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9/19/2014 1

Anesthesiologist Assistants

David Shimabukuro, MDCM Associate Professor Medical Director 13 ICU

Disclosures

• I have no disclosures

I am a:

1 2 3 4 5

51% 37% 4% 0% 8%

1. MD/DO 2. CRNA 3. RN 4. AA 5. Other

An Anesthesiologist Assistant is…

1 2 3

29% 19% 52%

1. I definitely know the answer 2. I think I know the answer 3. I have no idea

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An Anesthesiologist Assistant functions most similarly to a(n):

1 2 3 4

0% 40% 45% 15%

1. Attending 2. Anesthesia technician 3. CRNA 4. Resident

Anesthesiologist Assistant

From American Academy of Anesthesiologist Assistants: 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). … AAs are trained extensively in the delivery and maintenance of quality anesthesia care as well as advanced patient monitoring techniques.

Agenda

• Past
• Present
• Future

Agenda

• Past
• Present
• Future

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History

• Joachim Gravenstein, John Steinhaus, Perry

Volpitto

– “Analysis of Manpower in Anesthesiology” Anesthesiology 1970 Sep; 33(3):350-7

• First anesthesiologist assistant training

programs at Emory University and Case Western University in 1969.

Agenda

• Past
• Present
• Future

Education/Training

• 24-28 month Master’s level program

accredited by the Commission for the Accreditation of Allied Health Educational Programs

Education/Training

• Average program hours (total):

– 600 classroom/laboratory – 2600 clinical

• Minimum of 600 anesthetics

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Education/Training

• Based at or in collaboration with a university

that has a medical school AND academic anesthesiologist faculty.

• Main clinical sites MUST BE academic medical

centers

Education/Training

• Admission’s requirements:

– Bachelor’s degree – Medical school science pre-requisites

• General + organic chemistry
• General + advanced biology
• Physics
• Math

– MCAT/GRE

Emory University

• Prerequisites

– General Medical School – GRE: 55th percentile; MCAT: 27P

• 27 continuous months (7 semesters)

– Semester 1: Classroom – Semester 2-4: Classroom and Simulation Lab – Semester 5-7: Clinical

• Tuition: $100,000

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Colorado University

• Prerequisites

– General Medical School – GRE: 55th percentile; MCAT: 25

• 28 continuous months (7 semesters)

– Clinical is integrated through all semesters – Semester 4-7: Clinical only

• Tuition: $55,000(in-state)/$78,000(out-state)

Education/Training

• 10 accredited anesthesiologist assistant

programs

– 2: Florida and Georgia – 1: Colorado, Connecticut, Missouri, Ohio, Texas, Washington DC

Education/Training

AA CRNA Number of schools (Pu/Pr) 8 (1/7) 108 (48/60) Program length (median) 25.5 months 28 months Cost for Public (median) $68, 210 $37,243 Cost for Private (median) $71, 410 $61, 345

MacIntyre P, Stevens B, Collins S, and Hewer I. Cost of Education and Earning Potential for Non-Physician Anesthesia Providers. AANA Journal 2014 February; 82(1):25-31

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Certification

• National Commission for Certification of

Anesthesiologist Assistants

– Over half are anesthesiologists – Administered and scored by NBME

• Re-certification exam every 6 years

Practice

• Licensure

– Legislation (specific) – Medical Board (specific)

• Delegatory authority

– Medical Practice Act (broad to narrow)

• 1. Anesthesiologist remains ultimately responsible
• 2. Assures individual is qualified to perform tasks.

Practice

• Must work under the direction (not

supervision) of an anesthesiologist

– 7 Criteria

• Ratio is usually between 2:1 and 4:1

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Billing

• For CMS, same as a CRNA, except only medical

direction qualifier can be used (QX,QS,QY)

• For third-party payers, there is usually no

difference between CRNA and AA under medical direction

Pay

AA CRNA Number of schools (Public/Private) 8 (1/7) 108 (48/60) Program length (median) 25.5 months 28 months Cost for Public (median) $68, 210 $37,243 Cost for Private (median) $71, 410 $61, 345 Compensation (median) $127,020 $158,092

MacIntyre P, Stevens B, Collins S, and Hewer I. Cost of Education and Earning Potential for Non-Physician Anesthesia Providers. AANA Journal 2014 February; 82(1):25-31

I would work with an Anesthesiologist Assistant (medical direction or colleague).

1 2 3

49% 24% 27%

1. Yes 2. No 3. Undecided

Agenda

• Past
• Present
• Future

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Anesthesia Workforce

Anesthesia & Analgesia August 2012; 115(2):407-427

Anesthesia Workforce

• Scenario 1: Strong Demand

– No growth 2008-2013 – 2.2% annual growth until 2020

• Scenario 2: Conservative Demand

– No growth 2008-2013 – 1.3% annual growth until 2020

Anesthesia Workforce

• Anesthesiologist supply has increased over the

years, but training output has plateaued (“cap” in residency positions)

• In 2020…
• Scenario 1: SHORTAGE
• Scenario 2: SHORTAGE (unless > 50%

conversion from solo practice to medical direction

Anesthesia Workforce

• High CRNA production over the past decade

with no changes expected in the immediate future

• In 2020…
• Scenario 1: SURPLUS
• Scenario 2: SURPLUS

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Anesthesia Workforce

• Anesthesiologist Assistant not directly

addressed in paper

• In 2013, estimated 180 graduates
• In 2020…
• Scenario 1: SURPLUS
• Scenario 2: SURPLUS

California Society of Anesthesiologist

• Whereas, Anesthesiologist Assistants are a

vital part of the Anesthesia Care Team across the country and have been for over 40 years; and

• Whereas, many Anesthesiologists in California

would like to utilize Anesthesiologist Assistants as part of their Anesthesia Care Team; and

California Society of Anesthesiologist

• Whereas the State of California does not

currently have a category recognizing and allowing for Anesthesiologist Assistants to practice within the state; therefore be it

• Resolved, that the California Society of

Anesthesiologists pursue recognition and practice of Anesthesiologist Assistants within the state of California.

Summary

• Anesthesiologist Assistants complete a

Master’s program (24-28 months) within a School of Medicine

• National certification exam with recertification

every 6 years

• Only practice under medical direction in states

(16 + DC) with statues (licensure or delegatory authority)

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Summary

• Payers do not distinguish between CRNA and

Anesthesiologist Assistant

• Salary is little less then CRNA, unless working

together in same department

• Could help mitigate predicted shortage of

anesthesiologists in the future by conversion

• f solo practice to medical direction

I would like to see Anesthesiologist Assistants in California

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33% 18% 50%

1. Yes 2. No 3. Undecided

THANK YOU!!