The medical field is constantly evolving and growing. With the constant change and rapid growth, medical professionals are tasked with keeping up and adapting. Now, more than ever, medical personnel are seeing just what keeping up really entails. Most medical facilities are understaffed and the staff that they do have is overwhelmed and working tirelessly. Due to staffing shortages, many patients are not getting the treatments and procedures that they need. The demand for more comprehensive and team based care is at an all-time high. In order to meet these demands, new positions and job titles are being created constantly. Schools are trying to meet the demands for more medical personnel by educating students as quickly as they can and medical facilities are more willing to train new grads just so they can be properly staffed. One of the many areas that is suffering is the field of anesthesia. Frankly put, there are not enough anesthesiologists. Certified Registered Nurse Anesthetists attempt to fill in the gaps but there is still a need for more anesthesia providers. So far 12 states have passed legislation allowing for anesthesiologist assistants to practice as part of the anesthesia care team model, which is a team based approach to providing anesthesia with non-physician anesthesia providers managing cases and procedures under the supervision of an anesthesiologist. In an effort to combat the shortage in anesthesia providers, the remaining states should take steps towards passing legislation that will allow anesthesiologist assistants to work as part of the anesthesia care team model.
The benefits of allowing anesthesiologist assistants to work as members of the healthcare team
Allowing anesthesiologist assistants to work as members of the anesthesia healthcare team enables patients to obtain timely and quality healthcare. The limited number of anesthesiologists is a major reason for delays or cancellations in scheduled surgeries. For instance, a report on the influence of the coronavirus pandemic on the outgrowth of acute care surgery patients established that a shortage of anesthesiologists during the pandemic caused elective surgical theaters to reduce by 50% (Krutsri et al. 51). For patients in need of elective surgery, health facilities were limited to conducting surgery only in cases of malignancy. These adverse healthcare outgrowths highlight the need to include anesthesiologist assistants to work as anesthesia healthcare team members. Research outcomes have demonstrated that including anesthesiologist assistants in the anesthesia care team increases the number of surgeries performed in hospitals. In this line, Pinegar and Townsend opine that anesthesiologist assistants provide “compassionate, consistent high quality anesthesiology care to an untold number of patients here in Missouri, and elsewhere in the country” (66). This statement indicates that including anesthesiologist assistants in the anesthesia, healthcare team helps prevent anesthesiologist shortages, thus enabling patients to receive the required surgery. Therefore, anesthesiologist assistants working in anesthesia care teams enable patients to obtain timely and quality healthcare.
Moreover, allowing anesthesiologist assistants to serve as members of the anesthesia healthcare team will increase access to anesthesia health services in rural areas. Inadequate healthcare services amongst the population inordinately affect individuals in rural areas. To this end, Orser and Wilson argue that the heightened concentration of healthcare services in urban centers “has contributed to the attrition of anesthesia, surgical and obstetric care services in rural Canada” (861). An immediate and ongoing solution to inadequate anesthesia healthcare services in rural areas requires using anesthesiologist assistants as anesthesia healthcare team members to support the limited number of anesthetist specialists in understaffed regions. Deployment of anesthesiologist assistants in rural areas will help decrease the shortage of anesthesia practitioners, thus enabling access to anesthesia services and reducing the disproportionate healthcare burden among rural residents.
Allowing anesthesiologist assistants in the care team is also crucial in supporting learners in the anesthesia field, thus accelerating the orientation and skills acquisition among learners entering the field of anesthetists. In the wake of the shortage of health practitioners in the anesthesia profession, academic institutions and health facilities have geared up to increase the number of qualified graduates entering the profession. Schools have increased enrollment, and hospitals are providing opportunities for learners to gain relevant skills in the profession. To this end, anesthesiologist assistants are crucial in supporting learners to gain practical anesthetist skills. According to Huang et al., some higher learning institutions use anesthesiologist assistants to “help introduce learners to the care team model and provide additional perspective” (646). While this approach is often employed based on resource availability, it provides a crucial platform for learners to effectively gain critical skills since the number of physician anesthesiologists and CRNAs is limited. Therefore, allowing anesthesiologist assistants in the care team is crucial in supporting learners in the anesthesia field.
The drawbacks of allowing anesthesiologist assistants to work as part of the care team
However, while including anesthesiologist assistants in the anesthesia care team environment has numerous benefits, it is limited because it leads to increased healthcare costs. Anesthesiologist assistants working as part of the anesthesia care team must comply with the medical direction health practice regulation that is costly and inefficient because it requires one physician anesthesiologist to work with four certified registered nurse anesthetists (CRNA) or anesthesiologist assistants (McCurdy and Phillips 13). Even though CRNAs can work independently and expand healthcare services in greater ratios, anesthesiologist assistants are supposed to work only in a 4:1 ratio framework. The expanded labor force increases the cost of surgical procedures, which calls for substantial subsidies from health facilities to sustain the high cost of anesthesia procedures. In this line, the outcomes of a recent study established that the continued “use of AA during outpatient colonoscopy increased significantly from 2006 through 2015, associated with increased cost for all payers” (Krigel et al. 2495). The increase in healthcare costs reflects the fact that the use of anesthesiologist assistants under the medical direction framework heightens medical costs since the high number of anesthesiologist assistants in the care team have to be compensated. Therefore, including anesthesiologist assistants in the anesthesia care team has the drawback of heightening healthcare costs despite increasing access to anesthesia services.
Similarly, while including anesthesiologist assistants in the anesthesia, healthcare team helps increase the size of practitioners available to conduct surgical procedures, it fails to meet demand. The increasing healthcare burden in the US has heightened demands in the operating room. This increasing healthcare demand for emergency cases pushes health facilities to have extra operating rooms, which calls for more anesthesia practitioners. This development poses significant staff shortages. While physician anesthesiologists and CRNAs can work independently to cater to increased healthcare demands, anesthesiologist assistants cannot since they are impeded by the low number of physician anesthesiologists present to supervise them. Tamura et al. report that “anesthesiologist assistants (AAs) perform tasks under physician anesthesiologists’ supervision” (609). This limiting working framework for physician anesthesiologists and anesthesiologist assistants implies that health facilities cannot meet the increased demand for anesthesia services, leading to the absence of flexibility to meet OR needs, delayed healthcare services, and reduced efficiency. Therefore, it is evident that including anesthesiologist assistants in the anesthesia, healthcare team does not meet OR demands.
The model under which anesthesiologist assistants work is marred with inefficiency, reducing the expected gains of using them as part of the anesthesia healthcare team. Under the medical direction requisite, anesthesiologist assistants must work under the supervision of a physician anesthesiologist, whereby “the cutoff for medical direction is 1:4 coverage” (McLoughlin 43). They have to adhere to this recommendation to avoid loss of revenue. Even though complying with this practice guideline alleviates possible loss of revenue, it is likely to result in delayed starts, reduced anesthetic procedures conducted per day, and increased charges to the system. In addition, the practice model impedes anesthesiologist assistants from extending their expertise in enhancing access to quality healthcare services among individuals in medically underserved regions. The model also prevents health facilities from maximizing revenues because anesthesiologist assistants cannot urgently extend their services to patients needing anesthetic care.
In conclusion, there is an urgent need for remaining states to take steps towards passing legislation that will allow anesthesiologist assistants to work as part of the anesthesia care team model. Even though this approach has various limitations, it has numerous advantages, such as enabling patients to obtain timely and quality healthcare, increasing access to anesthesia services in rural areas, and accelerating orientation and skills acquisition among learners entering the field of anesthetists. On the other hand, the primary drawbacks of allowing anesthesiologist assistants to serve as care team members entail increased healthcare costs, failure to meet demand, and the use of an inefficient model. Further research is required to identify methods of addressing obstacles that limit the attainment of optimal benefits in including anesthesiologist assistants as part of the care team.
Huang, Jeffrey, et al. “Methods of Orienting New Anesthesiology Residents to the Operating Room Environment: A National Survey of Residency Program Directors.” Journal of Education in Perioperative Medicine, vol. 22, no. 3, 2020, pp. E645.
Krigel, Anna, et al. “Substantial Increase in Anesthesia Assistance for Outpatient Colonoscopy and Associated Cost Nationwide.” Clinical Gastroenterology and Hepatology, vol. 17, no. 12, 2019, pp. 2489-2496.
Krutsri, Chonlada, et al. “Impact of the COVID-19 pandemic on the outcome, morbidity, and mortality of acute care surgery patients: A retrospective cohort study.” International Journal of Surgery Open, vol. 28, no. 1, 2021, pp. 50-55.
McCurdy, Kelly and Austin Phillips. “Comparison of CRNAs with and without Supervision on Cost and Safety of Anesthesia.” Williams Honors College, Honors Research Projects vol. 856, no. 1, 2019, pp. 1-25.
McLoughlin, Thomas M. Advances in Anesthesia, E-Book 2020. Elsevier Health Sciences, 2020.
Orser, Beverley A and C Ruth Wilson. “Canada Needs a National Strategy for Anesthesia Services in Rural and Remote Regions.” Canadian Medical Association Journal, vol. 192, no. 30, 2020, pp. E861-E863.
Pinegar, Matthew and Ty Townsend. “The Role of Anesthesiology Assistants in the Anesthesiology Patient Care Team.” Missouri Medicine, vol. 116, no. 1, 2019, pp. 63–66.
Tamura, Takahiro, et al. “Certified Registered Nurse Anesthetist and Anesthesiologist Assistant Education Programs in the United States.” Nagoya Journal Med Science, vol. 83, no. 3 2021, pp. 609–626.