Yes, it's related to licensing.
Medical direction for AAs is set at 1:4. It may be tighter than that in a couple states, but the CMS max is than four anesthetists can be medically directed at any one time.
Licensing is a different issue. In Georgia, there are sponsoring physicians and alternate supervising physicians, with specific regulations for each. I think this is similar in most states. A sponsoring physician is required for each AA (and PA) in Georgia. This is the physician that the AA is "licensed to". Georgia also allows any number of alternate supervising physicians that can also medically direct an AA in the absence of the sponsoring physician. So, while I have a single sponsoring physician, I have roughly 65 alternate supervising physicians - every other physician in my group. So while I am always medically directed by an anesthesiologist, it may not be by my sponsoring physician. He and I work different schedules, and we both work at varying locations. If there were no alternate supervising physicians, I would always have to work at the same place at the same time as my sponsoring physician. Obviously that's not manageable or efficient.
The change in Georgia law this year increases the number of AAs an anesthesiologist may associate with as a sponsoring physician from four to eight. While in most groups this is not even a concern, in larger groups that cover multiple hospitals and ASCs it becomes very important. Again, the anesthesiologist cannot medically direct more than four anesthetists at any given time.
