Tennessee’s anesthesia provider shortage sparks debate over allowing certified assistants in state

NASHVILLE, Tenn. (WKRN) — As the country faces an anesthesia provider shortage, lawmakers in Tennessee believe there could be a prescription: allow certified anesthesiologist assistants (CAAs) to practice in the state—but some argue it would make care more expensive and do little to address the issue of equity.

Senate Bill 453, which died in committee last legislative session, would have permitted CAAs to practice in TN, as they do in 21 other states.

CAAs undergo training in a two-year anesthesiologist assistant master’s program and pass a certification exam. They are required to practice under the direct supervision of a physician anesthesiologist.

📧 Have breaking news come to you: Subscribe to News 2 email alerts →

Shelley Courington with the Coalition for a Healthy and Responsible Tennessee told News 2 even though CAAs cannot practice independently, they’d still help address the backlog of patients needing anesthesia care in the state.

“It’s not just surgeries that we’re talking about,” Courington said. “It’s running the gamut of all of healthcare where we need anesthesia services and we just don’t have enough providers,” Courington said. “[ Allowing CAAs to practice ] does give further reach. Instead of just a medical doctor of anesthesia doing one case, the CAA can cover, and the doctor can cover more patients with that,” Courington said.

Advocates believe allowing CAAs to practice in TN would decrease wait times for surgeries and other procedures where anesthesia is needed.

However, Dr. Chris Hulin, the president of the Middle Tennessee School of Anesthesia , which trains nurse anesthetists (CRNAs) argues allowing CAAs in TN would “lock in” the most expensive care model.

“They have no independent license. They can do no patient care without a physician anesthesiologist being present in a ratio of one to four, so every time you have a patient encounter, you’re paying two people,” Hulin said.

In addition, since CAAs are required to be supervised by a physician, they wouldn’t be able to work in the areas that need providers the most, unlike CRNAs, according to Hulin.

“Forty counties in Tennessee do not have a physician anesthesiologist living there. [ Anesthesiologist assistants ] cannot help any healthcare going on in those counties.”

Hulin told News 2 the Tennessee Association of Nurse Anesthetists would like to work with lawmakers on legislation and other potential solutions to the shortage of anesthesia providers, including rural training programs for CRNAs, and loan forgiveness to help retain providers.

“I think some of the concerns around it have been this would somehow hurt the CRNAs, but the simple fact is we don’t have enough providers and nobody is pushing them out of the way,” Courington said. “There are still going to be plenty of jobs for them and anybody else.”

⏩ Read today’s top stories on wkrn.com

The bill to allow CAAs in TN will be presented again this upcoming legislative session, which begins in Jan. 2025.

For the latest news, weather, sports, and streaming video, head to WKRN News 2.