ASA March 2003 Newsletter

Filling a Void

Three decades of experience has shown that AAs can become important players in care team practices, especially in a field that is battling a shortage of qualified anesthesia providers. (Photography by Pamela Dabrowa)

Anesthesia care team practices across the nation are facing a continued shortage of qualified anesthesiologists and nurse anesthetists. There is a growing interest and an ever-increasing effort by practice groups to recruit the other category of dependent anesthesia providers, namely, anesthesiologist assistants (AAs). The question then arises as to how a practice group should undertake introducing AAs into their daily anesthetist staffing pool.

Once a decision has been made to add AAs to an existing care team practice, department leaders may be surprised to learn firsthand that opposition to AAs by members of the American Association of Nurse Anesthetists is second in priority only to their continued efforts to achieve independent practice for nurse anesthetists.

It is not uncommon that some nurse anesthetists already employed would attempt to undermine the leadership’s recruiting decision by telling hospital employees and surgeons that “AAs have inadequate training and experience” (easily refuted by 30 years of experience) or that “We (the nurse anesthetists) will all quit if they are hired, and you will not be able to staff your operating rooms.”

The real issue is why people remain loyal to a given practice. Based on my 17 years as chair of a department that now includes 34 physicians, 34 nurse anesthetists and 33 AAs, I would suggest the following as major factors for recruitment and retention:

1. Location (a desirable city and a desirable hospital site)

2. Competitive salaries

3. Competitive benefit packages (health and disability insurance, retirement plan)

4. A stable practice environment

5. Consistent, responsive departmental leadership

6. Good company communications

7. Respectful treatment of all employees

8. The same range of duties for all anesthetists

9. The same salary base for all anesthetists

10. The same support from anesthesiologists for each category of anesthetist

In our experience, no nurse anesthetist (despite threats to the contrary) resigned when we began recruiting AAs. In fact, the turnover rate among our nurse anesthetists has been less than 3 percent over the past five years.

In the final analysis, no one abandons an otherwise desirable position because of the identity of a practitioner working in the next room. If a department’s leadership determines that recruitment of AAs is desirable, they should proceed without fear of a “job action” by their existing employees.

For the last 30 years, AAs have demonstrated that they are safe, skilled, dependent anesthesia providers who work harmoniously with nurse anesthetists in the care team mode of practice. I encourage ASA members to consider AA employment in the states where they have obtained practice privileges. Further, I would encourage members in states not yet open to AA practice to evaluate the potential of extending the pool of providers to include AAs and engage in the effort to offer a proven option for quality anesthesia care.

John B. Neeld, Jr., M.D., is Chair, Department of Anesthesiology, Northside Hospital and Northside Anesthesia Consultants, Atlanta, Georgia. He was ASA President in 1999..

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