Patients want to know, and clearly deserve to know, who is treating their injury or illness in every medical setting. Clarity and transparency have never been more important than they are today, when healthcare is delivered by a broad range of health professionals.
Asking medical professionals to display their credentials and capabilities allows patients to make informed choices about their healthcare. American Medical Association (AMA) research shows that 91% of patients believe a physician’s years of education and training are vital elements of optimal care. Similarly, an overwhelming majority of patients (88%) believe healthcare providers should be required to display their level of training and legal licensure, including full disclosure in all advertising and marketing materials.
A current debate digs into this issue: Should certified registered nurse anesthetists (CRNAs) be allowed to use the title, “nurse anesthesiologist” in the healthcare setting? We strongly believe this would muddy the waters between anesthesiologists and CRNAs, leading to confusion and decreased quality of care for patients.
Differences in Training and Experience
In the current environment, the likelihood of confusion is growing. A cursory review of today’s healthcare landscape reveals a wide range of health professionals, with an equally broad array of alphabetic initials following their names. Yet, nearly nine out of 10 patients believe only a medical doctor (MD) or doctor of osteopathic medicine (DO) should be able to use the title “physician.”
Physicians draw upon a level of education, training, experience, broad-based clinical knowledge and decision-making skill that is unmatched by any other member of the healthcare team. Physicians call upon this background to tackle complex medical issues and tap into the unique strengths of each professional within the team to provide the high-quality care patients deserve.
This is not to denigrate the skills or care delivered by nonphysician providers, who are essential members of the team-based approach that modern healthcare requires. But the fact remains that these other types of health professionals are not physicians — and that distinction matters, because removing physicians from the care team results in lower-quality care and higher costs. And research tells us that 95% of patients want a physician to be involved in their diagnosis and treatment.
Anesthetist Versus Anesthesiologist
A proposal now pending before the District of Columbia (D.C.) Department of Health exemplifies the growing concern. The measure in question would allow a CRNA to use the title, “nurse anesthesiologist.” The AMA strongly opposes this proposal. Not only would such a change would violate a District statute that restricts the word and term “anesthesiologist” solely to those authorized to practice medicine, but also, it would create unnecessary confusion for patients.
It is important to note that the legislative intent behind the D.C. statute — protecting the public by reserving the term “anesthesiologist” to licensed physicians — is codified in similar laws nationwide. These measures, known as medical “truth in advertising” laws, are designed to prevent consumers from being misled. That same section of the D.C. code cited above also limits use of the terms “cardiologist,” “surgeon,” “internist” and “medical doctor,” among others, to licensed physicians.
Preventing Uncertainty, Avoiding Risk
Allowing a nonphysician to use the title “anesthesiologist” in a medical setting puts patient safety at risk, because the patient may mistakenly conclude that the person providing their anesthesia possesses the same level of education, training, and qualifications as a licensed physician. This is particularly concerning in the typically unfamiliar and anxiety-laden atmosphere surrounding surgery.
The education and training of anesthesiologists and CRNAs clearly differ. The former complete 4 years of medical school followed by a 4-year residency, including 12,000-to-16,000 hours of clinical training. By contrast, CRNAs complete 2-to-3 years of graduate-level instruction and roughly 2,600 hours of clinical training.
Patients deserve to know with whom they are dealing in every healthcare interaction — including whether the person providing anesthesia services to them is a physician or a nonphysician. Needlessly blurring that distinction muddies the healthcare waters at a time when clarity and accuracy are vitally important.
Bruce A. Scott, MD, is the 179th president of the American Medical Association. He is the president of his six-physician independent private practice group, medical director of a multispecialty ambulatory surgery center, and holds a clinical appointment at the University of Louisville School of Medicine in Kentucky. Scott is board-certified in both otolaryngology and facial plastic surgery.
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