1. Who are Anesthesiologist Assistants (AAs)?
Anesthesiologist Assistants (AAs) are highly skilled health professionals who work under the direction of licensed anesthesiologists to implement anesthesia care plans. AAs work exclusively within the anesthesia care team environment as described by the American Society of Anesthesiologists (ASA). All AAs possess a premedical background, a baccalaureate degree, and also complete a comprehensive didactic and clinical program at the graduate school level. AAs are trained extensively in the delivery and maintenance of quality anesthesia care as well as advanced patient monitoring techniques. The goal of AA education is to guide the transformation of qualified student applicants into competent health care practitioners who aspire to practice in the anesthesia care team.
Anesthesiologist Assistants and certified registered nurse anesthetists are both defined as "non-physician anesthetists" within the Centers for Medicare & Medicaid Services section of the Code of Federal Regulations.
2. What is the origin of the Anesthesiologist Assistant
profession?
In the 1960s, three anesthesiologists, Joachim S. Gravenstein, John E. Steinhaus, and Perry P. Volpitto, were concerned with the shortage of anesthesiologists in the country. These academic department chairs analyzed the spectrum of tasks required during anesthesia care. The tasks were individually evaluated based on the level of professional responsibility, required education and necessary technical skill. The result of this anesthesia workforce analysis was to introduce the concept of team care and to define a new mid-level anesthesia practitioner linked to a supervising anesthesiologist. This new professional - the Anesthesiologist Assistant or AA - had the potential to at least partially alleviate the shortage of anesthesiologists.
The new type of anesthetist would function in the same role as the nurse anesthetist under anesthesiologist direction. An innovative educational paradigm for anesthetists was created that built on a pre-med background during college and led to a Master’s degree. This pathway placed AAs on an anesthesia “career ladder.” Some AAs have leveraged their premed background, Master’s degree and clinical experience to successfully apply to medical school. A few have returned to anesthesia to become the physician leader of the care team that launched their professional career.
The chairmen’s vision became reality in 1969 when the first AA training programs began accepting students at Emory University in Atlanta, Georgia, and at Case Western Reserve University in Cleveland, Ohio.
3. What are the differences between AAs and Physician Assistants?
Although AAs and physician assistants (PAs) both function as physician extenders, they do not perform the same functions. Each has its own separate educational curriculum, standards for accreditation, and its own agency for certification. PAs receive a generalist education and may practice in many different fields under the supervision of a physician who is qualified and credentialed in that field.
An AA may not practice outside of the field of anesthesia or apart from the supervision of an anesthesiologist. An AA may not practice as a physician’s assistant unless the AA has also completed a PA training program and passed the National Commission for the Certification of Physician Assistants (NCCPA) exam.
Likewise a PA may not identify him- or herself as an AA unless he or she has completed an accredited AA program and passed the National Commission for the Certification of Anesthesiologist Assistants (NCCAA) exam. If also certified as an AA, such a dual-credentialed PA would be required to practice as an anesthetist only as an extender for an anesthesiologist and could not provide anesthesia care at the direction of a physician of any other specialty.
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4. What are the differences between Nurse Anesthetists (NAs) and AAs?
Although both are considered to be equivalent clinical non-physician anesthesia providers and may serve as physician extenders in the delivery of anesthesia, AAs and NAs are very different with regard to their educational background, training pathway and certification process.
Admission Requirements
According to the Council on Accreditation (COA) of Nurse Anesthesia Educational Programs, a typical applicant to an NA program must have attained a bachelor’s degree in either nursing or another appropriate area. Before 1998, applicants with only an associate's degree in nursing were accepted. Additionally, the applicant must be licensed to practice as a registered nurse and take either the Graduate Record Exam (GRE) or the Miller Analogies Test (MAT) prior to matriculation. Finally, one year of nursing experience is required in an “acute care setting.”
In order to be admitted to an AA program, the applicant must have achieved a bachelor’s degree with prescribed prerequisites typical of premedical course work. Specific requirements include general and organic chemistry, advanced college math, general and advanced biology, and physics. Applicants must then take either the (MCAT) or the (GRE). Although many applicants who are from allied health backgrounds such as respiratory therapy and emergency medical technology may have years of clinical experience, a clinical background is not an absolute requirement. Nurses who meet the premed coursework prerequisites have been admitted to AA programs.
Educational Programs
NA training programs must include a minimum of 24 months in a Master’s level program accredited by the COA. The training programs may be based at any college or university offering a Master’s level degree. Many nurse anesthetists do not possess a Master’s degree as this was not required until 1998. Nurse anesthetist programs do not require involvement of a medical school or academic physician faculty. Community hospitals may serve as main clinical sites. A minimum of 450 hours of classroom/laboratory education, 800 hours of clinical anesthesia education, and administration of 450 anesthetics, including all types of surgery, must be achieved for the student to successfully complete the training program.
AA training programs must include a minimum of 24 months in a Master’s level program accredited by the Commission for the Accreditation of Allied Health Educational Programs (CAAHEP). The programs must be based at, or in collaboration with, a university that has a medical school and academic anesthesiologist physician faculty. Each AA program must have at least one director that is a licensed, board-certified anesthesiologist. Main clinical sites must be academic medical centers. An average of 600 hours of classroom/laboratory education, 2600 hours of clinical anesthesia education, and more than 600 anesthetics administered, including all types of surgery, are typically required to successfully complete AA training.
Certification Process
Upon completion of an accredited nurse anesthetist program, a student may become certified by passing the Council for Certification of Nurse Anesthetists certification exam. This examination is an adaptive computer examination consisting of 90-160 questions. Forty hours of approved Continuing Education Units (CEU) are required every two years in order to recertify. To be recertified, nurse anesthetists do not take an additional exam.
Upon completion of an accredited AA program, a student may become certified by passing the NCCAA examination. The examination is administered and scored by the National Board of Medical Examiners as part of services contracted to NCCAA. Performance information for test items and the overall exam are provided by NBME. NCCAA uses this data to set the passing score and provides notification of certification. NCCAA awards a time-limited certificate to each candidate who successfully completes the Certifying Examination.
To re-certify, an AA must complete 40 hours of CME every two years and register the activities with NCCAA. Additionally, AAs must take the Continuing Demonstration of Qualification Exam every six years.
5. What is the professional organization for AAs?
The professional organization for AAs is the American Academy of Anesthesiologist Assistants (AAAA). AAAA was founded in 1975 and serves the various educational, advocacy and national organizational needs of the AA profession. Their website may be found at: www.anesthetist.org.
6. Can AAs become members of ASA?
AAs and AA students, as well as NAs and NA students, are eligible for ASA membership. They join under the category of “Educational Members” and are entitled to all of the educational benefits of ASA memberships, including free registration at the ASA Annual Meeting and a subscription to Anesthesiology.
Educational members are nonvoting members and cannot run for office. However at the invitation of the President, AAs can and do serve on committees and attend Reference Committee and House of Delegates meetings. Dues for Educational Members are currently the same as for Affiliate Members. Applications for membership may be obtained from the ASA website.
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