AA Profession Faq's
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.
The specific job descriptions and duties of AAs may differ according to local practice. State law or board of medicine regulations or guidelines may further define the job descriptions of AAs. The constant ingredient no matter what the local variation is that AAs always practice under the medical direction of a qualified anesthesiologist.
As part of defining the educational goal of AA training programs, the CAAHEP accreditation Standards include a template AA job description. The excerpt is included below. Wherever the term 'assisting' occurs, it is understood that such assistance may be actual performance of the stated task by the AA as part of duties directed by the supervising anesthesiologist.
"Under the medical direction and supervision of an anesthesiologist, the AA.s functions include, but are not limited to, the following:
- Making the initial approach to a patient of any age in any setting to obtain a preliminary preanesthetic health history, perform an appropriate preanesthetic physical examination and record pertinent data in an organized and legible manner for review by an anesthesiologist. These activities help to define the patient's current physical status as it relates to the planned anesthetic.
- Performing or assisting in the conduct of diagnostic laboratory and related studies as appropriate, such as drawing arterial and venous blood samples.
- Establishing noninvasive and invasive routine monitoring modalities as delegated by the responsible anesthesiologist.
- Assisting in the application and interpretation of advanced monitoring techniques such as pulmonary artery catheterization, electroencephalographic spectral analysis, echocardiography and evoked potentials.
- Assisting in inducing, maintaining and altering anesthesia levels, administering adjunctive treatment and providing continuity of anesthetic care into and during the postoperative recovery period.
- Assisting in the use of advanced life support techniques such as high frequency ventilation and intra-arterial cardiovascular assist devices.
- Assisting in making postanesthesia patient rounds by recording patient progress notes, compiling and recording case summaries and by transcribing standing and specific orders.
- Performing evaluation and treatment procedures essential to responding to life-threatening situations, such as cardiopulmonary resuscitation, on the basis of established protocols (basic life support, advance cardiac life support, and pediatric advanced life support).
- Assisting in the performance of duties in intensive care units, pain clinics and other settings, as appropriate.
- Training and supervising personnel in the calibration, trouble shooting and use of patient monitors.
- Performing delegated administrative duties in an anesthesiology practice or anesthesiology department in such areas as the management of personnel, supplies and devices.
- Assisting in the clinical instruction of others."
The complete Standards for Accreditation of Anesthesiologist Assistant Education is available from CAAHEP at AA Standards.
Anesthesiologist assistants may be either licensed as AAs or practice under the license of an anesthesiologist under the principle of delegation. Anesthesiologists may delegate those tasks or duties involved in the practice of anesthesiology to qualified individuals such as AAs as long as the anesthesiologist is immediately available and the anesthesiologist retains ultimate responsibility for the care of the patient. The exact details regarding delegation and licensing of AAs are different from state to state, and an anesthesiologist seeking to employ AAs should consult the board of medicine of the state in which he or she practices.
Anesthesiology practices in many states presently employ AAs. Inclusion of AAs in anesthesia care team practices across the country is a dynamic and evolving situation. To get the latest and most accurate information, please contact your state board of medicine or the ASA Washington Office for any questions on the licensure and practice locations of AAs.
Another excellent resource is maintained by the American Academy of Anesthesiologist Assistants (AAAA). Click here for a map highlighting the states where AAs currently practice.
Licensure for AAs is created by legislation that is enacted and codified into state law or through regulation adopted by the board of medicine.
Delegatory authority may take the form of either recognition and action by the board of medicine or expressed in a delegation enabling statute such as the state’s medical practice act. It is well accepted in various medical specialties, including anesthesiology, that the board of medicine may grant a physician the authority to delegate tasks or duties related to the practice of medicine to qualified individuals so long as the physician: 1) remains ultimately responsible to the patient and 2) assures that the individual performing the tasks is qualified to do so. An anesthesiologist seeking to employ AAs under the principle of delegatory authority should seek input from the board of medicine of their specific state.
Licensure for AA practice, although sometimes more difficult to achieve, better defines and anchors the practice of AAs in a state than does the simpler delegatory authority.
In all states AA practice falls under the auspices of the board of medicine. In contrast, nurse anesthetists' practice is regulated by state boards of nursing.