Download this proposal as a PDF.

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

My name is Mike Burley and my daughter is a CAA who lives in Virginia.  Currently, she must travel to the District of Columbia in order to practice.  I support the VSA's proposal for licensure in VA, and I request that the MSV continue support of this proposal. Thanks.

I am a MD resident and I would like the opportunity to practice in VA as a CAA.

I am in favor of proposal 20. My practice group would be in favor of using CAA's as an alternate physician extender in the Anesthesia Care Team model. With the growth of physician extenders of both physician's assistants and nurse practioners with my surgical and medical colleages as viable options for meeting the demands of their practice, it would only be practical and just that my speciality would be allowed the same lattitude to meet the growing and continuing needs of my practice. My group practice of anesthesia is limited to just CRNA's. To meet the growing demands of my practice the option of a CAA in the marketplace would improve the recruitment of and possibly retention of valuable members of our Anesthesia Care Team with a physician extender which has now proven itself and been adopted by neighoring localities to the Commonwelth of Virginia.

I support Proposal 20 and licensure for Certified Anesthesiologist Assistants.  Please continue to support CAA and increase access to safe quality anesthetic care. 

I am a Virginia resident and I have lived here my entire life. I am currently a student at Case Western Reserve University's Master of Science in Anesthesia program at Washington D.C., studying to become a C-AA. I fully support VSA's proposal for C-AA licensure in VA. I want to be able to work in my home state. Currently, I would have to commute to D.C. to work if I wanted to stay in Virginia. Please continue your support for CAA licensure in Virginia. I know many of my peers who are from Virginia would love the option to work here in the future as well.

i support CAA LICENSURE! :)

 

I strongly support the VSA's proposal of licensure of CAAs in Virginia.  I was personally involved in getting CAAs in DC and have seen it become a great success these past 13 years.  I request that the Medical Board continue their support of CAA's  

 

I suuport the VSA's proposal for CAA licensure in Virginia

Virginia resident from Springfield, VA here. Grew up in northern VA and went to VCU for college. Recently graduated from Case Western anesthesiologist assistant program in Washington D.C. I would really like to see Medical Society of Virginia support the proposal for AA licensure in VA. I will going out of state for job opportunity but I would love to come back to Virginia to work here.

1. I am a District of Columbia resident who lived in Virginia for 2 years.  I moved because there were no jobs for CAAs in Virginia.  I would love the opportunity to work and live in Virginia

2. I highly support the VSA's proposal for CAA licensure in VA.  It will benefit the state and the people of Virginia

3. I Request that the Medical Society of Virginia continue to support the proposal for CAA licensure.

To Whom It May Concern,

I am a current resident in Washington, DC and have been intrigued with expanding our practice in the state of VA. I support the VSA proposal for CAA licensure in the state of Virginina. I hope the Medical Society of Virginia continues to support the licensing of CAA's in the state of Virginia.

I am the program director for the Anesthesiologist Assitatant program in Washington, D.C., offered throgh Case Western Reserve University, School of Medicine, D.C. location and I encourge the VMA's suport for Anesthesiologist Assistant licensure in Virginia.  We actively recruit, train and graduate many exceptionally competent CAAs who are Virginia residents and strongly wish to return home and support the heath care needs of Virginians .  If I can be of any assitants on education and practice of Anestheisiologist Assistants, please let me know.  

Shane Shane Angus, CAA, M.S.A. Program Director Master of Science in Anesthesia Program Case Western Reserve University School of Medicine 820 1St. N.E. Washington, D.C. 20002   http://casemed.case.edu/anesthesiaprogram/program/dc.cfm   P 202-758-2545 F 216-844-7349

 

Certified Anesthesiologist Assistant

http://www.medstarwashington.org/

 

Immediate Past Chair

Accreditation Review Committee for Anesthesiologist Assistants

http://www.caahep.org/arc-aa

 

Board of Directors

Anesthesia Patient Safety Foundation

http://apsf.org

 

I am requesting for the Medical Society of Virginia continues to strive for approval for CAA licensure. I am currently enrolled in an Anesthesiology Assistant program in Washington D.C. and I live in Alexandria, VA. I plan on staying in Virginia after graduating and hope to practice in a nearby hosptial. Commuting into D.C. for work does not seem ideal for me because of my plans of starting a family in the next few years. 

I am starting a CAA program this summer and am excited to begin this new chapter in my life. The CAA profession is a great way to to administer anesthesia to the growing population. I am currently in DC, but am very interested in potentially practicing in Virginia and the other surrounding areas. 

I highly support that CAAs become approved to practice in the state of Virginia. CAAs are a highly motivated and important part of the OR team, and expanding their practice to additional states would be extremely beneficial. The Medical Society of Virginia should continue to support this cause in order to provide a higher level of medical care to the state.  

To whom it may concern: 

I am currently a Washington DC resident and would like to express my thoughts about the possibility of expanding the Anesthesiologist Assistant profession to Virginia. I would be interested in seeing a neighboring state open so that I may possibly practice there when I am graduated. I definitely support the VSA's proposal for AA licensure in the state of VA. I hope that the Medical Society of Virginia continues to foster support for this movement and our profession can grow like other physician extender professions. 

 

Best regards, 

 

Kerlly Castellano 

CAA student 

Case Western Reserve University 

Washington D.C. Program. 

I am a Virginia resident currently commuting to DC to practice as a Certified Anesthesiologist Assistant. The VSA's proposal of licensing CAAs in Virginia not only has a positive impact on patient care within the care team model, but it also allows many CAAs like me to practice in the state in which they reside. I look forward to the Medical Society of Virginia's continued strong support of the proposal for CAA licensure and to a push to make this effort a top priority.

I am a resident of DC and currently work at a DC hospital, and am in support of expanding to Virginia. I was trained in DC and have grown very fond of the state of Virginia and am in support of Anesthesiologist Assistants getting the opportunity to provide safe and efficient Anesthesia care.  Please consider the advantages and continue to support our cause! 

 

Alexa Aramini, Certified Anesthesiologist Asst

I currently live in Washington D.C. as an MSA student at CWRU DC. I am looking forward to the aspect of being able to work in a neighboring state such as a Virginia. I believe that the expansion of licensure will provide more opportunities for students and jobs for CAA's. I hope to see VSA's Proposal for CAA licensure in the state of Virginia to be approved in the near future. I would like to request that the Medical Society of Virginia continue to support the proposal for CAA licensure as this is vital to the growth and expansion of this career. 

Hello,

My name is Janet and my family moved to Virginia over twenty years ago. I am currently a student at Case Western Reserve University- DC, obtaining my master's in Anesthesia. As a future CAA, I support the decision of VSA for CAA licensure in Virginia. If passed, it would mean not having to move my young family or travel a distance to work. I request that the Medical Society of Virginia to continue to support the proposal for CAA licensure.

Thank You,

Janet E. Ha

Approving CAA license would be great for people like me who wish to leave and work in VA

I am a practicing Certified Anesthesiologist Assistant and have been living in VA for over 6 years. The disappointing part of being a tax paying citizen of VA is that I have to work in DC due to lack of licensure for CAAs in VA. I would love the opportunity to contribute to my community in one of the many hospitals I'm surrounded by in my residing state and I fully support the VSA proposal for CAA licensure in VA. I humbly request that the Medical Society of VA continues support of the proposal for CAA licensure proposed by the VSA.

My sister is a practicing CAA in Washington DC but has been a resident of VA for over 6 years. She is unable to work in her residing state and commutes almost an hour each way every day to practice her profession. I fully support the VSA proposal for licensure for Certified Anesthesiologist Assistants in Virginia and request that the Medical Society of Virginia continues to do the same. This will allow her to contribute to her community hospitals and allow her to spend more time with family without a long commute.

My sister is a practicing CAA in Washington DC but has been a resident of VA for over 6 years. She is unable to work in her residing state and commutes almost an hour each way every day to practice her profession. I fully support the VSA proposal for licensure for Certified Anesthesiologist Assistants in Virginia and request that the Medical Society of Virginia continues to do the same. This will allow her to contribute to her community hospitals and allow her to spend more time with family without a long commute. As a former resident and tax payer of VA, I would like to know that tax dollars are being utilized for initiatives to provide affordable and quality healthcare for the citizens of Virginia.

My daughter is a practicing CAA in Washington DC but has been a resident of VA for over 6 years. She is unable to work in her residing state and commutes almost an hour each way every day to practice her profession. I fully support the VSA proposal for licensure for Certified Anesthesiologist Assistants in Virginia and request that the Medical Society of Virginia continues to do the same. This will allow her to contribute to her community hospitals and allow her to spend more time with family without a long commute.

My daughter is a practicing CAA in Washington DC but has been a resident of VA for over 6 years. She is unable to work in her residing state and commutes almost an hour each way every day to practice her profession. I fully support the VSA proposal for licensure for Certified Anesthesiologist Assistants in Virginia and request that the Medical Society of Virginia continues to do the same. This will allow her to contribute to her community hospitals and allow her to spend more time with family without a long commute.

I would just like to express my support for this legislation in Virginia. As a student Anesthesiologist Assistant, employment opportunities are very important to me. I currently study in the Washington DC area and would like to some day consider moving. I know many of my fellow classmates and instructors live in Virginia or have family they would like to move closer to. If Virginia were to allow CAAs to practice in its state, many qualified individuals would quickly seize the opportunity. Thank you to those who have supported and will continue to support this proposal for Certified Anesthesiologist Assistant licenture.

I strongly support the licensure of CAAs in Virginia.  We employ CAAs at Medstar Washington Hospital Center and are extremely pleased with their quality of work with special emphasis on patient safety.  The quality of work from our CAAs are equal if not superior to our CRNAs. 

I am a student anesthesiologsit assistant that will be graduating in 2018. I support the VSAs proposal for licensure of CAAs in Virginia. This is important to me because when I graduate I would like the ability to practice in Virginia. Thank you.

I've worked with AA students for 4 years now in private practice. I've found them to be a very competent midlevel provider, and no less trained than CRNAs. They approach midlevel training in an educational equivalent manner to a PA, and their clinical training is similar also. In my experience, they graduate perfectly able to conduct a safe anesthetic under the direction of an anesthesiologist. They should be licensed and able to work in VA, as they are in many other states. 

As a Certified Anesthesiologist Assistant working in Washington, DC, I would like to express my interest in expanding the AA profession to Virginia. CAAs are highly trained members of the Anesthesia Care Team and would make a strong addition to Virginia's group of anesthesia providers. I personally hope to relocate to Viriginia in the future and would love to be able to establish a career there as well. I ask that the Medical Society of Virginia continue its support for the licensure of CAAs.

I have been a VA resident for the last 10 years. I continue to reside in VA and must commute to DC everyday for work. I am in support of the VSA's proposal for CAA licensure in VA. I would like to be able to work in Virginia. Please support the proposal for CAA licensure. Thank you. 

I am a current Student Anesthesiologist Assistant at Case Western Reserve University in Washington, D.C. Coming to D.C. from MI, a delegatory authority state, I see how greatly CAAs can improve healthcare. I agree that licensure will improve healthcare provider shortages, increase access to care, improve economic efficiencies and optimization, and provide the selection of mid-level providers to suit patient needs. I strongly support the VSA's proposal for licensure in Virginia and request the Medical Society of Virginia to continue to support the proposal for CAA licensure.  

I am Certified Anesthesiologist Assistant (CAA) currently practicing at Medstar Washington Hospistal in Washington D.C. I am part of the DC Anesthesiologist Assistant Association and would like to proclaim my support and advocate for licensure of Anesthesiologist Assistants in Virginia. I have providing great services for the communities in DC metropolitian area and it has been a blessing.  I am highly interested in seeing a neighboring state open up for CAA practice so I would be able expand my service outside of the immediate DC area. I highly look forward for the day that I will be able to assist patients in the Virginia. I am thankful for the support thus far from the Medical Society of Virginia and hope that they will continue to support our endeavors of expanding the practice of Certified Anestheisiologist Assistants starting with the state of Virginia.

I am a recently graduated Anesthesiologist Assistant who will be working in the DC area. It would be great to have the opportunity to work in Virginia in the future. I fully support the VSA's proposal for CAA licensure in Virginia, and request that the Medical Society of Virginia continue to support the proposal for CAA licensure.

I think it is the time to bring CAA to our Anesth care team.

I think it is the time to bring CAA to our Anesth care team.

There is a significant shortage of anesthesia providers.  CAA are licensed and trained providers and could help alleviate this shortage.   The only opposition to there practice is based on license politics.

There exists a significant shortage of CRNAS in Virginia. I believe it is our duty to address this shortage at every opportunity. Addition of AAs is a necessary step. 

i believe this would greatly improve the scope and availability of anesthesia services in Virginia. I urge you to approve this. 

Thank you

As an MSV member, and an Anesthesiologist with extensive experience in training of mid-level providers, I hope that the MSV will support the efforts to have Proposal 20 enacted.  The addition of CAA's to the option of care poroviders would be of clear benefit to healthcare in Virginia.

Thank you for your involvement in this matter.

I fully support CAA's to be licensed in Virginia. PA 's have been well received in other areas of medical practice in Virginia. The team model with CAA's medically directed by Anesthesiologists would continue to provide safe, secure, and cost- effective care in Virginia.

Hello,  My name is Jasleen Kaur, and I am a CAA working at Children's National Medical Center in Washington, DC. I am writing to show my support for the VSA's proposal for CAA licensure in Virginia. CAA's are an integral part of the anesthesia care team, and especially as a resident living near VA, I hope to be able to expand my practice into VA with this licensure. I am requesting that the Medical Society of Virginia continue to support this CAA licensure proposal. Thank you.

My sister is a CAA living in Virginia but has to commute to DC to work. She owns a home in Virginia and would very much like to stay in the Commonwealth for work. Please support the upcoming licensure efforts for CAAs in Virginia.

I know several hospitals which would benefit from AAs and I also have several close relatives and friends who are looking to stay in the area but are unable to practice in Virginia.

Aspresident of the Danville/Pitsylvania Academy of Medicine I support this bill

This group of providers has the potential of helping avoid a growing shortage of safe anesthesia delivery in Virginia. They are well-trained and qualified as extenders for anesthesiologists and have proved their value in other states.

I know several hospitals which would benefit from AAs and I also have several close relatives and friends who are looking to stay in the area but are unable to practice in Virginia.

I support anesthesiology assistants in the state of Virginia.

I am writing to fully support this effort by the Virginia Society of Anesthesiologists to increase the options for the work force of anesthesia providers in the Commonwealth.  This is a topic that has been thoroughly discussed in recent years in our Society meetings, and the conversation has evolved after meetings with practitioners in other states who have incorporated anesthesia assistants (AAs) into their practice and with national anesthesia assistant leaders to create the current proposal.  The Society has very thoughtfully reviewed the training of the AAs and has found that it contains much more clinical content and prescribed clinical work than that of CRNAs. As the illness index of our patients increases, this added expertise in the OR arena is more likely to facilitate more favorable outcomes.  The Certified Anesthesia Assistants as a professional group have been very successfully integrated into anesthesiology practices in other locales.  These individuals work in coordination with the physician anesthesiologists and are not trying to assume all other aspects of contemporary anesthesiology such as critical care and pain medicine.  There are AAs who live in our state but cannot, yet, practice here.  There is such emerging interest in AAs that options for creating a training school for such practitioners in the state are being investigated.  Anesthesiologists should have the options for extending their patient care using NPs or PAs as currently do other specialties.  I hope that you will look favorably on this proposal enough to gain your support.

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