Today’s inane image of the day:
Introduction
I posted an Instagram reel about certified anesthesiologist assistants and there was a flurry of questions and comments about the profession as well as an outpouring of supportive comments from the CAA/AA community. I realized that this profession is a hidden gem and wanted to share more about it.
Starting with the basics: What is a certified anesthesiologist assistant (CAA)? I liken them to the PA (physician assistant/associate) of anesthesia. In the United States, there are 3 different types of anesthesia providers: anesthesiologists (MDs/DOs, physicians), CRNAs (Certified Registered Nurse Anesthetists) and CAAs (Certified Anesthesiologist Assistants; often we refer to them as AAs or just anesthesiologist assistants). The pathway to each of these roles differs. The big picture thing to know is that CAAs have the shortest pathway to being able to provide anesthesia to patients in a care team model (i.e., working with an anesthesiologist). If you’d like a more detailed Statement from the American Society of Anesthesiologists (ASA), you can check out their official explanation from 2022 here: https://www.asahq.org/standards-and-practice-parameters/statement-on-certified-anesthesiologist-assistants-description-and-practice
What do CAAs do?
It seems obvious to those of us in anesthesia practice, but a CAA provides anesthesia (i.e., medications, procedures, management of hemodynamics, etc) for patients! I think people wonder if a CAA is more like an anesthesia tech – providing a supportive role for our equipment and when we’re securing lines, etc… but that’s not the case! CAAs provide anesthesia to patients with an anesthesiologist as part of a team. CAAs can often operating relatively independently on providing an anesthetic. Anesthesiologists will be present during critical aspects of the anesthetic, but are not in the room with the CAA/patient the entire time.
Where can CAAs practice?
The caveat? At the time of this entry, CAAs are only able to practice in 24 jurisdictions (22 states and D.C. and Guam). Those jurisdictions include: Alabama, Colorado, District of Columbia, Florida, Georgia, Indiana, Kentucky, Missouri, New Mexico, North Carolina, Ohio, Oklahoma, South Carolina, Utah, Vermont, Wisconsin, Guam, and specific authorization in Kansas, Michigan, Pennsylvania, Texas, and Virginia. CAAs can practice at any VA facility in all 50 states.
If it’s easier for you to visualize, here’s the official map from AAAA (American Academy of Anesthesiologist Assistants):
Currently the state where I am an anesthesiologist (Massachusetts) does not have authorization for CAA practice. There is active legislation trying to introduce practice authority for CAAs in the state. If you live in a state without CAA licensure, consider getting involved with the local anesthesia state component to learn more about how you can advocate to your lawmakers about expanding access to anesthesia services through introduction of CAA practice.
Who should consider this profession?
Any pre-medical student should consider looking into the career. A component of the application process involves shadowing an anesthesiologist – this is vital to understanding the operating room environment as well as the day-to-day of the profession. Most people have no idea what we do when we provide anesthesia. Either they haven’t had a surgery/procedure with anesthesia OR they have and they’re the patient so if we did our job properly, the patient is not aware of what we are doing. Anesthesia is delivered on a continuum so some anesthetics are “lighter” and more like sedation compared to general anesthesia. But most patients get something like general anesthesia and don’t remember us or what we’re doing.
The operating room environment is a special place with its own proclivities. There are a lot of personalities in the operating room. You will always be working in a team when you’re delivering an anesthetic. You are often forgotten about (by the patient – see above, that’s kind of the point). You have to be ok with the realities of the profession. If you’re looking for more of an outpatient clinic job or the sight of blood makes you faint, then the practice of anesthesia may not be for you. We are exposed to a lot of different bodily fluids in the operating room, so you have to be comfortable with this.
But if you enter an operating room and feel like you’re at home in the sterile environment filled with protocols and procedures and the ability to provide a vital part of a patient’s surgery, consider the CAA route. The profession also includes procedures like peripheral intravenous line placement, airway placement, arterial lines, epidurals, regional blocks, etc. You will learn skills that multiple healthcare providers possess: nursing (drawing up medications, using infusion pumps, placing peripheral intravenous lines, etc), pharmacist (identifying and confirming a medication, determining the appropriate dose), respiratory therapist (management of the airway, ventilator), and as a provider (need to know a patient’s medical history and how that influences you anesthetic plan).
Every anesthetic is a work of art. So there’s creativity involved, too. There’s a million different ways to provide an anesthetic that are “right.” It’s a beautiful thing.
How do you become a CAA (pre-requsities)?
Congratulations on deciding to join the anesthesia profession! It’s incredibly rewarding. But you do have some work ahead of you before you can start practice. Most of the prerequisites for CAA school are similar to the premedical prerequisites, so if you were thinking about medical school but decide to pivot to another healthcare profession, you may already have what you need to apply to become a CAA.
The general prerequisites to apply to CAA schools are as follows:
- Bachelor’s degree from an accredited institution
- Two semesters of biology with laboratory
- Two semesters of vertebrate anatomy and physiology (or other advanced biology) with laboratory
- Two semesters of general chemistry, one semester of organic chemistry, and either a second semester of organic chemistry or biochemistry, all with laboratory
- Two semesters of general physics with laboratory
- Two semesters of college mathematics including calculus
- Either the Medical College Admissions Test (MCAT) or the Graduate Records Admission Test (GRE)
- Prior health care experience is desired but not required
As I alluded to earlier, I recommend that you shadow an anesthesiologist and most schools require that you have a form filled out by an anesthesiologist you shadowed.
I also got feedback from my Instagram post that many schools prefer the MCAT over the GRE.
After completing the CAA Master’s degree program, there is a National Commission for Certification of Anesthesiologist Assistants (NCCAA) examination to pass. Then you’re ready to look for jobs!
CAA Schools (length, cost, list) to obtain a Master of Science in Anesthesia or Master of Medical Science in Anesthesia
There are < 30 schools that train CAAs/offer the Master’s degree. The program length ranges from 24-29 months. The cost of tuition is somewhat frightening – can range from $100-200k/total. But with how lucrative the pay is for the work, if you hustle and pick up overtime, this cost is certainly manageable to pay off in several years.
The best resource I found that will give you a current list of the institutions you can train at, the cost of tuition, and additional information about the prerequisites for acceptance is available here: https://docs.google.com/spreadsheets/d/1Ip4vtluVfNlwlkvs74kstH–h10smKKGIap5aZVi2h4/edit
What’s the pay like? How does it compare to a CRNA?
Let’s see what Google says:
What I can say from speaking to CAAs and knowing that the anesthesia market is hot right now is that it’s reasonable to get to $200,000, especially with a extra work. The pay is dependent on if you take a full time position or if you decide to do locums or if you do a mixture of both. It’s also dependent on the state and the type of practice you’re at.
How do CAAs pay compare to CRNAs? In many places if there are CRNAs in practice and CAAs are introduced, the contract is similar to the CRNA one. So the pay is similar.
CAA versus CRNA
Some have asked me why not choose the CRNA path (which allows for practice in all U.S. territories and even independent practice) over the CAA path. I’d say that the advantage to the CAA path is that it is quicker to get to practice. For CRNAs, they must get a few years of ICU RN experience before applying to a 3-year nurse anesthetist program. This is at minimum a ~5-6 year process. If you have the prerequisites done for CAA and you’re willing to practice in the states where there is an ability to work, then you can start practice in ~2.5-3 years. Tuition costs end up being similar. The RN route does allow for the ability to work to save money for school as well as maintain at least a per diem job during school (many of the ICU RNs I work with have done this but many have also noted that it’s really challenging trying to juggle CRNA coursework with maintaining per diem status). Ultimately the RN path also offers more flexibility since there are opportunities to pivot to other RN-based careers but CAAs are essentially “stuck” in the specialty of anesthesia.
What’s the job/career outlook?
As of 2026, the anesthesia market is hot. Because the market is hot, a lot of places cannot keep anesthesia providers and have been using locums. Many anesthesia providers are looking at changing practices since there are so many high paying offers out in the market. This being said… no one has a crystal ball and anesthesia as a specialty has fluctuated. Back in 2008, anesthesiologists couldn’t find jobs but since then, there has been an increase in demand for anesthesia services. Additionally, our aging patient population is needing more and more procedures/surgery and asking for anesthesia services for them.
I personally think it’s impossible to sustain this high demand for anesthesia services and the high pay that is required to retain anesthesia providers. But I’m not sure how our bubble will burst. If for some reason, surgical reimbursement/payment goes down, I could see the demand for anesthesia services decreasing. But I think the job prospects for the foreseeable future are good.
Is this a good second career?
I think that if someone is looking to transition into a medical career, can get the prerequisites done, and actually likes the day-to-day work, this is absolutely a great second career option. The field of anesthesia can be very rewarding and currently has a stable and comfortable income potential. Again, you should go into the field with eyes wide open about the location practice limitations and should assume no further states will be granted practice authority.
Final comments
If I hadn’t gotten into medical school and I knew about the CAA path, I probably would have seriously explored it. I am originally from the midwest (Michigan) and CAAs have the ability to practice in the state. Looking at job postings, there are certainly lucrative opportunities there now, though I realize I wouldn’t have had as much choice in the hospital systems that I could work in.
Anesthesia isn’t for everyone though, so I think it’s really important that you know and accept what your day-to-day work will look like. Personally, I think I could find the silver lining of any medical job as long as I felt like there was a component that was rewarding, but I know everyone’s opinion on work is different.