Careers in Nursing and as an Anesthesiology Assistant

Transcription AA

Dr. Llalando Austin

Before we get started I want to tell you guys that I love an interactive audience ok so if I pose

questions to you feel free to raise your hands or provide feedback. I want to start by asking you

guys how many of you know or can tell me what the job description of an anesthesiologist

entails? Anyone in the audience? Usually the people in the front are the ones that are all over it

and the ones in the back are like I’m here for a reason. Well how about this gentleman back

here? Ok. Alright. Loosely. I’d say that I agree with you 100% but yes an anesthesiologist is

basically a physical. These are people that have gone to medical school, whether it is allopathic

or osteopathic in nature. The went to school for four years. Went further to complete their

residency in anesthesia to be licensed as anesthesiologists. By a raise of hands in here how many

of you have hear of a Certified Nurses Anesthetists, or a CRNA? Alright that’s most of you guys

I’d say, maybe about 50% of the class. Now here’s a big question, how many of you have heard

of an Anesthesiologist Assistant or an AA? Much greater than I anticipated. And we’ll get into

the difference between those three as we move forward but I want to start and open with

basically a little video for you guys.

VIDEO (2:14)

My toes are cold why can I feel them? When does the anesthesia kick in? Wait! Wait a minute!

That burns. Why am I feeling this? Check that out…omg what are you doing? Stop please! I can

feel that! This must have been done with a serrated knife. Stop please! The carver never used a

serrated knife before did he? Doesn’t he like precision? I told you she did this to herself. It looks

like she used a grapefruit knife. Who cares what it was, shit head?! Stop! I can feel it! I can feel

the pain! I can’t take it anymore. Stop please!

END VIDEO (4:15)

Alright. So an episode here of Nip/Tuck. How many of you can maybe point out some

things that you saw in this video just now. Anything you noticed-good or bad? Ok good. The

physicians or whomever these individuals were. Anything else? So this is an example clearly of

something that happens in anesthesia but it happens very infrequently…and that is awareness

under anesthesia. What you learn in a program such as this one is how to effectively manage

your patients in a perioperative environment alright?

Slide 1 [05:21]

So as we mentioned before there are three recognized anesthesia care providers and these

three anesthesia care providers are recognized by CMS for reimbursement purposes and also by

the federal government. The anesthesiologist was the first one I mentioned that individual who

had completed medical school and moved on to complete their residency. Anesthesiology

Assistant, however, which is this specific program, is an individual who has completed an

undergraduate degree, much like you all are doing right now, in some discipline. Now that

discipline doesn’t have to be any specified discipline. However, these individuals do need to go

back and complete the pre-med course work if they have not already done so. And what pre-med

course work am I speaking of? The same coursework that would be required to get into medical

school. So your chemistries, biologies, we’ll get into these as we move forward. And after you

meet the admissions requirements of getting an undergraduate degree, completing the pre-med

coursework, you then go on to anesthesia school which is approximately twenty-seven months of

duration depending on what school you attend. Nurse Anethetists, or Certified Registered Nurse

Anesthetist, I don’t’ know if that’s going to be a test question or not, hopefully if there’s a test

question it will be about AA specifically, CRNA on the contrast is an individual that has a

Bachelor of Science in Nursing, goes on to work in the field of nursing in critical care or at least

one year of critical care experience prior to applying to anesthesia school which is specific to

those individuals that have degrees. Same amount of duration, it’s about 27 or 28 months. Some

as high as 30 months or so but approximately the same. If at any point in time even during the

presentation feel free to ask away.

Slide 2 [07:26]

So an anesthesiologist, or you’ll hear the term ‘anesthesia care team’ and this team is a

model that we follow which basically means that to work in the anesthesia care team model,

there are all three of those anesthesia care providers that you just learned of, so an

anesthesiologist typically does the supervising. They’re usually supervising CRNAs or AA at

about 4 at a time. So you can see how this is a cost-effective practice, right? The cost that it

would take to hire one single anesthesiologist who can only work in one room at a time, for that

equivalent cost you can likely hire at least three CRNAs or AA which can obviously cover three

times the rooms.

Slide 3 [08:20]

But we work under the direction of the Anesthesiologist, meaning he’s our supervisor.

And I guarantee you if any of you guys have already or if you will, and hopefully you won’t, but

if you’re having some sort of surgical procedure or have, more than likely, I’d probably say

there’s about a 90% chance that your anesthesia was provided by a CRNA or an AA. Because

again, like I said, Anesthesiologists do mostly supervisory type work. Programs such as this one

will train you extensively in all things in the peri-operative realm inclusive of effective and

adequate monitoring of a patient during surgery. Well that face looks familiar. This is from an

older brochure, I don't know it looks like somebody knows what they’re doing maybe. But

currently there are a total of ten AA programs. Ten schools that have AA programs. Now I’ll tell

you that the AA concept originally began in the late 60’s and from that point until 2006, there

were only three schools. Since 2006 when Nova brought…err..the concept of a program at Nova.

From 2006 to today, an eight year span, there has been a 200% increase of growth in AA

programs. So currently there are ten AA schools. There are two that affiliated with the school

that I’m speaking to you from. Nova Southeastern University has their main campus in Ft.

Lauderdale and also where our original AA program was established. Then we also have this

program which is actually located in the Brandon/Tampa area. So there’s only two schools in

Florida, lucky for you there’s one that’s pretty much in your backyard. We have one school in

Connecticut, we have a school at the University of Colorado, there are two schools in Georgia;

Emory and South, there is one school in Missouri-University of Missouri Kansas City and a few

others. All ten of these schools are CAAHEP accredited programs and also accredited by a

subset of CAAHEP, which is the ARCAA or the Accreditation Review Committee for AA

programs. So our roles as anesthesia care providers is basically to manage a patient

perioperatively, which is surrounding the operative environment, perioperatively. So we will

obviously monitor patients preoperatively, entraoperatively, and postoperatively. Now I pose a

question to you or multiple questions. Anyone tell me maybe what an anesthesia care provider or

an AA do in a preoperative realm? One back here-I love the back. Ok absolutely. We want to

assess when the patient last had something to eat. Do you know why that may be important? No?

Ok absolutely…anything in the stomach can obviously come out of the stomach and there are a

number of reasons why that may happen. There was one comment back here as well. Say that

again? Mmkay. So we definitely in the preop environment we will assess multiple things that

will delineate exactly how much anesthesia we can give to a patient. So we want to know the

patient’s height, weight, how sick they are, how healthy they are, to know if they have any

allergies, which would obviously forbid us from using certain types of drugs and anesthetics. The

patient has an IV placed usually we conduct the preop interview which gives us all of this

information. Alright. Anyone have any idea of what we would di intra operatively? Which is

during the procedure? This side of the room? Ok so you’re monitoring the amount of anesthesia

a patient is receiving and you’re also monitoring a number of other things. Vital signs tells us

everything we need to know about the patient. And I think you had a comment. Same thing.

Right. Very good. And there’s a number of things obviously that can point us in the direction of

whether that patient is having some discomfort or not. Postoperatively. What we do as anesthesia

care providers post-operatively, after surgery. Pain management is a big one. So yes the residual

anesthetic, whatever it may be, needs to be eliminated from their system via some means. And

this depends on how we give it to them. If we give them an IV drip, then it just has to be

redistributed. If they get it in a gas, then we eliminate it the same way we gave it to them via

them breathing it in they need to expire it out. And that is approximated by many things. For

instance, that individuals’ respiratory rate. So you guys seem to have a pretty good understanding

so far of what things would be expected in these various phases. Now the intraoperative phases

has three phases itself. There is induction, there is maintenance and there is emergence. And this

usually you’ll hear some people describe this as like flying a plane. So there’s a takeoff where

it’s a lot of busy work, usually. And then when you reach altitude, or the maintenance phase, and

if everything goes well we do absolutely well….we do minimal to our patients. We monitor our

patients and if you’re perfect we’re on cruise control. Then there’s the landing for us, which is

emergence, or waking the patient up from anesthesia. And much of our titration and control of

many of the things we use in anesthesia, you will really see requires art. Similar art that you

would expect to see while flying a plane

Slide 4 Video Two [02:37]

So where do we work? As AAs we can work basically anywhere in the hospital. Anywhere and

everywhere. And you’ll find that this is one fo the areas in anesthesia that I feel that is maybe

one of my preferred options or areas is that I can come in to work, do pediatrics one day I can do

cardiac case one day, neurosurgery another day…and even if you work in the same area of

anesthesia or surgery, no two patients are alike. So that, in and of itself, mandates, you treat each

patient with their own individual considerations. So that is one of the benefits and things that I

loe so much about my job is that there’s so much variety. It’s not like a call center, it’s not like I

can establish a routine of everything I’m going to do with my day because that can easily be

thrown off by one or two different things. Areas that we can work in: general surgery, pediatrics.

General surgery is going to be like if a patient comes in to have their gallbladder or appendix

removed or any type of laparoscopy or something of that nature. Pediatrics are kids. Anything 18

and under is a kid. SO some of them are really big. Obstetrics and Gynecology, you can also

work in open heart surgical procedures, ENT procedures which is otolaryngology, and

neurosurgery which would be inclusive of spine procedures and anything to do with the brain or

skull for various reasons, maybe tumor, bleeding, further, we can work in orthopedics which is a

very popular area of anesthesia because you get to do a lot of different things. Not only do you

get to provide general anesthesia, which is what you guys generally think of when you think

about anesthesia: put the patient to sleep, wake the patient up, and take them to recovery. But in

this area, you can also do peripheral nerve blocks which is just numbing one extremity or

specified body parts. We can do epidurals, we can do spinals. All of that would be taught in a

program like this one. And actually for the past three weeks we’ve been teaching our current first

year students neuraxial anesthesia which are epidurals and spinals and they’ve already gone into

clinical rotation and had the opportunity to do them so they’re leaning very quickly. General

ophthalmology are your general eye procedures, vascular surgery, thoracic surgery. I love

thoracic surgery and after I finished anesthesia school this was pretty much my specialty.

Thoracic and neuro surgery. Which I like is because there was this ability for us to use this

specific airway adjunct which allowed us to ventilate only one lung while not ventilating the

other so that the surgeon can work on the lung that we’re not ventilating and we can still breathe

for the patient with one lung so this is very exciting stuff. Transplants, trauma, you name it.

Pretty much anything that comes into the ER, at some point, if it’s severe enough, probably will

be required to come to the operating room. OK if it’s a car accident, or someone’s shot or

someone’s stabbed or any of these things

Slide 5 VIDEO TWO [06:13]

So as I mentioned before the requirements for our program are that tyou have a

bachelor’s degree. And this bachelor’s degree is not a specified concentration as I mentioned. It

can be in anything. Food Science. Engineering. Biology…any of these things. However,

regardless of your undergraduate degree, you need the necessary pre-med prereqs. And here they

all are. These are our required pre-reqs, but in additional to the required prereqs, we have

recommended. GRE, well if you’ve been on top of it you’ll know that the formatting for the

grading of the GRE has changed, so therefore you need an approximate score of 310-somewhere

in there is going to be a competitive score or you can take the MCAT. Either one of these exams

you definitely have to take. Oftentimes I get the question of which one should I take? Well that’s

an easy question-if you have a remote interest in going to medical school, take the MCAT. If you

do not, then I would spare myself all the stress and I would take the GRE.

Slide 6 VIDEO TWO [07:43]

You’ll find that all of their varied backgrounds. These are usually or typically the most

popular degrees of people that apply to our program have. And the reason is that many

individuals that apply to our programs were those that maybe at one time considered anesthesia

school and then they kind of looked at things and said you know status of healthcare today and

eight years of school and who knows how much debt and twenty-seven months and you

know…salaries as they are I think it’s a better choice to go to anesthesia school. Me it was

exactly the same. I had no knowledge of what an AA was and I worked in health care and I was a

respiratory therapist. I worked at the time at University Community Hospital right up the street,

now it’s Florida Hospital Tampa and I still work there I just work in Anesthesia. But you know I

was working and getting ready to apply to medical school and completed all of my prerequisites

and then a fellow RT who I was working with came past this information that there was some

new program in Florida, I’m going to check it out-why don’t you do the same thing? So I did and

the minute that this was offered to me, I decided that I wasn’t even going to fill out an

application to medical school. I’m going to do this. So you can see many individuals have that

same sort of entry to the AA profession. Sometimes we receive individuals or applicants that

have some sort of clinical or healthcare experience. Is it required? No. But I’m going to tell you

right now that the current class of first year students that we have, none of them have clinical

experience. They’re a relatively young group, most of them right out of undergrad. If you

contrast them to maybe the class that I was in when the program at NSU was established I’d say

about 40% of us had healthcare experience. Three of us were Respiratory Therapists, we had a

physical therapist, physician assistant, nurse practitioner, we had a guy that went to medical

school but didn’t complete his anesthesia residency in the allotted time, we had some other

individuals with healthcare experience as well. So these are just some of the healthcare clinical

work that you will see that maybe some of our students will present with.

Slide 8VIDEO TWO [10:12]

Now our curriculum and our program itself is a 27 month program which basically broken into

largely two units. The first year where you’re learning most of your didactic, very little clinical.

Second year is where there is heavy emphasis on clinical training and almost no didactic training

at that point. In the second year students are on clinical rotations 40-50 hours per week learning

various ways of practicing different types of anesthesia. This is just an example of one semester.

I like the sigh. The timing was impeccable. This is just an example of one semester. This being

the second semester. So we admit students annual and we admit them so they start the end of

May or the beginning of June and they run for twenty-seven consecutive months. Semester two

starts in September. All the courses you see in the darker writing is basically what you’d see as a

first year students. So for any student that started in June and this is thei second semester. They

would be taking these courses, the darker courses. Now I put other courses up here, the lighter

ones, like Anesthesia 3 because you’ll see that our second year students are in full time clinical

rotations and you can see the difference in the load there. Now I will tell you again, these

studnets are doing 40-50 hours a week with clinical rotations and when they come out they’re

really sharp anesthesia care providers. So anesthesia lab this is basically where we expose our

studnets to a siginicant amount of high fidelity simulation training. As Dr. Cooperman had

mentioned, if you came to our actualy campus, you will find that we heavily utilized high fidelity

simulation training. Now who knows what high fidelity means? Someone knows. This guy?

Very precise. That’s a very good definition, gery accurate too. So I’d so that basically it’s

representative of simulation materials that very, very closely mimic what would be expected in a

real situation. So these simulation mannequins breath, they blink, talk, scream, cry, they respond

to the anesthesia drugs that we give exactly as you would expect to see in a real patient. Very,

very interesting to see. And I think the first time you see it it might be a little shocking especially

considering we have a pediatric mannequin too and he looks a little scary but he does all the

same thing. He responds exactly as a kid would that you’d provide anesthesia for that kid. So

anesthesia lab is where we’re learning all of these things. We use a lot of high-fidelity

simulation. We also utilize a lot of task trainers. Or things specific for a certain type of airway, or

not airway, but anesthesia process. Applied physiology for anesthesia practice is very close to the

physiology that you guys might take like if you’re taking it in a combination with anatomy and

physiology. It’s physiology but it’s set to the specific practice of anesthesia so how would we

apply that in anesthesia. Pharmacology for anesthesia practice is an example of a course in which

you learn all of the drugs. And there are a ton of drugs to use in anesthesia. We’re probably the

specialty that utilizes the most varied application of drugs. So for instance we’re the only

specialty that utilizes the volatile agents, or the inhalations, or the gases that we use to keep you

asleep. And then then there’s that we use to render one unconscious that we call induction

agents, there’s muscle relaxants which obviously paralyze a patient, there’s narcotics an

obviously analgesics and multiple types of drugs, classes of drugs and things you use in that

course. Principles of instrumentation and monitoring will be a course in which you learn about

an anesthesia machine, you learn about various monitors that we utilize to monitor the patient

perioperatively. Principles of Airway Management is one of the courses that I teach and this is

basically the bread and butter of the anesthesia care provider. We’re considered airway experts

and this is where you learn how to asses one’s airway and how to place airway adjuncts. For

instance that one device I mentioned about isolating one lung and breathing independently of

each other, this is the course where you learn that. Intubation, which is the process of passing an

endotracheal tube into one’s trachea. Writing for medical publication, we’re the only anesthesia

AA program that offers these writing courses. And we do that because we don’t’ just like to

prepare competent anesthesia care providers, but we like to prepare leaders and so therefore we

like to apply that knowledge and ability to publish documents, poster presentations, speaking,

lectures, and things like that. And finally Principles of Life Support which is something that

occurs in the semester it’s where you’re going to take your basic cardiac life support, advanced

cardiac life support and also your pediatric advanced life support as well. You can tell this

semester is intense because it took about ten minutes for me to speak off of that one slide.

Slide 9 VIDEO THREE [00:00] Clinical rotations, you know I mentioned that in the first semester there’s no clinical rotations.

First semester, you’re inundated with high-fidelity simulation training in the lab. Second

semester, the same thing maybe just a little bit of growth. You grow from semester one to

semester two. Again, this is going to occur in the lab. And semester three is where you being to

have some clinical training. And we easer our students into clinical. Maybe about two to three

days per week so they can make that adjustment affectively. So the first year you can anticipate

that at minimum you will get about 300 clinical hours. Most of our students have about 350 or

so, first year. IN the second year, full time clinical rotations, but the minimum is at 1700 hours.

Most of our students probably do 1900-2000 hours in that second year. And if you combine the

two there’s a minimum of 2000 hours that you need to successfully finish and none of our

studnets have any issues with that. And in the lab there are about 382 hours of laboratory

teaching as well. So if you did attend our campus, and I would recommend that you did. First,

you may see myself or one of my faculty members. You may see this gentleman here, Mr. Eric

DeRise. But another thing that you’d see is both of our fully functional operating rooms that we

have. So if you’ve gone into an operating room or if you’ve done some shadowing in an

operating room you kind of get a layout of the land, and what you’ll find on our campus is very

very close to what you would expect to see in a real operating room. So surgical lights,

everyone’s wearing the attire, the blue, the masks, and everything of that nature, we have a

patient on an OR table we have an anesthesia machine which is always on the anesthetists right,

we have an anesthesia cart which is always behind the anesthetist which is where you would

obtain all of your drugs and tools and things you would need in anesthesia.

Slide 10 VIDEO THREE [02:28]

We are the largest on the east coast. Largest of any AA program as far as our functioning

operating rooms. We also have a designated pre-ope and post-op area. So this is where we’d

learn those things in a pre-op interview and managing a patient after surgery as well. Where we

would do that is our pre-op or PACU, and modified ICU

Slide 11 VIDEO THREE [03:08]

First on our campus, you’ll see that we have, Nova Southeastern University has a total of

five adults, 2 pediatric, and two infant high fidelity simulation mannequins. On our campus we

have two adults, one pediatric, and one infant. So on the main campus they have approximately

the same equipment that we do. That right there is just a picture of the pediatric. He actually

doesn’t look that scary right there.

Slide 12 VIDEO THREE [03:38]

So how much can one expect to make completeing a program such as this one. Getting out

there…you’re first job, how much can you expect to make. Well pretty much in anesthesia

wherever you work, you’re going to make a significantly large amount of money which should

be considered, but not the heaviest consideration. Salries range foerm about 120,000 to about

180,000 or so but you will find that on average coming right out of school you can expect to

make anywhere from 120,000-160,000 starting out. Alright? As a starting salary. In addition to

that you expect a lot of flexibility in your schedule. You can see why this becomes a little more

favorable than medical school. You’re going to have a high salary and then you’re going to have

lucury in the flexibility of your schedule. You don’t have to take calls is you don’t want to. If

you want extra money you can work and take calls and things like that. You can work ten hour

shifts, eight hour shifts, whatever. I’ll tell you when I graduated, the year that I finished. I

worked over at the hospital in Clearwater at Morton-Plant, and I worked three 13.5 hour shifts.

So I worked three days and I was off, that was it. I worked 40. 5 hours per week making these

types of salaries. If you wanted to you could work an entire separate job if you wanted to to

supplement that. SO very important points. Right now I’m the director of the anesthesia program

in Tampa, so limited clinical ability, but I still do work clinically. But basically I’m an

independent contract with the hospitals. SO I make my own hours and my own schedule. I work

when I feel like going in to the hospital. Average job offers that you can expect to have right out

of school are largery going to be depend on your clinical abilities. When you’re on that second

year and you’re completing you’re clinical rotations, that’s where these anesthesia groups are

looking at you to see if you’d be a good fit with their group ad also a good opportunity for you to

see if you want to work for that hospital or that anesthesia group. But approximately three to four

offers right out of school. So no problems getting a job, and when you get a job there’s definetly

going to be a pretty satisfying salary to accompany that. Currently, all of our students that

graduate from our program they all get jobs. A really, really solid point to consider for our

program is that as licensed practitioners you have to take that board exam and you have to retake

that board exam every six years. That face was priceless! So actually I have to take my

recertification exam this year in June, so I’ve been preparing for that. But we have 100% first

time pass rate. The first time our students take the exam, 100% of them pass. Last year-100%.

The year before that-100%. This year, our students haven’t taken their exam yet they take it in

June. But with the tools we utilize and the practices we use to prepare them, I anticipate that

100% will pass, which basically means you’re going to pass your certification exams, you’re

going to get a job, and you’re going to get paid well. Ok well Anesthesiologist Assistant’s

currently work currently in 18 states. And we work in these states either by delegatory authority

which is under the license of the supervising anesthesiologist, or by regulatory authority which is

by licensure. In Florida you have to have a license from the board of medicine to practice. So

therefore it depends on where you’re transitioning to or moving to…you may have to apply for a

separate license if you move to Georgia for instance.

Slide 13 Video Three [08:15]

So what about the future of anesthesia? Well there is a shortage of anesthesia care providers and

that’s not anticipated to change very much in the coming years. Therefore, our program remains

extremely competitive, about as competitive as medical school is for obvious reasons. But the

demand will continue to increase and that means more highly skilled anesthesia providers and

that means more AA’s. Any questions? We have a question right here. Dropout rate of the

program. Very small. We only take 30 students a year in Tampa. Ft. Lauderdale accepts 45

students per year. Now, with 30 students per year and if 3 of them left, there goes 10% attrition

right there. Usually what we’ll find is that we’ll lose one or two students. But the bigger reason is

why. And I’ll first one of the major reasons for that is that the individual kind of stumbled across

this and didn’t’ really know what they were getting into and then they get into the operating

room and they’re like whoa and then they get adjusted to this or attempt to get adjusted to the

course load and they decide that this is not what they want to do. And then individuals

sometimes have health reasons or family reasons. The important thing is that it’s not due to

failure of getting through the program and I think that is largely due to the help and assistance

that is provided by the faculty and program itself. We do an extended amount of work so that

even if we see that a student is having difficulty in a certain area, we jump all over it extremely

quickly and help them and hope they graduate and do well. Other question? Ok. Very good

question. And this gentleman right here knows more about the specifics of the applications, but

I’m going to say right now about two hundred applicants. And our application window itself

opens on July 15th of one year and runs all the way until March 15th of the subsequent year. And

we usually have our interviews from about October to March. Any other questions? It is

extremely rigorous and I would liken that to medical school. Could one work through medical

school? Probably. Is it wise to do so? Probably not. Most of our students, all of our students, we

tell them you can’t basically maintain a job…it is extremely difficult and this can be a tough

program if you make it that way by doing too many things at one time. Question back here?

Minimum GPA if you open up that brochure it says 2.75. However, that is not competitive, so go

with that. What’s the recommended? It varies. Clearly if you don’t have a 2.75 your application

won’t even be received by what we like to see is maybe around a 3.2 or 3.3 at least, you’ll see

that some come in with 3.8, 3.9. or 3.7 and some of them 3.1 Does it mean you won’t get called

in for an interview if you don’t have a 3.1?No it doesn’t mean that because we don’t at one

specific thing when we look at applications, we look at the all-encompassing application

package. So understand we look at other areas too. Question in the back? Very good question.

Short answer to the question is yes. Now, the bigger and better question is who has to pay for it?

Well if you’re working for an anesthesia group they pay for it, you don’t have to pay for it. Even

if you did have to pay for it, it’s not that much. It’s like $2,000 a year or something like that, it’s

not that much, but you don’t have to pay for it. I think it would depend on the other components

of your application. For instance, if your GPA is a 2.9 and you didn’t’ have all three of the letters

of recommendation that we require and your GRE score was a little low, but you had some

clinical experience, you can see how we kind of have to asses these from multiple angles and just

not looking at specifically one thing. But it does look good because it means that you’ve

interacted with patients before and that means something. I’ll say too that starting out in

Anesthesia school as a respiratory therapist. First semester we’re taking Principles of Airway

Management and I’m thinking to myself man this course is extremely easy, why am I taking this

course? Because it was everything I was already expected to know as a respiratory therapist but

building on top of it. So I kind of felt like I started out with maybe a slight advantage over other

classmates of mine that didn’t have healthcare experience. But I’ll tell you that the program does

a great job of taking individuals of varied backgrounds through the program so they collectively

end up right on par with each other when we’re graduated. So that’s what I think is important.

What type of personality do we look for? There’s no one size fits all rule. It’s just that we can

gauge the ability to do certain things in the interview and through our questions but I think one of

the core qualities that I look for in the applicants is hard work, willingness to work hard, and I

think that if you have that even if you don’t gain concepts as easily as others, you’ll make it

through and you’ll be fine because you’ll work harder than you need to. And that’s one of the

things I appreciate in applicants. And that’s just me. Tuition for our program is about $35,00 a

year, so for two years. And of course there is an expense you can add to that for books and

housing but I myself as an anesthesia student took out loans only for what I needed. I did some

work as an RT on the weekends I know it’s not recommended. Because if you violate everything

you’re not supposed to do, you’ll be the director of these programs, so that’s a lesson learned.

You had a question? A lot of people do. A lot of nurses before they went into nursing school

couldn’t stand the sight of blood. A lot of physicians who were, I sometimes go into work and

there’s some medical students there and he falls and someone has to catch him and take him out

of the room because he’s fainted in the operating room. So many people start there but as you get

exposed to certain things, I think that’s where everything kind of takes care of itself so it’s

something that you might be concerned about but if you gain that experience and gain that

confidence and see these things on a daily basis, you know someone’s chest wide open,

someone’s head open or face in half of something of that nature then it doesn’t bother you. It

doesn’t bother me. In that second year you will have some online requirements but not very

extensive. Why is it only in 18 states? There’s’ a lot of politics involved in anesthesia in general.

And it is such that…of course our ultimate goal is to be in all 50 states but we’re only recognized

as an anesthesia care provider in certain state. And I think the better and more important question

is that if you want to see growth in all 50 states, what does growth look like so far? Well, when I

was, well prior to be being a student in anesthesia school, I think there were probably ten states

at the time. And you know that span of difference between eight years there has been 8 states

that have been opened resulting from opening more schools and making more individuals

knowledgeable about what we do, that sort of thing. There’s also you know the political aspect of

how we’re viewed in the eyes of the CNAs, these sorts of things. There are a lot of politics and I

definitely advise you to make yourself knowledgeable of these things before you go into a

program such as this one. But they exist, there’s politics in every profession. Question? My

personal opinion. I’m through the roof, I love what I do. I couldn’t imagine doing anything else

and that is the reason why I’m teaching and working to assist others with the transition that I

made. This thing is something like a piece of gold hidden under a chair-nobody is going to

recognize it. Nobody knows what an AA is. It takes going to discussions and lectures to figure

out hey this thing even exists. So I feel it’s my duty to assist in making you guys knowledgeable.

I wouldn’t change one thing about it. I graduated. I was. I thought I was doing pretty well as a

respiratory therapist. You know I was working three days a week, happy with what I did, made

pretty good money, then I finished anesthesia school in my twenties and making this kind of

salaries and working the way I want to work and it’s just like man this is really really nice> The

variety, I love the patients…you get to do everything! Since working in obstetrics, place a spinal

in a young lady whos having pain so that she’s numb form the waist down so she can proceed to

having her kid or c-section or maybe place an epidural so she can give labor to her baby. These

things are very rewarding to see that you assisted this young woman and how difficult it would

be and how much pain would she be in in this process> So it’s very rewarding. I want to call up

Mr. Eric Derise and I’ll answer your question too. Training. Training in that they pretty much

supervise while we work in the operating room and take care of the patient. Now can an

anesthesiologist do that? Absolutley. Do they do that in some places? Absolutely. But most

places adopt that anesthesia care team as I mentioned.