Some CRNAs Oppose Bill That Aims to License Anesthesiologist Assistants

A new bill in the Tennessee Senate aims to establish licensure for anesthesiologist assistants in an effort to address a shortage of anesthesia providers in the state. Senate Bill 0453 would formally define the scope of practice for anesthesiologist assistants and allow them to become certified and licensed to practice in Tennessee.

Anesthesiologist assistants have been working in the U.S. since the 1960s, but currently can only practice in 20 states with licensure. They give anesthesia under the guidance of an Anesthesiologist. If passed, the bill would prohibit anyone from practicing as an anesthesiologist assistant in Tennessee without a license and a certification from the National Commission for Certification of Anesthesiologist Assistants.

Demand Growing for Anesthesia Providers

The demand for anesthesia services is growing in Tennessee due to an aging population, increased rates of chronic disease, and more complex surgeries. Licensing anesthesiologist assistants is seen as one way to help meet the growing need for anesthesia care, especially in rural parts of the state.

“The purpose of the bill was to try to bring anesthesia assistants into Tennessee who would be licensed to perform, they would have to be able to work with an anesthesiologist if at the site in the same building with them,” said Sen. Richard Briggs (R – Knoxville).

Although the bill has garnered backing from hospital systems and the Tennessee Association of Anesthesiologists, it encounters resistance from certified registered nurse anesthetists (CRNAs). CRNAs do not currently have full practice authority in Tennessee, while many other states do.  CRNAs have the authority to give anesthesia without a Physician’s guidance while CAAs cannot. 

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Furthermore, detractors contend that the bill might not adequately tackle the healthcare workforce challenges in rural regions and express worries regarding the credentials and cost-efficiency of Certified Anesthesiologist Assistants (CAAs) compared to CRNAs, who possess substantially more experience, training, and experience in the state. CRNAs are required to have at least 2 years of ICU experience before being admitted into a Nurse Anesthetist program and hold either a Master’s Degree or a Doctorate Degree. This discourse underscores the intricate nature of healthcare staffing and underscores the necessity for a well-rounded strategy in resolving shortages.

Some nurse anesthetists and anesthesiologists have expressed opposition to the bill, arguing that anesthesiologist assistants have less training and education than physician anesthesiologists and nurse anesthetists. They believe patient safety could be compromised by allowing anesthesiologist assistants to practice.

There are several differences between CRNA, Anesthesiologist, and Anesthesiologist Assistants. 

What is an Anesthesiologist Assistant?

Anesthesiologist assistant training programs typically span 24 to 28 months, culminating in the awarding of either a Master of Science in Anesthesia or a Master of Medical Science degree.

After completing their training, certified anesthesiologist assistants operate solely under the medical supervision of physician anesthesiologists. They apply their acquired knowledge of anesthesia patient care as essential members of the physician-led Anesthesia Care Team (ACT) model.

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What is a CRNA?

A certified registered nurse anesthetist (CRNA) is an advanced practice registered nurse (APRN) specializing in administering safe and effective anesthesia care to patients. Their primary responsibilities encompass administering anesthesia, monitoring patients during surgical procedures, and overseeing post-anesthesia recovery. CRNAs ensure patient comfort, manage pain and uphold physiological stability throughout surgeries.

Some states adopt CRNA-only models or grant full-practice authority, empowering CRNAs to practice autonomously. Tennessee does not grant CRNAs full-practice authority – anesthesiologist supervision is mandatory for practicing CRNAs.

In 2007, the American Association of Nurse Anesthetists (AANA) issued a position statement endorsing advanced graduate education and proposing that the entry-level degree for nurse anesthetists be elevated to the “doctoral” level by 2025. The designated degree would be the “practice doctorate,” commonly referred to as the “Doctor of Nursing Practice” (DNP) or the “Doctor of Nurse Anesthesia Practice” (DNAP) degree. These degrees, focused on practice or clinical expertise, have different standards and requirements compared to the more research-oriented doctorates such as the Ph.D. or the education-focused EdD, which are typically pursued by nurses seeking advancement in academic positions.

What is an Anesthesiologist?

An anesthesiologist is a medical doctor (MD) or doctor of osteopathic medicine (DO) specializing in delivering anesthesia care to patients. Anesthesiologists are physicians who have undergone extensive education, training, and certification in anesthesiology. They play a pivotal role in the perioperative care of patients, ensuring their comfort, safety, and well-being during surgical procedures.

Anesthesiologists collaborate closely with surgeons, nurses, and other healthcare professionals to provide comprehensive care before, during, and after surgeries.

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Unlike CRNAs, anesthesiologists possess the ability to practice independently throughout the United States. Additionally, anesthesiologists often oversee CRNAs within their practice.


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