9/19/2014 Disclosures • I have no disclosures Anesthesiologist Assistants David Shimabukuro, MDCM Associate Professor Medical Director 13 ICU I am a: An Anesthesiologist Assistant is… 1. MD/DO 1. I definitely know the answer 2. CRNA 2. I think I know the answer 52% 51% 3. RN 3. I have no idea 37% 4. AA 29% 5. Other 19% 8% 4% 0% 1 2 3 4 5 1 2 3 1
9/19/2014 Anesthesiologist Assistant An Anesthesiologist Assistant functions most similarly to a(n): From American Academy of Anesthesiologist Assistants: 1. Attending Anesthesiologist Assistants (AAs) are highly skilled health 45% professionals who work under the direction of licensed 40% 2. Anesthesia technician anesthesiologists to implement anesthesia care plans . AAs work exclusively within the anesthesia care team 3. CRNA environment as described by the American Society of Anesthesiologists (ASA). … AAs are trained extensively in 4. Resident 15% the delivery and maintenance of quality anesthesia care as well as advanced patient monitoring techniques. 0% 1 2 3 4 Agenda Agenda • Past • Past • Present • Present • Future • Future 2
9/19/2014 History Agenda • Joachim Gravenstein, John Steinhaus, Perry • Past Volpitto • Present – “Analysis of Manpower in Anesthesiology” • Future Anesthesiology 1970 Sep; 33(3):350-7 • First anesthesiologist assistant training programs at Emory University and Case Western University in 1969. Education/Training Education/Training • 24-28 month Master’s level program • Average program hours (total): accredited by the Commission for the – 600 classroom/laboratory Accreditation of Allied Health Educational – 2600 clinical Programs • Minimum of 600 anesthetics 3
9/19/2014 Education/Training Education/Training • Based at or in collaboration with a university • Admission’s requirements: that has a medical school AND academic – Bachelor’s degree anesthesiologist faculty. – Medical school science pre-requisites • General + organic chemistry • Main clinical sites MUST BE academic medical • General + advanced biology centers • Physics • Math – MCAT/GRE Emory University • Prerequisites – General Medical School – GRE: 55 th percentile; MCAT: 27P • 27 continuous months (7 semesters) – Semester 1: Classroom – Semester 2-4: Classroom and Simulation Lab – Semester 5-7: Clinical • Tuition: $100,000 4
9/19/2014 Colorado University • Prerequisites – General Medical School – GRE: 55 th percentile; MCAT: 25 • 28 continuous months (7 semesters) – Clinical is integrated through all semesters – Semester 4-7: Clinical only • Tuition: $55,000(in-state)/$78,000(out-state) Education/Training Education/Training • 10 accredited anesthesiologist assistant AA CRNA programs Number of schools (Pu/Pr) 8 (1/7) 108 (48/60) – 2: Florida and Georgia Program length (median) 25.5 months 28 months – 1: Colorado, Connecticut, Missouri, Ohio, Texas, Cost for Public (median) $68, 210 $37,243 Washington DC Cost for Private (median) $71, 410 $61, 345 MacIntyre P, Stevens B, Collins S, and Hewer I. Cost of Education and Earning Potential for Non-Physician Anesthesia Providers. AANA Journal 2014 February; 82(1):25-31 5
9/19/2014 Certification • National Commission for Certification of Anesthesiologist Assistants – Over half are anesthesiologists – Administered and scored by NBME • Re-certification exam every 6 years Practice Practice • Licensure • Must work under the direction (not supervision) of an anesthesiologist – Legislation (specific) – Medical Board (specific) – 7 Criteria • Delegatory authority • Ratio is usually between 2:1 and 4:1 – Medical Practice Act (broad to narrow) 1. Anesthesiologist remains ultimately responsible 2. Assures individual is qualified to perform tasks. 6
9/19/2014 Billing Pay • For CMS, same as a CRNA, except only medical AA CRNA Number of schools ( Public/Private ) 8 (1/7) 108 (48/60) direction qualifier can be used (QX,QS,QY) Program length (median) 25.5 months 28 months • For third-party payers, there is usually no Cost for Public (median) $68, 210 $37,243 difference between CRNA and AA under Cost for Private (median) $71, 410 $61, 345 medical direction Compensation (median) $127,020 $158,092 MacIntyre P, Stevens B, Collins S, and Hewer I. Cost of Education and Earning Potential for Non-Physician Anesthesia Providers. AANA Journal 2014 February; 82(1):25-31 I would work with an Agenda Anesthesiologist Assistant (medical • Past direction or colleague). • Present 49% • Future 1. Yes 2. No 27% 24% 3. Undecided 1 2 3 7
9/19/2014 Anesthesia Workforce Anesthesia Workforce • Scenario 1: Strong Demand – No growth 2008-2013 – 2.2% annual growth until 2020 • Scenario 2: Conservative Demand – No growth 2008-2013 – 1.3% annual growth until 2020 Anesthesia & Analgesia August 2012; 115(2):407-427 Anesthesia Workforce Anesthesia Workforce • Anesthesiologist supply has increased over the • High CRNA production over the past decade years, but training output has plateaued with no changes expected in the immediate (“cap” in residency positions) future • In 2020… • In 2020… - Scenario 1: SHORTAGE - Scenario 1: SURPLUS - Scenario 2: SHORTAGE (unless > 50% - Scenario 2: SURPLUS conversion from solo practice to medical direction 8
9/19/2014 Anesthesia Workforce California Society of Anesthesiologist • Whereas, Anesthesiologist Assistants are a • Anesthesiologist Assistant not directly vital part of the Anesthesia Care Team across addressed in paper the country and have been for over 40 years; • In 2013, estimated 180 graduates and • In 2020… • Whereas, many Anesthesiologists in California - Scenario 1: SURPLUS would like to utilize Anesthesiologist - Scenario 2: SURPLUS Assistants as part of their Anesthesia Care Team; and Summary California Society of Anesthesiologist • Whereas the State of California does not • Anesthesiologist Assistants complete a currently have a category recognizing and Master’s program (24-28 months) within a allowing for Anesthesiologist Assistants to School of Medicine practice within the state; therefore be it • National certification exam with recertification every 6 years • Resolved, that the California Society of • Only practice under medical direction in states Anesthesiologists pursue recognition and (16 + DC) with statues (licensure or delegatory practice of Anesthesiologist Assistants within authority) the state of California. 9
9/19/2014 I would like to see Anesthesiologist Summary Assistants in California • Payers do not distinguish between CRNA and 1. Yes Anesthesiologist Assistant 50% 2. No • Salary is little less then CRNA, unless working 3. Undecided together in same department 33% • Could help mitigate predicted shortage of 18% anesthesiologists in the future by conversion of solo practice to medical direction 1 2 3 THANK YOU!! 10
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