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Background
Anesthesiologist assistants (AA) are AHPs who practice under the supervision of
licensed anesthesiologists to develop and implement anesthesia care plans. They are
trained extensively in the delivery and maintenance of quality anesthesia care as well
as in advanced patient monitoring techniques. They work exclusively within the anes-
thesia care team environment, which is directed by a licensed anesthesiologist and
may also include anesthesiology residents and nonphysicians (e.g., AAs and certified
registered nurse anesthetists [CRNA]).
To qualify for practice, AAs must complete an educational program accredited by the
Commission on Accreditation of Allied Health Education Programs (CAAHEP). AA
programs are based on the master’s-degree model and require at least two full academic
years. Programs are required to be codirected by board-certified anesthesiologists.
AA programs accept students who have prior education in the sciences that would
qualify them to pursue careers in medicine, dentistry, or one of the basic medical
sciences. Students are taught course work that enhances their basic science knowledge
in physiology, pharmacology, anatomy, and biochemistry with special emphasis on the
cardiovascular, respiratory, renal, nervous, and neuromuscular systems.
Upon graduation from an accredited program, AAs must pass a national certifying ex-
amination administered by the National Commission for Certification of Anesthesiologist
Assistants (NCCAA). To maintain certification, AAs must submit documentation to the
NCCAA stating that they have completed 40 hours of continuing medical education
(CME) every two years. In addition, they must pass the Examination for Continued
Demonstration of Qualifications every six years. Failure to meet the CME or examination
requirements results in withdrawal of certification for the AA.
AAs may be licensed or practice under the license of an anesthesiologist who can dele-
gate tasks or duties involved in the practice of anesthesiology to qualified individuals
(e.g., AAs) as long as the anesthesiologist is immediately available in the operating
room area. The licensed anesthesiologist retains ultimate responsibility for the care
of the patient.
The exact details regarding delegation and licensing of AAs differ by state, so a health-
care facility or an anesthesiologist seeking to employ AAs should consult the board of
medicine of the state in which the practice is located.
For more information, see Clinical Privilege White Paper Anesthesiology, Practice area 125
and Clinical Privilege White Paper Certified registered nurse anesthetist, Practice area 170.
§ Baccalaureate degree
§ Premedical curriculum
§ Grade point average of at least 3.0
§ Completion of a Medical College Admissions Test
or Graduate Record Examination
Positions of other The NCCAA provides the certification process for AAs in the
interested parties United States. The NCCAA charter includes assuring the public
§ 21 years of age
§ a graduate of a CAAHEP-accredited educational program
for AAs
§ practicing as an AA or eligible to practice as an AA in at least
one of the 50 U.S. states, or
§ a student in good standing in an accredited program who
will graduate from that program within 180 days of the
certifying examination
Minimum threshold criteria The following draft criteria are intended to serve solely as a
for requesting core AA starting point for the development of an institution’s policy
privileges or duties regarding this practice area:
References A letter of reference must come from the director of the appli-
cant’s AA training program. Alternatively, a letter of reference
regarding competence should come from the applicant’s super-
vising licensed anesthesiologist at the institution where the
applicant most recently practiced.
Core privileges for AAs Core privileges for AAs include but are not limited to the following:
Physician oversight A physician oversight policy that is in accord with the organiza-
tion’s overall policies and with appropriate state laws and regula-
tions should be created by the organization. The policy should
define when he or she can work with limited oversight or when
the AA would be required to work under the direct supervision
of a licensed anesthesiologist. The policy should also define
areas such as
Note: State practice acts and licensure regulations must be used to define
the licensed-anesthesiologist-to-supervised-AA maximum ratio.
Special requests for AAs For each special request, threshold criteria (e.g., additional train-
ing or completion of a recognized course and required experi-
ence) must be established. Special requests for AAs include but
are not limited to procedures that were not a part of the appli-
cant’s AA training program.
For more information For more information regarding this practice area, contact
§ Basic education and minimum formal training: Applicants must be able to demonstrate
successful completion of an AA educational program accredited by the CAAHEP or a program
that offers equivalent training. In addition, AAs should meet the following requirements:
§ Required previous experience: Applicants must be able to demonstrate that they have
successfully provided anesthesia services for at least 350 patients during the past 12 months.
§ References: A letter of reference must come from the director of the applicant’s AA training
program. Alternatively, a letter of reference regarding competence should come from the appli-
cant’s supervising licensed anesthesiologist at the institution where the applicant most recently
practiced.
§ Core privileges: Core privileges for AAs include but are not limited to the following:
Note: State practice acts and licensure regulations must be used to define the licensed anesthesi-
ologist to supervised AA maximum ratio.
Applicants must be able to demonstrate that they have maintained competence by documenting
that they have successfully provided anesthesia services for at least 350 patients annually dur
ing the reappointment cycle.
I understand that by making this request I am bound by the applicable bylaws or policies
of the hospital and hereby stipulate that I meet the minimum threshold criteria for this
request.
Date: __________________________________________________________
James F. Callahan, DPA John E. Krettek Jr., MD, PhD Beverly Pybus
Executive vice president and CEO Neurological surgeon Senior consultant
American Society of Addiction Medicine Vice president for medical affairs The Greeley Company
Chevy Chase, MD Missouri Baptist Medical Center Marblehead, MA
St. Louis, MO
Sharon Fujikawa, PhD Richard Sheff, MD
Clinical professor, Dept. of Neurology Michael R. Milner, MMS, PA-C Chair and Executive Director
University of California, Irvine Medical Center Senior physician assistant consultant The Greeley Company,
Orange, CA Phoenix Indian Medical Center a division of HCPro, Inc.
Phoenix, AZ Marblehead, MA
John N. Kabalin, MD, FACS
Urologist/Laser surgeon
Scottsbluff Urology Associates
Scottsbluff, NE
The information contained in this document is general. It has been designed and is intended for use by hospitals and their credentials
committees in developing their own local approaches and policies for various credentialing issues. This information, including the
materials, opinions, and draft criteria set forth herein, should not be adopted for use without careful consideration, discussion, addi-
tional research by physicians and counsel in local settings, and adaptation to local needs. The Credentialing Resource Center does not
provide legal or clinical advice; for such advice, the counsel of competent individuals in these fields must be obtained.
Reproduction in any form outside the recipient’s institution is forbidden without prior written permission. Copyright 2006 HCPro, Inc.,
Marblehead, MA 01945.