“D.O.P.E. THE SCOPE” ON AA’S PRACTICE IN TEXAS
Data on Anesthesiologist Assistants Scope of Practice in Texas
Nitin Wadhwa, MD,
Member, TSA Communications Committee
If you are an anesthesiologist practicing in the State of Texas and you haven’t worked with an Anesthesiologist Assistant (AA) before, it is likely that you will be in the near future.
Texas is the third largest employer of AAs in the country. The only accredited AA training program in Texas is the Case Western Reserve University Master of Science in Anesthesia program, which is affiliated with The University of Health Science Center in Houston. According to the Texas Academy of Anesthesiologist Assistants (TAAA), there are currently 57 AAs and 38 AA students in Texas.
The functional role of AAs has its foundation in the Anesthesia Care Team model in which an anesthesiologist concurrently supervises one or more midlevel providers in the administration of an anesthetic plan. Their scope of practice extends from the performing a preoperative anesthesia evaluation to advanced techniques such as placing invasive monitoring or performing ACLS. Since these roles are to be performed strictly under the medical direction of an anesthesiologist, a lot of what they can and can’t do is highly dependent on the anesthesiologist’s discretion. Therefore the functional role of AA’s is similar to that of CRNAs. As a result, AA salaries are comparable to that of CRNAs.
There are a few important differences between AAs and CRNAs.
First of all, training requirements are different. CRNAs require a nursing degree prior to being able to enroll in a CRNA program. AA training programs require a bachelor’s degree along with prerequisite science courses and MCAT and/or GRE score.
Second, CRNAs can practice under the supervision of any physician (not necessarily an anesthesiologist), or even independently in some states.
AAs can work only under the direct supervision of an anesthesiologist.
Third, CRNAs practice in all 50 states, whereas AAs currently practice in 17 states and the District of Columbia.
Finally, the governing body for CRNAs is the State’s nursing board, while the governing body for AAs is the State’s medical board.
States are classified as regulatory or delegatory governing how AAs are allowed to practice. Texas is considered a delegatory state (along with Colorado, Michigan, New Hampshire, West Virginia and Wisconsin) where an anesthesiologist “delegates” tasks to AAs, provisions of which are derived from The Medical Practice Act. Thus, AAs in Texas do not have a specific license or equivalent. All other states are regulatory in the sense that AAs have a license, regulation, or certification also derived from a medical practice act.
Texas State licensure is the current hot topic for AAs. AAs are the only entity without a license in the operating room. Anesthesiologists, OR nurses, CRNAs, OR techs are all licensed. Currently, there are lobbying efforts from anesthesiologists and AAs in Texas to change this so that AAs do become licensed. Should these efforts be successful, it could result in greater acceptance of AAs and a resultant increase in jobs in Texas. This lobbying effort is being opposed by CRNAs as it would significantly increase competition for anesthetist jobs in Texas.
Although AAs are authorized to work in Texas, the Texas State Medical board only has guidelines, not laws, as to the minimum standards for AAs. The Board is an unbiased entity and these guidelines are not meant as encouragement or endorsements for the use of AAs.
