also known as
Anesthesiology Physician Assistant, Type B

Anesthesiologist assistants (AAs) are health care professionals who have successfully completed an accredited program of academic and clinical training and are qualified to work under the supervision of an anesthesiologist (a physician with special residency training in anesthesiology). AAs assist in administering anesthetics to patients undergoing surgery.

Anesthesiologist assistants are to anesthesiologists what primary care physician assistants are to primary care physicians (i.e., family practitioners, pediatricians, etc.) -- that is, they are dependent practitioners participating in a medical care team. Specific responsibilities may vary from site to site depending on the particular practice guidelines in individual hospitals and individual states. Although some AAs may participate in the pre-anesthetic evaluation, more commonly they are involved in assisting the anesthesiologist in reviewing the data available from the surgical and medical teams. In collaboration with the anesthesiologist, they participate in the induction and maintenance of anesthesia and in monitoring the patient's status during the surgical procedure.

More specifically, AAs' responsibilities may include: pretesting and calibrating anesthesia delivery systems and monitors; collecting pre-operative data and performing physical examinations; inserting venous, arterial, and other invasive catheters; administering drugs for the induction and maintenance of anesthesia; administering and monitoring regional anesthesia; airway management (including intubation, fiberoptics); administering cardiovascular drugs as support therapy; providing safe transition from operating room to recovery room; performing functions in the intensive care unit and pain unit; and participating in administrative affairs, research, and clinical instruction.

It has been the general plan that the anesthesiologist has been available in the hospital (although often not always present in the room) during all portions of the case. As a general rule, both the AA and the anesthesiologist are present at the beginning and the end of the case and at the time of major changes in the patient's status.

SETTING, SALARIES, STATISTICS

Anesthesiologist assistants work wherever anesthesiologists work: in hospitals, clinics, outpatient surgical facilities, and academic settings. AAs currently practice in thirteen states, with other states being added as the population of AAs increases. The greatest concentration of AAs is in the two states that currently have educational programs -- Georgia and Ohio. There are only approximately 700 AAs at this time. Men and women are equally represented in this profession.

Salaries for anesthesiologist assistants begin in the $60,000 to $80,000 range.

HOW TO BECOME AN ANESTHESIOLOGIST ASSISTANT

Formal educational requirements for this field are only about fifteen years old. A master's degree specializing in anesthesia is required, and this degree is offered by only two universities at this time: Emory and Case Western Reserve, which established their programs only twenty-five years ago. Both of these programs are accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP), which accredits most allied health education programs in the United States and which, in 1994, became the successor to the American Medical Association's Committee on Allied Health Education and Accreditation (CAHEA). CAAHEP is an independent body. Last year, thirty-five men and women graduated from these programs.

Applicants to a program must have premedical undergraduate backgrounds but may have college degrees in one of several areas. Typically, they are degrees in biology or chemistry or a related allied health area such as respiratory therapy, nursing, or medical technology. The age of students entering these programs ranges from those who are immediately out of college to those who have been out of college and have been working in other areas for ten to fifteen years. Over the years, approximately ten to fifteen percent of the graduates of the two programs have gone on for further graduate medical education, and the overwhelming majority of those who have gone to medical school have done residencies in anesthesiology.

Since 1992, a national certification examination for anesthesiologist assistants has been available. This examination is given by the National Commission on the Certification of Anesthesiologist Assistants (NCCAA) in collaboration with the National Board of Medical Examiners, which is the group that also assists with the national examination for primary care physician assistants.

A practicing AA who has successfully completed an educational program accredited by CAAHEP and passed this examination is designated an Anesthesiologist Assistant-Certified (AA-C). He or she, thereafter, must submit continuing education credits or certification renewal, as well as successfully complete a Continued Demonstration of Quality exam every six years.

Anesthesiologist assistants are regulated by different legislation depending on the state in which they are practicing. In some states, AAs are, by definition, qualified to be licensed as physician assistants (PAs) and, therefore, practice within mandates set forth in the legislation for regulations governing the PAs (see Chapter 48). For example, in Georgia AAs are defined as one type of physician assistant with a corresponding appropriate job description. In these states, an AA is called an Anesthesiologist Physician Assistant, Type B (or APA). The Board of Medicine of the National Academy of Sciences (NAS) defines three categories of physician assistant -- Type A, Type B, and Type C. Type A is the designation for a primary care/generalist physician assistant. A Type B assistant is distinguished by exceptional skill in one clinical specialty or, more commonly, in certain procedures within a specialty. In this area of specialty, the assistant would have a degree of skill beyond that normally possessed by a more general Type A assistant and, perhaps, beyond that normally possessed by physicians who are not engaged in the specialty. (A Type C assistant is similar to a Type A assistant in the number of areas in which he or she can perform, but he or she cannot exercise the degree of independent synthesis of information and judgment of which a Type A is capable.)

Since each state's legislation, regulations, and definitions are different, consult the medical board of the state where you intend to practice or contact the American Academy of Anesthesiologist Assistants (AAAA).

THE FUTURE

Recent graduates are much in demand, and it appears that employment in this still relatively new profession will remain stable.