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SALT LAKE CITY — A Utah bill to create a new license for anesthesiologist assistants prompted a debate on Thursday about whether it would serve as an anticompetitive measure for nurse anesthetists, who receive more training, or help fill health care shortages.
"I think our job as legislators is to play referee but it's not necessarily up to us to decide who gets to play in the game, if all of them have the necessary skill set to play in the game," said Sen. Mike McKell, R-Spanish Fork, during a House Business and Labor Committee meeting.
SB121 would establish a license for anesthesiologist assistants and require Utah's Physicians Licensing Board to regulate them. The bill would require anyone who gets the license to graduate from a certified program and pass a certification exam offered by the National Commission for Certification of Anesthesiologist Assistants.
McKell said anesthesiologist assistants are licensed in 17 other states.
"In the real world of medicine, I think we all recognize that there are multiple levels of providers," he said.
The senator compared the profession to physician assistants and nurse practitioners. He said anesthesiologists are the only doctors who do not have people licensed to be their assistants. Anesthesiologist assistants work directly under the supervision of a medical doctor anesthesiologist, McKell said.
Meanwhile, nurse anesthetists, or CRNAs, have some supervision but "far, far more flexibility," he added, explaining that he doesn't intend the bill to replace nurse anesthetists but to create an additional profession.
Trina Vick, anesthesiology assistant and secretary of the Utah Academy of Anesthesiology Assistants, said her training required 2,600 clinical hours and 600 hours of training with anesthetics. She received a master of science degree.
Vick said she works as a lead anesthetist at a clinic in Colorado, where anesthesiologist assistants and CRNAs are "interchangeable."
"I have personally performed thousands of safe anesthetics under the direction of an anesthesiologist," who is always available when complications arise, she said.
The bill would give medical groups the option to hire anesthesiologist assistants but would not require them to. Vick contends it would not affect the scope of CRNA licensing or practice.
But when the meeting opened for public comment, Crystal Tipping, a nurse anesthetist and president-elect of the Utah Association of Nurse Anesthetists, said the state does not need another anesthesia provider.
A national database shows three job postings for nurse anesthetists — at the same time, 110 nurse anesthetists from Utah want to return to the state to work, Tipping said. Westminster College also trains CRNAs, but she said hospitals "refuse" to bring them in to train in their hospitals.
Nurse anesthetists need a bachelor of nursing degree, and on average they receive 36 months of intensive care unit experience "before we can even apply to CRNA school," she said.
"The difference is great between us, and we are not interchangeable," Tipping said, adding that in states that have created the new license, anesthesiologist assistants have been "preferentially" replaced by nurse anesthetists.
Dr. Wesley Mortensen, an anesthesiologist, said others in his profession would like assistants to be licensed as a "free market choice."
He said he would like to hire both anesthesiologist assistants and CRNAs.
But Kirk Moore, a plastic surgeon in private practice, said he sees safety concerns with the potential license.
"I don't see this as a turf war with anybody. I don't see this as an issue with turning somebody out," he said. "There is nothing out there that's proven that (anesthesiologist assistants) are safe."
He said the training between CRNAs and anesthesiologist assistants isn't comparable. Studies haven't been done to show that anesthesiologist assistants are safe, Moore added, calling the issue of "paramount importance" to patient safety.
Michelle McOmber, CEO of the Utah Medical Association, said the group supports the bill and believes anesthesiologist assistants are safe providers.
"They are the PAs for anesthesiologists. Every other doctor has the ability to have a nurse practitioner or a PA, and this just gives the opportunity to anesthesiologists," she said.
The bill received a 9-5 favorable recommendation from committee members, meaning it now moves to the House for a vote. The bill passed the Senate on Monday.
