What’s the news: The AMA has sent a letter (PDF) to the District of Columbia’s Department of Health expressing “strong opposition” to proposed regulation 3969 that would allow certified registered nurse anesthetists (CRNAs) to use the title “nurse anesthesiologist.”
The proposal goes against an existing Washington, D.C. law that “preserves the word and term ‘anesthesiologist’ to those authorized to practice medicine,” says the letter from AMA CEO and Executive Vice President James L. Madara, MD.
“Anesthesiology is a physician specialty, and the title ‘anesthesiologist’ has always been used solely by physicians. This makes sense and is therefore already codified in DC Code 3-1210.03 (g),” says the letter to the D.C. Department of Health.
Further, the letter notes, patients commonly know that the terms “nurse anesthetist,” “certified registered nurse anesthetist” and “CRNA” refer to those trained and licensed differently than physicians.
“Even the certifying body and accreditation organization for certified registered nurse anesthetists use the terms ‘nurse anesthetists,’ ‘certified registered nurse anesthetists,’ or ‘CRNA,’” Dr. Madara wrote.
The AMA is fighting scope creep, defending the practice of medicine against scope of practice expansions that threaten patient safety.
Why it matters: Allowing nurse anesthetists to refer to themselves as nurse anesthesiologists “muddies the water and will create unnecessary confusion for patients,” the AMA letter says. Beyond that, it “does not further the health, safety and public welfare to the people of DC.”
For starters, there is a big difference in the training that anesthesiologists and nurse anesthetists undergo.
After earning a bachelor’s degree in college, anesthesiologists complete four years of medical school, plus a four-year residency program. They complete all the courses relevant to practicing medicine, including laboratory courses and courses that give them comprehensive medical knowledge, as they are expected to manage patients care and prevent or respond to complications and complex situations for patients receiving anesthesia.
Nurse anesthetists complete two to three years of graduate level education. They are advanced-practice nurses who provide a variety of anesthesia and pain medicine service. Working in a team with physicians, they administer anesthesia and monitor patients’ vital signs.
Anesthesiologists’ clinical training is nearly six times more than that of nurse anesthetists: Anesthesiologists’ education includes 15,000 hours of clinical training, while nurse anesthetists receive about 2,600 hours of formal clinical training during their nurse-anesthetist program. Even though nurse-anesthetist educational programs are shifting toward awarding doctoral degrees, no significant changes have been made to the number of formal clinical hours required in the nurse-anesthetist training program.
“Given this stark difference, patients have the right to understand who is providing their medical care,” Dr. Madara wrote.
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See how the AMA defends against scope of practice expansions that threaten patient safety.
And surveys show that patients do define “anesthesiologist” and “nurse anesthetists” differently.
An AMA survey (PDF) shows that 70% of patients recognized an anesthesiologist as a physician; 71% said a nurse anesthetist was not a physician.
On top of that, 91% of the respondents said that a physician’s years of medical education and training are vital to optimal patient care, especially in the event of a complication or medical emergency.
“If passed without changes, the language in the proposed regulation would create unnecessary and problematic confusion,” says the AMA letter. “In our view, patients clearly understand that ‘anesthesiologists’ and ‘certified registered nurse anesthetists’ are two different types of providers on the health care team, and this is a very good thing.”
It’s also important because patients are increasingly expected to be part of their own health care decision making. The letter tells the health department that “our mutual goal should be to provide more clarity and transparency, not less.”
Learn more: The Litigation Center of the American Medical Association and State Medical Societies also is working to ensure that the distinction between anesthesiologists and certified nurse anesthetists remains intact. Learn about an amicus brief the Litigation Center filed, along with the American Society of Anesthesiologists, on the issue when it went before the New Hampshire Supreme Court. That state’s top court sided with physicians and the state medical board on the matter.
The AMA Truth in Advertising campaign is designed to ensure that physicians and nonphysicians clearly and honestly state their level of training, education and licensing. Patients deserve to have this information when in face-to-face encounters, as well as in advertising, marketing and other communications materials.
Discover more about what sets apart physicians and nonphysicians. Also, visit AMA Advocacy in Action to find out what’s at stake in fighting scope creep and other AMA advocacy priorities.
