Certified anesthesiologist assistants (CAAs) can currently practice in 22 states, Washington DC, and the territory of Guam. Beyond geography, they work across a range of clinical settings, from major trauma centers to outpatient surgery centers, always under the direction of an anesthesiologist. If you’re considering this career or planning a move, both the state you live in and the type of facility matter.
States That Authorize CAA Practice
As of 2025, 22 states permit CAAs to practice, along with Washington DC and Guam. The specific legal mechanism varies by state. Some issue a dedicated license, others use certification, and a few rely on delegatory authority from the supervising anesthesiologist. The practical result is the same: you can legally deliver anesthesia care in those jurisdictions.
The remaining states do not currently authorize CAA practice, which is a significant consideration for anyone entering the profession. New York, for example, has an active bill (Assembly Bill A1072) in committee during the 2025-2026 legislative session that would create a licensure pathway for anesthesiologist assistants. The bill’s sponsors note that “support for this profession has been rapidly growing across the country, as can be seen by more states granting licensure and new programs opening.” If you’re weighing a CAA career, tracking legislative activity in your state is worth the effort, since the list of authorized states has been expanding over the past decade.
Types of Facilities
Within states that authorize practice, CAAs work in most settings where anesthesia is delivered. The most common workplaces include:
- Hospitals: Community hospitals, academic medical centers, and Level 1 trauma centers all employ CAAs. Hospital operating rooms represent the largest share of CAA positions.
- Ambulatory surgery centers: Outpatient surgical facilities are a growing employer. These centers handle procedures that don’t require an overnight stay, from orthopedic repairs to endoscopies.
- Labor and delivery units: CAAs assist with epidurals and anesthesia for cesarean sections.
- Intensive care units: Airway management and sedation in ICU settings fall within the CAA scope when directed by an anesthesiologist.
- Pain clinics: Some CAAs work in interventional pain management, assisting with nerve blocks and other procedures.
Getting credentialed at a specific hospital or facility is a separate process from state licensure. The American Society of Anesthesiologists notes that initiating hospital credentialing “is multi-procedural and requires significant time,” so expect paperwork and waiting periods when starting at a new facility.
VA Medical Facilities
The Department of Veterans Affairs recognizes anesthesiologist assistants as anesthesia professionals alongside anesthesiologists and CRNAs. VA facilities hire CAAs under federal employment guidelines, but there’s an important caveat: VA hospitals still require CAAs to hold a valid state license. The VA looks to “the license permitting the highest or broadest scope of practice” when a provider holds licenses in multiple states, but the facility can also grant a narrower scope than the state maximum.
At VA medical facilities, anesthesiologist assistants require “medical direction and the immediate physical availability of an anesthesiologist at all times,” which the VA defines as being in a nearby care area or immediately adjoining office space. This is stricter than some private practice arrangements and worth knowing if you’re considering federal employment.
What CAAs Actually Do on the Job
Regardless of setting, CAAs are trained in every facet of anesthesia delivery. Their clinical duties include airway management, placing arterial and central lines, performing regional anesthesia (nerve blocks), and administering neuraxial anesthesia (spinals and epidurals). They participate in induction, maintenance, and emergence from anesthesia for surgical cases.
The defining feature of CAA practice is the supervision model. Under Medicare rules from the Centers for Medicare and Medicaid Services, “an AA always performs anesthesia services under the direction of an anesthesiologist.” This is different from certified registered nurse anesthetists, who in some states can practice independently. For CAAs, working without an anesthesiologist directing your cases is never an option, which shapes both where you can work and what your daily workflow looks like. In practical terms, the anesthesiologist oversees multiple rooms simultaneously while the CAA manages moment-to-moment patient care in one room.
Salary Across Settings and States
CAAs earn an average of $206,200 per year in the United States, or roughly $99 per hour. The pay range is relatively compressed compared to many healthcare professions: the bottom 10% earn around $200,000, while the top 10% earn over $216,400. That narrow spread reflects the fact that the job itself is fairly consistent regardless of employer.
Salary does vary by state and setting. States with higher costs of living or fewer CAA programs nearby tend to offer higher compensation to attract candidates. Ambulatory surgery centers sometimes offer different pay structures than hospitals, with some favoring per-case compensation over straight salary. Academic medical centers, where CAAs may also help train residents, occasionally pay less than private practice groups but offer more predictable schedules.
Choosing Where to Practice
Your options as a CAA come down to three overlapping factors: whether the state authorizes your practice, whether the facility will credential you, and whether an anesthesiologist-led care team model is in place. Large hospital systems in authorized states are the most straightforward path. Ambulatory surgery centers offer lifestyle advantages like fewer nights and weekends. Pain clinics and labor units provide more specialized, predictable caseloads.
If you’re in a state that doesn’t yet authorize CAAs, relocation is currently the only option for clinical practice. However, the legislative trend is clearly toward expansion. Several states have added CAA authorization in recent years, and bills like New York’s A1072 suggest that trend will continue. Graduating from an accredited program and passing the certifying exam positions you to practice wherever the next state opens its doors.