Certified anesthesiologist assistants won their battle for licensure in Tennessee in May 2025, and its first CAAs began taking on anesthesia cases in October.
The first cases took place at HCA Centennial Medical Center in Nashville, marking a significant moment for the anesthesia workforce in Tennessee. Health Resources and Services Administration projections show the state will have about 850 anesthesiologists to meet demand for 1,400 by 2036, a shortfall of 550.
Two Nashville-based Lipscomb University faculty members, Todd Christian and Joseph Parrish, became the first certified anesthesiologist assistants to manage anesthesia cases
“There are some states that open CAA practice and licensure, and Washington is a good example. And it took them several years to get their first CAAs working in the state,” said Mr. Christian, program director of the CAA program at Lipscomb University. “What we’ve done here is actually pretty amazing and unique.”
The state’s approach works on two tracks at once: recruiting experienced CAAs to Tennessee now, while Lipscomb builds an in-state training pipeline for the years ahead. Mr. Christian and Mr. Parrish, who helps lead the program, are examples of the first track.
Mr. Christian’s path to the program started more than a decade ago. After serving in the military and working as a Nashville police officer, he found the CAA profession while finishing his undergraduate degree. With no CAA training or licensure in Tennessee, he left the state to earn his degree at the University of Colorado.
“So next steps for me were to practice in Southern Indiana, which was about as close as I could get back to Tennessee,” Mr. Christian said.
He practiced in Indiana for about four years, then spent roughly five more in Florida, before the program’s medical director, Jeff Bennie, MD, asked him to help launch a CAA program in Nashville. At the time, CAAs couldn’t yet practice in the state, but legislation was moving, and Mr. Christian said Tennessee lawmakers wanted to see an in-state program that could train and supply the providers they were preparing to license.
Mr. Parrish came from Tampa, Fla., where he had practiced for nearly a decade and taught for about three years. He had followed CAA legislative fights for years, and when Tennessee passed licensure, he reached out to Mr. Christian.
“It was kind of like a ‘drop everything and get up here’ as soon as we could,” Mr. Parrish said.
The pair had been working in the OR for about three weeks at the time of the interview, and Mr. Christian said at least 28 CAA licenses have been issued or are pending in Tennessee.
“We’re building a workforce here really quickly,” he said.
The second track will take longer. Lipscomb’s inaugural class of 24 students began in August, and once the program is running three cohorts at a time, it expects to graduate about 24 CAAs a year, with the goal of keeping them in the state.
“We’re building the workforce from practicing CAs already, but we’re also building the pipeline workforce from the student perspective,” Mr. Parrish said. “It’s a long-term goal here that we have to really build up this workforce and fix the holes and fix the leaks.”
Clinical partners have been key to the speed. Mr. Christian, who worked for U.S. Anesthesia Partners in Fort Myers, Fla., for five years, said USAP has supported the program from the start. A new provider type entering a state can create friction among anesthesia colleagues, and he said USAP’s leadership worked to head that off.
“They’ve taken us in with open arms,” he said. “It has the potential to be a little contentious, but the leadership at USAP has really taken the reins and made sure that this is a good, smooth transition for us.”
Some anesthesia leaders in Tennessee still worry that hiring CAAs will drive away certified registered nurse anesthetists, Mr. Christian said. But in Florida, he said, CAAs and CRNAs have worked side by side for a decade, and new provider types tend to push employers to compete harder on compensation, not less. Both see the demand as too large for CAAs to take anyone’s job.
“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,” Mr. Parrish said.
For CAAs still practicing out of state, Mr. Christian has a simple pitch.
“I tell my colleagues that the water’s warm,” he said. “Come on in.”
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