What is a Certified Anesthesiologist Assistant (CAA)?
A certified anesthesiologist assistant (CAA) is an integral, highly skilled member of an anesthesia care team. CAAs work under the direct supervision of an anesthesiologist and perform many key duties, including conducting preoperative physical exams, administering medications, evaluating and responding to life-threatening situations, setting up external and internal monitors, and implementing general and site-specific anesthetic techniques.
Like a physician assistant (PA) who works as a “physician extender,” a CAA allows an anesthesiologist to direct several cases at one time. However, unlike PAs, who handle a broad range of needs, CAAs are very highly trained in one specialty: anesthesia. Their extensive education makes them uniquely qualified to provide the highest quality of care in the surgical setting.
What do CAAs do?
The specific job descriptions and duties of CAAs may differ according to local practice. State law or board of medicine regulations or guidelines may further define the job descriptions of CAAs. The constant ingredient no matter what the local variation is that CAAs always practice under the medical direction of a qualified anesthesiologist.
As part of defining the educational goal of CAA training programs, the CAAHEP accreditation Standards include a template AA job description. The excerpt is included below. Wherever the term 'assisting' occurs, it is understood that such assistance may be actual performance of the stated task by the CAA as part of duties directed by the supervising anesthesiologist.
"Under the medical direction and supervision of an anesthesiologist, the CAAs functions include, but are not limited to, the following:
- Making the initial approach to a patient of any age in any setting to obtain a preliminary preanesthetic health history, perform an appropriate preanesthetic physical examination and record pertinent data in an organized and legible manner for review by an anesthesiologist. These activities help to define the patient's current physical status as it relates to the planned anesthetic.
- Performing or assisting in the conduct of diagnostic laboratory and related studies as appropriate, such as drawing arterial and venous blood samples.
- Establishing noninvasive and invasive routine monitoring modalities as delegated by the responsible anesthesiologist.
- Assisting in the application and interpretation of advanced monitoring techniques such as pulmonary artery catheterization, electroencephalographic spectral analysis, echocardiography and evoked potentials.
- Assisting in inducing, maintaining and altering anesthesia levels, administering adjunctive treatment and providing continuity of anesthetic care into and during the postoperative recovery period.
- Assisting in the use of advanced life support techniques such as high frequency ventilation and intra-arterial cardiovascular assist devices.
- Assisting in making postanesthesia patient rounds by recording patient progress notes, compiling and recording case summaries and by transcribing standing and specific orders.
- Performing evaluation and treatment procedures essential to responding to life-threatening situations, such as cardiopulmonary resuscitation, on the basis of established protocols (basic life support, advance cardiac life support, and pediatric advanced life support).
- Assisting in the performance of duties in intensive care units, pain clinics and other settings, as appropriate.
- Training and supervising personnel in the calibration, trouble shooting and use of patient monitors.
- Performing delegated administrative duties in an anesthesiology practice or anesthesiology department in such areas as the management of personnel, supplies and devices.
- Assisting in the clinical instruction of others."
The complete Standards for Accreditation of Anesthesiologist Assistant Education is available from CAAHEP at AA Standards.
How can I hire CAAs in my practice?
If your state does not presently provide the legislative or delegatory option of CAA practice, consultation should take place with the board of medicine or other governing body to explore the specific legal implications of CAA practice in your state. General information on the steps to establish CAA practice is available from the ASA's Office of Governmental and Legal Affairs. You may also inquire of other state societies as to their local advocacy and procedural steps that have led to gaining the option to hire CAAs.
Also, the American Academy of Anesthesiologist Assistants is a valuable resource on suggested methods of licensing and establishing practice of CAAs drawn from various states. Click here to contact AAAA.
How many CAAs can I supervise?
In addition to the practical issues that limit how many anesthetists may be supervised by an anesthesiologist at any one time, ratios are also often specified as contract requirements from payors. For instance in order to meet CMS requirements for medical direction, no more than 4 anesthetists (CAAs or CRNAs) may be concurrently directed by an anesthesiologist.
The supervision ratio may also be defined in state law or Board of Medicine guidelines and is usually between 2:1 and 4:1. New Mexico's current supervisory ratio is 3:1. It is important to note that in states where statutes specify a supervision ratio of CAAs to anesthesiologists at less than 4:1, the anesthesiologist may also concurrently supervise CRNAs up to a total combined ratio of 4:1 for both non-physician anesthetists.