Nurse Anesthesiologist Name Change

I know... a rose by any other name...

but for those who care, what's your thoughts on the name change for CRNAs to nurse anesthesiologists? Is it good for the profession or just deceptive advertisement? Thanks!

Specializes in Former NP now Internal medicine PGY-3.
jfratian said:

And shadowing doctors treating patients (med school) isn't really medicine either.  Both are relevant clinical experience few AAs have.  The need to differentiate ourselves from them is the point here. 

If you take a hard look at the hours spent in the operating room in a 3 year doctoral CRNA program vs a physician anesthesia residency, there is not a massive difference.  Physician anesthesia residents have an intern year and a significant portion of their remaining 3 years outside of the OR in the ICU and doing research.  We train alongside one another and use many of the same textbooks.  In the OR we both get asked the same questions, we both do all types of cases (transplants, hearts, etc), and we do all types of procedures (peripheral nerve blocks, spinals, epidurals, central lines, a-lines, etc).  Based on the comparable time actually rendering anesthesia care, I believe both groups can fairly call themselves experts in anesthesia care and anesthesiologists.

I would point out that our 2nd year MD/DO anesthesia residents come in very green and are often trained by CRNAs for the first 6 weeks or so.  Our physicians don't want to deal with them, since they come to the OR with no idea how to work an IV pump, start an IV, or set up a ventilator to name a few.  No new CRNA student has that issue; CRNA students have a initial leg up on them in several areas.  However, I find the MDs have a initial stronger grasp of didactic content.  It really does even out by the end and you would not be able to tell the difference between one of our senior CRNA students and a 4th year MD/DO resident if you removed nametags.  I suspect a blind experiment would be quite revealing.

I agree let's do it. 

Specializes in Adult Critical Care.

Back to the actual topic here: 

Professions change their names all the time; a profession gets to decide what to call themselves unless it is a specifically protected title in law.  'Anesthesiologist' is not a protected title; 'physician' is a protected title.  There are vet techs out there right now calling themselves Veterinarian anesthetists for the same reason. 

 PAs are now going to be 'physician associates.' The MDs and CRNAs called themselves physician and nurse anesthetists, respectively, until 1945.  The ASA has been using 'physician anesthesiologist' since 2013.  The AANA has been using 'nurse anesthesiologist' since 2018.

A 2013 survey commissioned by the American Society of Anesthesiologists (ASA) found only 40% of Americans associated 'Anesthesiologist' with a physician.  That's why the ASA has been trying to get docs to refer to themselves as 'Physician Anesthesiologists' for the last decade. 

I would point out that 5 states' boards of nursing (Arizona, Alaska, New Hampshire, Florida, and Idaho) already recognize the term Nurse Anesthesiologist.  When New Hampshire's board of medicine tried to sue the board of nursing over this, the state supreme court threw out the case.  Today, their state nursing license reads "Certified Registered Nurse Anesthesiologist."  

The term anesthesiologist is widely recognized in American case law as profession neutral protected free speech...dental and veterinarian anesthesiologists also use it.  Here's an opinion from the 5th circuit court of appeals in Texas from 2017 explaining the rationale.

http://www.ca5.uscourts.gov/opinions/pub/16/16-50157-CV0.pdf

 

I think they tried to blur the lines by letting AA’s call themselves anesthetist. 

Specializes in Anesthesia.
Robin Wilson said:

I think they tried to blur the lines by letting AA's call themselves anesthetist. 

The ASA has run a campaign for decades stating that CRNAs and AAs are equivalent while promoting AAs to call themselves anesthetists.  

Specializes in Adult Critical Care.

https://pubmed.ncbi.nlm.nih.gov/8418748/https://pubmed.ncbi.nlm.nih.gov/8418748/

Also wanted to share this little beauty with the group.  Table 3 on page 3 shows that physician anesthesia residents are only providing 31.5 to 35.3 hours per week of patient care in the OR and PACU combined during their CA-1 to CA-3 years.  Yikes.

Keep in mind that a physician anesthesiologist did this research and it's based on self-reporting from the residents.  Also, this research is from 1993 before restrictions on resident hours.   So the truth is likely lower than this.

Specializes in Former NP now Internal medicine PGY-3.
jfratian said:

https://pubmed.ncbi.nlm.nih.gov/8418748/https://pubmed.ncbi.nlm.nih.gov/8418748/

Also wanted to share this little beauty with the group.  Table 3 on page 3 shows that physician anesthesia residents are only providing 31.5 to 35.3 hours per week of patient care in the OR and PACU combined during their CA-1 to CA-3 years.  Yikes.

Keep in mind that a physician anesthesiologist did this research and it's based on self-reporting from the residents.  Also, this research is from 1993 before restrictions on resident hours.   So the truth is likely lower than this.

Useful activities still are around 60 hours. I think it's about the same now. Anesthesia isn't typically one of the specialities though work hour restrictions were put in place. More for surgery and maybe some medicine programs.

They may also nit pick educational cases for them, I know this is the case in several programs I know people in. 

The assumption that ICU and pre/post visits arent important causes loss of merit to this post since preoperative medicine is becoming more of a thing

Specializes in Anesthesia.
Tegridy said:

useful activities still are around 60 hours. I think it's about the same now. Anesthesia isn't typically one of the specialities though work hour restrictions were put in place. More for surgery and maybe some medicine programs.

They may also nit pick educational cases for them, I know this is the case in several programs I know people in. 

The assumption that ICU and pre/post visits arent important causes loss of merit to this post since preoperative medicine is becoming more of a thing

The big difference and the ongoing political campaign over hours is CRNAs/SRNAs only count case times while MDA residents count all time in the building. It has created a huge discrepancy on actual hours that the ASA seeks to capitalize on for political purposes. 

Specializes in Adult Critical Care.

The ward/ICU time in this study was only self-reported as 5 to 10.7 hours per week.  Self-reported time is notoriously over estimated to begin with.  Add that up, and I doubt they're doing even 40 hours/wk of actual patient care.  The rest of those hours (reading, studying, conferences, etc) are things few other healthcare professionals in a training status would hold up to the public as relevant points of discussion related to provider quality.  

There is very little credibility in lying to the general public about the nature of one's clinical training.  The ASA is telling the public MDAs have 12,000+ hours of clinical training when the reality is probably closer to half that.

There is also very little credibility in pretending that an anesthesiologist assistant is an 'anesthetist' and has the exact same training as a CRNA. The reality is they can enter with unrelated bachelor's degrees and no healthcare experience: a barista at Starbucks one day and intubating you the next. In reality AA's are just a ploy to reduce the market power of CRNAs. 

We would have been fine with 'nurse anesthetist' if they hadn't tried replaced us.  Now we'll be 'nurse anesthesiologists.' 

Specializes in Former NP now Internal medicine PGY-3.
jfratian said:

The ward/ICU time in this study was only self-reported as 5 to 10.7 hours per week.  Self-reported time is notoriously over estimated to begin with.  Add that up, and I doubt they're doing even 40 hours/wk of actual patient care.  The rest of those hours (reading, studying, conferences, etc) are things few other healthcare professionals in a training status would hold up to the public as relevant points of discussion related to provider quality.  

There is very little credibility in lying to the general public about the nature of one's clinical training.  The ASA is telling the public MDAs have 12,000+ hours of clinical training when the reality is probably closer to half that.

There is also very little credibility in pretending that an anesthesiologist assistant is an 'anesthetist' and has the exact same training as a CRNA. The reality is they can enter with unrelated bachelor's degrees and no healthcare experience: a barista at Starbucks one day and intubating you the next. In reality AA's are just a ploy to reduce the market power of CRNAs. 

We would have been fine with 'nurse anesthetist' if they hadn't tried replaced us.  Now we'll be 'nurse anesthesiologists.' 

LOL what? The only residents I know who might work less than 40 are psych. Sometimes. 

Specializes in Adult Critical Care.

That's what this one study is self-reporting at 7 hospitals.  I'm happy to consider evidence to the contrary.  But, if you're more into anecdotes... it's pretty on par with what our physician anesthesia residents do in terms of direct patient care.  If our residents ever do go over 40 hours, they get overtime pay get overtime pay from the CRNA budget...so not terribly often.

Specializes in Former NP now Internal medicine PGY-3.
jfratian said:

That's what this one study is self-reporting at 7 hospitals.  I'm happy to consider evidence to the contrary.  But, if you're more into anecdotes... it's pretty on par with what our physician anesthesia residents do in terms of direct patient care.  If our residents ever do go over 40 hours, they get overtime pay get overtime pay from the CRNA budget...so not terribly often.

To level out the hour problem as mentioned above it would be reasonable to consider cases only and also the acuity/difficulty of the cases. Something left out of that 30 year old paper. I would still count wards and ICU time + pre post visits as something. Nursing in general counts ICU RN experience as something and I would assume the same should be done for general medical and ICU wards.

Also if that is true of your hospital I went into the wrong speciality. Medicine residency sucks.

jfratian said:

That's what this one study is self-reporting at 7 hospitals.  I'm happy to consider evidence to the contrary.  But, if you're more into anecdotes... it's pretty on par with what our physician anesthesia residents do in terms of direct patient care.  If our residents ever do go over 40 hours, they get overtime pay get overtime pay from the CRNA budget...so not terribly often.

So, you want to change the name to reflect the 'similar' training? Because the hours logged determines the title? Don't know what to do with that.

I do know that I've been a clinical instructor in anesthesia for going on 2 different nurse anesthesia programs and I can say without hesitation, and I know for a fact I speak for the CRNA's in my group, that the intensity, quality, depth and sheer access to high quality learning cases and experiences isn't even in the same zip code for most SRNA's as anesthesia residents. The SRNA's are easily as intelligent and capable, but they simply do not have the same access to the cases, the conversations, the teaching that the residents do. So even if the time spent 'at task' was relevant, the differences in the quality of the experiences and exposure to learning opportunities are, by and large, enormous. 

Throwing in  blocks for orthopedic surgeries 50 to 75 times is great. But anyone can do that. How many SRNA's can manage a straight forward cardiac surgery from start to finish completely independently by the end of their training? How about be the managing anesthetist from start to finish on a liver transplant? Are there residents that can't either? Sure. But the proportion of MD's that can dwarfs the number of SRNA's that can and that's just for starters. 

+ Join the Discussion