John McDonough: Ambiguous titles for health providers are not good for patients

Portrait of professional anesthesiologist doctor medical team and assistant standing with surgery equipment in modern hospital operation emergency room
Don’t CRNAs deserve the same freedom to clarify the role of their profession?

When a patient is looking for a health care provider, it makes that task easier if the provider’s title is clear and unambiguous, consistent with the title given to other professionals with comparable expertise, training and certification. Unfortunately, a bill currently moving through the state Legislature would muddy the waters for patients by allowing one group of medical assistants to claim the same title as advanced, highly skilled nursing professionals.

House Bill 721 introduced by Rep. Ralph Massullo purports to be an effort to eliminate patient confusion by reserving the title “anesthesiologist” exclusively for medical doctors. But, as is often the case, there is more to this story than meets the eye. It all began several years ago when people who assist anesthesiologists began to move away from their past title of “anesthesiologist assistant” and started referring to themselves as “anesthetists.”

Since I am a certified registered nurse anesthetist (CRNA), this did not sit well with me and with my dedicated CRNA colleagues who have spent at least seven to eight years to acquire the education and clinical training to become experts in the administration of anesthesia to patients. By contrast, one needs only 24 months of training to become an anesthesiologist assistant.

So began a movement and consensus in the CRNA profession that “nurse anesthesiologist” is a better term to clearly distinguish for patients the unique role of CRNAs. In 2019 I petitioned the Florida Board of Nursing and received a unanimous declaratory statement that I could use “nurse anesthesiologist” as a descriptor for my role along with the official CRNA designation. This action placed Florida in step with the growing national acknowledgment of the term “nurse anesthesiologist” for CRNAs. The American Association of Nurse Anesthetists (AANA) has recognized the optional titles “nurse anesthesiologist” and “Certified Registered Nurse Anesthesiologist.”

Ironically, proponents of House Bill 721 contend that calling a CRNA a “nurse anesthesiologist” will imply that the CRNA is a medical doctor. Yet, they have no concern about the term “anesthesiologist assistant.” In fact, the American Society of Anesthesiologists has noted that 55% of the country does not recognize an “anesthesiologist” as a physician and acknowledged that these specialists have adopted the term “physician anesthesiologist” to make their credentials more clear. Don’t CRNAs deserve the same freedom to clarify the role of their profession?

A recent study by the AANA Foundation found that CRNAs have played a critical role on the front lines of patient care during the COVID-19 pandemic, putting their advanced skills to work and providing a steady hand for overwhelmed intensive care unit teams. More than half of the states in the U.S. now allow CRNAs and other Advanced Practice Registered Nurses (APRNs) to work autonomously. Numerous independent studies show no difference in the safety or quality of care when APRNs and CRNAs administer the services they have been educated and trained to deliver, compared to physicians providing the same services.

House Bill 721 (and its companion Senate Bill 1142) would create a murky and ambiguous landscape for patients, in which both highly trained CRNAs and significantly less-trained assistants describe themselves as anesthetists. Furthermore, this legislation would unfairly tie the hands of CRNAs by forbidding them to use a far better descriptor, “nurse anesthesiologist,” that clearly differentiates them from both physicians and assistants.

I strongly urge all Florida citizens concerned about the quality of health care and the clarity of patient communications to call on your state legislators to defeat this misguided and harmful legislation.

 ___

Dr. John P. McDonough, APRN, CRNA, EdD, is a nurse anesthesiologist, and serves as a professor of Nursing, Director of Graduate Programs for the School of Nursing, and Director of Anesthesiology Nursing at the University of North Florida. He is president of the Florida Association of Nurse Anesthetists.

Guest Author


47 comments

  • Rmartin

    April 21, 2021 at 3:49 pm

    Anesthesiologist = medical doctor. If you didn’t graduate from medical school, you’re not a medical doctor, and you don’t get to call yourself an anesthesiologist. Why is this so complicated? Should everyone just start calling themselves whatever they want because we want to include everybody? These titles are earned, not stolen. You can be a certified nurse anesthetist, but you can never be a medical doctor.

    • Michael Awai

      April 21, 2021 at 4:04 pm

      You’re wrong. Is that why a ASA survey sent out 5-6 years ago found that 60% of patients didn’t know an Anesthesiologist is a medical doctor? Hence the ASA started calling themselves Physician Anesthesiologist. Using the title Nurse Anesthesiologist is no different. Anesthesiologist is one who studies anesthesia such as Veterinary Anesthesiologist and Dental Anesthesiologist. Saying Nurse Anesthesiologist is a descriptor identifying that a nurse with advanced and specialized training is an expert in all aspects of anesthesia.
      This is all about money. Not sure how one profession can tell another profession what to call themselves. That is why we each have respective boards.

      • John Jacob

        April 21, 2021 at 4:14 pm

        Are you also ignoring the fact that the survey found that the majority of patients (>70%) knew a nurse anesthetist was NOT a doctor? Why are you trying to deceive patients into making them believe you’re a doctor rather than a nurse?

      • Albert J

        April 25, 2021 at 2:38 am

        So would you have a problem if CAAs called themselves Assistant Anesthesiologists? According to your logic, anyone who studies anesthesia should be allowed to be called anesthesiologists right? The hypocrisy…

    • Ronald Ray

      April 21, 2021 at 4:59 pm

      What about Dentist Anesthesiologists?
      How about Vet Anesthesiologists?

      Medical Doctor does not equal Anesthesiologist.

      • john constantine

        April 21, 2021 at 6:24 pm

        Just how dental anesthesiologists provide anesthesia during advanced dental procedures, and vet anesthesiologists provide anesthesia to dogs and cats, maybe nursing anesthesiologists could provide anesthesia during cleaning bed pans?
        Moron

        • Ronald Ray

          April 21, 2021 at 6:38 pm

          Is that the best you can do? Really?

      • Drew

        April 23, 2021 at 10:51 am

        Dentists are included in the bill and may refer to themselves as anesthesiologists.

  • John Jacob

    April 21, 2021 at 4:04 pm

    You want to be a doctor (anesthesiologist) so bad go to medical school! You will always be a nurse, so be proud of that!

  • xnc12

    April 21, 2021 at 4:11 pm

    It doesn’t surprise me that a midlevel is trying to undermine the skills/knowledge obtained from a medical (MD/DO) education and residency. Don’t let this nurse anesthetist fool you at the expense of quality medical care. If you are injured or killed at the hands on an independent nurse anesthetist, they will be the same ones that won’t claim responsibility and avoid liability. Most nurse anesthetists at fault try to brush responsibility on the surgeon who has no education in anesthetic care. They want the money/prestige with half the work/education and zero liability. This is mid-level creep at its finest.

  • Matt Wilson

    April 21, 2021 at 4:13 pm

    “…CRNA colleagues who have spent at least seven to eight years to acquire the education and clinical training to become experts in the administration of anesthesia to patients. By contrast, one needs only 24 months of training to become an anesthesiologist assistant.”

    CRNA training is 7-8 years? I did not know this.

    Anesthesiologist assistant programs are 24-28 months, this is correct. We also have a bachelor degree, all of the same science based premedical prerequisite courses that medical students take to apply to medical schools, and take the MCAT or GRE. We don’t just wander into AA school from our job at McDonalds like the AANA likes to imply.

    We should all be working on the same team and focused on taking care of our patients. Not taking low jabs at each others titles and creating false narratives about our educational backgrounds. We are medical professionals we should be advocating for our patients not trying to confuse them.

    • Jay12

      April 21, 2021 at 4:28 pm

      Out of curiosity, how do you introduce yourself to patients?

      • Matt Wilson

        April 21, 2021 at 4:33 pm

        “Hello, my name is Matt I am an anesthesiologist assistant and I will be taking care of you with Dr. _______”

        • Drew

          April 23, 2021 at 10:47 am

          I usually add “Dr. _____ who is an anesthesiologist.”

          Talk about muddying the waters and confusing patients with terms like “nurse anesthesiologist.”

          • Jay12

            April 23, 2021 at 2:30 pm

            Or assistants confusing patients with terms like “anesthetist.”

        • Jay12

          April 23, 2021 at 1:03 pm

          ok well thats definitely not the norm, as most of the AAs i’ve met call themselves anesthetists.
          Also see anesthetist.org, and their their “meet your new anesthetist campaign.”

  • Konstantin Inozemtsev

    April 21, 2021 at 4:32 pm

    Using a physician’s title does not “clearly differentiate” you from a physician. It’s an unearned title – medicine’s equivalent of stolen valor. If you did not complete four years of medical school, four years of residency, and were board-certified as an Anesthesiologist, you have no right to call yourself one – just as you can’t claim to be a dermatologist, vascular surgeon, radiologist, or pediatrician. No amount of posturing and mental gymnastics will change that, and the hypocrisy of this entire article is absolutely staggering.

    • Ronald Ray

      April 21, 2021 at 5:01 pm

      Tell that to the dentists and vets.

      Moron

      • Bill Johnson

        April 21, 2021 at 8:30 pm

        Sad Ronald couldn’t get into medical school.

        You’re a nurse, not a physician, no such thing as a nurse-ologist.

        You give gas, give some phenylephrine when you see small numbers for the BP, then call the physician when the patient crumps. And when an unfortunate med student gets paired with you and asks a question that requires a deeper understanding of cardiac/respiratory/vent physiology or pharmacology, you divert.

        • Ronald Ray

          April 22, 2021 at 10:36 am

          Not even remotely true. I was good enough for soldiers. I continued my independent practice when I left the military. I have provided solo anesthesia services for 30 years and have NEVER worked with a MD anesthesiologist.

          Come to where I practice. I’ll be happy to educate you in peripheral nerve blocks, acute pain management or maybe teach you how to place a chest tube or US guided paracentesis.
          Just another subpar, insecure physician. It’s ok…I’m sure you work in an ACT practice and could not do a anesthetic if your life depended on it.

          • john constantine

            April 22, 2021 at 9:21 pm

            lol good enough for soldiers…that’s rich! you know what else was good enough for soldiers? M-16s that jammed, humvees without doors against IEDS, and now bed pan cleaners providing anesthesia

          • Ronald Ray

            April 23, 2021 at 1:12 am

            What a truly nasty person John Constantine is. Too bad the peer reviewed studies prove that Nurse Anesthesiologist patient outcomes are as good as physician anesthesiologist. That is why we are independent and do the same job in 49/50 states.
            He shows his nasty disposition and hatred of nurses.
            Just another sub par, insecure physician who feels safe to spew his vitriol behind a keyboard.

          • john constantine

            April 23, 2021 at 6:38 am

            lol tough guy keeps talking about being behind a keyboard, but trust me i have no problem pointing out nursing inadequacies (ask all my colleagues). and of course, nurses will still drag out the same tired, low power studies that prove nothing other than the fact that nurses should stay away from statistics and stick to bed pans. do you want to know why crnas are independent in 49/50 states but only 1/150 countries? because the USA’s true expertise is in how to get stupider

    • LetTheTruthBheard

      April 22, 2021 at 7:18 am

      Isn’t it funny that you all DONT have to be board certified lol and I work with anesthesia residents. What’s so stellar and different about their training again? As we study from
      The same exact books? Also they are clueless out of medical school. I mean CLUELESS but they get a little sack downstairs because their badge can say “doctor” now. Such a joke. The my anesthesia training as a CRNA was grueling and about 80 hours clinical a week. I will say with fact my training was superior to the residents I see!! Also to the AAs that always talk about their “prerequisites” and their GRE, lol that’s laughable
      You forget we took the same prerequisites and the GRE. AAs are trained to assist. Period.

      • ConcernedCOnsumer

        April 22, 2021 at 8:13 pm

        This post is pure delusion. I would love to see you try taking the MCAT, USMLE Step 1-3, Anesthesiology board exams and pass. 80hr work week is the norm for all 4 years of residency, as well as medical school and for fellowship. There is no shortcut to getting the skills and knowledge base a physician has, not matter how much you have deluded yourself into thinking there is. It blows my mind because I love working with 99% of my CRNA colleagues, people like you with pure delusion are the bad apples really giving your profession a bad name

      • john constantine

        April 22, 2021 at 9:23 pm

        And nurses are trained to clean bed pans. Period. Have fun with your kaplan class to pass the NCLEX, an autist level exam

      • YouCantHandleTheTruth

        April 23, 2021 at 11:01 am

        You did not take the same prerequisites.

        Anybody can pull up our programs and compare them.

        We also have a higher clinical hour requirement and many programs exceed 3000 hours by substantial margins. This fact bothers CRNA’s with insecurities so much that your lobbying organizations have to muddy the waters by including time spent as a nurse in clinical hours.

  • MidlevelWTF

    April 21, 2021 at 4:50 pm

    Wow, this guy is a real piece of work. CRNA McDonough wants “clear and unambiguous” titles, and yet he calls himself a “nurse anesthesiologist”? Does he have any self-awareness at all of his mental gymnastics on display here? Why can’t he take pride in the title that he supposed worked so hard for – a nurse anesthetist?

    We will be authoring a response to Midlevel McDonough on our site soon, midlevel.wtf.

  • Michael

    April 21, 2021 at 5:14 pm

    This is a joke of an so article. It doesn’t follow logical sense. If anyone introduced themselves as a nurse anesthesiologist or anesthesiologist and was a CRNA I would report them and ask for an actual anesthesiologist.

  • Rhiana Ireland

    April 21, 2021 at 5:14 pm

    The entirety of this article is about how CRNA’s feel about their title, when it should be about how the patient feels. It is a dereliction of duty to expect patients to have to know all of these different terms before needing anesthesia. Patients know what an Anesthesiologist is. They know to ask for one prior to getting a procedure. Instead CRNA associations want patients to have to google through an alphabet soup of letters to determine who they are getting care from. It is unfair to patients and erode patient faith in medicine.

  • James

    April 21, 2021 at 5:33 pm

    Certified registered nurse anesthetist is already the title that signifies additional training in a nursing program. What a disrespectful article that both tries to diminish the title physicians use as well as attack AA’s. Pieces like this only create a larger divide between medical groups and you’re just helping identify more and more reasons to hire AA’s over a CRNA.

  • john constantine

    April 21, 2021 at 6:20 pm

    CRNA wants to “unambiguously” present himself as equivalent to a doctor after 7-8 years of training in cleaning bedpans

  • Anthony

    April 21, 2021 at 6:54 pm

    Does “Dr. John P. McDonough, APRN, CRNA, EdD” not see the irony in writing this piece and calling himself a “Dr” when he has no doctorate in medicine or healthcare but in education. Talk about hypocrisy

    • john constantine

      April 22, 2021 at 9:24 pm

      stick to cleaning bedpans…medicine and history are out of your range

  • GoJackets

    April 23, 2021 at 8:51 am

    False information and propaganda like this from John McDonough is what really makes him a joke. The sad thing is the public has no clue that this is just the hate he spews. CRNA programs are 28-36 months not 7-8 years as described above. You can’t just count random generic nursing as experience. The term certified NURSE anesthetist is clearly defined – a NURSE who is an anesthetist. Just as I am a Physician Assistant anesthetist.. The real farse is that a CRNA can also call themselves an ARNP which implies to the public that they have been trained in primary care which is completely false!!! Stop misleading the public.

    • Ronald Ray

      April 23, 2021 at 5:38 pm

      You can’t count as most of your physicians buddies.

      CRNA program is year round school. A MINIMUM of 7 full semesters which = 3.5 years.
      Unlike medical students who get summers off etc. CRNAs have to do 7 (for masters programs, longer for doctorate) semesters in that time frame.
      ARNP (should be APRN, you don’t even know) does not mean anything remotely that you have been trained in primary care. You should stick to your own lane.
      Have you forgotten about acute care NPs? Emergency medicine NPs?, How about midwives? Yep, all APRNs.

      • john constantine

        April 24, 2021 at 9:16 am

        Ah yes, year round schools with tests that MAs can pass. We WISH we can forget about all those doctor wannabe NPs! Maybe someday when this country wakes up and realizes that its not the destination for premiere, world class medical care anymore cause the bed pan cleaners have taken over because they were cheaper.

      • corrector

        April 24, 2021 at 5:00 pm

        You are mistaken. Medical students generally get one summer off during their four years of medical school, plus 0 summers off during their four years of post-medical school full-time residency training. You are being disingenuous if you are saying that the length and intensity of nurse anesthetist training are comparable to that of an actual anesthesiologist.

      • Bryan Lewis

        April 27, 2021 at 9:59 am

        Ronald is a big dumb dumb. “Me CRNA, me so great!”

  • Terry Woolson

    April 23, 2021 at 8:58 am

    Oh yeah. I believe it was a nurse anesthesiologist that killed that patient the other month in Michigan during a routine colonoscopy….

  • Sam Berry

    April 23, 2021 at 10:35 am

    What a joke hahaha. The amount of misinformation is laughable. CRNAS literally go through the same amount of anesthesia training as CAAs. CAAs go through a much more rigorous undergrad curriculum than nursing students who take watered down “science” courses. Why do you think most universities have separated Chemistry and biology courses for the pre-med and nursing students? CRNAS like to talk about the word assistant in the title of CAAs but forget that’s literally what nurses are for their whole career. Nurses can’t even make any decisions or admin any meds without physician order. I guarantee you about 75% of BSN students cannot score in the 50th percentile for the MCAT. Please stop this misinformation for the safety of patients. Thank you.

    • Ronald Ray

      April 23, 2021 at 5:34 pm

      I’m amazed that people come here and lie and think people won’t post the actual facts? Below is the norm for prerequisite classes for CRNA.
      All RN programs take the same general chem and biology. You may want to check.
      In any case CRNA require those as well as organic and biochem.

      Now, CRNA programs also require a minimum of 2 years of ICU experience. To be competitive, the average candidate has 7 years.
      The CRNA undergrad degree is a BSN (actual nursing degree) not gender studies, music or bartending as AAs are allowed to have.
      There is a reason why nurse anesthesiologists (CRNA) are independent practitioners while AAs are only allowed to practice under DIRECT supervision of MD Anesthesiologist.
      Finally, who cares about the prereqs? Seriously? I hate to burst your bubble but once you are out practicing, you will forget all your physics, gen chem etc. It means squat.

      https://keck.usc.edu/nurse-anesthesia-program/admission/admission-prerequisites-faq
      Anatomy and physiology: (1 [ONE] semester each or 1 [ONE] year combined course)
      Chemistry: 2 (TWO) semesters. One semester of general (inorganic) chemistry and one semester of either biochemistry (preferred) or organic chemistry. Combined courses are acceptable but TWO semesters are required.
      Physics: (introductory or general) ONE semester, No lab required
      Biology or microbiology: ONE semester

      • john constantine

        April 23, 2021 at 10:31 pm

        lol highschool AP chem is harder than the chemistry nursing students have to take in college

  • Ronald Ray

    April 23, 2021 at 5:21 pm

    Oh yea, it was a physician anesthesiologist that killed the patient by overdosing them on narcotics. Let us not forget about the IM physicians that was covering ER and sent an acute MI home “because they had been stented two weeks prior. I could go on all day but I’m educated enough to understand that one incident does not mean a whole profession is bad. I’m not trying to fear monger.
    Unlike you, I’m educated enough to understand EBM as they actually taught it in my masters and doctoral degrees.
    I understand that the peer reviewed scientific studies show no difference in outcomes between physician anesthesiologist and nurse anesthesiologist. Those are facts not fear mongering and opinion.

    • john constantine

      April 23, 2021 at 10:31 pm

      buddy keep LARPing…you’ll never be a real doctor

  • Martin mandin

    May 2, 2021 at 10:42 am

    As a CRNA, when hospital and medical staff assume I’m a doctor and call me “doctor,” I quickly correct them, and tell them “it’s ok, just never insult me again! “ You docs can keep your doctor title. You will see how much respect the title anesthesiologist soon receives, when CRNAs start being referred to as nurse anesthesiologists. Lol.

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