Certified anesthesiologist assistants have been managing cases in Tennessee operating rooms since Oct. 20, giving the state’s anesthesia practices, hospitals and surgery centers a new provider type to recruit.
Many of those leaders are weighing one question before they do: How will hiring CAAs impact their certified registered nurse anesthetist workforce?
Todd Christian, program director of the CAA program at Nashville-based Lipscomb University and one of the first two CAAs to practice in the state, said that fear is the biggest deterrent he hears from anesthesia and surgery center leaders in Tennessee.
“I think that there’s always concern. Anything that’s new is concerning, right? Especially in the healthcare world,” Mr. Christian said.
In markets where CAAs already practice, he said, the fear hasn’t materialized into true workforce tension.
“So far, we haven’t seen that largely in Florida or across the country in other practices where CAAs have started,” Mr. Christian said. “At the end of the day, these jobs are in locations where people are raising their families. It’s not just as easy to pick up and leave.”
Before returning to Tennessee, Mr. Christian practiced for about five years in Florida with U.S. Anesthesia Partners, where CAAs and CRNAs have worked side by side for a decade. In those practices, he said, “everybody works together very well.”
Rather than shrinking the market for CRNAs, he argued, a new provider type tends to make it more competitive.
“Typically, as these employers start recruiting CAAs, they start competing with each other for salaries and all the rest,” he said.
Once CAAs are on staff, they take calls and support the rest of the anesthesia team, which he described as a rising tide that lifts all boats.
The stronger argument for ASC leaders, Mr. Christian said, is the size of the gap they’re trying to fill. Federal projections put Tennessee’s anesthesiologist shortfall at 550 by 2036.
“Demand is the biggest reason why these ASCs should be considering hiring CAs right now,” he said.
Joseph Parrish, who left Tampa, Fla., to help lead the Lipscomb program and practices alongside Mr. Christian, put it more bluntly.
“You could call any surgery center, any hospital right now, and say, ‘Hey, are you fully staffed in anesthesia?’ And I can almost guarantee you that 99% of them are going to say no, so it’s not like we’re coming up to compete in the job market and compete for jobs and stuff,” Mr. Parrish said. “We’re here to help kind of fill the voids.”
For leaders running the numbers, the staffing model is part of the pitch. CAAs work under physician supervision, with up to four CAAs per anesthesiologist. That ratio is set by licensure in most states and tied to the rules for billing medical supervision, not to limits on what CAAs are trained to do, Mr. Christian said. It reflects the physician-led anesthesia care team model the profession was built around, and “the belief that physicians still very much have a role in every patient’s care.”
Mr. Parrish acknowledged that some anesthesia colleagues still have reservations, and that trust will take time to build.
“Ultimately, we’re just here to keep patients safe and do what we know how to do and what we are trained to do, and I think that will show through,” he said.
Mr. Christian said CAAs aren’t pitching themselves as the only answer to the shortage.
“I don’t want to say they can’t afford to do it without us, but we’re definitely part of the solution in helping resolve some of these shortages,” he said.
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