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Commenting for this proposal will be open until the close of business on Monday, June 5.

Title of Proposal:

Licensure of Certified Anesthesiology Assistants

On behalf of:       

Virginia Society of Anesthesiologists

Describe the Idea or Issue:

The Virginia Society of Anesthesiologists (VSA) requests that the Medical

Society of Virginia advocate for a bill permitting the licensure of certified anesthesiologist assistants (CAAs) in the Commonwealth during the 2018 General Assembly Session.

Desired Outcome:

The VSA requests that the Medical Society of Virginia advocate for a bill permitting the licensure of CAAs in the Commonwealth during the 2018 General Assembly Session. This is an issue that should be important to the House of Medicine, not just to anesthesiologists, because it impacts:

  • Provider shortages
  • Access to care
  • Economic efficiencies and optimization
  • Selection of mid-level practitioner to best suit patient needs

Licensure of CAAs would help alleviate all of these issues, so we are seeking the support of the entire community of medicine in this endeavor.

Background/Supporting Information:

CAAs are highly skilled health professionals who work under the direction of licensed physician anesthesiologists to implement anesthesia care plans. All CAAs possess a premedical background, a baccalaureate degree and complete a comprehensive didactic and clinical program at the master’s level.

CAAs work exclusively within the anesthesia care team environment and, unlike nurse anesthetists; they must be supervised by a physician anesthesiologist.

Eighteen jurisdictions as well as the District of Columbia currently regulate CCAs. Virginia is surrounded by other states that have already adopted the CAA approach (North Carolina, Washington, D.C., Kentucky and Ohio).

There are 10 accredited CAA educational programs in the U.S. There are nearly 2,000 CAAs already practicing throughout the nation.

Eighteen jurisdictions as well as the District of Columbia currently regulate CCAs. Virginia is surrounded by other states that have already adopted the CAA approach (North Carolina, Washington, D.C., Kentucky and Ohio).

CAA students currently rotate through Virginia hospitals, but must go elsewhere to work when they finish training. There are currently about a dozen CAAs who reside in Virginia but travel to work elsewhere (including Arlington, Alexandria, Danville, Fort Royal and Williamsburg).

Anesthesiologists are the only physicians in the Commonwealth with only one physician-extender option (nurse anesthetists). CAAs would provide an additional choice of physician-extenders for anesthesiologists who adhere to the Anesthesia Care Team model of patient care.

CAAs are recognized by CMS, Tricare and all major commercial payers. Data from the Bureau of Labor and Statics shows that the cost of nurse anesthetists decreases in the states with the highest number of CAAs:

Mean Wage

Nationwide Rank in CAA Employment

  • Georgia - $137,940 - 1
  • Florida - $143,870 - 2
  • Ohio - $152,310 - 3
  • Texas - $161,740 - 4
  • Missouri - $151,330 - 5
  • Virginia - $171,160 - None

*Note – Texas is likely still above average because the 130 CAAs don’t compete significantly with the 32,000 nurse anesthetists statewide.

The VSA has been studying CAAs for several years, and has watched with interest as other states have adopted CAA licensure. The VSA surveyed its members in August of 2015, and found that:

  • 88% of its members thought that having CAAs as an available physician extender alternative to nurse anesthetists would be a good for anesthesiologists in Virginia.
  • 74% of members said that their current practice would use at least one CAA as an alternate physician extender.
  • 42% of members said that their current practice would use more than five CAAs as an alternate physician extender.

The Virginia Department of Health Professions is currently evaluating the feasibility of state licensure for CAAs. The Virginia Society of Anesthesiologists plans to pursue legislation licensing CAAs during the 2018 Genera Assembly Session.

Additional background materials in appendix.

Comments

 

I am a practicing anesthesiologist at Augusta Health in Fishersville, VA.  We have been mentoring C-AA students for the last few years.  The students are certainly capable clinicians, on par with nurse anesthetists for the same amount of experience.  The American Society of Anesthesiologists has deemed anesthesiologist assistants equal to nurse anesthetists for practice in the operating room.  The vast majority of anesthesiologists in Virginia desire C-AA licensure.  Please support the proposal to allow C-AA licensure.  Thanks,

Tim Nitzsche, MD

Strongly in support.  Please support this effort!

 

Thank You!

 

Elmer Choi

 

CAAs provide another option to help extend anesthesia services while maintaining the care team model.

 

I support this measure and think this would improve access to healthcare. Anthesiologists need to have more than one physician extender. 

I speak in strong support of the licensure of CAA's. To enter CAA school one needs a pre-med background and take the MCAT's. Once in school their philosophy is to work within the Anesthesia Care Team. The care team model is one in which a physician Anesthesiologist is in charge and the team approach is used. I have been practicing Anesthsiology since 1982, including teaching anesthesia residents and nurse anesthetist students at MCV for 4 1/2 years. Following that I have been in private practice, doing my own cases and supervising nurse anesthetists. Additionally I have had the opportunity to work with 3 CAA students as Sentara Health Care has an agreement with a CAA school in Florida. Thus I had the opportunity to teach and observe the students. I became very familiar with their education and work philosophy. The addition of CAA's to the work force would give us additional well trained mid level providers who want to work within the care team model, which is essential to maintaining excellent care. It is worth noting that currently the United States is the only country in which non-physicians are allowed to provide unsupervised anesthesia to patients. We must maintain in Virginia the care team model for patient safety. Having additional mid-level providers will insure that we not only have enough providers, but that we have affordable providers. Please give your support to this important legislation.

I support Proposal 20

I have met several CAAs and they appear highly professional and qualified.It would be a great benefit to allow them to practice in the anesthesia care team model.

i personally worked very closely with CRNA and AA in residency, and the quality of care provided by AA was excellent. They were very committed to the team care model.  I support their licensing in Virginia.

I think this is a great way to provide more access to patients, keep quality high, and maintain adequate supervision of mid level providers.  I think this will improve patient safety by keeping independent mid level providers to a minimum.

please support proposal 20

I support the propositon

My practice currently employs several CRNA's.  Over the past few years we have had a difficult time hiring more CRNA's due to a very competive market.  The addition of Anesthesiology Assistants would hopefully ease the recruitment burden and help my practice maintain staffing requirements.  Additionally, it seems that Anesthesiology Assistants are more coducive to the anesthesia team model instead of desiring to be independent practioners.

 

 

I support th discussion of allowing CAA to practice in Virginia. 

Having worked with CAAs in the care team model in Ohio and having had a very good experience, I fully support the state licensure for CAAs here in Virginia, as they add greatly to the provision of excellent anesthesia care through their sound educational foundation in science. Allowing them to practice here in Virginia will greatly enhance our ability to provide safe, efficient and cost-effective care for Virginians. Thank you for considering this great addition to our care team. 

These well trained practice extenders would be a great additiona to the Anesthesia Care Team. Our practice is in desperate need of additional providers and have been having a difficult time finding enough providers to fill open positions. Having additional providers available to hire would go a long way in improving our practice's services and employee's morale. 

I support CAA Licensure in Virginia.

CAA will clerly help drive the cost of healthcare down and help with privider shortage.  They will not create an increase risk of "undertrained providers" as CRNAs repeatedly claim and will prevent false advertizing by CRNA's who are not insisting the be called "Doctor" because they have a PhD

CAA will clerly help drive the cost of healthcare down and help with privider shortage.  They will not create an increase risk of "undertrained providers" as CRNAs repeatedly claim and will prevent false advertizing by CRNA's who are not insisting the be called "Doctor" because they have a PhD

I am in support of Proposal 20 to license CAAs.

Thank you.

I support Proposal 20 to license CAAs in the state of Virginia.

Thank you.

I have worked in Georgia before, and got to see firsthand the work of CRNAs and anesthesia assistants.  Both are good, but anesthesiologists generally found CAAs easier to work with, which should translate to better ability to pay attention to the patient undergoing surgery. I highly recommend Virginia support the shortage of anesthetic providers by recognizing the abilities of a CAA

I wholeheartedly support proposal to have CAA to provide and extend healthcare to all Virginians as a part of Anesthesia  team as our neighboring states adapted it successfully. 

I support.

I am an anesthesiologist writing to urge licensure for Anesthesiolgist Assistants (CAAs) in the state of Virginia. I have worked with AAs in Georgia and the District of Columbia, and find that they make excellent assistants in the Anesthesia Care Team model. They are the PAs of the anesthesia world, and have training at least on par with the other currently licensed midlevel provider of anesthesia, certified registered nurse anesthetists (CRNAs). I would argue that their training is actually superior to that of most CRNAs, as the few AA programs in existance are all affiliated with large university health systems, allowing for more opportunities for a wide variety of clinical and didactic training. CAAs work under the direction of anesthesiologists in the care of all types of patients for all procedure types, and should not be barred from practice in this state because of the jealousy of CRNAs who do not wish to have even a small amount of competition for anesthetist jobs. Please, do not listen to the lies from the CRNAs and their lobbying organizations who are trying to protect their service monopoly.

CAAs are highly skilled health professionals who work under the direction of licensed physician anesthesiologists to implement anesthesia care plans. Please support the approval of their right po practice in the state of Virginia.

I am in support of Proposal 20 for Licensure of Certified Anesthesiology Assistants in Virginia. 

Good evening.  The VSA has outlined the rationale and background information for why AAs should be licenced in Virginia.  I wish to speak from a personal level.  I attended Case Western Reserve University in Cleveland, studying to be an AA. I worked at Mt. Sinai Hospital in Cleveland before attending medical school. AAs and CRNAs worked side-by-side in hopitals in many states and DC.  Duties are interchangable.  I completed an Anesthesiology residency at Yale and have practiced in Virginia since 1989, initially in Norfolk and Virginia Beach and for the last 13 years at UVA - Department of Anesthesiology.  I feel that having the option for AAs in  Anesthesiology practices will be valuable to pateints as well and practices. AAs must complete a pre-med undergraduate curriculum. This demanding undergradutate curriculm well serves the AA student to negotiate the complexity of Anesthesiology. They are well trained and have been practicing under direct physician supervision for 40+ years. They are care team oriented and as their title explains, they do not aspire to autonomous practice. Workforce demands warrant expanding the resources available to practices and pateints. I believe Virginians and their doctors need the addition of AAs to the healthcare provider ranks in Virginia.  I will gladly speak with your committe if you so wish. Thank you for your attention to this matter.

Robert B. Goldstein, MD

Associate Professor

Medical Director - Pain Management Center

University of Virginia

Department of Anesthesiology and Pain Medicine

434.243.5676

rbg7a@virginia.edu

Good evening.  The VSA has outlined the rationale and background information for why AAs should be licensed in Virginia.  I wish to speak from a personal level.  I attended Case Western Reserve University in Cleveland, studying to be an AA. I worked at Mt. Sinai Hospital in Cleveland before attending medical school. AAs and CRNAs worked side-by-side in hospitals in many states and DC.  Duties are interchangeable.  I completed an Anesthesiology residency at Yale and have practiced in Virginia since 1989, initially in Norfolk and Virginia Beach and for the last 13 years at UVA - Department of Anesthesiology.  I feel that having the option for AAs in Anesthesiology practices will be valuable to patients as well and practices. AAs must complete a pre-med undergraduate curriculum. This demanding undergraduate curriculum well serves the AA student to negotiate the complexity of Anesthesiology. They are well trained and have been practicing under direct physician supervision for 40+ years. They are care team oriented and as their title explains, they do not aspire to autonomous practice. Workforce demands warrant expanding the resources available to practices and patients. I believe Virginians and their doctors need the addition of AAs to the healthcare provider ranks in Virginia.  I will gladly speak with your committee if you so wish. Thank you for your attention to this matter.

Robert B. Goldstein, MD

Associate Professor

Medical Director - Pain Management Center

University of Virginia

Department of Anesthesiology and Pain Medicine

434.243.5676

rbg7a@virginia.edu

Every physicain can have a physician's assistant except Anesthesiology. This needs to change. 

Licensure of CAAs improves access and affordability of medical care within the context of the team anesthesia

model which has been shown to deliver the highest quality care.

I support the new push for CAA involvement. This will help alleviate the provider issue without needing independent practice from any mid-level provider. It allows CRNAs to stay mid level providers and grants the population more access to anesthetic expertise. This proposal is safest for patients who need a physician led team and CAAs are willing to work under physicians willingly. Great for patient care! 

 

I highly support the licensure of CAAs. They are an invaluable resource for the medical community that Virginia is currently without. Advancing patient safety with the physician led anesthesia team is of paramount importance and licensing CAAs is a huge step towards providing the high-quality medical care all Virginians deserve. 

I support the licensure of CAAs in Virginia. 

 

I do support CAA practice in Virginia.  

The anesthesia care team model of providing our services in the operating room is ideal.

Anesthesiology assistants will be a great addition to this team concept of providing optimal patient care for Virginians.

The experience of Anesthesiologists in other states with Anesthesiology assistants has been all positive.

An excellent proposal to expand the availability  of anesthesia care while preserving the care team model.

please support Proposal 20!

I support the VSA's proposal to license CAAs in the state of Virginia and I hope this is also a top priority for the MSV.  I am a Certified Anesthesiologist Assistant living in Alexandria, Virginia and practicing in Washington DC.  I would love to be able to practice in the state I call home.  Thank you.  Layne DiLoreto, CAA  

As you know, the VSA has been working on this proposal for several years.  We sincerely hope that the MSV will support the licensure of CAAs during the 2018 Session.  This issue is very important to our members.

as a Physician Anesthesiologist in the state of Virginia I do support this proposal.

I strongly support proposal 20 and the licensure of CAAs in Virginia. 

Thank you!

I support allowing these well trained health care professionals into practice in Virginia.  There is a need and they are prepared to fill it.

 

I am strongly in favor of allowing AAs to train and work in Virginia.  This will enhance care and improve access to anesthesia care within a team model.

 

Robert Shafer MD

I am a CAA currently living in Virginia but practicing in DC as I'm unable to get a license in my home state. I would very much like to practice in Virginia and I know CAAs would be beneficial to Virginia patients and anesthesiologists. I support the VSA proposal to support CAA licensure in Virginia and I hope the MSV will consider advocating for the bill in the coming legislative cycle. 

I strongly support this proposal.  Anesthesia assistants provide excellent, cost-effective care and would work to improve the health of all citizens of the Commonwealth.  

I fully suport the licensure of CAA's who would be a valuable addition to the anesthesia care team.

I support the licensure of Anesthesiology Assistants in Virginia.

I was originally opposed (a generation ago) to the development of non-RN anesthesiology assistants, because I saw the possibility of their seeking the right to  independent practice of medicine.  However, the development of anesthesia care teams, and economic reality for patients and hospitals, leads me now to support such licensure in the interest of broadening the availability of care to patients and suppression of expanding costs.   I believe that legislation should require regulations that anesthesiology assistants should be credentialed only after completion of a sanctioned course of study and experience.  Furthermore, that they  should provide care only in the environment of physician direction, not to be by the operating surgeon, and limited to two simultaneous procedures under the direction of the anesthesiologist physician in charge of their work.  The suggestion that physician practices would include "more than five CAA's as an alternate physician extender" should apply only to the organization of groups, not to the ratio of supervision in the individual cases. 

 

I am a Virginia state resident and a practicing Credentialed Anesthesiologist Assistant (CAA).  Currently, I have to travel outside of my home state in order to work in the District of Columbia.  I strongly support the Virginia Society of Anesthesiologists' proposal for CAA licensure in Virginia, as I would love the opportunity to work in my home state.  I request that the Medical Society of Virginia continue to support this proposal.

Thank you!

I am the parent of a Certified Anesthesiologist Assistant (CAA) who lives in Virginia.  As a tax-paying resident, I would love for my daughter to be able to provide anesthesia care in her home state.  Currently, she crosses state lines in order to practice.

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