The Importance of a Title: Anesthesiologist vs. Nurse Anesthetist

[Melissa Mills]

Your job title probably means a lot to you.It might even be as important to you as your birth-given name. You went to school so that you could write specific letters behind your name, such as LPN, RN, or FNP. However, if you decided that it was easier to tell your patients that you were a caregiver, caretaker, or health assistant, would it matter? What if your preferred title was one that other professionals feel is reserved only for them?

For one advanced practice registered nurse, it mattered quite a bit. In fact, it was important enough for him to be able to call himself an anesthesiologist that he fought for this right in front of the Florida Board of Nursing.

Nurse Anesthetist vs. Anesthesiologist

John McDonough has identified himself to his patients as a nurse anesthesiologist for years. After recently appearing before the Florida Board of Nursing, McDonough can legally use this title. However, the Florida Society of Anesthesiologists doesn't agree with the decision. Chris Nuland, an attorney, and lobbyist for the organization told The News Service of Florida, "The FSA firmly believes that, although this declaratory statement only applies to this one individual, this sets a dangerous precedent that could confuse patients.”

McDonough didn't mince words regarding how he feels about his right to call himself an anesthesiologist. He was quoted in an article on nwfdailynews.com saying, "I'm not a technician. I am not a physician extender. I am not a mid-level provider. I am, in fact, a scientific expert on the art and science of anesthesia. So I think anesthesiologist is a perfectly acceptable term, especially since the term anesthetist has been hijacked from my profession.” He goes on to offer similar examples to his situation like dentists who identify as physician anesthesiologists.

Florida's Board of Nursing seems to make several statements about the role of advanced practice nurses these days. They are also deciding if advanced practice nurses can practice independently from physicians. Other nursing boards across the country are making critical decisions about the expansion of advanced practice nurses to work with greater autonomy. Given the continued expense of healthcare and the increased need due to an aging population, it only seems logical to allow these nurses more ability to work with less oversight.

Understanding the Role of the APN

It's essential to know that the term APN refers to several different types of nursing professionals. These various roles perform tasks such as diagnosing illnesses, performing head-to-toe physical exams, providing specialized exam such as functional and developmental testing, ordering lab tests, performing a variety of testing, and dispensing medications.

APN includes the following

• Certified Nurse Practitioner
• Certified Registered Nurse Anesthetist
• Certified Nurse Midwife
• Clinical Nurse Specialist

Advanced practice nurses have various levels of autonomy across the country. Some states allow APNs to operate clinics or offices independently. Other states require physician collaboration or supervision at all times. Because each type of APN has a different job description and role, the settings in which they practice and how they practice varies too. For example, a family nurse practitioner may work in an office with one or two MD's and only consult on cases as needed. For roles like a nurse anesthetist, the setting is likely larger, and they usually work with doctors and surgeons while performing their job functions.

What Do You Think?

So, what's in a name? Does it matter if you call yourself a nurse or caregiver? Should nurse anesthetists be limited to this term or should they be allowed to call themselves an anesthesiologist since this is the specialty for which they are certified? Let us know your thoughts by leaving a comment below.

[wtbcrna, MSN, DNP, CRNA]

1 hour ago, Ummmmmm said:

So the MAJORITY of CRNAs practice independently and not in the care team huh?

That's interesting, considering CRNAs are only able to practice independently in 1/3 of the states in the US. Hmmmmmmm.....

Its just shocking that y'all claim such superiority above AAs and yet claim equivalence to MDs/DOs, when whatever gap in training you think there is between CRNAs and AAs is so minute compared to the gap between CRNAs and MDs. Yet you so emphasize the small gap, and trivialize the giant one.

You apparently do not understand the difference between billing and practice requirements. There are 17 states that do not require CRNAs to have a physician, dentist or podiatrist to sign off as the “supervising” physician to bill for Medicare. That billing “supervision” does not require any type of actual supervision of anesthesia. That is why you have independent CRNAs in every state and even states that aren’t opt out states sill have independent practice and CRNA only anesthesia shops, because the only thing that is required of the operating surgeon is to sign an order requesting anesthesia. That “supervision” for billing in no way increases surgeon or hospital liability as has been shown in several court precedences. Should a CRNA choose to not to bill Medicare then there are even fewer restrictions. CRNAs have been practicing independently without MDAs for over 150 years.

Its not unexpected that you don’t realize this since it is something an AA can never do and as your profession is a subsidiary of the ASA. The ASA lies and misleads people about what CRNAs can and do all the time.

This is just like you assume that CRNAs and AAs make the same salaries, which maybe true at practices that have AAs but is not representative of the average CRNA salaries. AAs, per the AAAA, have a starting salary of $110,000. The median base salary for a CRNA with less than 1 year experience is 157,000. That doesn’t include call pay, overtime etc. The average base salary for all CRNAs was $185,000 in 2018. The ASA doesn’t want anyone, but MDAs to practice independently. That isn’t about patient safety it is about market control, if all practices were ACTs then MDAs would control the salaries of every other type of anesthesia provider just as they do with AAs now. AAs are just a way for the ASA to try and control the anesthesia market, if AAs are so comparable to CRNAs let AAs try to become independent anesthesia providers like CRNAs have done and see what happens.

Your lack of knowledge of CRNAs is again not surprising since you have myopic view of what anesthesia practices are like.

[Ummmmmm]

Y'all can't have it both ways. Either your "extra training" makes you better than AAs, but you have to concede therefore, that MDs extra training makes them more capable than you. And thus, you must concede your right to practice independently is merely a political power grab by the AANA, not due to equivalency. OR, your nursing degree don't mean that much and AAs and CRNAs learn what they need to know about anesthesia IN ANESTHESIA (not nursing) school, and then you can talk about equivalency with MDs. But you can't have it both ways.

.....and you'd still be wrong about equivalence with MDs, cause their training FAR exceeds yours. (here's where you count years in nursing school as equivalent with medical school...LOL),

We've all met crappy anesthesiologists that you can talk about anecdotally, but the mean MD is miles ahead of most CRNAs. And I've met some CRNAs who couldn't find their way out of a paper bag, but anecdotes are just that, anecdotal. Yeah, if someone is at the pinnacle of nursing, doing ICU work for 20 years before anesthesia school, yeah, that's worth something. But be honest with yourself, that ain't the majority of CRNAs, not by a long shot.

[wtbcrna, MSN, DNP, CRNA]

On 8/27/2019 at 11:04 AM, Ummmmmm said:

Y'all can't have it both ways. Either your "extra training" makes you better than AAs, but you have to concede therefore, that MDs extra training makes them more capable than you. And thus, you must concede your right to practice independently is merely a political power grab by the AANA, not due to equivalency. OR, your nursing degree don't mean that much and AAs and CRNAs learn what they need to know about anesthesia IN ANESTHESIA (not nursing) school, and then you can talk about equivalency with MDs. But you can't have it both ways.

.....and you'd still be wrong about equivalence with MDs, cause their training FAR exceeds yours. (here's where you count years in nursing school as equivalent with medical school...LOL),

We've all met crappy anesthesiologists that you can talk about anecdotally, but the mean MD is miles ahead of most CRNAs. And I've met some CRNAs who couldn't find their way out of a paper bag, but anecdotes are just that, anecdotal. Yeah, if someone is at the pinnacle of nursing, doing ICU work for 20 years before anesthesia school, yeah, that's worth something. But be honest with yourself, that ain't the majority of CRNAs, not by a long shot.

Yes, anecdotal evidence is just that, but there is zero evidence that shows MDAs give superior care over independent CRNAs. There is also zero evidence that compares independent CRNA outcomes to independent AA outcomes, which is impossible since there is no such thing as an independent AA.

Isn’t interesting that the ASA, the best funded medical PAC, has never able to show better outcomes than CRNAs. The best the ASA has come up with is the Silbler study that didn’t look at at anesthesia outcomes but post operative outcomes. The study was refused by JAMA for poor methodology and when the study tried to be replicated using their own data it couldn’t be replicated. Please be our guests and show us all this evidence that MDAs provide superior care than CRNAs, and show us all that evidence where AAs work independently...lol

By the way if length of school was all that mattered MD/PhD would be superior to just MDs.

Why don’t regal us with all that clinical experience AAs are required to have prior to AA school? How many years of critical care experience they had prior to going to school? How AAs had to learn basic assessments, IVs, and everything else that nurses had been doing for years prior to going to anesthesia school...

[Subee2, BSN, MSN, CRNA]

CRNA's have more anesthesia class hours devoted exclusively to anesthesia than the docs have. We can only use hours actually in the OR our totals for graduation while anesthesia residents can add up hours that they are merely in the house...whether they are watching TV on call or actually doing a case. So no, I don't believe that MDA's have more training in anesthesia. They DO have the advantage of a lengthy residency but CRNA's are starting to have clinical post grad specialty training also. Not saying we don't need the MDA's..we just could use a lot fewer of them to streamline the process. There was a study several decades ago in the AANA Journal done at Kaiser in California where MDA's and CRNA's were asked specifically what percentage of cases required the presence of an anesthesiologist. Both groups independently came up with a 10% number, so even the docs know they are primarily doing the same job as a CRNA.

[wtbcrna, MSN, DNP, CRNA]

1 hour ago, Undercat said:

CRNA's have more anesthesia class hours devoted exclusively to anesthesia than the docs have. We can only use hours actually in the OR our totals for graduation while anesthesia residents can add up hours that they are merely in the house...whether they are watching TV on call or actually doing a case. So no, I don't believe that MDA's have more training in anesthesia. They DO have the advantage of a lengthy residency but CRNA's are starting to have clinical post grad specialty training also. Not saying we don't need the MDA's..we just could use a lot fewer of them to streamline the process. There was a study several decades ago in the AANA Journal done at Kaiser in California where MDA's and CRNA's were asked specifically what percentage of cases required the presence of an anesthesiologist. Both groups independently came up with a 10% number, so even the docs know they are primarily doing the same job as a CRNA.

There are zero cases MDAs are needed for. We need MDAs as providers to do their own cases not to supervise, direct, consult etc.

[globalwarrior]

With all CRNA programs changing to require a Doctorate, most CRNA new graduates will have more anesthesia specific hours than MDA/DOA's. The programs will be a minimum of 3 years up to 4.5 years. Only cases are counted for CRNA's compared to all hours for physician residents (regardless of it being outside a case, on a break, reading, sleeping, lunch, etc.). There are no "magical" things that physician anesthesia residents are taught that are not also taught to CRNA's.

[subee, MSN, CRNA]

On 9/23/2019 at 11:05 PM, wtbcrna said:

There are zero cases MDAs are needed for. We need MDAs as providers to do their own cases not to supervise, direct, consult etc.

Sorry but that is hubris. If my fetus needed a procedure or my 1 year old needed a liver transplant, I would expect to have MDA who is pediatrician . Bread and butter cases, yes we are perfectly qualified.

[MinasTurning]

MDAs are not pediatricians. They can however go through pediatric fellowships.

If you're saying that sub-specialty cases deserve those with sub-specialty training, I agree. I really do, I would never do that case, ever. However, many MDAs are not and have no experience in sub specialties. As such it is the training, not the degree, which is the key factor.

[wtbcrna, MSN, DNP, CRNA]

1 hour ago, subee said:

Sorry but that is hubris. If my fetus needed a procedure or my 1 year old needed a liver transplant, I would expect to have MDA who is pediatrician . Bread and butter cases, yes we are perfectly qualified.

Speak for yourself not your profession then, because there is zero evidence to support that.

[subee, MSN, CRNA]

2 hours ago, MinasTurning said:

MDAs are not pediatricians. They can however go through pediatric fellowships.

If you're saying that sub-specialty cases deserve those with sub-specialty training, I agree. I really do, I would never do that case, ever. However, many MDAs are not and have no experience in sub specialties. As such it is the training, not the degree, which is the key factor.

Nonsense. Both groups I worked with had pediatric anestheologists on staff to care for the sickest kids, except when our ace CRNA that did the most peds of all was on duty for day surgery cases.

[Travel_RN_0714, MSN, RN]

I've worked with them all. MDA's, CRNA's and AA's. I'm usually there when the "anesthesia provider" interviews the patient just before going to surgery and virtually all of them never use their title and simply say...

Hi.. I'm so and so from the anesthesia department.

[Subee2, BSN, MSN, CRNA]

On 10/7/2019 at 11:21 AM, Travel_RN_0714 said:

I've worked with them all. MDA's, CRNA's and AA's. I'm usually there when the "anesthesia provider" interviews the patient just before going to surgery and virtually all of them never use their title and simply say...

Hi.. I'm so and so from the anesthesia department.

Sorry but I would have been taken to task for not introducing myself in some vague catagory like that. That's a sloppy practice. Besides we have our names and category on our scrubs at the mothership and have to wear ID everywhere else. Over the years I have had about 3 patients who refused care from a CRNA and we always sent them the youngest, rawest resident we could find to replace me or tell the patient they would have to move to the end of the day when an MDA was freed up.