ASA March 2003 Newsletter

Most of us are familiar with the concept of the anesthesiologist assistant (AA), which was developed by J.S. Gravenstein, M.D., and John E. Steinhaus, M.D., nearly 40 years ago. Despite the merit of AAs as valued members of the anesthesia care team, their national impact until now has been underappreciated with fewer than 600 practicing in 16 states and only two AA schools in existence. This situation now appears to be changing with endorsement of the AA concept by the ASA leadership, consideration of AA licensure by a number of additional states and serious proposals for several additional AA schools. For this reason, the pages of this NEWSLETTER issue are dedicated to updating the ASA membership with respect to AA education, certification, licensure and practice.

Why, after approximately 30 years of dedicated practice in relative obscurity, are AAs suddenly finding themselves in the limelight? The answer is that AAs are finally being recognized for the value they provide to the anesthesia care team.

We are all acutely aware of the fact that there simply are not enough physician extenders available to fill the needs of anesthesia care team practices. This shortage, exacerbated by the extender monopoly held by nurse anesthetists, is handicapping hospital and ambulatory surgical centers across the country. Also at issue is the unceasing drive by the nurse anesthetists’ lobby for independent practice. For the safety of our patients, we realize that physicians must remain in charge of all aspects of medicine, including the delivery of anesthesia care. Although most nurse anesthetists, like most anesthesiologists, have as their pre-eminent goal the provision of good clinical care for their patients, the nurse anesthetists’ state and national organizations all too often appear to be fixated on the single issue of independent practice. The resultant need to constantly battle the nurses’ “trade union” has been a major albatross for our profession. And for many of us, the final straw was the need for ASA to expend an enormous amount of its scarce resources in response to the recent Centers for Medicare & Medicaid Services proposal to eliminate physician supervision of nurse anesthetists in Medicare/Medicaid-supported facilities.

There is little wonder why so many anesthesiologists are finally saying, enough! Imagine what we could be doing to improve patient care if we could instead channel our resources into organizations such as the Anesthesia Patient Safety Foundation (APSF) or the Foundation for Anesthesia Education and Research (FAER). In re-examining the physician extender component of the anesthesia care team, AAs come to the forefront. AAs are educated by anesthesiologists in a medical school environment, and many of us firmly believe AAs are actually better trained than nurse anesthetists. Historically, those AAs who want to practice as anesthesiologists have gone to medical school instead of the state and national legislatures for their career advancement.

The national emergence of the AA is long overdue. It is time to work with well-trained physician extenders who want to work with us and who are committed to the anesthesia care team concept.

David C. Mackey, M.D., is Clinical Associate Professor of Anesthesiology, University of Florida, Gainesville, Florida.

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