ASA: Need anesthesiology providers? Consider anesthesiologist assistants

A guest column by the American Society of Anesthesiologists, exclusive to

On March 28, 2012, Governor Scott Walker signed into law SB383, a bill to license Anesthesiologist Assistants (AA) in Wisconsin.  The Wisconsin Academy of Anesthesiologist Assistants (WAAA), the Wisconsin Society of Anesthesiologists (WSA), the Wisconsin Medical Society, numerous other medical specialty societies, the Medical Examining Board, and six major hospital systems supported the bill.  Since 2001, seven states have opted to license AAs in order to meet the growing demand for anesthesia services.

AAs practice either under physician delegation of duties in accordance with the respective medical practice act or as enabled by practitioner specific statutory licensure.  In all situations, AAs provide care as medically directed by an anesthesiologist.  AAs are credentialed by a facility in the same manner as other midlevel providers and function equivalently to nurse anesthetists in the Anesthesia Care Team model.

As a practicing anesthesiologist in Wisconsin, I can tell you that this bill will benefit our patients in a number of ways:

Access to anesthesia services. The national shortage of Anesthesiologists and Certified Registered Nurse Anesthetists has increased in recent years due to a) the escalating number of healthcare procedures requiring anesthesia b) the increased requirement for surgical procedures in the elderly population, the fastest growing segment of our population.  This legislation would address the growing need for anesthesia services in Wisconsin.  Similarly to Physician Assistants, AAs would fill the need for more midlevel providers in anesthesia services, particularly in rural areas where anesthesiologists are in short supply.

Tranparency.  The bill creates a Council on Anesthesiologist Assistants under the auspices of the Medical Examining Board, similar to Physician Assistants and Respiratory Therapists.  The Council will increase transparency by defining AA scope of practice in state law.

Ensuring quality.  Hospital credentialing committees and insurance carriers increasingly are looking for assurances that anesthesia providers are competent.  Licensing is one way of accomplishing that goal.

Addressing manpower needs. Though AAs have worked in Wisconsin under delegatory authority since 1980, licensure over time would make Wisconsin a more attractive place for AAs to live, work and pay taxes.  Experience from other states has shown that licensure leads to an increase in the number of practicing AAs in the state

For further information about Anesthesiologist Assistants’ education, qualifications, and practice, visit the American Academy of Anesthesiologist Assistants and the American Society of Anesthesiologists.

James R. Mesrobian is Alternate Director (Wisconsin), American Society of Anesthesiologists.

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  • stanley kristiansen

    utter falsehood, at this time there is
    1. No shortage of providers
    2. Will not alleviate rural shortages as the AA MUST be supervised by an anesthesiologist not possible in most rural practices.
    No more then another front in the war between the AANA and ther ASA.

  • Warren Amyx

    In WIsconsin as in all of the United states: There are already very competent, highly skilled and trained providers available. Look to CRNA’s. Proven track record, Proven economic record. Proven time and time again.

  • Jim Carroll, CRNA

    This: –

    “This legislation would address the growing need for anesthesia services
    in Wisconsin.  Similarly to Physician Assistants, AAs would fill the
    need for more midlevel providers in anesthesia services, particularly in
    rural areas where anesthesiologists are in short supply.”

    – is a gross misstatement.  As others have already pointed out, AAs practice only under the direct supervision of anesthesiologists.  A shortage of “anesthesia providers” in rural America cannot be alleviated by licensing AAs.

    Rural anesthesia practice is an arduous commitment.  Anesthesiologists, by and large, avoid rural practice in favor of large multi-specialty group practices with sane work schedules and backup coverage from other anesthesiologists.  And AAs practice with and under the direct supervision of anesthesiologists.  Unless and until anesthesiologists accept the long hours and unpredictable workloads of rural hospitals, Certified Registered Nurse Anesthetists (CRNAs) are the rural anesthesia providers of choice, and certainly the most cost-effective model. 

    High-risk Obstetrics is the bete noir of rural practice.  Unless and until high-risk pregnant patients can be required to move near a medical center from the beginning of the third trimester until after delivery, rural hospitals must be staffed for the obstetric emergency.  At two AM, when the high-risk mom enters the Emergency Department in active labor with a stressed baby, there is no time to “ship her” to the spectacularly-appointed “High Risk Perinatal Center” 50+ miles down the freeway, even if EMTALA permitted such a transfer.  So, it often falls to the solo rural “anesthesia provider” to provide anesthesia care to the mother and baby, under the most difficult circumstances.  This solo provider must follow all the standards of care that are fulfilled by a large team of anesthetic and perinatal providers in a large center.  Often, after the mother is delivered safely to the post-anesthetic care unit nurses, that same solo provider must attend to the newborn.  That may be a three-hour commitment awaiting the perinatal care team from the perinatal center where the patient intended to deliver, and indeed would have if not for the blizzard that was in its full fury as the contractions began.

    I submit that no provider other than an experienced CRNA can provide this full service, 24 hours a day, 365 days a year, on 20 minutes’ notice.  There may be a few exceptions that prove that rule; I don’t know, I haven’t seen them.

    I have read other articles in KevinMD presenting the ASA’s side of controversies such as this one, and I know that AANA has written substantial written viewpoints that KevinMD did not publish.  I am fully aware that what I have written here will probably not see the front page of KevinMD.  But it must be pointed out that it is disingenuous at best to posit that licensing AAs does anything to staff rural hospitals.

  • 57jeff88


    I would be willing to “bet the farm” that the three previous posts were all placed by CRNA’s.
    Is it not telling when these mid-level providers so vehemently attack other mid-level providers
    when all they are trying to do is gain recognition and a chance at legitimate licensure? It is
    amazing that CRNA’s cry foul so loudly when another skilled provider starts to encroach on
    their turf! They certainly did not have any qualms when they began comparing themselves
    to M.D.’s. Now that the shoe is on the other foot it is sooo… apparent that CRNA’s want to
    have their cake and eat it too!

  • Karen Sibert MD

    Although I hate the word “provider”, in all other respects I agree with the information in this column and would like to see AAs licensed in every state including my own state, California.  Their training is excellent, and their loyalty to the specialty of anesthesiology is unquestioned.

  • megstern

    I’m really excited that WI has gained legislative licensure.  Colorado has almost become a legislative state as well!  It’s great to have more options for places to work.  I am a second year anesthesia student and I graduate in August. It’s exciting to watch the AA profession grow in strength as well as in numbers.  Anesthesiologist Assistants are fantastic physician extenders and a great asset to an anesthesia care team.   I look forward to graduating, practicing, and helping the profession continue to mature.

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