Anesthesiologist Assistants: Qualified Members of the Anesthesia Care Team
Who are Anesthesiologist Assistants?
Anesthesiologist assistants are highly qualified non-physician anesthesia providers who assist anesthesiologists in implementing an anesthesia care plan developed for the patient. Anesthesiologist assistants administer anesthesia under the supervision of an anesthesiologist who is immediately available. They are trained extensively in the delivery and maintenance of quality anesthesia care, as well as advanced patient monitoring techniques. Anesthesiologist assistants work exclusively within the anesthesia care team environment as described by the American Society of Anesthesiologists.
There are approximately 1,800 anesthesiologist assistants who are practicing in 18 states and the Veterans Affairs system. Anesthesiologist assistants are recognized as qualified anesthesia providers by the Centers of Medicare and Medicaid Services, Department of Veterans Affairs, and TriCare. It is a testament to their education, skill, and training that these agencies authorize anesthesiologist assistants to provide anesthesia to the population’s sickest patients.
Equivalency of Supervised Anesthesiologist Assistants & Nurse Anesthetists
Anesthesiologist assistants are as safe and effective as nurse anesthetists. The federal government and 18 states recognize anesthesiologist assistants and nurse anesthetists as being qualified anesthesia providers who have identical clinical capabilities and responsibilities. There is no evidence of any sort that the care provided by an anesthesiologist assistant is less safe than that of a nurse anesthetist. For nearly four decades, the anesthesia care team has safely and effectively delivered anesthesia care with either an anesthesiologist assistant or nurse anesthetist as the nonphysician anesthetist member of the team.
An analysis of over 50,000 anesthesia cases by the University Hospital Health System in Ohio did not find a difference in patient outcomes between nurse anesthetists and anesthesiologist assistants. Additionally, professional liability insurance carriers treat anesthesiologist assistants and nurse anesthetists equally; there is no difference in risk when insuring the two providers. No state has amended its state law to limit the scope of practice of an anesthesiologist assistant due to safety concerns. In fact, states have increased the anesthesiologist/anesthesiologist assistant supervision ratio as they have proven to be highly qualified anesthesia providers. Because anesthesiologist assistants work under the supervision of an anesthesiologist, patients will always have an anesthesiologist involved in their care. An anesthesiologist will be immediately available to respond to any complication that may arise.
While differences exist between anesthesiologist assistants and nurse anesthetists in regard to the prerequisites, curriculum, instruction in regional anesthesia and invasive monitoring, and requirements for supervision in practice, these differences are not based on superiority of education or ability, but rather a product of differences in historical development and the philosophies and motivations of those that practice within each profession.
History of Anesthesiologist Assistants
The first anesthesiologist assistant programs began at Emory University and Case Western Reserve University in 1969. The education program and profession is a result of the physician shortage faced by the field of anesthesiology in the mid-1960s, a shortage of nurses in anesthesia, and the increasing technological demands of the field. In response, three anesthesiologists proposed the concept of an "anesthesia technologist" who would be a member of the anesthesia team and be considered an "applied physiologist."
Education and Training
There are five accredited anesthesiologist assistant programs in the United States. All of the programs require the Graduate Record Examination or Medical College Admission Test entrance exam and a bachelor's degree that is based upon a premedical curriculum. The programs consist of 56-132 classroom hours of course work and from 2,000 to 2,700 clinical hours. As part of the program, anesthesiologist assistant students must complete a clinical rotation in all subspecialties of anesthesia with additional training in regional anesthesia and invasive line placement. The anesthesiologist assistant programs are accredited by the Commission for the Accreditation of Allied Health Education Programs. The programs are located in academic facilities that meet anesthesia residency requirements for physicians. Graduates of the anesthesiologist assistant programs are awarded a master’s degree.
Upon completion of the program, certification is awarded upon successful completion of the certifying examination administered by the National Commission for Certification of Anesthesiologist Assistants. To become recertified, an anesthesiologist assistant must complete 40 hours of continuing medical education credits biannually and successfully complete every six years the Continued Demonstration of Qualifications (CDQ) exam, which is administered by the National Board of Medical Examiners.