At the beginning of March, Covered California reported that total enrollment in the individual health insurance marketplace is more than 1.4 million people. As more people enter the healthcare system and as baby boomers enter senior status there is increased demand for services, especially surgeries and outpatient procedures requiring anesthesia. Administering anesthesia has become even riskier and more difficult as patients with multiple medical problems have been able to live longer. Complex medical problems requiring surgical procedures require physician oversight and are best handled using a team based model of care.
Annually in the U.S., more than 100 million operations and procedures are performed with anesthesia. And at same time as demand for anesthesia services is growing, the supply of physician anesthesiologists and nurse anesthetists will be falling short of our state’s needs. According to a 2010 Rand report, the U.S. is experiencing a shortage of anesthesiology providers as many physician anesthesiologists and nurse anesthetists are reaching retirement age and leaving the workforce. In fact, the American Society of Anesthesiologists reports that California has the lowest ratio of anesthesia providers to the general population.
The disparity in the increased demand for healthcare and anesthesia services coupled with the shortage of anesthesiology providers means that we need to train more physicians as well as increase the number of appropriately trained assistants to extend physician care. To do just this, the California Society of Anesthesiologists is sponsoring a bill AB 890 (Ridley-Thomas) which would establish practice for Anesthesiologist Assistants (AAs) in California. AAs would increase efficiency and provide greater access to care, while protecting the safety of patients.
AAs currently practice in 17 other states and the District of Columbia, but they do not have licensure in California. AB 890 would open the door for these important health professionals to practice here and serve as valuable members of the physician-led anesthesia care team. AAs are to anesthesiologists what physician assistants are to physicians in other specialties. They would serve as physician extenders to help with mid-level duties and improve the overall efficiency of the system.
Anesthesiologist Assistants would work alongside physicians and nurses in the physician-led, patient-centered model of care. AAs do not practice independently, so emergencies are handled in a team format, which has been shown through substantiated research to lead to better patient outcomes. By extending the physician’s reach, AAs allow physician anesthesiologists to focus where their medical training is needed most, on complex medical problems and emergencies.
Not only is this good medicine, it is what patients want and expect. According to a public opinion survey from the American Medical Association, 70 percent of respondents want a physician to administer and monitor anesthesia levels before and after surgery; 78 percent want only a physician to perform pain medicine procedures like spinal injections; and 90 percent said a physician’s medical training is vital to care, especially in the case of complications or emergencies. Incorporating AAs into practice under physician supervision in California will ensure those patient expectations are met, while providing a real-world solution to staffing issues.
Growing demand for services has led to various policy efforts in California to redefine the scope of practice for different levels of health providers. Rather than expanding nursing scope and duties beyond their training and eliminating physicians from patient care, it is a much safer approach to preserve the physician led model of care and incorporate AAs as another option for fulfilling assistant roles on the team.
California can’t ignore the growing gap in our healthcare system. Adding another class of healthcare providers who are proven an effective and safe part of the Anesthesia Care Team is an important part of the solution. As demand for healthcare services continues to grow, it is incumbent on policymakers to protect patient safety and access by supporting efficient models of physician-led, team-based care.
Ed’s Note: Paul Yost, a past mayor of the city of Seal Beach, is president of the California Society of Anesthesiologists and director of cardiac services at St. Joseph Hospital.