Answer: Anesthesiologist assistants and CRNAs follow different education pathways. Assistants have a medical school-based assistant education pathway. CRNAs begin as registered nurses and complete advanced nurse anesthesia education. Assistants work under anesthesiologist direction. For CRNAs, state authorization and hospital supervision requirements are separate parts of the comparison. Keep certification as its own question when discussing either role.
The short answer
A federal regulatory definition requires anesthesiologist assistants to graduate from an accredited medical school-based assistant education program. It also requires them to work under an anesthesiologist's direction and meet applicable state requirements, including licensure requirements.
The CRNA pathway begins with nursing and includes advanced nurse anesthesia education. The resident also says CRNAs have a different governing body and that the anesthesiologists' governing body does not impose anesthesiologist supervision stipulations on them.
A federal program agency requires CRNAs to be authorized to perform anesthesia and related care in the state where they provide services. Its hospital supervision requirement includes an exception for states that have opted out of the Medicare supervision requirement.
What usually goes wrong
Education, certification, state authorization and practice relationships are distinct questions. For an owner comparing these roles, each deserves a separate place in the discussion. Ask about the education pathway, then certification, then state authorization, then the direction or supervision relationship for the setting.
A certified anesthesiologist assistant says assistants work only within the anesthesia care team model, while CRNAs may work outside it. Keep that practice model comparison alongside the federal agency's hospital supervision requirement and state opt out exception. Discuss both when considering how a role fits into a hospital practice.
What a veteran checks first
- Education: an accredited medical school-based assistant program for assistants and nursing followed by advanced nurse anesthesia education for CRNAs.
- Certification: a separate question for each role in the comparison.
- State authorization: applicable state requirements for assistants and authorization to perform anesthesia and related care for CRNAs.
- Practice relationships: anesthesiologist direction for assistants and hospital supervision for CRNAs, including the state opt out exception.
What the requirements say
A federal program agency states that Medicare-enrolled anesthesiologist assistants must work under an anesthesiologist's direction. They must also comply with applicable state requirements, including licensure requirements.
For CRNAs administering anesthesia in a hospital, the agency requires supervision by the operating practitioner or an anesthesiologist who is immediately available if needed. The exception applies when the state has opted out of the Medicare supervision requirement.
The certified anesthesiologist assistant's comparison concerns participation in the anesthesia care team. Keep the discussion of team participation, hospital supervision and certification in their respective parts of the owner conversation.
Questions to bring to the partner meeting
- What education pathway is being discussed for each role?
- What certification requirements apply to each role?
- What state authorization applies to each role?
- What direction or supervision relationship applies to the proposed setting?
- How does the hospital supervision exception relate to the practice model under discussion?
Sources
- Centers for Medicare & Medicaid Services
- Office of the Federal Register
- Sunny, certified anesthesiologist assistant
- anesthesiology resident at Emory
