Certified Anesthesiologist Assistant Profession

What is a certified anesthesiologist assistant (CAA)?

Certified anesthesiologist assistants are highly skilled healthcare professionals who work under the direction of licensed anesthesiologists to implement anesthesia care plans. CAAs work exclusively within the anesthesia care team, as defined by the American Society of Anesthesiologists.

All certified anesthesiologist assistants possess a premedical background, a baccalaureate degree, and a master’s degree from an accredited anesthesia program. CAAs are trained extensively in the delivery and maintenance of quality anesthesia care as well as advanced patient monitoring techniques.

Both CAAs and CRNAs are anesthetists, and are recognized by the Medicare and Medicaid Services section of the Code of Federal Regulations.

The scope of certified anesthesiologist assistants’ clinical practice is generally the same as that of a nurse anesthetist on the anesthesia care team and is typically defined by the directing anesthesiologist, the hospital credentialing body, the state’s board of medicine, and any applicable state statute or regulation. 

The Anesthesia Care Team

According to the American Society of Anesthesiologists, certain aspects of anesthesia care may be delegated to other properly trained and credentialed professionals. These professionals, which include certified anesthesiologist assistants, are directed by the anesthesiologist and comprise the anesthesia care team.

Within the anesthesia care team, an anesthesiologist and CAA work together to provide anesthesia care. The foundation of this collaboration is the shared belief that the interests of patient safety are best served with an anesthesiologist’s involvement in the delivery of every anesthetic.

The care team statement, which was last amended in 2019, notes that “such delegation and direction should be specifically defined by the anesthesiologist director of the Anesthesia Care Team and approved by the hospital medical staff. Although selected functions of overall anesthesia care may be delegated to appropriate members of the Anesthesia Care Team, responsibility and direction of the Anesthesia Care Team rests with the anesthesiologist.”

In addition to certified anesthesiologist assistants, the care team may also include anesthesiology residents and nurse anesthetists.

Certification and Licensure

Graduates or second-year students in their final semester of the MSA program may apply for initial certification from the National Commission for Certification of Anesthesiologist Assistants (NCCAA), which consists of commissioners representing the American Society of Anesthesiologists, the American Academy of Anesthesiologist Assistants, physicians, and certified anesthesiologist assistants. Initial certification is awarded to a CAA who has successfully completed the Certifying Examination for Anesthesiologist Assistants, which is administered by the NCCAA and PSI Services.

The content for the certifying exam is based on knowledge and skills required for anesthetist practice. A test committee, comprised of anesthesiologists and certified anesthesiologist assistants, is responsible for writing and evaluating test questions for the examinations as well as for an item bank containing material that will be used in future years.

The NCCAA publishes an annual list of certified anesthesiologist assistants. This public document is made available to state boards of medicine and other bodies responsible for credentialing healthcare professionals.

To maintain licensure, CAAs must submit documentation to NCCAA every two years indicating that they have completed 40 hours of continuing medical education. In addition, every six years they must pass the Examination for Continued Demonstration of Qualifications. Failure to meet any of these requirements results in withdrawal of certification.

In a handful of jurisdictions, CAAs practice under the license of an anesthesiologist under the principle of delegation in addition to holding their own certification. In these instances, anesthesiologists may delegate tasks or duties involved in the practice of anesthesiology to CAAs as long as the anesthesiologist is immediately available, and the anesthesiologist retains ultimate responsibility for the care of the patient.

In all states, CAA practice falls under the auspices of the board of medicine. The exact details regarding delegation and licensing of CAAs vary from state to state, and an anesthesiologist seeking to employ CAAs should consult the board of medicine of the state in which he or she practices for more details.

The Origin of the Profession

In the 1960s, three anesthesiologists—Joachim S. Gravenstein, John E. Steinhaus, and Perry P. Volpitto—were concerned with the shortage of anesthesiologists in the United States. Each held an academic department chair, and used their departments to analyze the spectrum of tasks required during anesthesia care. The tasks were individually evaluated based on the level of professional responsibility, required education, and necessary technical skill.

The result of this anesthesia workforce analysis was to introduce the concept of team care and to define a new mid-level anesthesia practitioner linked to a supervising anesthesiologist. This new professional practitioner, the certified anesthesiologist assistant or anesthetist, had the potential to partially alleviate the shortage of anesthesiologists.

This new type of anesthetist was envisioned to function in the same role as the nurse anesthetist under the direction of an anesthesiologist. An innovative educational paradigm for anesthetists was created, built on premedical coursework in undergraduate studies and more rigorous exploration of anesthesia care at the graduate level.