Advocacy

AOA statement on American Association of Nurse Anesthetists name change, title misappropriation and the importance of physician-led care

Organization calls for truth in advertising, intellectual honesty and transparency through the use of consistent and clearly discernible professional designations for all healthcare professionals.

On Tuesday, the AOA released the following statement on the recent decision to change the name of the American Association of Nurse Anesthetists and its stance on the use of ‘doctor’ and other misleading titles in the health care setting:

In response to the recent announcement that the American Association of Nurse Anesthetists (AANA) has changed its name to the “American Association of Nurse Anesthesiology,” the American Osteopathic Association reiterates the deep concerns expressed in our May 28, 2021 statement opposing the American Academy of Physician Assistants’ title change.

Efforts by non-physician clinicians to obfuscate their credentials through title misappropriation serve to mislead the public regarding their education, training and qualifications. The AOA calls for truth in advertising, intellectual honesty and transparency through the use of consistent and clearly discernible professional designations for all healthcare professionals so that patients can clearly understand the qualifications and roles of their providers.

“Anesthesiology” is a discipline and specialty within the House of Medicine practiced by “Anesthesiologists,” denoting physician-level of care and thus, are terms which should be reserved for physicians.

We encourage and call for organized, collaborative discussions among stakeholder organizations in the Physician, Nursing and Physician Assistant communities to find common ground on these important topics that are in the best interest of patients. Such discussions have begun and have occurred between the AOA and some organizations, and we welcome others to join these important conversations.

The American Osteopathic Association (AOA), which proudly represents its professional family of more than 168,000 osteopathic physicians (DOs) and medical students nationwide, remains committed to the physician-led, team-based model of care.

A physician-led team ensures that professionals who have earned the right to practice medicine through completion of medical school and accredited residency/fellowship training in their chosen specialty/subspecialty and who have achieved board certification in their chosen specialty/subspecialty are adequately and uniquely prepared to be licensed to practice medicine. Only DOs and MDs can be licensed to practice medicine. “Physician-led” should not mean “physician-optional.”

The AOA and the DOs and osteopathic medical students whom we serve value the important contributions made to our healthcare system by our non-physician colleagues. Certified Registered Nurse Anesthetists (CRNAs), Physician Assistants (PAs) and others have worked tirelessly alongside physicians to care for patients prior to and throughout the COVID-19 pandemic, often under suboptimal and emergency conditions that put their own health and safety at risk. Osteopathic physicians have gladly worked side by side with non-physician clinicians; we commend their selfless service.

Non-physician clinicians, including CRNAs and PAs, are an integral part of physician-led healthcare teams. Healthy discussions and collaboration regarding safe and appropriate skill set substitution, roles and responsibilities are in order, and we welcome them. However, non-physician clinicians’ use of misleading professional titles, such as “Nurse Anesthesiologist” and “Doctor” in a clinical setting by non-physicians imply to patients that a physician (DO or MD) is caring for them. Although such efforts may serve to advance the professional standing of non-physicians, it is done so at the expense of clear and transparent communication with our shared patients.

There are important and substantive differences between the education and training requirements for physicians and non-physician clinicians. Physicians across the United States, osteopathic (DO) and allopathic (MD) alike, must meet rigorous requirements for education, postdoctoral training and testing and then practice in supervised environments that afford progressively greater autonomy before ultimately becoming eligible to treat patients on their own through licensure competency assessment and rigorous board certification standards. These requirements ensure that all patients are treated safely and with the same standards of care.

A Certified Registered Nurse Anesthetist’s (CRNA) training requires a minimum of a two-year master’s degree following their bachelor’s degree. In stark contrast to physicians, no postgraduate training is required. Anesthesiologists complete a four-year medical school curriculum, followed by four years of supervised residency training. Anesthesiologists also sit for rigorous board certification examinations to demonstrate their knowledge and competence in this complex medical specialty. These steps confirm the physician commitment to the public interest and patient safety.

The AANA’s new name, the American Association of Nurse Anesthesiology, creates confusion between the CRNA credentials and those of physicians practicing anesthesiology, commonly known as “anesthesiologists.”

Over the past several years, individual CRNAs and their state chapters have begun a push to re-brand themselves as anesthesiologists through title misappropriation rather than through education and training. After the AANA adopted a position statement in 2018 to allow CRNAs to use the descriptor “nurse anesthesiologist,” the Florida Board of Nursing agreed to allow John McDonough, a Florida CRNA and professor of nursing at the University of North Florida, to use the “nurse anesthesiologist” title in 2019. In the same year, the New Hampshire Board of Nursing decided to allow CRNAs to call themselves “nurse anesthesiologists.” However, the state Supreme Court rejected the change earlier this year. In addition, in 2020, the Idaho Board of Nursing adopted a position statement in support of the “nurse anesthesiologist” descriptor for CRNAs. A group calling itself the “Committee for Proper Recognition for CRNAs” maintains a website (nurseanesthesiologistinfo.com) dedicated to these and similar efforts to misinform the public regarding CRNA credentials. These title-change efforts have not been accompanied by any corresponding change in educational or training requirements.

The AOA reaffirms that all patients deserve access to high-quality, physician-led medical care. The House of Medicine needs to collectively support the practice of medicine and work to ensure physician leadership remains integral to patient care. We are calling on our peers in the healthcare community to join together with policymakers to support policies that recognize the importance of the physician-led team-based model, ensuring that physicians, the only professionals with comprehensive medical education and training that are eligible for licensure to practice medicine, are appropriately distinguished from non-physicians and are adequately involved in the care of this nation’s sick and injured.

Related reading:

AOA statement on physician-led care, physician assistant title change and non-physician clinician use of the title ‘doctor’

11 comments

  1. Fantastic article. Well-written and researched. Thank you AOA for honoring our practice of medicine and standing against misleading identifiers from non-physician providers.

  2. It is not uncommon for nurses to identify themselves as nurse cardiologists, nurse endocrinologists, nurse family physicians, etc. And it appears that hospitals and insurers are supporting this movement. Yet it is very clear that the education and training of a nurse does no even begin to approach that of a physician. This is misleading and confusing to patients, and should be considered as fraudulent.

  3. Sometimes I feel as if this is a never ending wave of infringement. For years, physicians worked hard to create board certification and residency training as the Gold Standard for medical practice…now we are taking giant steps backwards. Almost inconceivable to me. And the worst part, we as physicians watched and sometimes promoted this malignant growth. Shame.

  4. Thank you AOA, for speaking out about title misappropriation and obfuscation of distinctions in education and training. The clarity of this article is excellent. I have known several ARNPs, Advanced Registered Nurse Practitioners, with Ph.D’s. They asked to be called “Doctor,” in recognition of their Ph.D. degree. This created confusion and misperception by patients as well as staff as these were not physicians. Yet we call individuals with Ph.D. degrees, “Doctor.” Indeed, more discussion and further effort towards transparency in titles is needed for the safety and well-being of all.

  5. Making statements changes nothing. There should be legal ramifications, otherwise we as physicians will continue to get walked over.

  6. Physician associate…… The PA name change, is not misleading. As a PA, I found it interesting the name change was mentioned, but the article goes on to talk about crna’s wanting to be called anesthesiologist, which I completely agree is confusing to patients. A physician associate/assistant, either word implies “has to collaborate with a physician”. Since the medical community has opened its arms to NP and DNP on-line training, the term physician assistant, has lost their ability to gain meaningful employed in such a saturated market. Who doesn’t know 30 floor nurses taking on-line classes to get their NP. The training is completely different, yet PA’s are bundled into the APP realm. A term the puppy mill on-line NP/DNP schools have happily clung. PA’s will always be an associate of the physician and would like to stay that way, but allowing nursing to practice independently wasn’t the PA professions doing. I am tired of being bundled into a group who made it clear it never wanted physician oversight, NP/DNP. I love working along side my MD/Do colleagues for the past 20 years. I’d like the next generation of PA’s to enjoy the same. Great article

    1. I agree with your thoughts Patrick, and I have tried to warn of this on this site and others. My MD colleagues seem not to care except to raise the “harm argument” unpersuasively. One good thing to note about PAs. They are getting drawn into name changes and calling themselves “Doctor” as a reaction to nursing political action and lobbying. I can understand this. They are still closer to DO/MD lead teams and can be preferentially selected and hired, If medicine would only orient itself that way.

      Medicine needs a better public message than the “harm argument” : Techs and technology can do nursing and the benefit is low cost and access. Medicine also needs negotiating leverage: PAs are leverage against nurse practitioners.

      Osteopaths are politically smarter than we allopaths, but not that much smarter. They still get drawn into the “harm argument”. If that argument is used, then find the bodies. You won’t find many because the system works (DOs MDs PAs Nurses of all stripes, Techs, Candy Stripers all do their jobs). So a nurse practitioner has trouble and hands off a difficult patient problem to a DO, and little to no harm results. Then the nurse lobbies for more privileges. No harm, but the scope laws are changing for questionable benefit.

  7. People will get what they ask for. Then they may wake up and find out they did not know what they thought they needed in the first place. I know some great CRNA’s, PA’s, and CNM’s. When I ask a PA student why they want to be a PA, they say they want to care for patients, but do not want to ‘waste time’ in school.

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