Florida Passes Anesthesiologist Assistants’ Licensure Bill

S. Diane Turpin, J.D.
Associate Director of Governmental Affairs


For three years, the Florida Society of Anesthesiologists worked to advance legislation in the Florida House and Senate to license anesthesiologist assistants (AAs). The bill finally passed the Senate by a vote of 28-12 and the House by a vote of 74-39. The bill has been sent to Governor Jeb Bush.

The legislation requires AAs to be directly supervised by an anesthesiologist, to work pursuant to a written protocol that must be filed with the medical board and to practice in accordance with the defined scope of practice established in the legislation and as further defined by the medical board.

The debate over the legislation was heated, with strong opposition to the legislation from the Florida Association of Nurse Anesthetists. The debate was not limited to the House and Senate but advanced in the press and was accelerated by paid radio and television advertising sponsored by the nurse anesthetists. The vitriolic attacks regarding the education and training of AAs, and the motives of anesthesiologists who are willing to medically direct AAs, were unparalleled in any other AA licensure debate. At the end of the day, it appears that the state legislators were able to weed out the noise and base their decision on facts.

The Florida Society of Anesthesiologists spent significant time and energy pursuing this legislation and deserves recognition for its vigilance in refuting the vast amount of erroneous information that was designed to kill the legislation.

The facts indicate that AAs are well trained to work under the medical direction of an anesthesiologist. Case Western Reserve University (CWRU), Cleveland, Ohio, and Emory University, Atlanta, Georgia, offer two-year educational programs for AAs. A third program, a consortium between South University and the Mercer University School of Medicine, Savannah, Georgia, will accept its first class in June 2004. Applicants to the medical school-based programs must have a bachelor’s degree, with an above-average performance in premedical courses, from an accredited institution. Required course work includes general biology, general chemistry, organic chemistry, biochemistry, general physics, calculus and statistics.

The science-based course work includes both didactic and clinical education. Students spend more than 2,000 hours in clinical rotations with more than 500 cases. Up to 10 percent of graduates have proceeded to medical school without having to double back to acquire premedical courses.

The master’s degree programs are accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP). CAAHEP accredits numerous allied health programs. Graduates of CWRU receive a Master of Science in Anesthesiology (M.S.A.); graduates of Emory receive a Master of Medical Science Program in Anesthesiology and Patient Monitoring Systems (M.M.Sc.).

Graduates of the AA programs take the national certification examination sponsored by the National Commission for Certification of Anesthesiologist Assistants (NCCAA). The five and one-half hour examination is administered by the National Board of Medical Examiners (NBME). Those who pass the examination are designated Anesthesiologist Assistant-Certified (AA-C) and must submit 40 hours of continuing education credits biennially for certification renewal. Every six years, the AA-C must complete a five and one-half hour Continued Demonstration of Qualifications examination, also administered by NBME.

AAs are currently licensed by statutes and/or regulations to practice in Alabama, Georgia, Kentucky, Missouri, New Mexico, Ohio, South Carolina and Vermont. In the District of Columbia and in Texas, AAs practice pursuant to guidelines implemented by the state medical board.

Legislation also has been introduced once again to license AAs in Louisiana. In addition, two bills have been introduced in Louisiana to prohibit anesthesiologists from delegating any authority to AAs. AA licensure bills are pending in Michigan and in the District of Columbia.