"I was on call Thursday night, April 8th, 2005, when an 18-month old who had been bit in the face by the family dog was brought in," recalls Joe Mihalka, MD, an Anesthesiologist with Children's Healthcare of Atlanta. "While we were in one room taking care of that patient, a surgeon had another emergency, a two-year old who was bleeding after a tonsillectomy. Since we couldn't leave our room for the anesthesia delivery on the new patient, and since I am allowed to supervise more than one anesthesia delivery, I called in another anesthetist so we could accommodate both patients. If we had not been able to reach anyone, the two-year old might have had to have a transfusion, or could have possibly bled to death."

The concern about reaching another provider is justified in many states, particularly because of the shortage of Certified Registered Nurse Anesthetists (CRNAs). But in the nearly twenty states in which Anesthesiologist Assistants (AAs) can practice, the health care system has
much more flexibility. AAs are a veteran allied health professional trained to work under the supervision of the physician anesthesiologist, who must be readily accessible as in Dr. Mihalka's case, even if not in the same room.

"If a hospital or anesthesia group can hire from two pools of mid-level anesthesia providers (AAs and CRNAs) instead of just one, then the chance of fully staffing an anesthesia department is greatly increased," says Ellen Allinger, an AA in South Carolina. "Sometimes my shift starts at 10:00 am, other times at 7:00 am," says Fleet Lester, Senior Anesthetist at Emory Outpatient in Atlanta. "I have the flexibility to adjust my hours, so we have more people in the operating rooms. That means a surgery does not have to be delayed. When there is a shortage of providers, this flexibility is critical." Lester says the presence of more anesthesia providers also allows the physician anesthesiologist to take care of other important aspects of medicine. "As an MD you have more responsibilities. If an MD is in a room all the time, there isn't the freedom to keep up with patient care as a whole, such as taking more time to answer questions from the patient and their families, or being present at medical staff meetings to determine the best course of patient care."

AAs have worked in Georgia and Ohio for more than 30 years. Florida's legislature licensed AAs in 2004, and Washington, DC in 2005. North Carolina's legislature is currently considering the progressive legislation. AAs are currently licensed to work in 10 states. In six others, AAs can work through delegatory authority, meaning that state's board of medicine allows a physician to delegate tasks to an AA working under supervision of the Anesthesiologist.

Provider Shortage Plus Increased Demand "I can think of numerous instances during my career where patients have had to wait because of a shortage of anesthesia providers," recalls Dr. Mihalka. "When I was in my training in Texas, before they had AAs, orthopedic patients would wait three or four days before they could get a rod placed, because their procedures were delayed by greater emergencies. We couldn't keep a full number of operating rooms running."

Vermont's legislature saw the same problem and turned the corner by licensing AAs in 2003. As quoted in the March, 2004 edition of Keep in Touch, a publication of Southwestern Vermont Medical Center (SMVC), "SVMC initially began to pursue the opportunity to employ AAs because a shortage of qualified nurse anesthetists forced the hospitals to close operating rooms and cancel surgeries last fall for lack of anesthesia staff. In addition to limiting access to care, the shortage of CRNAs was increasing the cost of health care in our community because of the need to hire traveling CRNAs through agencies whose fees are very high."

In South Carolina, where AAs were licensed in 2001, the shortage of providers in the city of Rock Hill is less and less of a problem,according to Allinger. "Our anesthesia department was having trouble filling its positions several years ago. Since we've been licensed here, five AAs have joined the department, meaning there is no longer a lack of anesthesia providers." But the shortage still exists in other states, says Rob Wagner, Immediate Past President of the American Academy of Anesthesiologist Assistants and Chief Anesthetist at Saint Josephs Hospital of Atlanta."Surgeries have been delayed and cancelled because there were not enough anesthesia providers in Florida"

" There is not only a decrease in providers, but an increase in demand," says Steven Sween, MD, Chairman of the Anesthesiology Department at Saint Josephs. "Utilization of anesthesia services are expanding rapidly to places like the GI lab, radiology suites, emergency departments and cardiac cath labs." "A message that needs to be told is that there is such a deficit in anesthesia providers and quality anesthesia care these days that AAs provide an avenue to high quality positions in the health care system for people not in the nursing profession."

Sween says that the AAs and CRNAs work interchangeably and in harmony in Georgia. "For the last ten years as Chair of Governmental Affairs for the Georgia Society of Anesthesiologists, I went to the state capital to testify on various medical issues. Not on a single occasion did I have to testify about disputes with anesthesia provider groups. The reason is that the balance between anesthesia groups in Georgia has brought everybody together. There are equal amounts of CRNAs and AAs (400) in Georgia."