Not many people consider a career in anesthesiology. Part of that is because not many people know that much about it in the first place. In this episode, anesthesiology assistant Sally Hoang joins Dr. Richard Marn for a conversation on how she found her path to a career in her specialization. Sally is a Certified Anesthesiologist Assistant currently practicing at Emory University Hospital. She gets into detail about the ins and outs of the job, from suctioning to flexible work hours, and shares why it has been a fulfilling career for her. Learn all about the life of an anesthesiologist assistant and see if this is the career for you!
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Dealing With Pain: A Day In The Life Of An Anesthesiologist Assistant With Sally Hoang
You’re going to enjoy this episode. We’re going to meet with someone who works in a profession that’s very close to my heart and similar to what I am doing. This profession is very hands-on, you meet a ton of different people in different healthcare professions and you have an immediate impact as well. Something to also consider however is that this profession is not licensed in all 50 states and we’ll learn a little bit more why. The person I’m going to talk to is Ms. Sally Hoang. She is a CAA or Certified Anesthesiologist Assistant. We’re going to learn what they do and how it’s a little different than other professions in the anesthesia world.
You’re going to have a fun time reading it. Not only is she very revealing in what this profession is all about but the story is also engaging and it’s pretty awesome how she tries to impact people’s lives. It’s also a great work-life balance too if you’re interested in learning a little bit about that. Let’s keep reading this. Before I do, please, if you enjoy this episode or other episodes and you like it or love it, smash that like button. That’d be helpful. Even better, write a great comment that will hopefully encourage other people to keep reading or start reading this show. I appreciate your support and I love that you’re here. Let’s dive into this.
Thanks for joining us. We are going to meet Sally Hoang.
Richard, thank you for having me.
My pleasure. Why don’t you give everybody a short bio about what you are doing?
My name is Sally. I’m a certified anesthesiologist assistant working in Atlanta, Georgia. My undergraduate degree was in Exercise and Sport Science at the University of Georgia. After that, I worked as a medical assistant for an ortho surgeon for a period of time but I became interested in anesthesia and got my Master’s from the Emory University program. I’ve been working at an academic hospital for years now.
I was introduced to you by your Instagram. Let’s do some questions. As an anesthesiology assistant, what do you do to help people?
We work along with the anesthesiologist and the Care Team Model. We take care of them as far as getting them in control, keeping them stable throughout the surgery, whatever the surgeon needs to get the operation done. We make the patient comfortable enough to endure that.
What are the usual steps to achieve your degree?
Typically they require all your pre-medical courses, Biology, Chemistry. Pretty much you can have any type of Bachelor’s degree and apply to the program as long as you have those certain classes taken. You can either take the GRE or MCAT, get some chatting hours and apply.
It’s a Master’s program to become an AA. How many years is that?
It’s a 27-month program. Some programs are a little shorter than that. They run about 25 or 27 months typically.
What is the best part of your career?
I love my work-life balance. My schedule is flexible and that’s the greatest part about the profession.
What’s your least favorite part of your career?
I’ll get into this a little more but it’s suctioning. A lot of secretions are in there. That’s the grimiest part that they don’t tell you about upfront.
What are three highlights of your profession that people should know about an anesthesiologist assistant?
It’s very hands-on. You are literally doing things with your hands every single day and very interactive with patients. That’s number one. Number two, important as well. We can’t work in all 50 states. It’s only about seventeen. If you’re interested, take a look at those seventeen states and be sure that you’re okay with staying there. Thirdly, you meet many people in the hospital. Nurses, surgeons, patients from all around the world. It’s different every day and we meet different people all the time. It’s pretty fun.
Even as an anesthesiologist, I got to meet many people that allowed me to get the show going very early on because of all the people that I’ve been able to meet in different divisions and departments. That concurs with that last sentiment. Hopefully, it gives somebody a nice overview of what an AA or Anesthesiology Assistant does. What is your typical day like start to finish? I know every day’s a little different. In general, what’s a typical day like for you?
Most people would work a twelve-hour shift and that’s pretty common. You wake up depending on how far you live away from the hospital. You have to be there at 6:30 in the morning. Some people come at 6:00 depending on how big their cases and they have to set up. You arrive, change into scrubs, set up your room and that’s a big component of the profession. You have to make sure that we have everything ready as far as drugs, airway set up, IVs, fluids so that you’re ready for whenever the case starts. Some cases are more involved than others. Sometimes you need a central line or A-line. You have to be prepared.
For some people who don’t know that terminology, what’s the central line and A-line?
A-line is Arterial Venous and it measures beat-to-beat pressure. Instead of having a non-invasive blood pressure measurement like a blood pressure cuff, it’s arterial. It goes right in your radial artery. It gives you instantaneous blood pressure readings. The central line, it’s large for venous access. You can go to subclavian if you want. It’s usually if you’re anticipating large blood loss and need to get products in fast. We use that for that.
You were saying your typical day three different access for different procedures.
After your room is all set up and you have everything ready, you go meet the patient. You interview them, make sure they are what the chart says. Sometimes, you find out things that aren’t written in the chart. You double cross-check everything and you get some lines started. For some patients, you can do one IV and get them off to sleep. Other patients, you need a pre-induction A-line? It varies but you use that IV to get the patient asleep and that’s the start of everything.
After you administer the anesthesia, what happens afterward? What’s your end of the day like? When do you leave? What happens if you’re in the middle case but your twelve-hour shift is done?
Once you get the case started, you’re in there. When the case finishes, you wake the patient up and you repeat the same thing with whatever is scheduled in your room. If you have a long, sixteen-hour case and your shift is up at 7:00 PM, another anesthetist will come in. You’d give a report to them and they will take over. You report, leave and your day is done. You don’t have to have to go home and chart or do anything like that. You just go home and forget. The next day you’ll check out and be like, “How did that patient do last night?” It’s nothing like other professions where you bring your work home. If you have a room with 5 to 6 cases, you’re going to be in there doing those cases until your shift is done. It’s a hit or miss. You can be in a room with one or more than that.
In the last few years, what has been a moment, a case that you took care of or a situation that left an impression upon you whether it’s something positive or even negative?
The biggest case that I’ve done was a AAA. It’s an aneurysm and vascular surgery has to go in. They have to either remove that portion, repair it or do something so that the artery or the aneurysm doesn’t rupture. I’m glad that artery or aneurism did rupture and ended up giving many blood products. There were many people in the room, anesthesiologists, nurses and we were checking blood, pushing it through the Belmont. We went on 2 to 3 hours into the night. After 1:00 in the morning, I was like, “This teamwork is amazing.” I don’t think I would have been able to do it with just me and the attending. No way could that have happened. We got the patient out of there and transport it to ICU. It’s amazing with the things we can do.
What did it feel when you were doing that at the moment? What were you doing? How did it feel?
It’s a rush of adrenaline. You have someone watching the blood pressure. They’re pushing the drugs and you’re checking the blood. You have to verify their name and MRI number as fast as you can, keep it going and keep hanging. Once I was on unit 98. I was like, “We’re going to hit 100.” It was many products.
Over 100 units of packed red blood cells or some type of bags all that blood product?
We emptied out the blood bank. It was ridiculous.
How did it feel? You’re over there and doing that. Was it gratifying?
I don’t think gratifying is the word. It’s more of, “This is my job. This is what we have to do to keep this patient alive.” Within our profession, we can’t let our emotions come into play. It’s more a plan A, B and C. You’ve got to keep it moving because if you get stressed and emotional, it hinders what you’re supposed to do.Whatever the surgeon needs to get the operation done, anesthesiologist assistants make the patient comfortable enough to endure that. Click To Tweet
A question I think people have is how did the patient do?
Unfortunately, a week later the patient didn’t make it. For us, we post the patient up, et them to ICU and that’s what we did. The patient didn’t pass on the table.
You’re able to get the patient successfully through the procedure. That’s a great story. Thanks for sharing because that’s some of the dramatic parts as an anesthesiology-related person, you are having a profound impact on keeping that patient not only safe and alive but successfully get them through that too with the minimal side effects. What are some of the misconceptions people have about your profession?
To start off it’s with the title of our profession, anesthesiologist assistant. A lot of people think we just do paperwork and assist like an administrative assistant. It’s completely the opposite of that. We are hands-on, direct patient care. We do patient IVs, intubate the patient, administer drugs here and there. It’s the least bit of paperwork. We electronic chart, sign our name and finalize. There’s no other paperwork to go with it.
Electronic charting is capturing the vital signs of the patient automatically so you don’t have to do that anymore.
There are a couple of offsite locations at my hospital where that system isn’t in place. We do have to check off the vitals and blood pressure every five minutes on paper. For the most part, a lot of hospitals are on electronic medical records.
You mention the least favorite part of your job is suctioning. Why is that? Why do you get to do that? What’s bad about it? It’s barely collecting poop.
We don’t do poop but we do a lot of secretions and gastric content. When we’re excavating a patient, you have to suction. You take a suction tube like in the dentist and suction out the mouth. Some patients are a lot juicier than others. They produce a lot. It comes out of their nose and mouth. It’s very juicy. You got to try and keep it as clean as possible. You don’t want to get it on yourself. You gloved up. You have to get used to it.
How would you describe your work-life balance? You have a good work-life balance because it’s shift work and you have some control over the shifts. Can you describe a little bit about the work-life balance for you?
When I first started, I want to work a lot. I would pick up extra every single day wherever I could. My main core shift was two 12-hours and 8-hours. That’s four days a week. I would always pick up extra on the fifth day. Now, it’s been able to work out where I can do one 24-hour shift on Sunday and a 16-hour shift any day during the week. I only work two days a week. That gives me more time to do other things that I’m interested in outside of anesthesia and it’s been amazing. My hospital is very flexible with the schedule. Some people will work four ten-hour shifts and call it a day. Others will work five eight-hour shifts or typical 7:00 to 3:00 shifts. It’s very flexible.
What is the approximate salary range for an anesthesiology assistant, maybe even just starting?
That will depend on the state you are in but on an average of all the states combined, it’s $130 to $190 starting.
That’s very important and useful information especially for a career that a lot of people don’t know about. What do you think the future outlook is like for your profession?
Kansas was making a mistake that is delegatory for AAs. That’s a huge one. It means that it is up to the hospitals to decide if they acknowledge certified anesthesiologist assistants or not. It’s not up to the state. The hospitals can decide if they want to hire and allow us to practice. Kansas and Texas are like that.
What are the other states like?
Georgia, for instance, we are acknowledged by the state. We can work anywhere. It’s not up to the hospital.
It’s important for people to realize that there are only seventeen states that technically acknowledge your profession to say you are allowed legally to practice in that role in this particular state. Do you see those number of states growing or is it slowed down a little bit?
It definitely slowed down a little bit. Indiana was the last state that opened up officially. Other than Kansas being a delegatory state, there haven’t been any other new ones that have opened up. It’s very political. It’s about money and lobbying. It’s a slow process.
When I checked out one of your Instagram posts, you highlighted visually which states allow AAs to practice and which states don’t. That’s very good to visualize that aspect so people who are interested in this can better understand where they could potentially work or can’t. What is the difference between an AA, CRNA and anesthesiologist or someone else that works in anesthesia?
I’ll do anesthesiologist versus CAA. Anesthesiologists go through medical school and a three-year residency in anesthesia. They become anesthesiologists, MD. They overlook or supervise the CAAs. Instead of them being in the room the whole time during a case, we are in the rooms for them and they will supervise. It’s a 1 to 4 ratio. Four rooms max and go oversee four anesthetists in the room, pop in and out during the important parts of the procedure.
How would you contrast that with a CRNA? Is it much different in Georgia?
No. We pretty much do the same thing. It’s the route of how they became and got that degree that makes the difference. As far as job title and job description in Georgia, it’s the same.
In terms of the role that you have versus a CRNA or an AA. I had an episode with Heather Angus in 2020 and she’s a CRNA. If anybody wants to go read that, they can compare and contrast but that’s a nurse who becomes an anesthesia provider. That’s a different route to do similar roles. What type of students do you think the best flourish in this career?
Students who love multitasking, love doing things with their hands, getting dirty and who don’t mind stress would love anesthesia for sure.
When did being a CAA, a Certified Anesthesiologist Assistant come on your radar. When did that happen?
It happened pretty late in my undergraduate journey. I majored in Exercise Sports Science. My dream was to become an orthopedic surgeon. I did the whole pre-medical route, took all my classes to the end path and ended up working as a medical assistant for an ortho surgeon during my summer months. I graduated a semester early. During that six-month period, I worked for the ortho surgeon. I did all his castings, X-rays and sat in on his procedures and saw that wasn’t the life I wanted.
It’s great that you did that shadowing then.
I saw what life could be and the type of patient care that was involved in orthopedics was not for me. It was a very long process before you could see the results of the patient. Let’s say a patient broke their leg. They had to come in, get surgery if they need it, cast it for 6 to 8 weeks and physical therapy for three months afterward. They would be back 90%, not even 100%. Whereas anesthesia, it’s instant. You put a drug in it and you can see it work in 5 to 10 seconds.
In his surgical center, he imploded an anesthesiologist. I was like, “What are you doing? This is so cool.” He said, “This is the anesthesia. You should look into it. Check out these CAA programs. This is pretty cool.” I said, “Perfect.” It was right before I was applying for medical school. I Googled Emory’s AA program quickly and I had everything that they needed. I submitted it and got an interview two weeks later. The timing of it was perfect. I felt like this was meant to be.
Were you considering any other careers? Were you thinking about, “Maybe I can go into medical school and be an anesthesiologist, CRNA or even other professions.”
I knew anesthesia was for me because I liked that instant gratification and there wasn’t anything else that could compare. As far as going to medical school and becoming an anesthesiologist, I didn’t want to go through all the different rotations and different specialties that they make you do during schooling. I wanted to do anesthesia right off the bat. That was what AA school provided me with, a direct route to anesthesia. With medical school, you had to match in residency too. That’s another factor that is unknown that you weren’t sure was going to happen or not. That’s why I decided to go the AA route.
What you said is very important that what we do also has an immediate impact on patients and we see results quickly in what we do as anesthesia personnel. Reflecting back, would you have done anything differently?
It’s hard to say. I was born in Los Angeles, California and all my family is over there. Aunts, uncles, cousins. I would love to go back, live and work there. Unfortunately, I can’t. It’s not one of the states that CAAs are practicing. With that, I do feel a little limitation but my parents are here in Georgia. That’s what’s most important to me so I’m okay with it.
You did a great overview of your career and I love the stories. I would like to go into these fun, rapid-fire questions. Are you ready? Favorite ice cream flavor?When you’re in healthcare, you can't let your emotions come into play. Click To Tweet
Cookies and cream.
What is your favorite vegetable?
I love broccoli.
That’s a good choice, very nutritious.
Green’s my favorite color. There are a lot of vegetables in green.
What musical instruments have you learned to play?
My mom had me take piano lessons since I was eight so piano. I also did cello in middle school and I do a little bit of self-learning guitar.
If you had to live in a different state, where would it be?
California, back home.
If you could choose your own nickname, what would it be?
A lot of people call me Sal, Salamander, Sally Wiley, Silly Sally, whatever rhymes with Sally.
Finally, if you could change something about yourself, what would it be?
I would love to be a little bit taller. Be like 5’8” or 5’10”, that’s a good height.
How tall are you now?
You want to add a few more inches there, 1 inch or 2 inches. Thanks for sharing and answering those quick rapid-fire questions. If people want to learn more about you and what you’re doing, where can people do that?
They can follow me on Instagram. My handle is @AnesthesiaSal. I post regularly on the stories and on the actual post every day. Otherwise, they can check me out on YouTube. That’s a little more detailed on what my day is like. All of the snippets here and there, put them all together and you can see what my day is like as an AA. I know shadowing is very hard to come by due to COVID. Check out the videos on YouTube. It’s @AnesthesiaSal.
That’s where you’re posting.
There’s also a Discord Group that I’m a part of and partner with. We have about 1,000 members in there. Students, CAAs, prospective students and you can ask anything and get a reply pretty quickly. It’s a great community.
What’s your Discord group called?
It’s like Reddit but the app is Discord. The link is on my Instagram. There’s a little linktr.ee and you can get to it there.
That’s very resourceful. Lessons could benefit from that if they want to learn more.
When I was applying to the program, it was very hush-hush. There’s not a lot of content out there for CAAs so I was reading through forums and trying to find out all that I could about their program. The Discord group is good. It’s up-to-date. Check it out.
What you’re providing in this episode is also going to be very helpful. It’s great that you were able to come on here and be a guest. Thank you, Sally, for doing that. I appreciate it.