The article examines the economic viability of introducing Anaesthesia Associates (AAs) in the UK National Health Service (NHS) to address the shortage of physician anaesthetists. The authors analyze the most efficient staffing model, where one physician supervises two AAs across two operating lists (1:2 model), and conclude that for this model to be economically rational, the employment cost of the two AAs should be equal to or less than that of a single supervisor physician (i.e., AAs should be paid <50% of the supervisor's salary). However, actual advertised AA salaries often exceed this threshold, with even student AAs being paid up to £48,472. The authors discuss several options to justify these salaries, including increasing AA autonomy, adopting higher supervision ratios (e.g., 1:3 or 1:4), or reducing nonclinical time and leave absences in AA contracts. They also highlight the potential medico-political consequences of these options, such as tensions with consultant anaesthetists and patient safety concerns. The article concludes that the UK AA program, as it has evolved, may be economically nonviable and suggests two rational choices: maintaining high AA salaries and maximizing productivity, or reducing AA salaries to economically justifiable levels.The article examines the economic viability of introducing Anaesthesia Associates (AAs) in the UK National Health Service (NHS) to address the shortage of physician anaesthetists. The authors analyze the most efficient staffing model, where one physician supervises two AAs across two operating lists (1:2 model), and conclude that for this model to be economically rational, the employment cost of the two AAs should be equal to or less than that of a single supervisor physician (i.e., AAs should be paid <50% of the supervisor's salary). However, actual advertised AA salaries often exceed this threshold, with even student AAs being paid up to £48,472. The authors discuss several options to justify these salaries, including increasing AA autonomy, adopting higher supervision ratios (e.g., 1:3 or 1:4), or reducing nonclinical time and leave absences in AA contracts. They also highlight the potential medico-political consequences of these options, such as tensions with consultant anaesthetists and patient safety concerns. The article concludes that the UK AA program, as it has evolved, may be economically nonviable and suggests two rational choices: maintaining high AA salaries and maximizing productivity, or reducing AA salaries to economically justifiable levels.