Anesthesiology assistants (AAs) and nurse anesthetists (NAs, or sometimes referred to as CRNAs — certified registered nurse anesthetists) are non-physician anesthetists. Although educational and training differences exist, AAs and NAs perform the same functions — either assisting anesthesiologists, who are M.D.s, in administering anesthesiology to patients, or performing duties themselves under direct, indirect or other contractual arrangements with physicians and health facilities. Both AAs and NAs are nationally certified to practice as non-physician anesthetists. Regulations and guidelines differ among states, but the American Society of Anesthesiologists finds no discernable difference in the capabilities of either profession.

Education

NAs and CRNAs are required to have nursing degrees, either a BSN or MSN, before applying to accredited nurse anesthetist schools. They also must have a year of critical-care nursing experience. AA schools require anesthesiology assistant candidates to possess undergraduate degrees with pre-medical school curricula. This difference is a result of the historical foundations of the two disciplines. The AA profession began in the 1970s through the efforts of anesthesiologists who needed “physician extenders” to provide much-needed anesthesiology care. Programs were developed to short-track providers in anesthesiology care with an eye toward practitioners eventually entering medical school. NAs developed much earlier, in the late 1800s, also to satisfy an anesthesiology shortage but with no visions of medical school or careers as physicians. The ASA claims that, while AA educations may prepare anesthesiology assistants better for careers as doctors, there is no advantage as a practicing AA.

Clinical Issues

Two critical anesthesiology procedures seem to define the differences between NAs and AAs, although the ASA disputes the importance of this distinction. AAs are more rigorously trained, during their clinical educations, in the use of invasive monitors such as arterial-line catheters and central-line IVs. NAs, by contrast, receive more instruction in the technical deployment of regional anesthesia, like epidurals. Again, history is the main culprit for these trends. Initially, anesthesiologists didn’t think any non-physician health care provider should perform invasive procedures -- thus schooling for AAs and (NAs) didn’t provide such training. Any current limitations placed on NAs and AAs regarding these procedures is strictly a personal or institutional one.

Supervision Guidelines

A nurse anesthetist can be supervised by any physician, whereas an AA must be supervised by an anesthesiologist. The ASA feels that this difference is more of a political victory for women and the nursing profession than proof of any inferiority on the part of AAs or their training. In fact, the ASA contends that the only reason that AAs still are prohibited from working under the supervision of doctors other than anesthesiologists is because the AA profession prefers that arrangement. Although best practices traditionally called for an anesthesiologists to lead the ACT (anesthesiology care team), no such requirement exists except in individual facilities and among some physicians.

Summary

The ASA concludes that, especially after the first year of clinical training, there is little — if any — difference among the capabilities of NAs and AAs. Any differences are more likely due to personal talent levels and skill sets than educational or experiential differences.

Salary

There’s very little difference between salaries of NAs and AAs, other than those attributable to geography, experience and employer types. CRNA starting salaries range from $140,000 to $200,000, with top-end pay reaching $250,000, according to a Merritt Hawkins survey. AAs can expect similar pay rates, with starting salaries beginning at about $120,000, according to Case Western Reserve University.