There are several different types of anesthesia providers, each of which has a specific role as outlined by state regulations and regional trends. Anesthesiologists are physicians and must undergo a bachelor’s degree, medical school, and residency. In some areas, surgical patients receive anesthesia care from an “anesthesia care team” led by an anesthesiologist (ASA). Certified registered nurse anesthetists (CRNAs) must receive a nursing degree and then complete additional master’s-level education (AANA). Depending on state regulations, a CRNA may practice independently or under the supervision of a doctor. The anesthesiologist assistant (AA) is also an important role, with a well-defined scope of practice that is distinct from anesthesiologists and CRNAs.
Anesthesiologist assistants are required to complete a bachelor’s degree that includes specific coursework with a pre-medical focus, then receive training for 2+ years in an accredited program. The AA degree is considered master’s level, like the CRNA degree. There are currently 13 accredited AA programs, all of which are located in states that allow AAs to practice (AAAA). 16 states and the District of Columbia have regulations that establish licensure and an associated scope of practice for the anesthesiologist assistant, while another three allow AAs to practice under the delegatory authority of an anesthesiologist (ASA, AAAA). For example, legislation in Georgia specify qualifications for licensure, limits the supervisory ratio to be at most four AAs to one anesthesiologist, and requires a supervising physician to be immediately available if an AA is administering general and/or regional anesthesia (Physician’s Assistants).
One key component of the AA’s role is that they act under the supervision of an anesthesiologist, who ultimately leads anesthesia patient care and remains available if needed. In comparison, CRNAs may often provide anesthesia care under the supervision of the surgeon, or even independently in some states. However, the American Society of Anesthesiologists (ASA) holds that AAs and CRNAs have equivalent responsibilities and capabilities, despite different educational focuses and regulations (ASA).
There are active efforts to expand the jurisdiction of AAs, alongside broader efforts to expand the use of non-physician providers as a strategy to reduce healthcare costs and improve access. However, some opponents have argued against these efforts based on a concern for patient safety and outcomes. Little empirical data is available to answer the question of patient safety, however, one study found no significant differences in several metrics when comparing care teams composed of an anesthesiologist and either an AA or a CRNA. Sun et al. retrospectively analyzed data from a random sample of Medicare beneficiaries who underwent inpatient surgery between 2004 and 2011, examining over 400,000 cases. Inpatient mortality, length of stay, and spending did not differ between the two team models (Sun et al.)
The anesthesiologist assistant plays an important role in many anesthesia care teams. The combination of anesthesiologists and AAs may allow healthcare facilities to provide surgical care to more patients, especially in areas with a shortage of physician-level providers. Additional research is needed to clarify the impact of AAs on patient outcomes, potentially paving the way for expanded jurisdiction for this field.
References
ASA. “Anesthesiologist Assistants.” American Society of Anesthesiologists. N.d. https://www.asahq.org/advocacy-and-asapac/advocacy-topics/anesthesiologist-assistants
AANA. “Education of Nurse Anesthetists in the United States – At a Glance.” American Association of Nurse Anesthetists. Updated Aug 8, 2019. https://www.aana.com/membership/become-a-crna/minimum-education-and-experience-requirements
AAAA. “Frequently Asked Questions.” American Association of Anesthesiologist Assistants. N.d. https://aaaa.memberclicks.net/faqs
Physician’s Assistants. State of Georgia Rules & Regulations, Chapter 360-5. https://rules.sos.ga.gov/gac/360-5
Sun EC, Miller TR, Moshfegh J, Baker LC. Anesthesia Care Team Composition and Surgical Outcomes. Anesthesiology 2018; 129:700–709 doi:10.1097/ALN.0000000000002275