Jennifer Golden has been living in Texas since she graduated with her Master's from Case Western Reserve University twenty years ago. It was a state she picked partially out of convenience, as she followed her classmates to a healthcare facility there.
A large part of her decision, however, revolved around the fact that her home state of Arizona, where she had lived since she was five years old, wasn't an option. In Arizona, her chosen career as an anesthesiologist assistant simply can't exist.
"I never realized that it was kind of a newer profession and that I wasn't able to move back home yet," Golden recalled. "I didn't know all the politics of everything."
The Grand Canyon State does not allow anesthesiologist assistants to get a license to practice, setting the state apart from its neighbors and much of the country. New Mexico, Utah, Colorado, and Nevada all allow for the licensure of the profession, also referred to as "AA."
AAs are highly trained — and highly paid — healthcare workers who help anesthesiologists across all areas of the field, including heart surgery, organ transplants, brain surgery, epidurals, pediatrics, and trauma.
As a mother of two children, Golden is desperate to move home to family and friends.
"It would be a dream come true, for real," she said.
The profession of anesthesiologist assistant has existed for around 50 years and requires at least six years of higher education, including 2,000 clinical hours in the operating room. As of March 2024, according to the American Society of Anesthesiologists, anesthesiologist assistants can practice in 21 states, federal districts, or U.S. territories. The profession is also practiced within the U.S. Department of Veterans Affairs (VA).
"It's been incredibly frustrating and disheartening that Arizona does not recognize and value all of my education, training, and experience," said Megan Iyer.
Iyer moved to Arizona nine years ago with her anesthesiologist husband, but she hasn't been able to use her years of education and work experience since. That limitation has been even more frustrating for Iyer as the state faces a health care worker shortage during the COVID-19 pandemic.
"This ultimately affects patients with longer wait times to schedule their surgery and increased costs," Iyer said.
A bill that would allow AAs to be licensed in Arizona has already passed out of the House with bipartisan approval. But House Bill 2674 faces criticism from certified registered nurse anesthetists, or CRNAs, who are against disrupting the existing system in Arizona. Unlike AAs, CRNAs can work independently, without an anesthesiologist, when administering anesthesia. They can also choose to work under the guidance of an anesthesiologist, according to a CRNA representative.
"This is an internal issue and not a public policy issue," Jeremy Browning, representing the Arizona Osteopathic Medical Association, told a House committee during a hearing in January.
Opponents of the bill say the change would impact rural areas, where CRNAs are vital. However, the bill would still allow CRNAs to continue in their positions.
The anesthesiologist assistant field is small, with only about 3,500 practicing nationwide. It's so small that two classmates from Case Western — Iyer and Golden — are now facing a new joint assignment: they've spent the last four years advocating for AA licensure in Arizona.
"To have to explain to someone that I can't work [in Arizona] because they don't recognize my profession? It's belittling," Golden said.
After two long decades away from home, Golden hopes the bill is the light at the end of the tunnel.
If the bill ends up passing, Golden says she'll move back to Arizona right away.
"Next day. I'll be there the next day," she said, laughing. "My parents have been dying for this."
The Arizona Association of Nurse Anesthesiology, the group representing Arizona CRNAs, did not respond to a request for an interview but later provided the following statement:
“The Arizona Association of Nurse Anesthesiology (AZANA) does not support the current version of the AA licensing bill. While we do not oppose licensing Anesthesiologist Assistants (AAs) in Arizona, we have concerns about the bill as it only allows physician anesthesiologists to supervise AAs, excluding nurse anesthesiologists. This creates an unfair advantage for physician anesthesiologists and hinders the experience of our nurse anesthesiology residents, while also failing to address the shortage of anesthesia providers in rural and underserved communities. Despite our efforts to find compromises, the bill proponents have rejected our proposals at every step. AZANA remains committed to finding a solution that addresses our concerns and brings more anesthesia providers to Arizona.”
HB 2674 has not yet been referred to a Senate committee for a hearing. The office of Senate President Warren Petersen, R-Gilbert, did not respond to an email Wednesday asking if Petersen planned to refer the bill to a committee.
