Steven D. Goldfien, M.D., Chair
Committee on Anesthesiologist Assistant Education and Practice

n searching for ways to alleviate the shortage of nonphysician anesthetists in the late 1990s, ASA rediscovered anesthesiologist assistants (AAs). Well known and established in practice for more than 30 years in parts of the South and in Ohio, this profession had remained unknown to the majority of ASA members, even those in the care team mode of practice.

In 2000 — and in recognition of the rigorous education they receive, the quality of the care they provide and their willing subscription to ASA’s principles of care team practice — ASA decided to support the expansion of AA practice. Since that time, the number of AA educational programs has doubled to four with a fifth scheduled to open later this year; the number of annual graduates will increase from 40 to more than 100 by the year 2008. With the recent addition of Florida, AAs can now practice in 15 states and the District of Columbia.

Within ASA a new standing Committee on Anesthesiologist Assistant Education and Practice was created in 2005 to provide a forum for AA affairs. This committee is composed of leaders in the field of AA education and practice along with interested anesthesiologists. Ex-officio members include the president of the American Academy of Anesthesiologist Assistants (AAAA), one ASA representative to the Accreditation Review Committee for the Anesthesiologist Assistant (ARC-AA) and a commissioner from the National Commission for Certification of Anesthesiologist Assistants. Generally speaking the committee’s activities involve fostering the opening of new AA programs, educating ASA members and the public, acting as a resource for AA program directors and working with ASA leadership to provide information on issues concerning care team practice. Some of the committee’s prior activities include the development of an FAQ piece for the ASA Web site <www.ASAhq.org/career/aa.htm> and educational materials on AA practice for distribution to other medical specialty organizations (available from the ASA headquarters office), the holding of daylong symposia for anesthesiologists and university administrators who are considering opening new AA programs, and assisting ASA in becoming the physician sponsor for AA accreditation.

What began as an invitation for AAAA to have a liaison on the Committee on Anesthesia Care Team (ACT) led to an appreciation of common goals and resulted in policy changes benefiting the members of both professions. After ASA offered educational membership to AAs in 2002, more than 30 percent of practicing AAs subscribed and are now receiving the benefits of ASA membership. In 2005 ASA became, through ARC-AA, the physician sponsor for AA program accreditation through the Commission on Accreditation of Allied Health Education Programs. Although ASA sponsors AA accreditation, actual accreditation as well as certification, continuing education and recertification are handled by independent organizations. At the same time, AAAA has assisted ASA in the political arena and supported ASA on important matters of policy. Some of these actions are notable and deserve mention.

1. In June 2006, AAAA drafted a letter in support of the one Senate and two House bills that deal with the “teaching rule” and that seek to restore full funding to anesthesiology teaching programs. AAAA also lobbied in support of ASA’s efforts to allow rural hospitals to use “pass-through” funds to employ or contract with anesthesiologists, something that is currently and inexplicably limited to nurse anesthetists.

2. AAAA has published a “Statement on the Anesthesia Care Team Model” that harmonizes with ASA’s own statement. It affirms AAAA’s belief that the involvement of an anesthesiologist is in the best interest of patient safety and that the responsibility of medical direction lies with the anesthesiologist who may then delegate aspects of patient care as appropriate.

3. In response to the stated intention of the American Association of Colleges of Nursing to change their advanced practice of nursing degrees from the Master’s level to a Doctor of Nursing Practice, AAAA published a “Statement on Use of Medical Terminology.” This helpful statement advocates the use of terms that would prevent members of the anesthesia care team with advanced degrees from confusing patients by misrepresenting themselves either unintentionally or by design. All AAAA practice statements can be read in their entirety on the AAAA Web site <www.anesthetist.org>.

It was an insufficient supply of anesthesiologists that led to the creation of the AA profession in 1969.¹ It was again insufficient supply that led to the rediscovery of AAs, while their quality education and commitment to the anesthesia care team became the impetus for ASA’s increasing support for their profession. Interestingly, as Great Britain struggles with the same problem, it also has discovered the relative merits of AA practice. In a recent editorial, the European Journal of Anaesthesiology² states: “There are two reasons why we feel that the AA model represents a better plan for anaesthetic practice in the U.K. (and other countries through Europe) than the CRNA model. Firstly, AAs are trained by anaesthesiologists in accredited universities. Secondly, there is a long history of friction between CRNAs and anaesthesiologists in the U.S. It is clear that CRNAs will continue to seek the right of independent practice. They are continually trying to ‘eat our lunch.’ They are also suffering from ‘job creep.’ There are cases of nurse anaesthetists with doctorates introducing themselves as ‘Hello, I’m Dr. X, your nurse anesthesiologist.’”

The committee similarly feels that AAs offer a distinct advantage to the anesthesia care team in our own country and hopes that more members of the academic community will consider the benefits to our profession of training AAs.


References:
1. Steinhaus JS, et al. Analysis of manpower in anesthesiology. Anesthesiology. 1970; 33(3):350-356.
2. Editorial. European Journal of Anaesthesiology. 2006; 23:899-901.

Steven D. Goldfien, M.D., is an attending anesthesiologist at California Pacific Medical Center, San Francisco, California.