergo a surgery. There'll be some moment in your life where what you're about to go through, or what you're going through, exceeds what the mind can tolerate in terms of pain, in terms of anguish, in terms of distress, all these things, there's going to be some point. Whether it's trauma, you're coming in oh my gosh, my leg's been chopped off, ah, help me right. Or you're scheduled for a surgery. We're going to crack your chest open and work on your heart. You could imagine that wouldn't be pleasurable for you to experience and for you to feel.

Speaker 1: 4:51

And so, as an anesthesiologist, it's my job to get patients through difficult, uncomfortable procedures or experiences, and to do so in a way that they don't remember what happened and in a way that they don't care, they're not traumatized by what happened and that they're not pained by what's happened, right? So when I crack your chest open, you're like oh, I don't remember the crack of my chest open. I pained by what's happened, right? So when I crack your chest open, you're like oh, I don't remember the crack of my chest open, I just remember being fine after my heart being fixed. That's my job, and so I administer medications to put you into a state where you don't stress, you don't have duress, you don't care, you're unaware of what's happening and you are not in pain. So you are pain-free throughout the procedure and, like I said, we give medications.

Speaker 1: 5:25

This is one of the big things that is missed. I was watching Grey's Anatomy with my wife. Now, as a physician, I can't even watch the show because there's so much disrespect towards the anesthesiologist, because the surgical interns do everything we're giving medications, we're doing whatever and that's not the case, guys, the anesthesiologist, we are the only physicians who give medications on a regular basis, and so it's an intersection of the pharmacology, of the physiology, of the pathology. It's the intersection of the medicine, of the patients, of the surgery side, of the surgeons, and all these things coming together. But you get to give medications and see that instant impact of what happens in your medication. So it's an awesome, awesome field.

Speaker 1: 6:01

As we talk about anesthesia and the complexities of it, this is so important, guys, as an anesthesiologist I mentioned, it's an intersection of a lot of things. I have to create an environment for a surgery where the surgeon can do his job or her job at the highest of levels. So they're going to want the patient to be still, they're going to want all these things to happen so they can do their surgery. It's my job to put them in position to be successful and at the same time I have to do that. I have to balance all the patient's medical history and what they come into. So I have what is the patient's background, the medical side, and then I have the surgical side of what they want to accomplish, and then I have to bring together these two things with my anesthesia and make them life-sustaining. So I have to be compatible with the patient's medical history and give the surgical conditions. And this can be very challenging because oftentimes patients' medical histories conflict with what the surgeon wants or what the surgeon needs to complete the surgery, and so I have to find a way. I have to be like a puzzle solver and I have to problem solve and find okay, I'm gonna do this because it gets me this, and then I sacrifice this. So you're finding this delicate balancing act between the two. Does that make sense to everybody? If you guys are with me right now we're live action, go ahead, drop a comment in the box. Let me know I'm not the only person here. Let me know that you are listening and that you are learning what anesthesiologists do.

Speaker 1: 7:23

As we talk about balancing patients' medical histories, their medications, things they're going through, we give them medications to put them in a surgical state. It's very important to understand that, as our technology advances, there are so many people who are surviving conditions, who are surviving situations that they previously never would have survived, and, as a result, the patients who make it to the operating room, who make it to the hospital, are more complex, they are sicker, they are a more difficult riddle to solve, and so, as that heightens, and then also as our technology gets better, the surgeries we do are amazing, right, things you wouldn't even thought we could do. We have robotic surgery, all these amazing things, and so everything's ratcheted up on both sides, so the complexity is super, super high, and so anesthesia has become a lot more complex as well. And because of that and this is what's going to kind of shade our discussion today is that we have to have an understanding that anesthesia is a complex specialty where you're dealing with complex environments where the variables are constantly changing. Right, if we were talking about algebra and solving a problem, anesthesia would be multivariate, right? Multivariable algebra, it'd be the highest levels. It'd be difficult calculus, where you have to solve and bring things in because there's a lot happening and because of that, right, it's very complex.

Speaker 1: 8:38

The other side of that coin is that it's a critical specialty, meaning you have to act immediately. The patient's blood pressure drops. What do I do? The patient's bleeding. What do I do? The patient becomes hypertensive. What do I do? The patient's brain is herniating on the bottom of the skull. What do I do? What is the intervention? And so you're not only dealing with complex things, but you're dealing with them in a short interval time vacuum.

Speaker 1: 8:59

Where be paying attention? You have to see what's happening and you have to quickly react to that. And react quickly because it is truly a life and death situation. Yes, because that is the case. It is absolutely imperative. You guys understand that anesthesia providers must be up to the task. This is not a specialty where you can half-ass it. You got to really be bringing it because in any moment either because you're not paying attention, you lack the vigilance that's required as a staple of anesthesiologist's vigilance and paying attention. But if you also don't have the knowledge, not only in your brain in general, but you're not so honed in that you can act quickly, people can die.

Speaker 1: 9:41

And so, if you guys liken it to your guys' journey in school, how many of you guys have taken a test where you're like man, if I just had more time I could have gotten all the answers? Oh, man, on the MCAT. If I just had more time I would get everything right. Well, anesthesia is the most expedited decision-making in healthcare because literally it's happening in the second I give a medication, this happens. I must give another medication to counteract it. Surgeon does this. Surgeon presses on the aorta. I've got to alert him. I've got to be boom, boom, boom, boom, right there in seconds. Otherwise it's a problem and it's a bad outcome. And it's not a bad outcome like oh, it's like death, it's like major morbidity, right when people are hurt and brain dead and different kinds of things happen.

Speaker 1: 10:19

So you have to be able to act from a huge base of knowledge in a complex environment and do it very, very rapidly. Because of that, it is a high stress, high pressure job. Despite how it looks from the outside, there are a lot of things we're constantly thinking about in our heads and going through. And I tell people, as anesthesiologists we get paid a lot. Make no mistake about it. Anesthesiologists is a high paying field. But the reason it's so high-paying is not because of what I do physically right, because there's physical stuff that we do. We intubate, we do access and lines, we do codes, we do all these kind of things. But what anesthesiologists are getting paid for at a high dollar figure for is for our intellect and our ability to tolerate stress Stressors that would cause other people to freak out and spaz out. We have to stay calm and collected and deliver accurately under pressure, and so because of that we're paid for our stress level, our stress tolerance and our ability to act in the crisis and act with high fidelity.

Speaker 1: 11:17

Yes, good evening Paul. Good evening D, good evening Witty, shannon. Hello Guys, can we say hi to Shannon real quick? Can everybody comment in the box say happy anniversary? It's my wife and I's wedding anniversary today. Because she loves me so much and she knows how much I love you guys she lets me come on here and live stream with you on our anniversary instead of taking her out to a nice dinner. So everyone say happy anniversary Shannon. Make her feel good because I'm clearly on here with y'all. Paul says he's glad to discuss this because they're interested in paramedic. They're a paramedic looking at AA programs. They're intrigued by the specialty, so I'm glad we can clarify it.

Speaker 1: 11:53

So the very first thing we had to do was establish what anesthesia is and understand the complexities and the difficulty and the acute nature of anesthesia. As we talk about the different types of providers, when we go into an anesthesia environment, there is the surgeon who performs the operation, the physical intervention. There's the anesthesia provider, which our job is to be like puppeteers and we maintain all the vital functions of the body, we keep them awake and we keep them comfortable throughout the procedure Sorry, keep them alive and keep them unconscious throughout the procedure. And then you have OR nursing staff and techs who help around as anesthesia providers. There are three main types. There's the MD DO anesthesiologist, so these people have gone to medical school and practice anesthesia. So that's me. There's also CRNAs, which are certified registered nurse anesthetists who have been around for over a century, and these are nurses who go through advanced training to specialize in anesthesia. And then we have the new kid on the block which is certified anesthesiologist assistant. And I say new kid on the block, but they've been around for a long time, but they're blooming recently for some things we're gonna talk about. But the CAA, the certified anesthesiologist assistant, is the third type of provider.

Speaker 1: 13:01

The big difference between these three is the education, is the salary, is the scope of practice, meaning what types of cases they can do, it's the level of independence that they have. So can they work alone? Do they work in team model? Are they sometimes alone? We'll talk about that and then, ultimately, how that affects their whole lifestyle, and then we'll talk about the career outcomes, right? So, starting with physician, anesthesiologist, md, do. So I'm a MD physician.

Speaker 1: 13:28

I went to Stanford Medical School, and so the pathway to become a physician, anesthesiologist is long, and that's the major drawback to it is that it's four years of undergrad it's the pre-med pathway, right and then it's four years of medical school either MD or DO Either one can become anesthesiologists and then you have to complete an anesthesiology residency. It's one intern year and then it's followed by three years of anesthesia focused training and then, after that residency training, there's optional fellowships, and one of the other great things about I love anesthesia y'all Can I hype anesthesia enough? If you are pre-med, think about anesthesia. It is amazing. All the fellowships in anesthesia are only one year and so it's minimal time commitment. But it allows you to have other practice options and to be in academics and so forth.

Speaker 1: 14:15

And one of the things I'll point out with this is that anesthesia residencies are no joke. They're very, very, very, very, very long hours, very intense settings and you train across the entire spectrum of anesthesia cases, from general cases, pediatric cases, ob cases, neuro cases, icu, cardiac, you name it we're across the whole spectrum of different types of anesthesia. And so because of that, when you come out of residency as a general anesthesiologist like I am you can do all sorts of cases. So I've supervised cardiac cases, I've done neuro cases, I've done OB and epidurals and all that kind of stuff. I've done PEDS. In fact, right now predominantly I do 90% pediatric cases, even though I'm a general anesthesiologist.

Speaker 1: 15:03

General anesthesiologist. And that's one of the cool things about anesthesia is that you have this huge, deep, broad base of knowledge that you can apply readily because the training is so rigorous and so you can do all these different things without a fellowship. But you can add a fellowship if you feel like you need additional training and still have that. Total training time is anywhere from 12 to 15 years. Gosh dang For me. I did four years of undergrad, I did a two-year master's, I did a year of consulting, so that's seven years. I had four years of med school, so that's 11. And then I did four years of residency, so that's 15. So I'm at that high end of training Took a long time but I'm thankful for all of it because all the experiences In terms of the scope of practice for a physician anesthesiologist, the biggest pro of being a physician anesthesiologist is the autonomy.

Speaker 1: 15:47

It is the autonomy. So if you want to work completely independently, call all the shots on your own cases, if you live to be that leader, then it's great to be a physician. You can diagnose, you pre-op, you manage cases, you do post-operative care, you do do ICU level, you do all the whole scope of procedures that anesthesiologists do, for epidurals to regional blocks, to spinals intubations, all sorts of things we do. And there's a variety of subspecialties. Like I said, we cover the whole spectrum from general to cardiac peds, neuro pain medicine, critical care. We're all the way across the spectrum.

Speaker 1: 16:27

In terms of pay, this is the other big pro of physician anesthesiologists that we get paid the most. Right, we spend the most time, we have the most serious cases and so we get paid the most. And I'll go back for a second and talk about the scope of practice and this is one of the big delineators from the other two is that when you talk about doing heart cases, complex heart cases, when you talk about doing complex OB, when you talk about doing very, very small kids. Physician anesthesiologists are the ones who do the most complicated cases. It's not debatable, it's one of the biggest separators. Okay, so even when CRNAs are working independently, they're doing ASA1, right, they're doing what we call ASA1, so healthier patients, straightforward cases, the most complex, the sickest patients, all go to physician anesthesiologists. Because why we have a deeper knowledge set? We have a deeper application set because we've had more practice, more reps, and so because of that we can manage the complex with much more fidelity and it's safe for patients. So that's the big thing.

Speaker 1: 17:28

For salary, because of all this extra expertise we have and all the difficult cases we take on, our salaries are more. According to Medscape from two years ago, the average salary range is $450,000 to $470,000. Top earners in anesthesia can earn close to a million dollars, but they're working a lot for that money, a lot of call shifts, a lot of malarkey to get to that figure, but you can make very good money half a million to a million dollars. And the job market for anesthesia is incredible. Guys. I get texts literally every single day saying hey, anesthesiologist in need, want to come work, want to come work, locum assignment I get all the time. The market is booming and the reason it's booming, like I said before, is that people are living longer and they're surviving things they didn't use to survive, and so, because of that, there's more need for surgery, more need for critical care, and so anesthesiologists are in huge demand. It's going to continue to go. As people age, people get sicker. The job market's incredible and it will continue to get incredible. So, yes, the outlook is great.

Speaker 1: 18:25

Quickly, the pros and the cons of it and you guys will see me glance down here. I took some notes, I'm trying to organize this. There's a lot of information I want to make sure I say it right, so the interweb people don't get at me but the pros of being a physician, anesthesiologist that you have the highest level autonomy, you get a diverse set of career options, and so for me this is one of the reasons that I picked anesthesia and be a physician anesthesiologist as opposed to being a CRNA is that my options? The sky is truly the limit when you are a physician, when you have that doctor in front of your name, you can work in educational settings, you can work in the ICU, you can be a leader, you can work on the healthcare side. You can work in so many different aspects, you can choose your career, and so I love the flexibility of anesthesia, both within anesthesia and outside of anesthesia. It also has huge flexibility within anesthesia, as I mentioned, because we have the whole spectrum of anesthesia provisions and cases and so forth, and it's the highest salary. You want to make big money anesthesia. As a physician you'll make the most. The cons are that it's a super long route and it's very expensive training. So you're going to have huge medical school debt potentially, especially with these loan changes that are going into effect, and it's a long pathway so you have less career years to earn and so the money kind of might be, you know, take a bigger hit and a trade-off.

Speaker 1: 19:42

There's high stress and burnout potential in all of anesthesia, but particularly for physicians because, as we'll talk about, unlike the other types of anesthesia providers, our hours are less set and this is so important. I'm not saying that all anesthesiologists physician anesthesiologists work more hours than everyone else, but at baseline all physicians we have less protection in our hours than other fields and so because of that, there's huge potential. There's huge rates of burnout and stress amongst physicians in general and it's even higher in anesthesia where you have long hours and you have stressful conditions, where you have complex patients, complex surgeries. All that adds up to lots of stress and lots of burnout. Like I said, we get paid based on our stress tolerance surgeries. All that adds up to lots of stress and lots of burnout and, like I said, we get paid based on our stress tolerance and so you get that kind of delayed potential for burnout. So watch that All right. Does that make sense for physician anesthesiologists? Do we understand what that is? And as we go through each one of these, I'm going to introduce them all and then I'm going to bring them all back together at the end and we're going to really compare them head to head. But I think it's important to go into depth on each one of these so we can walk it through and you guys can see what's happening here. If you're with me right now, like the video comment, let me know you're here with me and thank you. I appreciate y'all who are saying happy anniversary to Shannon Tay. I see you, paul. I see you. I appreciate that. Can CRNAs and AAs participate? Same fellowship programs? They can't go through physician fellowship programs but there are some additional training opportunities for CRNAs and AAs that are being made available to help them beef up their skills.

Speaker 1: 21:12

After physician anesthesiologist, next we have is the CRNA, the Certified Registered Nurse Anesthetist. This pathway follows the nursing pathway, so you'll get a bachelor's of science in nursing. You used to be able to go get associate's degrees in nursing, but it's really faded out as they pushed the bachelor's in nursing and even the master's in nursing now. So you'll go get a four-year bachelor's in nursing. Then, after they get their nursing degree, they have to go work in a critical care environment, and this is also something and this is, I think, what's interesting about this is healthcare changes and evolves because we have such a huge demand for healthcare and our supply of providers is so low and so we make concessions, we shift things and things are changing. But it used to be that nurses had to go through the ICU and get ICU experience and not just like one year. They'd get multiple years of ICU experience in order to get into nurse anesthesia programs, and that's kind of shifting and changing. So we'll see how that plays out over the next couple of years. But after that ICU experience they go on to get a doctorate in nursing practice in anesthesia. So they are DNP or DNAP, so they're a doctorate nurse in anesthesia. That takes three years, so they get three years of that training and the total training is seven to nine years. So it's a pretty substantial chunk of change because you have that time.

Speaker 1: 22:29

The other thing that a lot and this is one of the reasons people are shifting to CAA Some people are Is because much like there is in the pre-med pathway let me drink some water here real quick Much like in the pre-med pathway where there's lots of opportunities, you get caught on speed bumps where you don't get in or you need this and you got to make up this, and it can slow your journey to finishing With the nursing pathway. You have to find an ICU job, you have to right, you have to work your way into that. So a lot of times you have to work the floor first, then work in the ICU, so that delays your journey to becoming getting an anesthesia. If all you want to do is anesthesia, that can be frustrating for people and for me.

Speaker 1: 23:07

Again, one of the reasons I didn't do CRNA. I wanted the physician for the flexibility, but one of the things that I didn't like about CRNA is that I would have to work as a nurse in a hospital on a floor at the bedside, and I honestly, guys, I respect the heck out of nurses because there's a lot of things that nurses have to do and have to put up with that I can't and I won't, and so working at the bedside as a nurse is a very demanding job and that I wouldn't be interested in doing, and so the CRNA pathway for me wouldn't be worth it, because I'm like, well, I want to go work a year or two at the bedside. I don't want to do that. Additionally, I didn't enjoy ICU all that much. I see the necessity for it, I think it's great experience, but I don't enjoy the ICU and so I wouldn't want to have to go to the floor and then also go to the ICU to be able to get to anesthesia. I just want to go right to anesthesia.

Speaker 1: 23:56

The scope of practice for CRNAs and you'll hear this kind of distinguished from the CAAs, the anesthesiologist assistants is that the CRNAs over time originally used to be that CRNAs were worked underneath anesthesiologists and the physician anesthesiologists pushed CRNAs because they were like. This is amazing because we can handle some of the demands of patients by allowing CRNAs to handle some of the simpler cases while the physicians focus on the more difficult cases, and then we'll just supervise the CRNAs for these simpler cases. But over time the nurse lobbies have pushed it so that CRNAs can do independent practice, and so there's quite a few states where CRNAs don't need to be supervised by a physician and can do the anesthesia themselves, and so this is a big difference between the CAAs, where they don't have that same independence For CRNAs they have independence, and that independence is growing across the nation, much like with the physician anesthesiologist. They can administer all sorts of anesthesia, from general to regional, and some of the CRNAs I know are amazing regional technicians with their epidurals and their spinals, so they're great when they're independent. This is kind of the drawback is a lot of times in big cities you'll have physician oversight. Most of the time it's in rural locations or it's in locations that there's a need for a provider and you necessarily can't fill it with a physician anesthesiologist. You'll have CRNAs working independently.

Speaker 1: 25:23

Like I said, they practice under medical direction in some states where the physician is supervising and kind of guiding the plan, and to me this is one of the downsides of being a CRNA if you're not practicing independently is that you have to collaborate with the physician to come up with the plan and the physician ultimately has the final say on what that plan is. Because they're taking on the biggest chunk of liability in this. The average salary for CRNAs is in the $200,000 to $300,000 range, and I think that's actually an underestimate, even though that's what we're putting out here. According to the American Association of Nursing Esthetists, I think it's actually higher. Nursing esthetists are making big, big bucks and they're growing rapidly, so it's a great field to go into. And with their salaries this is one of the big things I want to point out to go into, and with their salaries this is one of the big things I want to point out. So I mentioned how, for physicians, our hours are less controlled, right For CRNAs.

Speaker 1: 26:12

One of the big reasons pay attention here why I recommend for students who are looking at anesthesia careers, I recommend CRNA over CAA in most circumstances is because of CRNAs being RNs and as an RN, you are under the protection and you are being steered by very powerful groups the nursing unions. You're being steered by the American Association of Nursing Estates, the Association of Nurses Nurses are all powerful in healthcare. Some might argue too powerful in healthcare, but nurses are very powerful in healthcare. Some might argue too powerful in healthcare, but nurses are very powerful in healthcare. When they want to move the needle, they move the needle. When nurses go on strike, they get what they want. This is what happens, and so, because of that, if you are a CRNA, you are part of the nursing family and so you will receive the protection. You'll be under the full power of those nursing lobbyists, and so I expect their jobs to only increase, their flexibility to only increase because they're protected by this, and it's the same thing with ours.

Speaker 1: 27:13

So, to give you an example, I was on faculty at University of California, san Diego, working with CRNAs, and so I was supervising CRNAs and residents and doing my own case as well, but supervising CRNAs. Crnas would have set shifts 8s, 10s, 12s, whatever and then, at that shift, if they worked a single minute more, they received either time and a half or double pay for all the hours over that, and so what would happen a lot of times is the CRNAs would be more than happy to stay and finish a case. Why? Because they're not getting one X, they're getting one and a half or two times the pay for that time. Physicians, on the other hand, when they work those same, they go over.

Speaker 1: 27:53

Let's say, I was supposed to schedule a 12-hour shift right, that's what our shifts were, as faculty was 12-hour shifts. But if I work 13 hours, I don't receive time and a half or double time. I receive my normal pay. And so because of that, if you're a CRNA who's willing to work, you could make huge sums of cash. And so I know quite a few CRNAs who have multiple, and this is kind of a you can kind of play with this stuff. This is actually why would you ever want to make less than you could? If I'm going to be at work for an hour, I want that hour to be worth as much as possible, wouldn't you? And so what CRNAs have figured out is that, instead of taking one full-time job and having a set amount of hours and anything over that being overtime, it's actually in their best interest to take multiple part-time jobs. And the reason they do that is because now we're part-time, so anything over that lower part-time limit gets them that time and a half or that double time pay. And so there's a lot of CRNAs I know who work multiple places but fewer hours at each place, instead of doing the same amount of hours at one place because they know they're going to cash in on those extra hours, those overtime hours where they're going to get time and a half or double pay. And so, again, that's that protection that these nurses have advocated for the nurses union, to get these kind of rights, to get these nursing rights For the pros of CRNA that's one of the big ones that I see, guys is that protection from those nursing groups. They have that strong union, strong advocacy.

Speaker 1: 29:19

You have the autonomy in some places. So if you want to be autonomous, you can. If you want to work with a physician in the team model, you can do that too. The salary is really high. It's shorter training than becoming a physician. The downs, like I said, you have to go through bedside nursing, you have to go through ICU experience and if you go through a CRNA process, you don't have the full range of anesthesia. So if you want to do the more complex cases, you're going to have to work with a physician. You don't have autonomy in those areas. Complex cases you're going to have to work with a physician. You don't have autonomy in those areas. The other kind of major con that I see, or sorry, the other major pro that I want to bring up about CRNA is that along the way you became an RN, and so what's cool is is, if you don't want to do anesthesia, you always have the RN to fall back on, or you can jump off the CRNA pathway and just be an RN or go a different pathway because you have that broad scope of practice. And so for nursing, nursing in general is a great career because there's all sorts of environments. You can work in the hospital, you can work in the clinic, you can work outpatient, you can be a school nurse. I have a friend who's a school nurse. She makes great money, has great flexibility, can be there with her kids, she has summers off, and so there's a lot of career flexibility in nursing where you can go different pathways, change it up depending on what the stages of your life are. So that's a huge perk of going that nursing track and being CRNA.

Speaker 1: 30:38

Did I hit CRNA enough? If you guys are still with me, like the video right now, comment, let me know. We are live action. I'm Dr Pineset. We're talking about anesthesia careers right now. We've done physician anesthesia, we've done crna and we're going to hit the certified anesthesiologist assistant next.

Speaker 1: 30:54

Let me look at some of these questions real quick to see if there's something I want to get to before the end of the video. Um, uh, can you give an example to the hours that physicians have to work? Okay, so I'll bring this this up because this is a good question and it fits in with what we're talking about. How about physicians? So when we talk about hours that physicians work in any job in healthcare, this is one of the things that people have to pay attention to. When you see high salaries in healthcare, you want to figure out how many hours they're actually working, because you can see specialties that have huge salaries, but what you don't realize is they're working 80 plus hours to get those salaries, so they're really not making more on a per hour basis For anesthesia.

Speaker 1: 31:35

One of the cool things about it is that as an anesthesiologist, you don't carry your own patients unless you're a pain specialist. So none of the patients I work on are my patients. They're actually all the surgeon's patients and I'm a consult helping them. So because of that, as an anesthesiologist, there is flexibility in the hours you can work, whether you're a physician, a CRNA or a certified anesthesiologist assistant. You can choose how many hours you want to work. There are some anesthesiologists who work per diem, meaning you work like anywhere from 12 to 30 hours and you're really flexible in those hours. Every week you can have a part-time where maybe we call it like equivalence, so maybe you're half-time equivalent, so you work a 20-hour work week and so how you fill out those 20 hours, how you fill it out, then there's full-time positions and then with all these positions, there's some positions come with a mandatory call, some come with optional calls, some come with mandatory plus optional call, and so those are like overnight shifts or weekend shifts or extra shifts, holiday shifts, and so the number of hours that someone works as any type of physician and including an anesthesiologist, it's really variable based on what you're looking for.

Speaker 1: 32:41

The problem with healthcare and the reason it's such high burnout now is that a lot of practices, a lot of hospitals, are demanding that physicians work full-time. And this is happening at a time when we're in that generation where people want to work less and live more, and so there's this budding where you have lots of people becoming physicians wanting to work part-time, and you have the groups and you have the practices and you have the hospitals pushing back saying we want you to work full-time, and so there's that big headbutt that's happening there, and so it really depends on the practice you want to be in. For me, as I mentioned, I was in academics and I actually didn't like the hours, I didn't like the lack of flexibility. As you guys know, I work with a lot of students, I do speaking events, I do coaching, I do all these kind of things, and so I wanted more flexibility in my schedule than academics could provide, and so I actually went private practice and then even that wasn't flexible enough for me and so I actually started my own group. So I have my own anesthesia group and I do all outpatient anesthesia now and that frees me up to be more available for my kids, be more available for my students and be more available in terms of being able to take time off to travel, to do speaking events and so forth. So it's really really variable and you can make your practice what you want it to be. If that answers your question, did that answer the question? All right. Robert's considering PA school right now.

Speaker 1: 34:02

Keeping up with Cece says I don't get the animosity between CRNAs and CAAs. There's enough work for everyone and people should be able to choose whatever career path best aligns with their goals, and I agree with you. But I agree with you in the sense that we all should be able to get along. But at the same time as we'll talk about let me finish this and then we'll talk about this question. This is actually a good question, but I'll tell you exactly why there's so much animosity and why the animosity will not go down. It's going to get up. It's going to get more and more heated as time goes on. I had a friend who started AA school, alex says, and then switched to go PA, and that happens too right, because careers don't work out. So that's why it's important to do videos like this, so you guys have an understanding of what it looks like on the other side.

Speaker 1: 34:45

Our last anesthesia priority to get to is the certified anesthesiologist assistant, the CAA, which a lot of people so a few people know what anesthesiologists do in general. A few people know about physician anesthesiologists and then even fewer know about CRNAs, and then even fewer know about CAAs, which is the certified anesthesiologist assistant, and depending on where you are, it might not even be an option for you because it's not available in your state. But what is a CAA? This is a position that was created to again supplement and provide additional care options and to get more care for patients in anesthesia. This career requires a bachelor's degree. Often it's a pre-med pathway, because there's lots of prerequisites for going into CAA programs, and so they'll do like the biology, the physics, all those kind of things, and then after their undergrad, their bachelor's degree, they go on to get a master's level CAA program, and these programs are anywhere from two years to three years. Most of them are in that like 24 to 30 month window, so two years to two and a half years, and then at the end of that they have to pass a certification exam, and so the total training time is much shorter for CAAs. And so this is like the big thing, the big pro.

Speaker 1: 35:57

Why people are liking the looks of CAA is that it's a very, very short, quick path to get to do anesthesia. This is great, and this is being pushed for by the ASA, which is the American Society of Anesthesiologists. Being pushed for by the asa, which is the american society of anesthesiologists, being pushed for by a lot of uh, a lot of influencers or leaders in the health care environment, because it is a short route route to quickly ramp up more anesthesia providers as anesthesia is needed, and so that's the big pro of it is that the short duration, the scope of practice and this is a big con is that they cannot practice independently currently, and so they're always working as part of a team, an anesthesia team-based model, under the supervision of a licensed physician anesthesiologist. But they have again, they can do pre-ops, they can do airway, they can do induction, um, they can do uh, regional, uh, blocks and and and the like, but they it's less common for them to do those things Um. And then they also, because they don't have the doctorate, they cannot prescribe medications, um. So right now, if you guys, oh, I want amoxicillin, I can prescribe you amoxicillin. A CAA can't do that. Their average salary is very good, especially given the short duration of training. They can make anywhere from $150,000 to $20,000. So it's a good salary, guys, for a short period of time, but they're limited to certain places underneath physician and only in certain states. However, they're going to get a good expansion in job market depending on how regulations shake out, and this is again when we talk about what we recommend.

Speaker 1: 37:31

I actually people get me a lot of flack on this when I talk about this on Instagram and maybe I didn't get into the specifics of it when I was talking about specifically. I'm not papooing CAA's ability to perform anesthesia. What I am papooing is the lack of flexibility of being a CAA, in the sense that, even though it's been around for a long time, caa is like 20 to 30 years behind CRNAs in terms of lobbying, in terms of regulation, in terms of policy, in terms of attempting to gain autonomy, and so they're still on that climb of building their specialty and building their practice out. And so, because of that their specialty and building their practice out, and so because of that, there are huge geographic limitations, autonomy limitations, and the growth is going to be kind of it's happening rapidly but it's going to potentially plateau and potentially decrease because of regulatory restrictions and because they're fighting that super strong nurse lobby. And if you guys don't believe me about how strong nurse lobbying is, should we get into that? I think it's time now, should we get into this?

Speaker 1: 38:34

So someone asked earlier why the animosity between CAAs and CRNAs. The huge animosity between CAAs and CRNAs is all political and it's all about protecting careers. Okay, and it's all about protecting careers, okay. Anesthesiologists propped up CRNAs about 30 years ago and said CRNAs, not 30 years ago, about 40 years ago, 45 years ago. Crnas are incredible, we want them, we want to be able to supervise them and they pushed how great CRNAs were and how safe CRNAs were and how amazing CRNAs were and the problem with that.

Speaker 1: 39:06

And this is again. This is again. This is yeah. Shannon said here we go. This is me speaking as myself. I stand behind everything I say. I bring to you guys the facts. My perspective is based in reality and based in facts.

Speaker 1: 39:21

A lot of times throughout the history and this is the reason healthcare is so jacked up right now is physicians have been very short-sighted and very narrow-sighted about healthcare and they were ignorant to healthcare business. They were ignorant to healthcare policy and, as a result, we're all from the physician side, from the nursing side, from the patient side, we're all suffering the consequences of physicians not keeping their eye on the ball, being too focused on the individual patient, not being focused at the population level, not being focused at the systemic level, not being focused at the policy level to really guide healthcare where it needed to go Okay. So, as I say this as a subset of that, the American Society of Anesthesiologists, the ASA, who I'm a member of because it's my society, has done a piss poor, awful, no good job of understanding the needs of anesthesia and the needs of anesthesia patients. 50 years ago-ish, roughly in that ballpark, the ASA was pushing for CRNA, crna, crna, crna, crna. Let's work with CRNAs as part of this team-based model. Crnas are incredibly safe. They're awesome. We stand by them. Blah, blah, blah to pump them up, because they were looking at it like, oh, we'll be supervising CRNAs, which will allow us to focus on complex patients and allow CRNAs to handle the simple patients under our supervision, but again, without the foresight to zoom out and say wait a minute. If we push CRNAs so hard, then the healthcare system at large is going to look at it and say wait a minute. These anesthesiologists, who are physicians, are telling us that CRNAs are incredible and we should trust them with our care, yet they cost a fraction of what a physician costs. So why wouldn't we use more CRNAs and less physicians? Because healthcare wants to stay economically viable, so we're always looking for ways that we can cut costs in healthcare, sadly, and so they were like hmm, crnas are cheaper and the anesthesiologists say that they're the same, so let's go ahead and use them.

Speaker 1: 41:31

And so CRNAs leveraged the ASA's own statements, the physician anesthesiologist statements against them, to say, listen, they're telling you we're the same, they're telling you, we're incredible, they're telling you we're super safe, let us practice in an expanded scope, independently, with autonomy, separate from them, them, and let's pay us more because we're worth more, because we're so qualified. And then, when the asa finally realized this was going to happen, they're like oh, no, no, no, no, but it's too late to put the cat back in the back, the cat back in the bag or whatever you want to call it, the rabbit back in the hat, because now you pump them up so much and they're using your own words against you, they're quoting you that now you can't stop the CRNA revolution. And so CRNAs rapidly got independent practice in a whole bunch of states. And so the ASA undermined their own physician anesthesiologists by promoting a CRNAs in hopes right, being short-sighted, in hopes of having this team-based model approach. But CRNAs outgrew the team-based model approach in their own estimates and, as a result of their powerful lobby, were able to make massive policy shifts. So there was huge animosity between. So the anesthesiologists were on the same team as CRNAs and the CRNAs wanted more independence and wanted to take over some stuff. And then so there was huge animosity between anesthesiologists and CRNAs.

Speaker 1: 42:54

Certified anesthesiologists have been around for a long, long time, but when CRNAs started beefing with the physicians and saying we're the same, we want independence, we want higher pay, the ASA, in all their wisdom, was like oh my gosh, we can't fight the nurses head up. We have to provide a cheaper alternative to hospitals that we feel we can control and won't go independent. And so the ASA switched their narrative and started being in opposition to CRNAs and started being in being pro CAAs, crnas and started being in being pro CAAs Because they're looking at it like oh, we can use the CAAs to diminish the CRNAs power, to undercut them and to maintain our autonomy as physician anesthesiologists. But my whole thing is is I think it's a terrible strategy because you're literally repeating the same thing you just did with CRNAs now with a new provider, a CAA, and so what you are doing is empowering a CAA group to then also fight for their autonomy, which is currently happening. And so the beef between CAAs and CRNAs is that CRNAs are saying, hey, now CRNAs are looking at CAAs the way physicians were looking at CRNAs. Is that CRNAs are saying, hey, now CRNAs are looking at CAAs the way physicians were looking at CRNAs. It's funny how it all happens and that we're all jockeying for market share.

Speaker 1: 44:16

This is the true, unfiltered talk. Y'all. This is not me as a physician being biased. I'm telling you the truth. Physicians, crnas and CAAs are in different levels of combat and are jockeying because it's all about protecting their own interests. Does everybody understand? This is so important. And so if you are jockeying for more pay and more independence, then it is never in your interest to call yourself inferior to any other provider who does a same or similar job. And so CRNAs want to say that they're equivalent to physician anesthesiologists Not all, but this is the narrative that we provide the same high quality care. We can do this by ourselves. That's their argument. Why? Because they want more pay and more autonomy. That's the truth. Caas are saying, hey, we're just as good and well-trained and safe as CRNAs because they want more pay, more practice, flexibility and, eventually, more autonomy. This is what's happening. It's the same thing that's happening in other specialties, where we have nurse practitioners and PAs saying they're the same as physicians. I don't know, it's not for me to comment on, but that's what's happening. And so we have to recognize this is more of a political argument and a business argument than it is an argument between people. People aren't beefing themselves.

Speaker 1: 45:50

I have no anima. I love working with CRNAs. I love CRNAs. I've never worked with a CAA. I know CAAs and I'm sure that's cool too, but all I can say is is as a physician, the true facts of it are that I have a broader, deeper knowledge base. I have repetized that knowledge base far more than any other anesthesia provider and therefore my knowledge is more top of mind. So I can action it quicker and I can action it with higher fidelity and accuracy Facts. Secondly, from that knowledge, I have longer training, more complex, more involved training than any other type of anesthesia provider Facts. So not only is my knowledge deeper and broader, not only is my clinical experience longer, but this is an important thing my clinical experience is deeper than a CRNA or a CAA Period. It's not arguable, do we understand?

Speaker 1: 47:13

As a first year resident anesthesia, I was handling airway burns. I was handling trauma, multi-gumshot, not like, oh, I'm watching, I'm handling. I'm infusing medications, I'm trying to put a line in to the leathery skin of a burn patient. I'm existing in the high humidity of the burn room. I'm existing in a trauma bay. I'm stocking that bay. I'm doing the procedure, I'm doing the intubation, I'm managing the hemodynamics, I'm giving the blood. I'm doing all these things. Blood, I'm doing all these things. Facts from year one and three years of that mess CRNAs and CAAs may do, let's just say.

Speaker 1: 47:55

Let's just say for argument's sake that CRNAs and CAAs have the same length of training, which they don't, but let's just say the complexity of cases they manage are not the same. And someone said same goes for CRNAs and AAs. They don't. I'm just telling you the facts, guys. Again, I love working with CRNAs. There are some CRNAs and this is again I'm getting in trouble for saying this, right, I'm a traitor there are some CRNAs.

Speaker 1: 48:23

I would trust with my family members over some anesthesiologists. I know Because in any careers I've always said, even with you guys, as students, as pre-meds, how good you are as a student, how good you are in your career, it's all dependent on you, because our standards for what we think is acceptable in this world is very mediocre. I am an incredible success and I continue to succeed because my standard for myself is so much higher than the bare minimum and, as a result, I rise to the top. And this can happen in all fields, with physician anesthesiologists, crnas and CAAs, but at the pinnacle, a physician anesthesiologist is just simply more trained and better trained than a CRNA or CAA. Facts with that being said, is there a place for CRNAs and CAAs in healthcare? Absolutely, absolutely, absolutely, absolutely, because not all cases are super complex. At the same time, I think it's very important that we recognize that the reason people think anesthesiologists don't do anything, that the reason people think anesthesiologists don't do anything. So this is again this must be a CRNA in the box. I'll pull it up so we can all see it.

Speaker 1: 49:49

So you think the breadth of CRNA knowledge base is the same as a CAA? I in no way, shape or form, said that. What did I say, chase? I said that my knowledge base, that my breadth and depth of my knowledge base, far exceeds CRNA, caa. That's what I said. I'm not comparing CRNA and CAA, training and knowledge and whatever, because it's too complicated and you can argue that, but you cannot ever be legitimate and argue that a CRNA or a CAA is the same as a physician. And so, chase, I wouldn't insult anybody by saying, oh, a CRNA is so much better trained than a CAA, and I wouldn't insult anybody a CAA is so much better trained than a CRNA. That's debatable, you know what I mean.

Speaker 1: 50:37

I think that that's debatable because you can argue well, how much is the nursing training relevant to the anesthesia? How much is the ICU relevant to the anesthesia? Okay, what happens in a CAA program versus a CRNA program? What's the difference in the programs and the criteria and what they actually did? Was it all VR simulation? Was it actual real world simulation? How much of the program was simulation versus cases? How much was actively managing cases versus participating in cases? How much was independent management versus co-management? And on and on, and on, and on and on. So that becomes very sticky.

Speaker 1: 51:09

And so to debate CRNA versus CAA in terms of proficiency and competency is very hard and we can't come to, at least in my again in my educated perspective. It would be very hard to make the argument one way or the other way, that a CRNA or a CAA is any better in a routine anesthesia case. I don't know If I were to, I mean have to take a stance on it. If I had to, you know, put my back against the wall. I would say that, as a CRNA, having the time spending time with patients on the floor who are sick, spending time in the ICU with patients who are very, very sick, even if you're just taking orders from a physician, whatever the ICU with patients who are very, very sick, even if you're just taking orders from a physician, whatever the assessment is huge. And this is so important. I tell all my residents when I'm training anesthesia residents. I tell all medical students I say a monkey could give medication. Right, the AI could give a medication.

Speaker 1: 52:14

What makes a qualified anesthesia provider and what makes a high-level anesthetic is the vigilance to assess and understand what happens after you give that medication. This is so important Additionally, exactly important. Additionally exactly. People hype in my comments. I do it in 50 minutes. I try to do 30 minutes. It's my anniversary, y'all. My wife is outside the door right now waiting for me to do something. Romanticals, and here I am yelling on here with you guys. So if you were on here, like I said earlier, take a second, say happy anniversary to my wife, okay, and like this video and let me know I'm on here for a reason. Let me know you guys are learning something and you appreciate me talking to you guys, so it's so important I just talked about I was getting into this. Let me get back into my mix for a second here. Anybody can give medications.

Speaker 1: 53:18

What a true anesthesia provider needs to be able to do is assess what is happening in a situation and the degree of how it's happening. How low is the blood pressure? How rapidly is that blood pressure dropping? What's the cause of that blood pressure drop? Is it going to correct itself? Do I have to correct it? How much do I correct it? How long will it last? What else is happening? All these things? I have to look at all those variables and I have to give a medication. How much medication? How fast? How rapidly? Which of the many medications that do very similar things, that have small degrees of variance? Then, once I give that medication, I must continue to pay attention and look at what's happening from the pharmacology I just administered. What is happening to the physiology? How am I changing the pathophysiology? What is going on? So we have to be able to assess, and this is where I feel like having ICU time as a nurse is hugely valuable because you're in these ICU rooms with these very sick patients, seeing, hearing, experiencing, watching, observing what these pathologies look like, feel like.

Speaker 1: 54:30

And I can tell you guys, as someone who has run simulations, who has participated in many, many, many, many simulations I always leave simulations thinking this sucks. As an educator, I see the value of simulation, but a simulation even the best simulators have a very difficult time emulating what it's actually like in the moment, even something as simple this is something a lot of people have experienced a mannequin, a dummy that you're intubating or doing a line on. It's entirely different when you're doing chest compressions on a dummy than doing chest compressions on a real human being. It's entirely different getting an airway on a human being than it is getting on a dummy. It's entirely different. So it's so important that we understand that simulation ain't the same as managing real cases. And I'll give you guys a practical example.

Speaker 1: 55:24

I live in San Diego and I do outpatient anesthesia, including dental anesthesia, and there's a thing called a dental. They call themselves dental anesthesiologists. I call them dentist anesthetists because really what they are is they're dentists who've gone through dental school and they do anesthesia training and then they're supposed to be able to manage anesthesia cases. It's crazy to me. And so one of these dentists anesthetists, whatever you want to call them killed a kid recently, like a month ago, about a mile from where I work. This same guy almost killed a guy like six years ago, and he did it because it's the perfect example. This guy did dental school and then did an anesthesia residency, a dental anesthesia residency where he did three years of anesthesia training. But I bet you and I know this because I have worked with dental anesthesia residency, where he did three years of anesthesia training. But I bet you and I know this because I have worked with dental anesthesia residents we treat them like medical students.

Speaker 1: 56:27

Yeah, come in, do an airway. Yeah, come in. This is what we're doing. I'm talking through it. Okay, now you just leave, like, get out of here. They don't know how to manage these cases. I'm gonna be honest with y'all. It's the truth. These dental anesthetists, it ain't the same. And so they do a lot of sim-based training. And so this guy and I 'll tell you this is the perfect example. And this is again when we talk about physician versus CRNA, versus CAA. This is important to understand. Doing real cases. Managing real cases is entirely different than simulation.

Speaker 1: 57:01

This dental anesthetist, this dental anesthesiologist, had a guy and this is why you have to have the whole scope of medicine. He had a patient coming in for a massive amount of dental work. This patient was a triathlete, meaning he's in excellent shape and if you understand the medicine of that, when you're in excellent shape you have a lower heart rate. So this triathlete probably had a baseline heart rate in the 40s or 50s. Well, this dental anesthetist didn't note the preoperative heart rate Big mistake, didn't take any serious in this person's triathlete. Big mistake.

Speaker 1: 57:34

He administered the anesthesia and then looked at the vitals and noticed that this patient's heart was in the 40s, which under normal circumstances we would call bradycardic. Oh my gosh, the patient's bradycardic. I got to do something about this heart rate. But if you have an understanding of the physiology and what exercise does to you, I would assume this patient came in with a heart rate in the 40s or 50s. I would have also checked a preoperative heart rate to see where I'm at as a baseline, because it's all relative right and so when I saw that heart rate I wouldn't do anything. I would sit there and watch it. I would check what's the blood pressure, what's everything else doing.

Speaker 1: 58:07

Well, this provider saw that the heart rate was in the 40s, saw the blood pressure was subnormal, so it was low. But again, knowing anesthesia, you know that when you give anesthesia, you, but again, knowing anesthesia, you know that when you give anesthesia, you know that the blood pressure is going to get lowered. Well, this guy saw a low heart rate, low blood pressure, freaked out and gave a code dose, strength dose of epinephrine. Gave a full milligram like Pulp Fiction style full dose of epinephrine to this guy. Well, what do you guys think happened? Robber's in the box, please let me get impressors.

Speaker 1: 58:44

He freaked out, went into simulation mode oh my gosh, bradycardia with hypotension, and gave a massive amount of epinephrine and the guy's heart rate shot up to over 200 beats a minute. His blood pressure shot up to almost 300, which now he took a non-emergent situation and made it truly emergent because he overreacted. And so then what does he do? He overreacts again and gives a code dose of adenosine. And when he gives that adenosine he immediately and briskly stops the patient's heart, creates an asystolic situation. So he worsened the very thing he was trying to prevent in the beginning Goes asystolic chest compressions begin, we call 911, the guy was without a heartbeat for nine minutes, goes to the hospital, ends up having brain damage right After this event, survives but ends up having brain damage.

Speaker 1: 59:46

And it's all because this person, who received three years of anesthesia training, was predominantly simulation-based, was predominantly healthy, simple, straightforward cases, and hadn't dealt with the complexities in complex situations, in critical thinking situations what is actually happening and to what degree. Additionally, not having the medical background to understand what exercise does to your physiology and a baseline heart rate, and then not having the vigilance from knowing all this stuff is happening. This is the same guy that six years later, yes, killed this kid because what happened y'all. He wasn't paying attention.

Speaker 1: 1:00:27

And this is the scary thing about medicine. This is why I was making the point in the beginning how dangerous anesthesia is. Anesthesia is truly life and death, y'all. This ain't no like whatever. It's not like going to and it's not to talk trash on anybody, but you go to a primary care provider, nobody's dying in an outpatient clinic for a sore throat, but in anesthesia it is truly life and death. You make decisions that cause people to live or die and if you don't know what you're doing, you can kill the patient, because a patient dying in surgery is a never event. It should never happen, right? An unscheduled trauma, whatever that can happen, right? But a patient in a scheduled pre-op case, if they die, somebody's going to be in trouble, somebody not paying attention, yes, and so this is.

Speaker 1: 1:01:17

I tell this story as you guys were talking about, like, as we're talking about physicians versus caas and crnas. It's so important that our standard of practice listen to me now, it's like being a c student in school. How hard is it to get a c in high school? The standard baseline of competency is low. What I am always striving for is excellence. As pre-meds, as young students, as nursing students, as anesthesiology assistant students, it's up to you to raise your standard above the baseline and to become highly proficient, your standard above the baseline and to become highly proficient, highly knowledgeable. And there are CRNAs who are highly knowledgeable, highly proficient. There are CAAs who are highly knowledgeable, highly proficient.

Speaker 1: 1:02:09

But it's very important to understand that the baseline of a physician coming out as a physician, anesthesiologist, is so much higher than the baseline of other providers. Is that fair? Can I say that y'all Do you guys believe? Have I made my point Right? And so Chase said I heard it was from methemoglobinemia, from nitrous. That's what the report said, chase.

Speaker 1: 1:02:27

But the question becomes this is why it's so important assessment what are the signs and symptoms of methemoglobinemia? How rapidly does methemoglobinemia develop? How severe does methemoglobinemia need to be for a person to die from it? The answer is it happens rapidly, has to be very severe for them to die from it. And the signs and symptoms? One of the biggest ones is that it would affect their oxygenation. And so if you have a patient who's so severely experiencing methemoglobinemia that they're going to die, you would see low oxygen saturation. Well, you would only see low oxygen saturation if you were doing what?

Speaker 1: 1:03:09

Having a high level of vigilance and having a high level of respect for how dangerous anesthesia is. And so if you are not vigilant, you're not paying attention. What does that mean? You are negligent and you are killing a patient, and that's why I say this guy is a murderer and I will not back off that point and I'll scream it from the rooftops. You could say accident due to medium globulinemia. Oh, how could we have known? If I'm watching my pulse ox, I would know. Do you guys get what I'm saying? And I won't get into the specifics of it because I know the insides and outs of it, because I have talked to people who worked at that office. I know what went down. And I won't get into the specifics of it because it's not popular knowledge.

Speaker 1: 1:03:53

But I'm telling you guys, it's very important that your anesthesia provider has the requisite knowledge and not only knowledge but functional knowledge from experience in real life patients to be able to handle when stuff goes wrong, because 99.999999% of cases go wonderfully smooth. I'm there for the 0.00001% of the time when it's your family member on the table and you want them saved. That's the separator. Yes, all right. So as we talk about all these careers, guys, I want to get to this because this is my audience. So we're at an hour, you guys still with me. My voice, you guys can hear me. I'm raspy. I was filming this new course before I got on here, so I was filming for three hours before I got on here earlier today. So my voice is going.

Speaker 1: 1:04:41

But I want you guys to understand that when we talk about anesthesia providers physician anesthesiologists, crnas, cas are all valid providers. They all have a place in healthcare. The important thing is that we understand that the place for certain providers might be not what it need to be when it won't not to be, and that we have to make sure that the right provider is in the right practice setting and with the right patients. I firmly believe in the team care model for anesthesia. So I believe again this is just me talking to you that the physician should be the head of the stake of anesthesia and should be guiding where the anesthesia industry goes, period. I believe that CRNAs and CAAs can do some cases independently Well, patients undergoing simple procedures in environments where you don't have a physician anesthesiologist. However, I believe that, if you can, the optimal model would be to have physicians on site with every CRNA, with every CAA Maybe not direct supervision, but I think it's incredibly. It boosts the safety profile dramatically to have physician anesthesiologists available, and I say this even as an anesthesiologist.

Speaker 1: 1:06:34

I do outpatient anesthesia. When I tell people I do outpatient anesthesia, a lot of people don't want to do outpatient anesthesia because they recognize it's the wild, wild west. I'm out here by myself, right? I work today and I'm in an office. I'm the only person who's an anesthesia provider. If something goes bad, it's all on me to solve it. If I'm in a hospital. I hit the button for anesthesia code and within I'm not even exaggerating within 30 seconds I'll have three anesthesiologists in there. Within a minute I'll have 10. Within five minutes we got 20 people in the room. There's safety in that and I believe that if we want to maximize patient safety because we can always make the argument that oh yeah, these patients get through all this totally fine Nothing ever happens. All I'm saying is is I don't want even one death to happen and I believe by having physicians present, you save yourself a lot of headache.

Speaker 1: 1:07:25

And I tell people all the time like my job is to get. I don't, I don't. If I'm like a referee, think about this. If you ever watched a sporting event and you know like we just watched the NBA finals, right, if I am thinking about the referees after a sporting event, the referees have done something wrong. It's the same way for anesthesia.

Speaker 1: 1:07:45

If the anesthesia provider looks like they're doing a whole lot of stuff heroic measures and da-da-da-da-da, something's amok, because a good anesthesia provider is a forward thinker. Muck, because a good anesthesia provider is a forward thinker. We're proactive. We see danger before it happens and we avert danger. We make things super smooth. If you're in a plane. Do you want your plane going up and down? No, no, no, no, no. You want smooth sailing. That's the job of an anesthesia provider.

Speaker 1: 1:08:15

I feel like the background knowledge I have in the medicine and the physiology and all the pharmacology and all these things allows me to see all the variables much clearer from a medical standpoint, from a pre-pharm standpoint, whatever the medication the patients are on, right From the current pathology they're currently going through that requires the surgery, and then from the surgical standpoint of managing those dynamics. I feel like my training and knowledge is unmatched, and so I feel like having someone like me in the building, even if it's not direct supervision, is hugely helpful, hugely helpful. So that's my 10 cents. The last thing I want to get to I'm sorry you guys got me off track here, you got me talking about this is that for you guys, as young people, looking at careers, it's so important that you do a deep dive, you do the research, all the different careers, watching a long video like this, going even more in depth even after this video, getting well-informed from all the perspectives, listening to all the sides, not just the CAA website, not just the CRNA website, not just the physician website. Go to all the websites and then recognize that the truth is somewhere there in the middle.

Speaker 1: 1:09:24

At the same time, once you get that baseline information, start seeking experience shadowing. I had my son shadow me today. Get shadowing experience so you can see what the career is like. Don't just shadow one. Try to shadow multiple providers so you can get a different sense of how different people are and different personalities and different dynamics, different practice environments. See what fits you and when it comes to physician anesthesia versus CRNA versus CAA, they're all great careers. Don't let anyone tell you that they're not great careers.

Speaker 1: 1:09:53

But physician side is if you want huge autonomy, huge flexibility worldwide. Crna is if you want some autonomy, some supervision, broader practice in terms of states you could practice in and you like the broadness of the RN to be able to have that flexibility, nursing leadership and so forth. As a CAA it's a short, direct route. If you only want to do anesthesia and if you don't mind working with a physician, if that's you, CAA is phenomenal because it's quick, it's cheaper and it lets you do the anesthesia and I love anesthesia.

Speaker 1: 1:10:27

I got flack in my video about CRNAs. Was saying, hey, crnas, get all the pros of anesthesia without the cons. There's not a whole lot of cons to being a CRNA. There's not a whole lot of cons to being a CRNA. There's not a whole lot of pros to being a CAA, as long as you don't mind having a physician like me working with you. So if you don't mind having extra mind power, having extra hands with you, caa is a great career. Y'all Great career, streamlined, all that good stuff. So I hope this kind of opened some eyes, maybe opened some perspectives, opened a dialogue, a healthy dialogue about anesthesia, and I hope to do more of these. There's a specialty you guys want to talk about, we can get into it and break it down. If there's other topics you guys want to talk about.

Speaker 1: 1:11:11

I know I've been kind of absentee on YouTube. I've been coaching students. Right now I'm in application season so I'm up to my freaking eyeballs in applications and personal statements and reviews and all that kind of stuff, and so I've been very busy. But I'm going to try to be on YouTube more and I only come on here. Guys, someone said earlier I'm trying to game the algorithm when I was talking about CRNAs. Guys, I don't need to game no algorithm y'all.

Speaker 1: 1:11:32

I've been on social media for 10 years. I've been working with students for over 20 years. I don't give no flips about my social media following. It's why I'm not the biggest, I'm not a million. I don't care about that, it doesn't matter to me. I don't care about followers. I'm trying to create leaders, I'm trying to impact people's futures, trying to empower people, and so I only come on here to empower you guys.

Speaker 1: 1:11:51

So if you could, if you would like, if you want me to be on here, more comment, would like, if you want me to be on here, more comment, let me know. Say Dr Pines, man, we've been missing you, we need you. Please come back on here, please talk about this topic, please talk about that topic, because we can do it and we can get educated, we can get informed and we can do it in a positive way. I hope that you guys saw I'm not negative on anything, but sometimes there is some negativity. That's required. We have to be clear on facts sometimes. Sometimes we do have to. Sometimes something is less, sometimes it's more, and we have to be honest about that and that's okay. Yes, so put your comments in the box and I'll get on here and I'll give you guys a word and a message.

Speaker 1: 1:12:25

But if you've enjoyed this video, take a second, like the video, subscribe, turn on notifications and if you guys want to work with me, if you like hanging out with me, we do live coaching every single week inside my programs. Get to my website, premedprojectivitycom, get into a course, get into a program, get it going. I'm very frequently in the box. The description is below. On YouTube You'll see. I put discount links down there. Get a discount, get in. If you don't see a discount link, you want one, email me. It's Andre A-N-D-R-E at premedprojectivitycom because, again, I'm here to empower students, I'm here to push forward, I'm here to educate, I'm here to make this world so much better, y'all, and that's what it's about. I'm on a mission, so I appreciate y'all hanging out with me being part of this mission and I hope that we can get at it again soon. Everyone, have a great and wonderful and fantastic day y'all Later. That's it for another episode of the Premed Productivity Podcast. Show your love by smashing the like button and commenting in the box below.

Speaker 1: 1:13:20

Today is the day, guys. No more excuses, no more complaining. You're going to take your future into your own hands. You're going to dominate. You're going to be successful. I challenge you what are you going to do today to make your life better? Get to my website, premedproductivitycom, grab a free ebook, sign up for a free webinar and, if you're really ready to transform, enroll in one of my life-changing courses or coaching programs. You have greatness inside you. Let me show you how to unlock it so you can dominate and make your dreams a reality. No excuses, just dominate.