Leopoldo Rodriguez: I am a physician anesthesiologist

Michael Dinos

September 7, 2021 at 8:31 pm

That’s a strange comment. CRNAs work independently all over the country and don’t require supervision from anyone . As the president of the Florida association of anesthesiologists did you not know this? Or are you being intentionally obtuse? Perhaps you could go shadow one of your independent CRNA colleagues in the OR to see what actually happens. Then you could make a more informed statement.

Leopoldo V. Rodriguez MD MBA
September 8, 2021 at 6:07 pm

Dear Mr Dinos,

Thank you for your comments.

I’m aware that in some countries Anesthesia is administered by people that have a three-month course. That does not mean that we should adhere to those standards. Some people argue about the battlefield, obviously, we can’t transfer what happens in a war, to what happens in an ideal world, where we have consultants.

The Florida constitution, protects the titles “CRNA” and “Nurse Anesthetist”, are CRNAs not proud of their title?
Why attempt to confuse the public?
In Florida to be clear, Nurse Anesthetists are either Supervised or Medically directed, changing a title will not change the law.

I’m a perioperative medicine consultant, with 11 months of critical care training, managing the ICU; I’m also a physician, I save significant money to the healthcare system by streamlining ERAS, coordinating care, not ordering labs.

We work as a care team doing mostly ASA III patients, on level I and II procedures, with almost 0 cancellation, transfer to higher level of care.

We have an early call system for unstable vital signs, a no ego, patient centered system. Our CRNAs and AAs are not interested in working independent, as they see the quality of care we do, and enjoy the team work. We have successfully resuscitated patients from massive pulmonary embolisms, etc., thanks to our no ego, system.
- Michael Dinos
  September 8, 2021 at 8:22 pm
  
  Thanks for your response. As you already know crnas have much more than 3 months of training and are licensed to deliver anesthesia independent of any physician anesthesiologist all over the country. It seems you’re okay with a surgeon with no knowledge of anesthesia supervising a CRNA? Is this really about patient safety? What value does that add? And what are the requirements for this “supervision”? State law of often only requires “delegation” which can be satisfied with an order for anesthesia from the surgeon. Nothing more. They need not be involved with the anesthesia plan as far as technique, medications administered ect. This is written in law. I’m sorry to hear you work with crnas that have been conditioned to depend on you to come and save them. That is shameful and embarrassing. Did it ever occur to you that another crna could just as easily come in and assist them? This is the reality of practices all over the country that don’t function similar to your facility.
  - Leopoldo V Rodriguez MD MBA FASA
    September 8, 2021 at 8:53 pm
    
    Mr Dinos,
    The Surgeon is not an Anesthesiologist, however, surgeons are physicians, who completed medical school and 5 to 7 years of residency, working in ICUs. In your case, they are the physician in the room, that in Florida, is responsible for the patient, not you, if you harm the patient, the surgeon is the one who will answer to the family. A surgeon has by far, received more training than a CRNA when it comes to management of the surgical patient, I’m sure you were in the ICU as an RN at one point in your career and either the Surgery, Anesthesiology, or Internal Medicine Residents or Fellows were managing the unit, giving orders to the RN.
    Surgeons may “delegate” but when the %$^& this the fan, they won’t delegate anymore and they will take over if they don’t have an Anesthesiologist. Are you now also pretending that you know more about Medicine than the surgeons as well?
    
    BTW, Anesthesia is pushing propofol and inserting an LMA,
    Anesthesiology, is a consultative perioperative medicine service that includes preadmission, preop, intraop, postop care. One phrase some people need to learn is “you don’t know what you don’t know”
    
    In regards to your question, we expect everyone to help each other, again no ego.
    
    A surgeon makes choices, some, unfortunately, don’t have an Anesthesiologists with them, taking care of the whole process as we do.
    
    I work with surgeons that opened an ASC in another city, they hired CRNAs, soon after they hired an Anesthesiologist to Medically Direct the Anesthesiology, because they didn’t know what they didn’t know that we do, so they don’t have the headaches. We decrease complications, we facilitate early discharge. The science is in publications (not based on administrative QZ data)….
    - Michael Dinos
      September 8, 2021 at 9:07 pm
      
      Exactly. As I said the only delegation that occurs is an order for anesthesia. Nothing more. Do you think the surgeon will tell you the difference between sevo and iso? Fentanyl and ketamine? Succ and roc? Of course they won’t. They know nothing about anesthesia. That’s why the fact that anyone believes the patient is more safe because the crna is “supervised” by the surgeon is a joke. The patient is safe because crnas are licensed INDEPENDENT practitioners. We administer hundreds of thousands of anesthetics safely and independently every year. This seems to be a common phrase with the folks at the ASA. “When the sh$/ hits the fan”. Do you think sh$! doesn’t hit the fan in crna independent practice? You’re being intentionally obtuse here. If you think crnas don’t care for their patients outside of the OR, from pre op to discharge you have clearly been trapped solely in your ego boosting bell system for too long. Thousands of independent crnas are reading your comments and laughing. Please if you have some type of actual proof that crnas deliver inferior anesthesia we are all waiting.
    - Nick
      September 8, 2021 at 9:25 pm
      
      I am
      Flabbergasted by your no who statement as your posts are riddled with ego….. the fact that you are a physician by no stretch of the imagination gives you a stronghold on knowledge acquisition. There is no such thing as knowledge only a “Physician Anesthesiologist” can possess that a CRNA cannot. If I’m being totally honest, such comments simply portray ignorance. I practice anesthesia completely independent of physician involvement every single day. In our military treatment facility, I perform all facets of my own anesthetics from pre-op to discharge, including my own cases, in house call a solo provider in house, regional anesthesia, neuraxial anesthesia etc… etc… I further find it intriguing that your group is taken aback by our profession gaining a title that better describes what we do. As you stated, we are by your definition “nurse anesthesiologists” since we don’t just push propofol… thanks for tour support in that aspect!! Further, as you stated “anesthetist” is a protected title, but the FSA collides with the FAAA to push AA’s to use the term anesthetist in attempt to convolute the role of a CRNA vs an AA. The term anesthesiologist is not conflicted or confusing to a pt because it will and should be preceded by physician or nurse “anesthesiologist”…. That leaves no room for confusion. I do take issue woth your description though, as anesthesia is the practice snd anesthesiology is the “study”… it doesn’t juts describe pushing propofol as you are well aware. I’ve yet to meet a CRNA that is unwilling or too ego stroked to collaborate with any other provider of anesthesia whether that be a CRNA or a Physician, but mandating “supervision” is ridiculous and counterproductive in most facilities. To me personally, the safety is with each individual provider… has nothing to do with pathway to board certification…. I hav meet many CRNAs and many Physicians that are terrifically wonderful anesthesia providers…on the converse, I’ve met many from both groups that I I would not let do anesthesia on my worst enemy. You also know that a surgeon is not responsible for the action of any anesthesia provider and to state such erroneous facts is to mislead the public at large. I totally get that is the point, but it’s very unprofessional and should be ceased immediately.
    - Jacqui Madere
      September 10, 2021 at 7:32 am
      
      Hi there!
      
      When I was an ICU nurse we had to tell the surgical residents what orders we needed and how to run a code… just saying 😉
  - Meghan
    September 13, 2021 at 12:03 am
    
    Your response is absolutely on point and amazing. It is everything I want to shout from the rooftops. THANK YOU for speaking the truth and not propaganda.
    - Meghan
      September 13, 2021 at 12:05 am
      
      To clarify- the truth about what CRNAs are capable of and bring to the table. Not what this nauseatingly misleading article represents.
Bill
September 9, 2021 at 2:00 pm

Why did the CRNA’s wait so long before they tiltled themselves as “nurse anesthesiologists”? I’m surprised that it took so long for such highly trained, nurse/doctors to figure this out!
- PK
  September 12, 2021 at 10:41 am
  
  This happened once the physicians anesthesiologists supported Anesthesiologist Assistants ti begin calling themselves “anesthetists”!
- Mike CRNA
  September 12, 2021 at 10:44 am
  
  Hi Bill
  
  2 Reasons:
  
  1) Anesthesiologist Assistants started using “Anesthetist” in all of their PR and meetings and the ASA decided to support that.
  
  2) The ASA changed their name to Physician Anesthesiologist and with dentist anesthesiologist already existing this clearly indicated that the ASA recognized there were multiple types of “anesthesiologist”
  
  You can learn all about the timeline here https://www.nurseanesthesiologistinfo.com/
  - Michael Dinos
    September 12, 2021 at 1:14 pm
    
    Your facts and evidence won’t be accepted here. The opposition debated only with emotion and personal opinion. As you can see in the comments.

Charles

September 7, 2021 at 8:40 pm

Good Information and your points appear to me (non med) to be important and well presented
Thanks for educating

Megan
September 13, 2021 at 12:15 am

Hi Charles!
Sadly, this article is extremely misleading to non med folks. CRNAs actually practice independently all around the country. “Supervision” is actually not required and CRNAs perform thousands upon thousands of safe anesthetics every year. Sadly, this article is being used to propagate fear for the pocketbooks of physician anesthesiologists. Did you know the anesthesia profession was started by nurses? No physician involvement until money got involved… anyway, I encourage you to read up on the education, training, and scope of practice of a CRNA, it is amazing and their usefulness is imperative in the hospital setting. If you have a CRNA do your anesthesia, they are likely performing ALL the tasks, without an anesthesiologist at all. They are amazing highly trained providers!

Crna

September 7, 2021 at 10:18 pm

Calm down Chicken Little…nurse anesthetists already practice alone all over the US, as well as overseas. Everyone is fine.

Sonia

September 7, 2021 at 10:18 pm

Don’t all seconds of anesthesia count? CRNAS are there for every second- because every second counts. CRNAS are made for every moment.

Leopoldo V. Rodriguez MD MBA FASA
September 8, 2021 at 6:56 pm

I once worked with a CRNA named Sonia, who failed to call on time for a laryngospasm, because of ego, I don’t need help, and the patient became hypoxic, bradycardia and almost arrested. Luckily the circulator called, and me, the Anesthesiologist rescued the patient. We luckily had a good outcome. But the CRNA has lectured again about the no ‘ego’ philosophy.

I other cases, a patient with a sudden intraoperative cardiovascular collapse. The CRNA had heard me talking about MINS “myocardial injury after noncardiac surgery”, sustained hypotension, and called immediately and several of us, successfully resuscitated the patient. The patient had a massive intraoperative pulmonary embolism, and survived, thanks to early calling, aggressive resuscitation. On a similar case, I did a diagnostic TEE with the same finding and took the patient to the cath lab for clot retrieval.

So yes, seconds count and having the right person at the right time working with you for the patient saves lives. That’s why the Anesthesia care team works.
- Michael Dinos
  September 8, 2021 at 8:31 pm
  
  Are you really stroking your ego for dealing with a laryngospasm? You seem to be far removed from the reality of ORs all across the country. Independent crnas deal with the things you mention every single day. It seems to me that you may be the one with the ego thinking only you or another physician anesthesiologist can fix these problems. It’s laughable
  - Leopoldo V. Rodriguez MD MBA FASA
    September 8, 2021 at 9:04 pm
    
    Over 1,500 anesthetics a year for over 20 years is far more than your extensive three-year career, and have encountered things that you have not encountered yet. I have also reviewed cases done by people who think like you….
    - Michael Dinos
      September 8, 2021 at 9:10 pm
      
      Easy to count 1500/ year when you have 4 people doing them and you come only when you hear a bell. I did it the hard way actually doing the cases to accumulate 1500 a year. Do they also ring a bell for you to review cases? I hope you’ve enjoyed your dose of reality this evening.
    - Jack hajjar
      September 13, 2021 at 2:53 pm
      
      So true ,I have seen multiple disasters by CRNA’s ,thanks for the quick thinking I’d anesthesiologists for saving patients lives
      Jack
- Jon Burks
  September 8, 2021 at 8:34 pm
  
  I’m a nurse anesthesiologist. Have been for 20 years. I once went emergently to a rm with 2 MDAs and a desatting 300 lb woman s/p induction. Neither could intubate or ventilate her. I grabbed a CMAC and intubated her. They were both good docs whom I respected and enjoyed working with. Anesthesia is easy until it’s not. They respected.the CRNAs they work with. I would never want to work with anyone like Dr. Rodriguez. The title of the article shows the ASA is losing the PR battle. The mistruths and half-truths in the article wreak of desperation.
  - Michael Dinos
    September 8, 2021 at 8:46 pm
    
    There was a physician anesthesiologist who was having trouble with a pediatric patient. After multiple attempts at intubation the case proceeded once intubated. High peak pressures and couldn’t maintain saturation he Diagnosed as bronchospasm. He had treated with medications and notified the icu that the patient was coming. Crna came into the room to watch the patient as the mda left the room. Crna reintubated the patient and found a mucus plug. Patient stabilized and no icu. There is no room for egos like Dr. Rodriguez.
- Sonia
  September 8, 2021 at 9:44 pm
  
  Believe me sir, that was not me. I call for help all the time. I have had the preop nurses, circulatory, scrub techs, students, surgeons, and post op nurses help me just like I have helped them. We too believe in the team model you speak of. It’s doesn’t have to be an physician anesthesiologist.
  I believe if we asked the circulator or nurse anesthesiologist, you walked in and took credit for saving the day. What happened to your other patients while you took this patient to cath lab?
  You talking about all the saves has nothing to do with ego? Kettle, please.
  See, you’re saying you must be at the right place at the right time to save patients from nurse anesthesiologist. I’m saying nurse anesthesiologist are present for every second because shit can hit the fan at any time- not just when YOU are freely available.
  I hope other patients weren’t harmed during your saves. One patient at a time = Nurse anesthesiologist
- Kristin Bouche
  September 12, 2021 at 10:46 am
  
  If you want to take this slippery slope, Joan Rivers died due to an laryngospasm that went unnoticed & untreated by a Physician Anesthesiologist for minutes. No provider / professional wants to have an adverse or fatal outcome – ever! The goal here isn’t to keep being disrespectful to each other. The real truth is …. That the name change from Nurse Anesthetist <~ one who practices anesthesia to Nurse Anesthesiologist <~ one who studies has Physician Anesthesiologist feeling encroached upon & they fear their (rightful & well earned) title doesn’t differentiate them enough from a “nurse” because that is embarrassing to them to think a Nurse & Doctor can function in very similar capacities. Quite frankly, I respect & care for 95% of my physician colleagues & enjoy the symbiotic relationship we share in our set up. If I have a need for a second pair of hands in a situation – I appreciate either CRNA or physician back up. We are all anesthesiologist & anesthetist – practicing & studying anesthesia with a common goal. The identifier lies before – Nurse or Physician. Why is this so so difficult to understand? I’m certainly not misleading anyone – ever. The fact that I spent 20 years in several different nursing specialties (before anesthesia) puts me well ahead of many physicians – in terms of caring for the “whole” person & family. Guaranteed, you probable excel in one area over another, just as nurses do. Remember, we too spent 12-24 hours in the ICUs – for years (myself I spent 12) watching med students & residents learn & asking us, “How do I close that gap? What’s the dose for this? What’s a VAP protocol? We all learn from & teach each other ….. or we should still be & we should stop this self indulgent narrative both sides can & do spew. Identify yourself by your degree, your specialty, your experience & there is nothing deceitful – period!
- Mike CRNA
  September 12, 2021 at 10:48 am
  
  Oh my
  
  If you want to trade anecdotal stories about lack of knowledge and bad decision making I can do that about physician anesthesiologists all day too. The problem is that sort of “mud slinging” is irrelevant. The data is what matters and the clear statement the data makes is that when comparing independent CRNAs to MDAs we are just as capable as you of managing anything that comes down the road.
  
  Oh, that includes doing TEEs and TTEs. I mean, there isnt a single POCUS technique I dont know, do you know them all? Does that mean all MDAs dont know them? Of course not and its silly to suggest otherwise. Your anecdotes are just that, anecdotes and are meaningless.

Nurse anesthesiologist

September 7, 2021 at 10:27 pm

You guys don’t seem to be up in arms with AA’s having anesthesiologist in their title. Is that why you encourage them to call themselves Anesthetists. I can say I was never trained to practice under supervision of a MDA and 90% of you that utilize the ACT model are committing TEFRA fraud. Let’s be honest this is about income and not patient safety, otherwise if you guys are so safe why aren’t you guys posing for an all MD model? Because you can’t Bill 200%, your greed is why you are losing contracts to all CRNA models.

Jasper

September 7, 2021 at 10:35 pm

I’m not sure what part of “nurse anesthesiologists learn to give anesthesia under a physician anesthesiologist” comes from. I’m a surgeon and watch nurse anesthesiologists do complete total anesthesia alone and sometimes I prefer them.

Leopoldo Rodriguez MD MBA FASA
September 8, 2021 at 6:20 pm

Dear Dr. Jasper
“sometimes” is defined in the Meridiam Webster dictionary as “at times”, “occasionally”

I can tell you that the surgeons I work with, like working in our facility, because I’m a consultant, who manages the perioperative period, so they don’t have to worry about anything.

Since you like the word, “sometimes” and don’t let surgeons operate on some patients, or do certain cases, because they go beyond their ability, or because the patient is not a good candidate, or the facility will not meet the needs of the patient.

And that is a consultant anesthesiologist does (a physician).
- Leopoldo V Rodriguez MD MBA FASA
  September 8, 2021 at 7:36 pm
  
  Correcting a typo:
  Dear Dr. Jasper
  “sometimes” is defined in the Meridiam Webster dictionary as “at times”, “occasionally”
  
  I can tell you that the surgeons I work with, like working in our facility, because I’m a consultant, who manages the perioperative period, so they don’t have to worry about anything.
  
  Since you like the word, “sometimes” I don’t let surgeons operate on some patients, or do certain cases, because they go beyond their ability, or because the patient is not a good candidate, or the facility will not meet the needs of the patient.
  
  And that is a consultant anesthesiologist does (a physician).
  - Independent Practice Nurse Anesthesiologist
    September 11, 2021 at 12:16 pm
    
    Perhaps Jasper (surgeon), was referring to his preference for some Nurse Anesthesiologists over some Physician Anesthesiologists as it relates to the egomania that appears to be integrated into some physician characters- as so obvious in your statements and arguing of semantics.
    As a side note, I find it entertaining that you take no issue with Veterinary Anesthesiologists, Dental Anesthesiologists, and take great pride in marketing Anesthesiologist Assistants.
Surgeon M
September 13, 2021 at 12:23 am

AMEN Jasper! I prefer the CRNA over the Anesthesiologists any day. I have seen CRNAs who are allegedly being “supervised” perform entire anesthetics without their “supervising physician” present over and over and over. They put the patient to sleep, intubage them, mange them throughout, wake the patient safely, etc. All on their own, and do a darn good job at it. I support the CRNAs.

Bob

September 7, 2021 at 10:38 pm

Per settled Law and common practice for over one hundred and fifty years… ANESTHESIOLOGY is the practice of medicine, NURSING and DENTISTRY. The good physician makes no mention of the hundreds of DENTIST ANESTHESIOLOGISTs that practice daily in Florida. Why doesn’t that deserve comment? All providers of anesthesia in Florida practice the same way, use the same anesthesia knowledge base, have to conform to the same standards and have the same amounts of malpractice. Insurance actuary table know the score. The proof is in the outcomes – the same for physician anesthetist or CRNA, thus the same insurance liability. Physicians “supervising” for the lounge or office, this the reason for the outrage : Physicians make gobs of money of the labor of CRNAs. PERIOD. So let’s all collaborate, provide more nurse anesthesiologists or physician anesthesiologists in the OR and provide safe, professional anesthesia care together. Respect, collaborate and celebrate as a cohesive team – not one that exploits it’s hardest working members to the detriment of the patient.

Leopoldo V. Rodriguez, MD MBA FASA
September 8, 2021 at 6:26 pm

Bob, no need to get emotional. In my facility Anesthesia Care Team model, we work in a cohesive environment, full of respect. Everyone knows what role they play in the patient’s experience, I interact with patients and consultants before they even arrive to the facility. In Florida, Anesthesiologists Medically Direct Nurse Anesthetists. I’m sorry that you have not experienced that, but you will always find me with patients.
Anesthesiologist leading a team of Preop RNs, CRNAs and AAs, PACU RNs, in a respectful manner.
Egos are not allowed. We expect everyone to ask for help, no matter who you are, because healthcare should be patient centered, and unfortunately, when the ego of some people gets in the way, patients can suffer, and that should never be tolerated.
- Bob
  September 8, 2021 at 9:52 pm
  
  No emotion Leo. Just tired of the history re-write the FASA / ASA try to give the public. Physician anesthesiologists are the only physicians that willing entered into the practice of nursing – that is anesthesiology. You can’t admit that you don’t know enough about the history of AA-C’s to admit to the public the ONLY reason they were developed at UF was because ole’ Gravestein was tired of the CRNAs saving his screw-ups and “can’t be controlled like a PA could”. Seriously, Leo; my military service showed me how “essential” medical direction is when the $h@* hits the fan. CRNA anesthesia is equal to physician anesthesia care. Legally we are held to the same standards, use the same anesthesiology principles and knowledge, we have the same results with PS 1-4, whether in an ACT abomination, Collaborative (CAT) practice or independent practice. No emotion, no ego – just facts.

Jason Hartman

September 8, 2021 at 5:05 am

Let me clear a few things up. Nurse Anesthesiologists are very capable of providing independent anesthesia. I routinely give office based anesthesia independently for the last 15 years. I’m also a retired army CPT, independently practiced while on active duty in Washington and Iraq.

Leopoldo V. Rodriguez MD MBA FASA
September 8, 2021 at 6:29 pm

If you practice in Florida, you are supervised by the Surgeon, or proceduralist, with a protocol. If you practice independent, you are breaking Florida law.
464.012 Licensure of advanced practice registered nurses.

To be clear

September 8, 2021 at 5:33 am

You lost this argument when you titled your piece with “physician anesthesiologist”. And let’s remind the public why you felt the need. The American Society of Anesthesiologists did a survey finding that the majority of Americans do not, in fact, believe that an anesthesiologist is a physician. So the ASA coined the term “physician anesthesiologist” and it is plastered on all their websites and literature. Meanwhile, you and many of your colleagues have decided to also downgrade Certified Registered Nurse Anesthetists to, as you put it, “anesthesia nurses”.

All that national and state CRNA organizations have done, is to dare to use the term “anesthesiology” in their organization names and to approve the descriptor “nurse anesthesiologist”. A descriptor is what is so offensive to you? When there was an attempt during the 2021 legislative session to protect the descriptor “anesthetist” for CRNAs, the physician anesthesiologist groups got ruffled about that as well. Those groups believe anesthesiologist assistants, who are indeed trained and licensed and/or delegated authority to ONLY EVER practice under direct supervision of a physician anesthesiologist, should have the right to use the term “anesthetist”.

If you believe patients can hear the word physician in front of anesthesiologist, then why do you believe they are deaf to the word nurse before it? Is your ability to explain the care you provide and your expertise to a patient so fragile and limited that the term anesthesiologist is all you have? Seems to me there are people in this state suffering with much bigger issues. Dying from COVID, dying because they can’t get their cancer surgery because hospitals are full, being kicked out of their homes, people whose children haven’t seen the inside of a school building for nearly two years. What a massive waste of everyone’s time this is.

Leopoldo V. Rodriguez MD MBA FASA
September 8, 2021 at 6:31 pm

Dear “to be clear”
Read the above responses.

SB

September 8, 2021 at 6:02 am

You are incorrect. My “training” is to call for an extra set of hands when my patient is crashing. I would much prefer a competent CRNA to assist, but the anesthesiologist is the individual who is free and not tied to a patient in a room already. I am not a “cowboy” anesthesia provider, so I know when help is needed when a complication occurs. (So don’t twist that into “the anesthesiologist comes in to save the day,” because that’s not how that works!).

Leopoldo V Rodriguez, MD MBA FASA
September 8, 2021 at 6:38 pm

Dear SB
Medical Direction starts in the preop clinic, when a patient is selected to come to the facility. Assignments are made based on the patient, providers.
In my facility, an Anesthesiologist Medically Directing, informs the team about the next patient’s condition, and is in the room for high-risk patients to help with airway, positioning, during critical portions of the procedure.
And I have reviewed cases done elsewhere, in which they waited too long to call for help, and unfortunately the patient suffered. In my facility, we have an early call system, in which anyone that sees something, immediately pushes a button, that calls the Anesthesiologist. Anyone can push the button, from the tech, RN, surgeon, etc., nobody will ever be reprimanded for pushing the button multiple times, but they will if they don’t and something happens to the patient. Again, Anesthesiology is a medical specialty, in which many providers participate. It should always be patient-centered, and not “ego-centered”

Crna

September 8, 2021 at 6:55 am

Well this guest article is not going well….😂

Leopoldo V Rodriguez, MD MBA FASA
September 8, 2021 at 6:41 pm

Dear Crna
Thank you for using your Florida protected title “CRNA”
464.015 Titles and abbreviations; restrictions; penalty.

Leopoldo V. Rodriguez, MD, MBA, FASA
Anesthesiologist

RA

September 8, 2021 at 7:03 pm

Thank you for this thoughtful article and comments.

I agree wholeheartedly that CRNAs and AA’s are very skilled at their jobs. They contribute to safe and effective care. We need people with varied backgrounds and training and everyone should feel like they are contributing to safe and effective care. Titles should be clear and PR should be done so that the public knows who what the roles are.

As you mentioned in war time, in emergency rooms and out on the streets, the standards are different than in an OR and many of the skills and tasks performed by medics, paramedics and first responders overlap with expertise of anesthesiologists. These are often desperate situations and outcomes are not as good, but it’s important that we do our best to train and support these critical healthcare providers.

It’s is too bad that money trumps safety in the United States and scope creep is supported by profit seeking. And yes, anesthesiologist of the past certainly deserve some of the blame regarding the concept of extending the supervision ratio to make more $$ without appropriate support and supervision.

The Dunning Kruger effect is in full effect when it comes to scope creep. The individuals can’t be blamed for not knowing what they don’t know especially when they usually get away with not knowing without I’ll effect.

Leopoldo V Rodriguez MD MBA FASA
September 8, 2021 at 7:33 pm

Thank you for your comments RA.

Patient-centered care, with an Anesthesia Care Team, is the most cost-effective system for a facility to have safety and efficiency.

Very unfortunate that we have not done a good job educating legislators about the difference in training.

Being a physician means that you were the best high school student, the best college student, you demonstrate resilience through a long Medical education and Residency. I have been practicing for over 21 years, I love my specialty, patients keep coming back to our facility because they see a cohesive team with defined roles and respect.

I was Chief Resident at a top program, completed a subspecialty year in Pediatric Anesthesia at a Children’s Hospital and worked as a Pediatric Anesthesiologist in a Children’s Hospital, did Adult Cardiac Anesthesia, Board Certified in Advanced perioperative Echocardiography.

We have to be realistic, there aren’t enough Medical Schools and Residency Programs that can produce enough Anesthesiologists to do every single procedure. That’s why we have an Anesthesia Care Team. Like an ICU has an Intensivist in Charge of the ICU, managing all the patients.

Some CRNAs are proposing the equivalent of removing the physician intensivist from the ICU because they are there with the drips. Not a very logical train of thought. They don’t have the Medical knowledge or training to do what we do.

Each of us adds value to the patient. And that is the message. Working in a team we can provide better care to patients. Anesthesiologists are the perioperative medicine consultants that lead a team of professionals, and we are where we need to be when the time is needed, preop clinic, preop, pacu, OR, etc. This is not warfare, this is Healthcare, there is no equivalent.

Changing a title is a marketing stunt that adds no value, nor gives them any additional knowledge, what it does is confuse patients furthermore.

I have taught in CRNA schools, Medical schools, Anesthesia Residency programs.

Elena

September 9, 2021 at 9:33 am

Thank you for your well written and informative essay. We need to spread the the word and raise the awareness of title misappropriation and misrepresentation of roles of allied health professionals who are hiding behind false titles. They are all valuable members of the physician led teams but should not pretend they are physician equivalents. It is the patience who will pay the ultimate price for misguided trust.

Michael Dinos
September 9, 2021 at 9:53 am

Is Anesthesiologist Assistant also title misappropriation? After all, it has the word “anesthesiologist”. Are you implying that people will recognize the word “assistant” that follows anesthesiologist but will not recognize the word NURSE when preceding anesthesiologist? That is ridiculous. Also, the ASA conducted research which found that the majority of the public didn’t even know who or what speciality “anesthesiologist” belonged to. That’s why they began using “PHYSICIAN anesthesiologist”. Yet now a organization wants to claim the term and thinks NURSE anesthesiologist is misleading.
- Average anesthesiologist
  September 9, 2021 at 3:17 pm
  
  Dino. Dude. You don’t get the difference between a word being used as a noun or an adjective; yet, you are trying to argue with possibly one of the smartest people in the country. All of these silly unrelated crna half arguments will never add up to a complete, truthful argument. Please, think about that. Good day to you, sir.
  - Michael Dinos
    September 9, 2021 at 4:27 pm
    
    Wow. The smartest in the country?!?! Those are the kind of proven facts that keep winning you legislative battles! Good day, average
Nick
September 9, 2021 at 12:02 pm

I can’t take you seriously when you aren’t spelling correctly. There is NO misappropriation of tittle as Nurse Anesthesiologist describes exactly what we are. Advanced practice nurses that studied anesthesiology and now practice anesthesia. Enough said.

Tom

September 9, 2021 at 9:43 am

Perhaps the author and president of the Florida Society of Anesthesiologists needs to do better research. I did not learn to perform anesthesia under the direction of physician anesthesiologists: I learned how to perform anesthesia. Period. Full stop.

While Florida relies heavily on the Anesthesia Care Team Model, many states in this country have no supervision requirements for Certified Registered Nurse Anesthesiologists, and these CRNAs perform the same cases with the same results, which every independent study has shown.

Additionally, while serving in the military, including overseas deployments, I never once saw a single physician anesthesiologist in our hospital, let alone our operating room. We were caring for the worst traumas you could ever imagine, to both US and Iraqi civilians, as well as non-trauma surgical cases to Iraqi civilians, whose baseline health status is far worse than in Americans. Our outcomes were as good as any outcomes in the US. We didn’t receive any specialized training or attend any specialized schools: our training was the same as any other CRNA in the country.

Lastly, mentioning training, I have been able to compare the education and training between several CRNA programs and medical schools. CRNAs learn the same physiology, pathophysiology, and pharmacology as medical students: in many cases they attend the same classes together. I, and many other CRNAs trained alongside physician residents: we did the same exact cases, the same exact procedures, and were held to the same exact standards as our physician counterparts, because anesthesia only has ONE standard… patients do not react differently to anesthesia being performed by a CRNA or MD. Lastly, I have helped physician anesthesiologists study for their boards, and have seen the level of knowledge required for them: there is no difference in the level of knowledge that must be demonstrated for either exam… again, because anesthesia only has a single standard.

I have been fortunate to work with, and have worked with, many fantastic physician colleagues, who I work with in an environment of mutual respect and friendship. Your condescending attitude shows a gross ignorance of the training and education that CRNAs receive, and the realities of the care CRNAs provide. They do nothing but further the hostility between some in both communities.

Anesthesiologist

September 9, 2021 at 11:22 am

Thank you for the informative post. It’s sad some CRNAs are trying to deceive the public due to insecurity in being nurses and not physicians.

They always like to claim anesthesia as a nurse founded specialty, but there is quite literally no literature that has ever been created or published by a CRNA that is practice-changing or advancing the field of anesthesiology. Physicians have and always will be the ones studying and adding to the field. CRNAs are not scientists, they’re not researchers, they’re not physicians. CRNAs are highly skilled protocol driven RNs… which is not a bad thing. They like to conflate reading Miller with being a physician.

Nurse Anesthesiologist
September 9, 2021 at 7:40 pm

“Protocol driven?” Show some facts to back up your claim, because you are showing nothing but pure ignorance. We don’t work on protocols: we work on a knowledge of physiology, pathophysiology, pharmacology, and applied critical care, just like MD anesthesiologists. Except that we’re actually in the room taking care of our patients.

You’re also showing how threatened you are that a “nurse” can do the same job just as well as you can.

Shawn Fouhy

September 9, 2021 at 11:45 am

Maybe the nurses should go to med school instead of nursing school if they want to be treated as physicians? Allied health professionals such as NPs, PAs, and nurse anesthetists that later go to medical school seem to always note the same thing. Their breadth of knowledge and critical thinking during dire situations is vastly improved. CRNAs should be happy being nurses, why would they change their name. Seems weird to me, like they’re trying to be something they’re not. If they want to be an anesthesiologist, do the required training. It should be easy for them if they’re already an anesthetist.

Mikhail Chernov

September 9, 2021 at 11:58 am

The fact that some States do allow nurses to practice “independently” doesn’t necessarily require the change of the title. Besides the fact that educational approach for MDs specialized in anesthesia vs CRNAs is completely different, our patients have rights to know and fully understand who provided the service in order to give a consent. Failure to appropriately identify yourself is a fraud. By the way, most of the States allowing CRNAs to practice without direct supervision of Anesthesiologist do require a “qualified” MD to be present during the procedure.
CRNAs in their current capacity and under their current title have always been and will remain a highly respected and extremely valuable members of any anesthesia practice.
Any attempt to change this status quo is simply a bad politics.

Nick

September 9, 2021 at 12:23 pm

Your reply to the list might be quite literally the most ignorant thing I’ve read today. NONE of us are ashamed of being nurses or trying to hide behind facade names nor narratives .we are simply gaining a descriptor that befits what we are. YOU all are the ones pushing AA’s to use the term anesthetist (which they are not). This push along with creation of PHYSICIAN anesthesiologist is what muddied then water. We are simply cleaning up your mess, per usual.

DE
September 9, 2021 at 1:54 pm

Don’t AA’s and CRNA’s undergo the same training in anesthesiology? A previous career in nursing does not give you an advantage in practicing anesthesia. We keep trying to redefine our roles in healthcare. The physicians worked long and hard to get where they are in their career. Not everyone can and want to do it. If you chose to become a CRNA, it should be for patient care and advancing your career goals. I understand that physicians can be egotistical but if you work on your craft and be skilled, the respect will be given without changing your title. The training isn’t the same period. Be proud of your role, take care of the patient and not your status.
- Michael Dinos
  September 9, 2021 at 4:06 pm
  
  Please tell me how working in a ICU managing vasoactive medications, taking care of the most sick, dying patients, responding to codes, rapid responses in the middle of the night guiding new residents on what to do is not considered applicable to anesthesia. A recent article by Dr Silbert highlights the fact that new CA1 anesthesia residents spend many months “learning how to be nurses”. AAs can work at Walmart, take the prerequisites and enter a AA program. The roles Of a crna and physician anesthesiologist are exactly the same.
- Nurse Anesthesiologist
  September 9, 2021 at 7:44 pm
  
  Having trained alongside both AA students and anesthesia residents, I am qualified to compare the training between all 3. CRNAs were trained to the exact same standards as the MDs, doing the exact same cases, exact same procedures, getting pimped exactly the same… AA students did not receive that training. So no, AAs and CRNAs are not trained the same, but MD anesthesiologists and CRNAs are.
  
  Sorry to burst your ignorance with facts.

Nick

September 9, 2021 at 12:26 pm

We chose the profession of advanced practice nursing. We CHOSE not to go to medical school. We are proud of our nursing background… we are NOT trying to be recognized as physicians, nor do we want to be. This were your fallacial assumptions not our words nor intent. Try again! Next!

DE
September 9, 2021 at 2:09 pm

“ we are NOT trying to be recognized as physicians”? That is is what the title of anesthesiologist means. Just saying “next” doesn’t mean you are right, just childish. Keep arguing…..
- Michael Dinos
  September 9, 2021 at 3:08 pm
  
  Then why say “physician anesthesiologist”??

Nick

September 9, 2021 at 12:28 pm

Your statement are riddled with inaccuracy. Why bad politics, because it doesn’t fit your agenda?

CRNA's daughter

September 9, 2021 at 12:29 pm

Thanks Dr. Rodriguez. Titles and training do matter. I remember my Mom (who was a CRNA) saying, “If I wanted to be an anesthesiologist I would have gone to medical school.” She never understood why some in her profession were pushing to practice outside the scope of their training.

Michael Dinos
September 9, 2021 at 12:38 pm

Your mom seems to be misinformed. CRNAs don’t practice outside of their scope when they deliver anesthesia independently. We are held to the same standards as our physician colleagues.

Dan

September 9, 2021 at 1:21 pm

There’s no doubt that CRNAs and AAs are valued, well trained and are good at what they do. CRNAs seem to use the argument that since crnas are practicing independently in some states, they should be able to in all states. It was a mistake to allow CRNA to practice independently in the first place. Just because someone can do something, doesn’t mean they should, or that it’s the best. Why not send surgical techs and surgical PAs to a weekend course to learn how to do a lap Appy, lap chole, carpal tunnel release, trigger finger, cataract extraction, knee arthroscopy, ear tubes, cyctoscopy, etc? These are all surgeries that can be taught during a three-day weekend course especially for people who have been assisting with those surgeries previously. Why not have flight attendants take a weekend course for takeoff and landing of an aircraft and let them fly the plane? Why not have the dental hygienist take a weekend course for doing filings and extractions and let them do it? Why not let the teacher assistant be the lead teacher in the classroom? The answer because there is order, there is a hierarchy in the professional world wether we like it or not. I respect the dental hygienist for doing the studies required for their profession. They have the choice to go to dental school, and chose not to, therefore, they should not be allowed to perform the duties of the dentist. Same goes for crna’s, they have a choice to go to medical school, they choose not to, they should have to function under the supervision of an anesthesiologist. If we let every professional person automatically jump to the next level in their respective fields it would cause chaos and eventually no one would choose to go study the higher level in their profession, ultimately leading to quality degradation.
My opinion for why anesthesiologists have a problem with CRNAs using the term anesthesiologist and don’t have a problem with anesthesiologist assistance using the term anesthesiologist is because AAa are not trying to practice independently while CRNAs are.

Michael Dinos
September 9, 2021 at 1:38 pm

Dan. CRNAs aren’t “trying” to practice independently. We already do all over the country. Your arguments are silly. Comparing the education of crnas to a weekend course being is intentionally deceitful. Flight attendants aren’t licensed to fly a plane. Hygienists aren’t licensed do be dentists. CRNAs however are licensed to practice independently and already deliver hundreds of thousands of anesthetics annually without any involvement from any physician in our delivery. CRNAs have the same scope of practice and are held to the same standards of physician anesthesiologists and dental anesthesiologists. As to your argument for using the term anesthesiologist. It has been clearly stated that their problem is that anesthesiologist = MD/DO. Again this is false. There are dental anesthesiologists. There was also data collected by the ASA that showed the general public didn’t think a anesthesiologist was a physician. Hence the term “physician anesthesiologist” now used. It’s literally the title of this article.
- Bill
  September 9, 2021 at 2:09 pm
  
  You are in error. Anesthesiologist = Physician. Dentists have a DDS, thus a doctorate in dentistry. Accept you are a nurse and be happy.
  - Michael Dinos
    September 9, 2021 at 3:06 pm
    
    There are in fact dental anesthesiologists.
  - Michael Dinos
    September 9, 2021 at 3:19 pm
    
    I find it amusing that you don’t know what a dental anesthesiologist is. Perhaps you could organize and denounce that organization next.
- Dan
  September 9, 2021 at 2:47 pm
  
  I know that crnas are practicing independently in some states, my point is that they should not be. same way that a surgical PA cannot practice surgery independently even though they are well trained, same should be with crna’s.
  I think anesthesiologists have a problem with CRNA being called anesthesiologists because of the combined effect of trying to practice independently in more States in addition to being called anesthesiologist. If CRNAs did not practice independently, I don’t think anesthesiologiss would have a problem with CRNAs being called nurse anesthesiologist.
  - Michael Dinos
    September 9, 2021 at 3:11 pm
    
    Surgical PAs are not licensed to practice independently. CRNAs are licensed to practice independently. Because you don’t want us to be licensed to practice independently isn’t a very strong argument. We don’t need the approval of any organization to do what we are trained and licensed to do.

Nick

September 9, 2021 at 1:46 pm

Wait wait eait. First off we don’t care what your mom thinks, second, changing a title has nothing to do woth scope of practice!?!?

Nick

September 9, 2021 at 2:23 pm

Nope, I said next, as in bring a valid pint. Anesthesiologist is NOT synonymous with physician… that is the crux. Anesthesiology is in it simplest form is the study of anesthesia… this is a quite simple fact… by default then an anesthesiologist is one who studied/trained in anesthesia…. By you argument an audiologist or cosmetologist (or many other examples) would be physicians?? NSM my friend.

Nick

September 9, 2021 at 2:29 pm

So by your own admission, it’s nothing more than a control issue for you? Got it! Likening CRNA training to a weekend course is absolutely ridiculous. Almost as ridiculous as the 25k plus hour number that many physicians tout from residency… pipe dream! That NEVER happens. Artificially inflated numbers. Fact!

Nick

September 9, 2021 at 2:32 pm

And I have a DNP= Doctor of Nursing practice… I am happy to be a Nurse… a doctorally prepared Nurse Anesthesiologist. !

Roxy

September 9, 2021 at 2:40 pm

Once the nurse anesthetist find themselves in the courtroom after being sued, all their knowledge should come in handy!

Michael Dinos
September 9, 2021 at 3:04 pm

CRNAs have been sued and judges against by a malpractice jury. Because we have the same scope of practice and are held to the same standards as physicians.
- Roxy
  September 9, 2021 at 4:23 pm
  
  Good, then your salary would take a major dip covering all the malpractice
  - Michael Dinos
    September 9, 2021 at 4:29 pm
    
    We also carry our own malpractice insurance. Same limits as our physician colleagues.

Nick

September 9, 2021 at 2:53 pm

And You think that doesn’t happen now? You’re fooling yourself!

Nick

September 9, 2021 at 2:55 pm

So…. Again, it’s about control?

Nick

September 9, 2021 at 4:10 pm

Didn’t take that long. Same question could be asked of the name change to physician anesthesiologist.? Since you seem to think you own “anesthesiologist” , or that it synonymous with physician, why the name change from the MD side of the house?

Roxy

September 9, 2021 at 4:25 pm

We have more training , more knowledge and we are physicians,that’s all!

Nick

September 9, 2021 at 4:28 pm

Nope.

Nick

September 9, 2021 at 4:36 pm

That’s right let me get back in my lane… I forgot being a physician gives you a monopoly on knowledge! We should probably praise you as the God you think you are. THAT is all!

Melanie J.

September 9, 2021 at 5:02 pm

I am a CRNA and I work with amazing MDAs. We make a great team and provide amazing care because we work so well together. I absolutely agree with your article. If I wanted to be a physician, and be called as such, I would have went to medical school. Please know we are not all behind this name change push. It’s embarrassing.

Michael Dinos
September 9, 2021 at 5:13 pm

I don’t believe any crnas are attempting to be called physicians to my knowledge.

Anesthesiologist

September 9, 2021 at 8:02 pm

If you google the definition of the word Anesthesiologist you will find the following:
Merriam Webster: a physician specializing in anesthesiology.

Dictionary.com:a physician specializing in anesthesiology.

Wikipedia: Anesthesiology is the medical specialty concerned with the total perioperative care of patients before, during and after surgery.[1] It encompasses anesthesia, intensive care medicine, critical emergency medicine, and pain medicine.[2] A physician specialized in anesthesiology is called an anesthesiologist.[3][4][5][6]. International standards for the safe practice of anesthesia, jointly endorsed by the World Health Organization and the World Federation of Societies of Anaesthesiologists, define “anesthesiologist” as a graduate of a medical school who has completed a nationally recognized specialist anesthesia training program.[10]

WebMD:Anesthesiologists are doctors who specialize in giving patients anesthesia.

Collins Dictionary:An anesthesiologist is a doctor who specializes in giving anesthetics to patients.

Free medical dictionary: a physician who specializes in anesthesiology.

Wiktionary:A physician who specializes in anesthesiology and administers anesthesia.

FreeBase: An anesthesiologist or anaesthetist is a physician trained in anesthesia and perioperative medicine.

So, it appears you have to go to medical school in order to use the word Anesthesiologist as part of your title. Just saying.

Michael Dinos

September 9, 2021 at 9:26 pm

Yawn.
If you Google the definition of physician you will find the following:
a person who cures moral or spiritual ills; a healer one exerting a remedial or salutary influence
a person who is skilled in the art of healing.
A person who heals or exerts a healing influence.
Any person or thing that heals, relieves, or comforts.

Apparently you don’t have to go to medical school to be a physician

Kimberly

September 9, 2021 at 10:19 pm

In the united states of America, physicians are considered medical doctors. To be a medical doctor in this country you have to go to medical school. Calling yourself a physician in this country when you do not have a medical degree (MD or DO) would be misleading.

Michael Dinos
September 9, 2021 at 10:53 pm

§ 702.404 Physician defined.
The term physician includes doctors of medicine (MD), surgeons, podiatrists, dentists, clinical psychologists, optometrists, chiropractors, and osteopathic practitioners within the scope of their practice as defined by State law

Nick

September 9, 2021 at 10:20 pm

You are correct! As a CRNA I don’t follow any physicians orders, your point is muted!

Nock

September 9, 2021 at 10:35 pm

Agree. No one is trying to call themselves physicians ghat are not. That response you received, was pointing out that if you want to go strictly by self reported definitions, the ln look at the definition of physician. At least that’s what I got from reading it. Again, no CRNA is trying to mislead any pt or any other staff member into thinking they’re a physician.. further to the pint of definition, Many if the definitions you posted stated a”doctor” that performs anesthesia. Again, physicians are absolutely 200% not the only doctors and don’t have the totals protected as such. DNP, DDS, OD, PharmD, AudD, DC etc etc etc… all are doctors but not all are physicians. All are entitled to utilize the term in the clinical setting should they desire.

Michael Dinos
September 9, 2021 at 11:07 pm

You received my point well 🙂

Anesthesiologist

September 10, 2021 at 12:35 am

Do you honestly believe a clinical psychologist or a chiropractor or an optometrist is a physician/medical doctor?

Michael Dinos

September 10, 2021 at 12:59 am

Don’t like the title and definition? Deal with it nobody cares what you think.

Anesthesiologist

September 10, 2021 at 1:05 am

Think of a medical doctor as someone who is able to provide care for a patient that is not limited to their specialty. This is just an example. Can a chiropractor manage hypertension, diabetes, covid- 19 infections? Can a chiropractor prescribe a beta-blocker or cancer treatment or do surgery? Would CMS accept a referral from a chiropractor to see an orthopedic surgeon? You should be proud to be called a nurse anesthetist. Why do you want the title anesthesiologist, physician/doctor of medicine who has specialized in anesthesiology? So Sorry this information offends you. Just trying to help bring some clarity to the meaning of the word Anesthesiologist.

Michael Dinos
September 10, 2021 at 8:28 am

Sigh…
These points are clearly missed by you. READ: No CRNA wants to call themselves a physician.
READ: Using dictionary entries as title protection is foolish.
It seems like YOU are offended with the information that a chiropractor and podiatrist are listed as a physician.
READ: ASA did a study that found that the general public didn’t associate
anesthesiologist with physician. HENCE: PHYSICIAN ANESTHESIOLOGIST
Are you denouncing dental anesthesiologists also?

Is a anesthesiologist going to diagnose HTN and prescribe BBS? Before you answer this question I’ll let you know it was rhetorical

Sarah K.

September 10, 2021 at 11:39 am

As a non-medical person, no one knows the difference between these no fields unless you are in it. This article is petty and the comments are even more worse. Grow up children.

Anesthesiologist

September 10, 2021 at 11:53 am

An Anesthesiologist is a medical doctor and can diagnose hypertension and can prescribe beta-blocker therapy. Not sure what BBS is.

You are absolutely right! There is no need to put the word physician in front of the word Anesthesiologist.

Words do have meaning. Defining the meaning of words allows us to communicate effectively. We do need definitions. Whether you are a physician, a person who holds an academic doctorate degree, or a law degree, or a medical degree does communicate a certain level and type of training to the public. There are definitions associated with those degrees that proffer transparency to the public. In the lexicon of medicine, an anesthesiologist is a physician/medical doctor who has specialized in anesthesiology.

Two wrongs don’t make it right. Once again I am agreeing with you. The ASA has failed Americans by allowing this dangerous farce to continue and not providing better public education about the practice of anesthesiology, about the providers that deliver anesthesia, and the different levels of training in our specialty and how that translates into patient care.

“The dental anesthesiologist is a creation of the dental profession. They are dentists who undergo three years of training in anesthesia. In the past, it used to be two, and long ago, just one year. In the end, it doesn’t matter. They are not physicians/medical doctors. Anyone delivering anesthesia without a medical degree (or without direction from someone with a medical degree) is putting patients at risk”.

I am not offened by the listing of chiropractors or podiatrists as doctors. However, they are not medical doctors. Chiropractors are doctors with chiropractic degrees. Podiatrists are doctors of podiatric medicine. True, a podiatrist can perform surgery and function as a physician but only as it relates to treating the ankle, foot, and other related areas of the leg. They are not medical doctors. In this country, a medical doctor holds the degree of MD or OD which refers to a person who has completed medical school and is allowed to broadly practice medicine.

It is really harmful when you start to blur the lines and confuse the public with title misappropriation.

Michael Dinos

September 10, 2021 at 12:06 pm

So your anesthesiologists are managing HTN and prescribing beta blockers? That’s interesting. Your organization suggested to use the term physician anesthesiologist because as it’s been proven through research conducted by the ASA anesthesiologist does not equal physician. Do you have any proof that crnas delivering anesthesia is a “dangerous farce”?? You sound like a lot of emotion without any facts. I don’t hear any physicians calling themselves physician nephrologist or physician cardiologists. Your organization recommended it lol. Get over yourself

Anesthesiologist

September 10, 2021 at 12:28 pm

I am sorry to have engaged you. I thought you were a healthcare provider. By the way, what is your profession?

Michael Dinos
September 10, 2021 at 12:33 pm

Oh no worries. I thoroughly enjoy correcting misinformation. I’m a CRNA 😉

Anesthesiologist

September 10, 2021 at 12:55 pm

So, you are a certified registered nurse anesthetist? Not a physician who specializes in anesthesia id est anesthesiologist?

What do you want a patient to call you?

How do you introduce yourself to the patient?

Anesthesiologist

September 10, 2021 at 1:24 pm

Do you want the title of certified registered nurse medical doctor who specializes in anesthesiology? What title do you want?

Shawn Fouhy

September 10, 2021 at 1:33 pm

If you’re a nurse, introduce yourself as such. If you’re a doctor, do the same. So easy.

Anesthesiologist
September 10, 2021 at 1:45 pm

That is an excellent idea!

Michael Dinos

September 10, 2021 at 1:46 pm

I always introduce myself as a nurse anesthetist. I let the patient know that I’m the only one doing their anesthesia from start to finish. However I do find it very amusing that your organization found out that the public doesn’t associate anesthesiologist with physician and starts using the term physician anesthesiologist for a more accurate descriptor . And then when a organization changes their title to “nurse anesthesiologist” you all lose your minds. Your surgeon colleagues don’t respect “your title” either. I can’t count how many times I’ve been introduced as the anesthesiologist. Surely you have more important things to be hurt about.

Anesthesiologist

September 10, 2021 at 2:00 pm

Great! when a surgeon introduces you as a nurse anesthesiologist you should correct him. That is an easy correction. Just say,” I am not a physician. I am a nurse specialized in anesthesia”.

Not sure what kind of care model you work in. So, you may be the sole anesthesia provider.

Not sure how you can speak for an entire specialty of which you don’t belong. My experience with surgeons has been quite different.

I am post-call today. So, just resting and doing a little reading and of course trying to enlighten the greater community about our specialty.

TruthInMedicine
September 20, 2021 at 9:19 pm

WOuldn’t that be great, if he could be honest, and not try to mislead his patients? But this belies his own confusion/delusion (the Dunning-Kreuger is strong with this one). He may be the only “anesthesia provider,” but he isn’t practicing independently in Florida, as the author has patiently explained multiple times. In this state, the physician with whom he works supervises him. Every. Time. He may dearly want the patients not to know that, and that is the issue to which most of us object: The intentional obsfucation. When his ego inevitably leads to a major problem, the unsuspecting (? some are; some aren’t) surgeon will go down with the malpractice ship with him.

Anesthesiologist

September 10, 2021 at 2:08 pm

Oh. I forgot to mention that you are absolutely right. ASA had done an awful job in educating the public about the field of anesthesiology. However, taking advantage of this is wrong.

Michael Dinos

September 10, 2021 at 2:21 pm

Lol. They do not say nurse anesthesiologist. They say anesthesiologist. Because they don’t care. Which most people dont. As research performed by your organization shows. No one goes to the hospital because you are delivering their anesthesia. They go because their surgeon brings them there. Yes I do all of my own anesthetics pre op to discharge. As I said my patients know I’m a nurse. I highly doubt anyone in my profession is ashamed of that as I’ve read here. We are independently doing the exact same anesthetics as our physician colleagues. Why would title matter to us when we do the same job? As I mentioned physicians first changed the title to physician anesthesiologist. I have no problem with the term nurse anesthesiologist as long as anesthesiologist is preceded by nurse. . It is an accurate descriptor.
For physician anesthesiologists who work in a medial direction model. Do they also explain to the patient that they personally haven’t done a case in a long time because they never sit their own cases? Now THAT would be transparency. Letting the patient know that if a difficult airway arises, they’ve intubated 10 times in the last 12 months. As opposed to the crna in the room who has intubated 3000 times? Maybe these are also things that should be discussed in addition to the nurses training.

Anesthesiologist

September 10, 2021 at 3:47 pm

Michael, If anyone calls you an anesthesiologist your response should be, ” I am not a medical doctor. I am a nurse who has specialized in anesthesiology”.

If the title does not matter, why did the American Association of Nurse Anesthetists formally changed its name? Why are they encouraging its members to use the term “nurse anesthesiologist,” instead of “nurse anesthetists”. Are they adding medical school to the CRNA curriculum?

Again, an Anesthesiologist is a medical doctor, meaning that person has graduated from medical school and has specialized in the field of anesthesiology.

If you want the word anesthesiologist someplace in your title you need to go to medical school.

This should not be this complicated.

Michael Dinos
September 10, 2021 at 3:56 pm

You are all hilarious. Are you actually telling me exactly what my responses should be? Are you that arrogant and egotistical? It’s a shame your opinion doesn’t matter to anyone but you. You all seem to ignore the fact that your organization discovered that in fact anesthesiologist does not equal physician. Accept it. You are a physician anesthesiologist. If someone wants to use the title nurse anesthesiologist and that hurts your feelings then you have to be a big boy/girl and get over it. No one cares what you think or how you feel about it. Grow up and move on. Go sit a case. You chose a specialties to share with nurses that people don’t see the difference. We all get it

Anesthesiologist

September 10, 2021 at 4:08 pm

Maybe this will help. The statement below is from a former AANA president.

“Since its very beginning 150 years ago, the administration of anesthesia by nurses has been essential in caring for patients safely, comfortably, and compassionately. “When anesthesia is administered by a nurse, it is recognized as the practice of nursing,” Steven M. Sertich, CRNA, MAE, JD, Esquire, President of AANA, asserted in the announcement.

The word anesthesiologist refers to a medical doctor, a person who has graduated from medical school.

CRNAs are practicing as a nurse. An Anesthesiologist is practicing as a physician.

Michael Dinos

September 10, 2021 at 4:14 pm

No one is trying to be called a physician lol. You’re being intentionally obtuse. CRNAs are NURSES. You don’t own the title anesthesiologist. Hence physician anesthesiologist. There is no physician cardiologist. Physician nephrologist. Again no one cares.

Anesthesiologist

September 10, 2021 at 4:14 pm

Sorry, I should have said, “CRNAs are practicing as a nurse. An Anesthesiologist is practicing as a medical doctor”. Did not want to cause further confusion. As you know words do matter.

Michael Dinos
September 10, 2021 at 4:18 pm

It’s okay I know that you are confused. You’re a physician anesthesiologist.

Anesthesiologist

September 10, 2021 at 4:32 pm

No need to call me a physician anesthesiologist. True, I’m a medical doctor who specializes in anesthesia. So, calling me an Anesthesiologist would suffice.

Michael Dinos

September 10, 2021 at 4:39 pm

Not according to your national organization. Have you seen the title if this article you’re arguing on 😂😂😂😂😂. You make it too easy

Anesthesiologist

September 10, 2021 at 4:40 pm

By the way, you are right I don’t own the title” Anesthesiologist”. I earned it.

Anesthesiologist

September 10, 2021 at 4:45 pm

Using the words “Physician Anesthesiologist “was a poor attempt by the ASA to educate the public. ASA has not done a good on this front. But once again, taking advantage of this is wrong.

Nick

September 10, 2021 at 4:49 pm

My doctoral degree (DNP) is not academic. It’s a clinical doctorate… so I guess by your def I’m gtg.

Nick

September 10, 2021 at 5:11 pm

You FB ring up a whole delete debate. The title physician is protected by law… the title Nurse or CRNA or Nurse practitioner is title protected by law… the term doctor is not titke protected for Physicians… it is a title that ANY individual can use ghat has been awarded a doctoral degree. Full stop. End of story.

Anesthesiologist

September 10, 2021 at 5:39 pm

Yes, you are good to go. You are able to practice as a nurse with an advanced degree. No shame in that game. I love it when the people I work with are learning and growing. However, DNP does not afford you the right to practice as a medical doctor or be referred to a medical doctor.

Anesthesiologist: A medical doctor, a person who has graduated from medical school, who has specialized in anesthesiology.

Shawn Fouhy

September 10, 2021 at 7:07 pm

CRNA=couldn’t get into med school, lol

Nick

September 10, 2021 at 7:34 pm

You’ve officially made your most ignorant statement!! I could have gone to MED school should I have had the desire. I finished my pre med, took my MCAT and was accepted to MED school, life happened and never matriculated… decided to go the nursing route a few years later as haven’t looked back. Now I’m a DNP, Family NP, CRNA, boarded in interventional pain and facial aesthetics and regenerative medicine…. Don’t try to play the nurses couldn’t make it through med school. I just left a professor position where I taught both APRN’s and med students. I know the curriculum as well as anyone and would have made it though school without a problem at all. Nice denigrating comments though oh wise one!! Go “supervise” someone else doing YOUR cases. LMAO

Shawn Fouhy

September 10, 2021 at 7:37 pm

Lol, keep telling yourself that!

Shawn Fouhy

September 10, 2021 at 7:42 pm

An easier reply would’ve been “I couldn’t hack it so I settled for a lesser degree.” We don’t blame you. Not everyone has the brains, time, and dedication.

Nick

September 10, 2021 at 8:36 pm

We’ll since that’s absolutely kit the case, I doubt I’d say that. Don’t let your PoS ego blind you to the fact that because yo ur a physician does not mean your a God. It does not mean your of superior intelligence or anything if the sort: I’m totally secure in what I do and would put my knowledge against yours any day any time anywhere! Those my weak friend are the facts:

Nick

September 10, 2021 at 8:38 pm

Don’t need to tell myself anything, I lived it and know the facts. Lmfao

Shawn Fouhy

September 10, 2021 at 10:33 pm

Ha, someone is triggered! Sorry I hurt your feelers.

Mike CRNA

September 11, 2021 at 11:30 am

It appears the only one ‘confusing the public’ is you as in this article you referred to CRNAs using just “Anesthesiologist”. We specifically indicated this was a prohibited use and only “Nurse Anesthesiologist” was appropriate. The reason for this is because there are many types of anesthesiologists out there. Dentist Anesthesiologists, Physician Anesthesiologists, Veterinary Anesthesiologists as well as Nurse Anesthesiologists.

As I am sure you are aware, in 2012 the ASA commissioned a PR firm to determine how best to present physicians who are trained in anesthesia to both legislators and the public. This was due to a concern that “anesthesiologist” was not synonymous with physician. Their determination after the survey data was collected was that about 60% of all people surveyed did not associate physician with Anesthesiologist. So then was born from this PR firms PCI and Reingold recommendation to switch to using “physician anesthesiologist”, which the ASA did. You can watch the presentation from the then ASA PR director of these findings here: https://www.dropbox.com/s/5plv3nk7lxuf4j4/asa%20Pr%202012.mov?dl=0

Recently, in the letter from the ASA President dated Aug 23, 2021 where she stated the term “Physician Anesthesiologist” was “in response to CRNAs “longstanding yet limited use of the term “Nurse Anesthesiologist””. I want you to know that this is not accurate. The term Physician Anesthesiologist originated with the ASA own PR firm data I attached for you in 2013 whereas the “Nurse Anesthesiologist” movement did not begin until 2017/18. It is unfortunate that the current ASA president is presenting this in an inaccurate manner which will only serve to cause more dissention. In truth “nurse anesthesiologist” came after and it was in response to another issue, AAs.

I want to make clear where this movement came from. Over the past couple of decades Anesthesiologist Assistants have been using the term “Anesthetist”. This has been a major point of contention for CRNAs. I imagine it would be similar to a CRNA just using “Anesthesiologist” from an MDs perspective. However, it reached new heights as the AAs changed their offical initials from AA-C to CAA and changed their website to be http://www.anesthetist.org. In addition to that the ASA appeared to start supporting them aggressively, including the use of “anesthetist” which exists as a term for CRNAs and CAAs in many ASA documents online.

CRNAs accross the country were getting frustrated and tried to legally stop AAs from using ‘anesthetist’ but were unsuccessful at doing so. We were trying to find ways to separate our profession from AAs since they were using what we felt like was our moniker. Fast forward to 2017 with the roll out from the ASA of “When Seconds Count” and “Physician Anesthesiologist” and it was not lost on us that the ASA appeared to have no problem with AAs having the term “Anesthesiologist” in their title. It was also not lost on us that the ASA was conceding with their new title that there were many types of Anesthesiologists but they were physicians. Hence the start of the Nurse Anesthesiologist movement. In that same year the American Society of Dentist Anesthesiologist won a 5th circuit commercial free speech decision that they could use Dentist Anesthesiologist (which they had been for decades).

This started the movement for Nurse Anesthesiologist 4-5 years after the ASA PR firm recommended using Physician Anesthesiologist and 1-2 years after the ASA seems to have started using it.

We also performed our own 3rd party data collection survey about the public perception of the term Nurse Anesthesiologist with about 4000 Americans across the country. You can read about it here. https://www.nurseanesthesiologistinfo.com/s/CRNA_NationalSurvey_Ascend_Revised_190404.pdf

The results showed:

When asked:

“Which term do you feel best describes a professional nurse who provides anesthesia during surgery, a Nurse Anesthetist or a Nurse Anesthesiologist?”

The majority chose Nurse Anesthesiologist (54%) over Nurse Anesthetist (23%).

When asked:

“Which medical professional do you consider to be the expert in the field of anesthesiology, a Nurse Anesthetist or a Nurse Anesthesiologist?”

The gap widens, with the overwhelming majority of respondents, again, choosing Nurse Anesthesiologists (57%) over Nurse Anesthetists (16%).

When asked:

Would you say you recognize a Nurse Anesthesiologist as a member of the nursing profession and a Physician Anesthesiologist as a medical doctor?

By a 3:1 Margin (58% to 18%) respondents stated they recognized the difference between the two professions.

It seemed pretty clear that the public had no confusion related to Nurse Anesthesiologist and had no problem identifying the difference between a physician anesthesiologist and nurse anesthesiologist.

I understand that to you and other physicians this may feel like an attack on your professional identity. I want to assure you we know how this feels due to the actions of the AA profession but that was not and never has been the intent. We specifically chose NOT to use “anesthesiologist” by itself as AAs chose to use “anesthetist” by itself. Though emotionally charged for many, the etymology of ‘anesthesiologist’ simply means those who study and practice the science of anesthesia.

Also, you quoted webster’s dictionary for anesthesiologist but there is also an entry for “Nurse Anesthesiologist” https://www.merriam-webster.com/dictionary/nurse%20anesthesiologist

So please, get the facts right, the title right and stop assuming patients do not know the difference in Nurse anesthesiologist and physician anesthesiologist. We did the research, they do. You paternal assumptions that patients are not smart enough to hear NURSE are incongruent with reality. All this relevant info and it can be found here: https://www.nurseanesthesiologistinfo.com/

Nurse Anesthesiologist

September 11, 2021 at 1:37 pm

After all the MDA comments saying how their only concern is “patient safety,” I’m going to have to call BS on their “concerns.” Every independent study has shown that CRNAs practicing without physician supervision provide equally safe care as MDAs practicing solo or CRNAs practicing with MDAs as part of an ACT.

So what is the real motivation for the ASA and FSA to push so hard for the most inefficient model to continue? One word: money. What the physician anesthesiologists at the FSA and the ASA will not reveal to the public and to policy makers is that they get to bill patients for their “supervision,” which usually involves them sitting in a lounge, and that billing allows them to make more money.

If the ASA and FSA truly was concerned with nothing but “patient safety,” they should put their money where their mouth is and immediately push for legislation to remove the billing for supervision… and take the pay cut for patient safety.

Backcountry

September 11, 2021 at 1:51 pm

Joan Rivers had a physician anesthesiologist when seconds counted…oh wait.

anesthesiologist

September 11, 2021 at 2:00 pm

Not really true.There are no decent studies that show anything either way. Retrospective chart reviews of billing data funded by political organizations do not qualify as quality research.
So why doesn’t the AANA and FANA lobby for AA licensure in every state as well as rural pass through funds for anesthesiologists? If they were truly worried about access to care, they would, right??

Nurse Anesthesiologist
September 11, 2021 at 2:40 pm

Clearly you haven’t worked with AAs, because if you truly care about patient safety, you would not want them subjected to AAs.

Their training is nowhere near the training either MDAs or CRNAs receive, and the level of care they provide is substandard, at least for the first several years of their career.

Your push for AAs, who do not provide the same level of care as CRNAs and who can ONLY function in an ACT model, and therefore allows MDAs to continue to bill for “supervision” just proves my point that this is about money and not about patient safety or access to care.
- anesthesiologist
  September 11, 2021 at 2:54 pm
  
  You realize that physicians could say the same about CRNA’s? All of the above comments are full emotion and opinion. Very little facts. You are correct that much of this revolves around money and control. However, both CRNA’s and anesthesiologists are playing the field. That’s how politics goes. We are making comments on Florida Politics after all!

Desantis2024

September 11, 2021 at 2:30 pm

Joan Rivers was otherwise healthy,undergoing a low risk procedure, and the physician anesthesiologist still effed it up with “all that training” you speak of. Keep shining your own a$$. Keep telling yourself how important you are. Your Ponzi scheme is obvious to all and legislators and hospital admins are finally figuring it out. Times up!

Nick

September 11, 2021 at 6:49 pm

You can put it all in caps all you want. I AM A DOCTOR… just not a physician. So your further point was?? I am a CRNA who has EARNED a clinical doctorate…

Nick

September 11, 2021 at 6:53 pm

Funny thing about that is, the facility I work in had a mix of CRNA’s and MDA’s… no supervision… we all do our own cases prepped to discharge… if I’m helping one of the MDA’s with a block or if they’re helping me, THEY always introduce me as Dr. I’ve never asked them to not have I ever expected her to… they show me the respect commensurate with my degree and I do the same with them. Very collegial environment which foster EXCELLENT patient care.

Shawn Fouhy

September 11, 2021 at 7:27 pm

Doctorate of nursing sounds like an oxymoron. What is the point of that degree??

Michael Dinos
September 11, 2021 at 7:42 pm

Sean. Nobody cares how you feel about doctorate of nursing. Your ego is hurt because nurses do the same exact job as you. Once you get over it life will get better. We promise

Nick

September 11, 2021 at 8:13 pm

It’s the highest degree in the field of Nursing, just like about every other professional track you can study… as I’ve stated before, DOCTOR just like Anesthesiologist is NOT synonymous with physician. Ignorant of you to think so. You support the move by PA’s to go doctoral?

Shawn Fouhy

September 11, 2021 at 8:35 pm

Nurses don’t do the exact same job, they do an adequate job. I’m a consultant of anesthesia, obviously not something you can achieve in nursing. Patients care who is doing their anesthesia, they prefer doctors. I do my own cases because nurses have enormous knowledge gaps and I wouldn’t trust them in critical situations. Nothing personal, it’s just matter of fact. Technical skills of nurses are fine, it’s the knowledge that ultimately matters.

Mike CRNA
September 11, 2021 at 9:05 pm

No, I do the exact same job. There are no MDAs for hours and we do every case but hearts, heads and Neonates. Every block under the sun, our own TEE/TTEs, we respond to the ICU and ER and manage every type of patient in the OR. Sick complicated patients live everywhere and its PS 3 everyday. All with better than the national average outcomes.

So i dont know what magical ‘knowledge’ you think you have but clearly it does not impact the course of anesthesia or we also have it.

Shawn Fouhy

September 11, 2021 at 8:48 pm

Excellent blocks are done by me solo, why do you need an anesthesiologist to help you? That’s some weak sauce right there. There are plenty of online resources if you need to bone up in your blocks.

Shawn Fouhy

September 11, 2021 at 9:28 pm

You do an ok job I’m sure, but lack lots of core knowledge from your educational path. It’s not your fault, that’s just what you chose. You don’t do the same job since you can’t do hearts or neuro. Good try though.

Mike CRNA

September 11, 2021 at 9:35 pm

Lol

Ok Sherlock. I CAN and DID do both those cases independently at my last gig. We don’t do them at the facility we own the contract for now (all CRNAs owned and operated).

There is no missing knowledge here, but clearly an over inflated ego there.

Good luck, that will get you in trouble.

Shawn Fouhy

September 11, 2021 at 9:42 pm

It’s served me well. The knowledge gap is just from not having enough time to learn what you need to. You’d have a hard time providing excellent anesthesia at all times just due to that. I’m sure you get patients through cases, but there’s a big difference between excellent and adequate. I’m teaching nurses things all the time, assuming they might have some knowledge of pharmacokinetics and pharmacodynamics, for instance. I quickly realized that pharmacology isn’t well covered in nursing school, but why would it be? Just one example of many. Do you think you know more than an AA? Why? I have the same argument.

Mike CRNA
September 11, 2021 at 10:09 pm

You seem to forget I didn’t come to anestheisa without any medical knowledge at all.

My patients don’t get “adequate” care they get the best of care.

But thanks for displaying the one thing I’ve noticed physician anesthesiologists often have more of. Hubris and ego. 🤦‍♂️

Anesthesiologist

September 11, 2021 at 9:45 pm

So Mike, should all medical doctors who specialize place the word physician in their title? Physician Cardiologist, Physician Pediatrician, Physician Oncologist, Physician dermatologist, Physician Psychiatrist, Physician Neurologist on and on. Physician anesthesiologist is redundant. It is like saying “female woman”.No need to put the word Physician in front of the word anesthesiologist. Once again, a poor attempt by the ASA to educate the public. This should not be used as an opportunity to misappropriate the title.

I am aware that the public has very little understanding of our specialty. Just because the public does not understand or know the definition of the word anesthesiologist it does not make it right to add to the confusion.

I understand the meanings of words can change over time. In fact, one of my hobbies is studying etymology. To my current knowledge of the meaning of the word, Anesthesiologist has not changed since the 20th century. Here is an article that may bring some clarity to the word Anesthesiologist.

Origin of the word ‘anesthesiology’: Mathias J. Seifert, MD
R. P. Haridas.

In addition, If you haven’t visited the Wood Library-Museum (WLM) of Anesthesiology in Illinois you should. It provides a wonderful historical display of our profession. One item on display is a letter written by Dr. Mathias J. Seifert to Dr, Paul Wood. You can go to the WLM to view the letter. The letter is one of the earliest definitions of the word Anesthesiologist.

Mike CRNA
September 11, 2021 at 10:13 pm

Hi

The word has been used by dentists for nearly 75 years. So there is that.

But more importantly your own organization determined it was not, in fact indicative of physician hence why they changed your title, clearly admitting that very fact.

Lastly, the other specialities aren’t my concern. But let’s be clear, CRNA are the only ones who did the specialty before physicians and have the same scope as physicians (unless artificially restricted of course). We are experts and learned in anestheisa hence nurse anesthesiologist. If you know etymology then you realize the word has NOTHING to do with one profession.
- Anesthesiologist
  September 11, 2021 at 10:45 pm
  
  If I am missing information please enlighten me. Please send legitimate references and citations. Please refer me to literature that supports your words. I have always focused on the medical aspect of anesthesiology and have not focused on the nursing aspect of anesthesiology. So, maybe I have missed a whole body of literature that supports what you are saying.
  - Mike CRNA
    September 11, 2021 at 10:50 pm
    
    I did already. In a previous post here.
    - Anesthesiologist
      September 11, 2021 at 10:55 pm
      
      Can you please cut and paste it here for me? I can’t find it. Thanks.

Shawn Fouhy

September 11, 2021 at 10:14 pm

Sounds like you suffer the same affliction lols

Mike CRNA

September 11, 2021 at 10:16 pm

Naw

I’ve just been doing the same job as you everyday for the past 14 years without someone sitting in an office Monday night quarterbacking getting worse at actual anestheisa daily.

It is what it is 😉

But the banter has been fun and you have been a good opponent

Shawn Fouhy

September 11, 2021 at 10:18 pm

Hubris would be a nurse wanting to be called a doctor to confuse patients. It’s rather silly

Mike CRNA

September 11, 2021 at 10:22 pm

Would it?

Doctor isn’t your title. physician is. Use it.

If I have a doctorate I can use it anywhere anyway I like. In a clinical situation I simply have to be clear.

My name is Dr Mike I will be your nurse anesthesiologist today. Which is legal in every state. 🤷‍♂️

Hubris would be assuming that you control an earned title simply becuase you say so. The days of paternalistic medicine are over. No one is getting up and give you their chair either.

Anesthesiologist
September 12, 2021 at 11:57 am

ASA, the American Board of Anesthesiology, the American Board of Medical Specialties and the American Medical Association affirm that anesthesiology is a medical specialty and professionals who refer to themselves as “anesthesiologists” must hold a license to practice medicine.

The New Hampshire Supreme Court upheld a ruling in March 2021 by the New Hampshire Board of Medicine to limit the use of the term “anesthesiologist” to individuals licensed to practice medicine.

The Council on Accreditation of Nurse Anesthesia Educational Programs defines an “anesthesiologist” as a doctor of medicine (M.D.) or doctor of osteopathy (D.O.) who has successfully completed an approved anesthesiology residency program.

The World Health Organization views “anesthesiology as a medical practice” that should be directed and supervised by an anesthesiologist.
- Mike CRNA
  September 12, 2021 at 12:44 pm
  
  Oh my.
  
  1) Your Boards do not define anyone else BUT you. You all came out against Dentists Anesthesiologists and couldnt win then backed off. https://asda.org/ You dont get to define them either but very paternalistic of you.
  
  2) That is not what the NH court ruling did. You might want to read it here it is https://www.dropbox.com/s/2ijj0f7n9t79jjr/NH%20opinion.pdf?dl=0
  
  What they did was tie 3 v 3 which is a locked ruling. Literally nothing changed and the BON ruling still stands (which is who regulates APRNS not the BOM) and CRNAs still use it today. So again, wrong.
  
  The COA changed this definition last year to PHYSICIAN ANESTHESIOLOGIST, the ASAs preferred title. So wrong again.
  
  No one cares what the WHO anesthesia council said which was a group of MDAs in a room back patting each other and creating edicts to support their own bias. But nice try.

Shawn Fouhy

September 11, 2021 at 10:25 pm

Doctor to a patient means you went to med school, not nursing school. You guys are silly for trying to use doctor as a title with patients. That’s very confusing, a doctorate of nursing? That’s weird.

Mike CRNA

September 11, 2021 at 10:28 pm

Does it?

Show me the data that the way I just said it supports your assumption?

There isn’t any.

Shawn Fouhy

September 11, 2021 at 10:30 pm

Data on what?

Shawn Fouhy

September 11, 2021 at 10:49 pm

You’re missing a ton of info from so much less schooling. You don’t need data. Nobody pursues this data because it would just show that nurses learned less in nursing school than doctors learned in med school. It’s obvious, that’s why there isn’t data.

Mike CRNA
September 11, 2021 at 10:53 pm

Uh huh

So how do you explain my Outcomes and all CRNAs outcomes being 6 sigma safe just as good as an ACT or MDA only?

Look at some point you have to recognize that just because you took longer to get the the same point does not mean that makes any difference in the delivery, safety, knowledge or capability of anestheisa.

The data on safety is blisteringly clear in the Med mal data alone. Here is a great video.

https://www.dropbox.com/s/pcdfcrtv5pnalzt/Mi%20legislator%20Med%20mal%20companies.mov?dl=0

Shawn Fouhy

September 11, 2021 at 10:56 pm

That’s what you consider data??

Shawn Fouhy

September 12, 2021 at 11:23 am

An AA and s CRNA have about the same level of knowledge and similar skill set, maybe that’s why calling them anesthetists makes sense? Just because they took your title doesn’t mean you should try to trick patients by changing yours. Jesus, you’re a petty bunch.

Mike CRNA
September 12, 2021 at 12:31 pm

Well

We will agree to disagree on the skill set and knowledge. It was never the last time an AA ran an anesthesia business with all CRNAs taking care of PS 3-4 all day doing everything. So no, not the same.

However, you see just fine with them using our moniker which is actually RIGHT in our title and totally fine with them using ANESTHESIOLOGIST in their title. Do you somehow think patients magically hear “assistant” when they say “Anesthesiologist Assistant” and are ear blind to “Nurse” in “Nurse Anesthesiologist” ?!

I mean come on, that logic is laughable at best hypocritical and self serving at worst.

Shawn Fouhy

September 12, 2021 at 11:50 am

Too bad the data shows otherwise! And please don’t quote any of the garbage data that your society paid for. You know the truth. Nurses mostly care for ASA 1 and 2 in surgery centers (I know some do more than that, I’m saying the numbers are skewed towards healthy pts receiving less complex procedures). And there are several studies showing worse outcomes when these factors are controlled for. Interesting. Just stay in your lane folks.

Mike CRNA
September 12, 2021 at 12:38 pm

Ok

There are NO STUDIES showing worse outcomes. But hey, if you wanna quote the crap from silber 30 years ago and Memtsoudis Ill tear them apart for you.

Here is what you need to know. Medical Malpractice insurance companies do not care about our politics. They only care about risk mitigation and making money. Actuaries are paid SPECIFICALLY for that. They dont charge me more as an independent CRNA than one working with MDAs in an ACT. Why? They do not see MDAs as a liability shield or value added when it comes to outcomes. Also, they do not see independent CRNAs at any higher risk for litigation. In other words, MDAs involvement does NOT lower risk, does NOT decrease liability for the CRNA, does NOT increase safety.

Also before you say something silly about facilities and surgeons taking on that risk, Surgeons and Hospitals who work with/have independent CRNAs do not pay any additional premium to do so. Why? They are at no higher risk for liability than if there were all MDAs or an ACT. Again, no benefit for safety, outcomes, liability with MDA involvement.

Here is a legislator or contacted the biggest med mal firms to confirm it.

https://www.dropbox.com/s/pn4ltivexxb7bth/Mi%20legislator%20Med%20mal%20companies.mov?dl=0

Anesthesiologist

September 12, 2021 at 1:36 pm

This particular conversation is not about patient safety, malpractice claims, money-making, or doing the same job. It’s about title misappropriation. Of course, this conversation should lead to patient safety as it does have implications. But for this conversation let’s stick to the meaning of the word anesthesiologist.

ASA, the American Board of Anesthesiology, the American Board of Medical Specialties, and the American Medical Association affirm that anesthesiology is a medical specialty, and professionals who refer to themselves as “anesthesiologists” must hold a license to practice medicine.

The New Hampshire Supreme Court upheld a ruling in March 2021 by the New Hampshire Board of Medicine to limit the use of the term “anesthesiologist” to individuals licensed to practice medicine.

The Council on Accreditation of Nurse Anesthesia Educational Programs defines an “anesthesiologist” as a doctor of medicine (M.D.) or doctor of osteopathy (D.O.) who has successfully completed an approved anesthesiology residency program.

The World Health Organization views “anesthesiology as a medical practice” that should be directed and supervised by an anesthesiologist

Can we all agree that the word “Anesthesiologist” means a medical doctor who has specialized in anesthesiology.

Mike CRNA
September 12, 2021 at 2:23 pm

Ive already answered this. No, to all.
- Anesthesiologist
  September 12, 2021 at 3:13 pm
  
  Mike, Do you disagree with all of the above organizations?
  - Mike CRNA
    September 12, 2021 at 4:29 pm
    
    1: “ASA, the American Board of Anesthesiology, the American Board of Medical Specialties, and the American Medical Association affirm that anesthesiology is a medical specialty, and professionals who refer to themselves as “anesthesiologists” must hold a license to practice medicine.”
    
    They regulate and name physicians NOT APRNs. So their opinion is not relevant and the ASA itself prefers Physician Anesthesiologist as well as all the research done by the ASA in 2012 about it.
    
    2) “The New Hampshire Supreme Court upheld a ruling in March 2021 by the New Hampshire Board of Medicine to limit the use of the term “anesthesiologist” to individuals licensed to practice medicine.” Again, that is NOT what they ruled and I already explained it and posted the actual decision which was a non-decision and the BON ruling (who actually regulates APRNs not the BOM) still stands and CRNAs can and do, still use Nurse Anesthesiologist.
    
    3) “The Council on Accreditation of Nurse Anesthesia Educational Programs defines an “anesthesiologist” as a doctor of medicine (M.D.) or doctor of osteopathy (D.O.) who has successfully completed an approved anesthesiology residency program.” This is inaccurate and an OLD document. The COA changed everything last year to “Physician Anesthesiologist”.
    
    4) “The World Health Organization views “anesthesiology as a medical practice” that should be directed and supervised by an anesthesiologist” No one cares what the WHO says about titles. Especially when it was ONLY MDAs in an echo chamber who made this decision. It is irrelevant in the US or anywhere else.
    - Anesthesiologist
      September 12, 2021 at 10:00 pm
      
      Mike, I did not make any of this up. This is published information from their websites. I don’t think any of those organizations are trying to put out bad information. Again, please direct me to a website, a reference, a citation, a piece of literature, or any legitimate source so that I can verify your information.

Shawn Fouhy

September 12, 2021 at 2:01 pm

Do you at least agree to the equivalent education of an AA and a CRNA? Now that you both have anesthesiologist in your title I suppose you do. After a year of two of practice AA=CRNA.

Mike CRNA
September 12, 2021 at 2:24 pm

No the eduction is not equivalent.

That is why there is a bridge program for AAs to become CRNAs.

https://harriscollege.tcu.edu/nurse-anesthesia/academics/aa-c-bridge-to-dnp-a/

Shawn Fouhy

September 12, 2021 at 2:51 pm

Then you understand that CRNA and MD aren’t equivalent. Same argument. And there’s also a bridge program for CRNAs to become MDs, it’s called medical school. And the CRNAs that complete the program snd become anesthesiologists always note how much the didn’t realize they didn’t know. Interesting

Mike CRNA
September 12, 2021 at 4:34 pm

Ah

I was waiting for this comment.

Just like DO is another pathway to medicine (and MDs fought against and marginalized them for decades) and podiatrist is another pathway to experts in foot and ankle, CRNA is another pathway to expert in anesthesia.

We dont need a bridge program because we can already do everything you do as an MDA. So there is no need for a bridge when the sides are, in fact level. As opposed to AAs who are only trained to assist and can only practice in a dependent manner.

Thanks for falling into my logic trap.

Shawn Fouhy

September 12, 2021 at 2:52 pm

The studies also note that care delivered by AAs is no different than that delivered by a CRNA, so there’s that

Mike CRNA
September 12, 2021 at 4:31 pm

Actually there are NO STUDIES which compare CRNA care to AA care because it is difficult to study since AAs are controlled by MDAs and CRNAs can work independently.

But also, AAs are TRAINED to be assistants not independent practitioners.
Cardiac Nurse Anesthesiologist
September 12, 2021 at 9:33 pm

Please show us this study.

Nick

September 12, 2021 at 3:45 pm

That’s funny since many programs ( that I have intimate first hand knowledge of) multiple pharm courses are a shared courses between SRNA’s and MED students… I myself taught pharmacology and can tell you there is no lack of pharm knowledge in our students. I can also tell you I’ve met many MDA’s hat couldn’t define pharmacokinetics nor pharmacodynamics… as far as a difference between CRNA and AA yes there a stark difference. AA programs have no experimental requisite. You could literally go form working at McDonald’s to AA school. With no foundation and no clinical experience to draw from, 24 months is not long enough to become an independent anesthesia provider. Hence the reason they’re extremely downer technicians. We on the other hand spend years gaining critical care experience then spend 3-3.5 years in anesthesia school being well trained as independent providers.

Nick

September 12, 2021 at 4:01 pm

I’m sure you’re famed and acclaimed museum cleverly omits the origin or anesthesia being rooted with in nursing?

Nick

September 12, 2021 at 4:04 pm

Again you’ve moved to a different tooic, this string was selected to Nurse Anesthesiologist, not doctor… but there is that too since most of us now do hold a clinical doctoral degree. I think what you meant was a nurse wanting to be recognized as a physician….. which is not happening anywhere in the country.

Nick

September 12, 2021 at 4:07 pm

It’s only weird to you because your ego thinks Doctor is synonomous with physician. Which it’s not. Get over it and do your job. Worry about what you’re doing (or not doing in this case) and let others worry about what they’re doing. We don’t need nor want your approval do do ours… lol

Shawn Fouhy

September 12, 2021 at 4:41 pm

Patients believe doctor is a physician, you dorks are trying to confuse the to boost your weak egos. Nice try. No matter how hard you try, you can’t become a doctor. None of this is about patient care, which is why your organization is so silly.

Shawn Fouhy

September 12, 2021 at 4:43 pm

CRNA and AA pretty much same

Shawn Fouhy

September 12, 2021 at 4:44 pm

You misspelled your, nurse mikey

Mike CRNA

September 12, 2021 at 4:56 pm

Since when did the argument become about the title “Doctor”?

But anyway, i guess that’s deflection.

The title “doctor” is an earned one and there are many types of “doctor” as well as many types of providers commonly using the term “doctor” in the clinical setting. For some examples here are ones ive personally witnessed.

– PharmD using Dr in the hospital
– Dentists using Dr
– Podiatrists using Dr
– Psychologists using Dr.
– Audiologists who use Dr.
and there are many more

None of YOU cared until nursing started to support doctorate degrees (one of the last actual professions in the hospital to do so). There is NOTHING confusing about saying “My name is Dr Mike, I will be your Nurse Anesthesiologist (or CRNA) today” and patients do NOT think either are confusing.

Here is the problem, your org is desperate, they know they are losing. This childish lashing out at APRNs in an attempt to paternalistically control them as org. med has always thought they could control everyone, is beneath you.

No one said you didnt do more school, no one said physicians are bad, no one said you shouldnt be in anesthesia and no one else is trying to CONTROL your profession.

But here is what we are saying:

1) You did more time but it was not relevant to anesthesia as evidenced by the outcomes. Also, stop lying about the hours it is easy to debunk and makes the ASA look desperate.

2) Physician Anesthesiologist are excellent providers of anesthesia, just not any better than your competition. CRNAs. Stop trying to control everyone else and either show value added to your much higher expected salary and compete.

3) I have no problem with MDAs who do their own cases, they get much respect from me. However, do not expect alot of respect given to a what is likely more than 60% of MDAs who barely do cases and a large % who haven’t done a case in YEARS. Ive met them, they can only supervise because they cannot do or manage. So then what is the point of stuporvision? $$$$$. Lets not pretend that the ACT isnt about making money. 1:4 making 200% of what an MDA can if they sat the cases themselves. That is what it is ALL about.

4) Stop trying to maintain the paternalistic history of medicine which dictates that only MDs know everything, only MDs are the best, only MDs can be leaders, only MDs can etc etc. It is just NOT accurate or reality and others do all this everyday as good as MDs. Its below you all. How about just competing in the market place and lets see who wins. Stop the anti-competitive and baseless fear mongering and lies.

Shawn Fouhy

September 12, 2021 at 5:27 pm

You’re getting too deep into this. Doctor means MD, anything else confuses the situation. Stop being so weird about it. You obviously understand what I mean.

Nick

September 12, 2021 at 8:58 pm

AA’s do not even come close to the same knowledge nor skill sets that a CRNA possesses. I get your trying to hist the rope at this point, but it won’t work…. You’ve shown enough ignorance to let your true colors flare.

Leopoldo Rodriguez MD MBA

September 12, 2021 at 10:14 pm

Having worked in Anesthesia Care Team Models composed of both C-AAs and CRNAs. Nick, I recommend that you read this article reviewing outcomes:
https://pubs.asahq.org/anesthesiology/article/129/4/700/19980/Anesthesia-Care-Team-Composition-and-Surgical
Using national claims data for 443,000 Medicare beneficiaries, the influence of care team composition on inpatient mortality, inpatient length of stay, and inpatient spending was evaluated.
There were no significant differences in mortality, length of stay, or inpatient spending between the care team models with CRNAs or C-AAs.

Mike CRNA

September 12, 2021 at 10:45 pm

Might wanna actually read the article, I was waiting for this post eagerly

1) Only 5% of the administrative health claims were AAs

The article reviewed 443 098 cases of which 421 230 were CRNA cases and 21 868 AA
cases. CRNA cases represent 95% of the data and AAs only 5%. So in order to compare they
had to use statistical models to extrapolate out the AA cases

2) Concludes MDA involvement mitigates AA weaknesses

The Epstein article also published in Anesthesiology shows that in a 1:2 ratio the
MDAs only meet the medical direction criteria 65% of the time and only 1% of the
time in 1:3 ratio meaning the MDA is NOT THERE or available to intervene with the
dependent AA provider.
(Epstein, R. H., & Dexter, F. (2012). Influence of supervision ratios by
anesthesiologists on first-case starts and critical portions of
anesthetics. Anesthesiology: The Journal of the American Society of
Anesthesiologists, 116(3), 683-691.)
-What if there is an emergency in 2 of the 4 AA rooms simultaneously?
– What if an emergency occurs in PACU or Pre Op requiring the MDAs full attention?
– What if all 4 AA rooms are 730 AM starts?
– In order to mitigate these lapses in supervision which the article suggests is how
MDAs eliminate the “systemic differences” with dependent AAs staggering start times
would have to be employed considerably decreasing both revenue generation and case
volume per day per OR impacting access to care. Additionally, this increases costs by
requiring the same number of providers to do less cases which ultimately generates less
revenue requiring even higher subsidies from facilities to maintain service. OR just use
CRNAs

3) Metrics studied are so general they cannot be applied

Only focuses on inpatient mortality, length of stay and inpatient spending
Inpatient Mortality: Entirely focused on death. However, nothing in the article explains
how death had anything to do with anesthesia services. There are many factors related to
inpatient mortality not the least of which are surgical complications totally unrelated to
anesthesia. Effectively this “study” says nothing as it does not provide the reasons for
mortality. If the mortality related to anesthesia complications is higher in the AA
population we would never know.
Length of stay: Presumably this metric was used to try and correlate anesthesia issues
resulting in longer or similar LOS. However, they do NOT explain the reason for LOS.
So, there is no way to know if additional LOS had anything to do with anesthesia care let
alone CRNA or AA care.
Inpatient spending: The increased costs of stay have no metrics showing the reason why
they had increased LOS. How can we know if that had to do with anesthesia or not?

4) Metrics NOT STUDIED which ARE relevant

NOT STUDIED: Anesthesia specific complications, mortality, morbidity or MDA need to
rescue/intervene
How can we know the impact of providers if we do not study ACTUAL anesthesia
complications? How can we know the involvement of MDAs if we do not have an
accounting of ‘need to rescue’ calls from AAs compared to CRNAs? How can we compare
at all when we have NO IDEA the involvement of the MDAs in each case?

5) Did not control for supervision ratios, case acuity or MDA intervention/Involvement

The article does not control for supervision ratios at all. This means AAs could be 1:1 and
CRNAs could be 1:4 but there is no way to know. If AAs are supervised much closer it is
effectively no different than the MDA performing the anesthetic but at a significantly
increased cost. The evidence has shown CRNA only and MDA only care is equal.
Without controlling for case complexity and case assignments how can we make any
statements on capability? What if all the CRNAs got the hard cases with sick patients and
the AAs mostly got easy cases?
If the MDAs are constantly intervening and rescuing dependent AAs but not CRNAs then
there is clearly more risk to patients particularity in light of the Epstein article lapses in
supervision previously mentioned.

6) Ignores Cost-Effectiveness of QZ CRNA models which dependent AAs cannot function in.

Collaborative Models: CRNAs can work in collaborative models with MDAs where
there can be an unlimited MDA:CRNA ratio or where MDAs and CRNAs are all in
rooms doing their own cases. This expands access to care and bends the healthcare cost
curve.
CRNA Autonomous Models: CRNAs working autonomously with surgeons lowers
costs of anesthesia delivery with same high-quality care/outcomes without providers who
add no value but increase the cost of services exponentially.
These models are already happening across the country and it is questionable why the
ASA would promote a model which does not expand access to care or decrease
anesthesia delivery costs except for the purpose of maintaining monopoly.
AAs cannot work in ANY of these models as they must ALWAYS work under the
supervision of an MDA thereby always generating revenue for them.

7) If MDA presence makes all the difference what happened with inpatient mortality?

The article suggests that MDAs presence mitigate mortality yet the inpatient mortality
rate was 1.6-1.7%
Either they were not there or their presence did not matter
The Epstein article clearly shows they were NOT there 35% of the time in a 1:2 ratio and
99% of the time in a 1:3 ratio.
Why are they getting paid 50% of each case if there is no value added or improvement in
outcomes?
(Epstein, R. H., & Dexter, F. (2012). Influence of supervision ratios by anesthesiologists
on first-case starts and critical portions of anesthetics. Anesthesiology: The Journal of the
American Society of Anesthesiologists, 116(3), 683-691.)

It’s good to have a doctorate which taught me how to critically review articles, especially one this poor

anesthesiologist
September 13, 2021 at 5:08 pm

Yes. Many, many problems with all retrospective chart reviews including those funded by the AANA. I’m sure you are aware of this. Everyone has read the Cochrane review which concluded all of the studies comparing physicians and CRNA’s are garbage. I’ve read all of them and I agree. Great for political banter not so good for actual facts. That’s why this will always be an emotional argument as evidenced by all the comments above. Again, both CRNA’s and physicians are playing the field.

Michael Dinos

September 12, 2021 at 11:03 pm

The study was also funded by the ASA and had an employee of the ASA as one of the authors. 👎👎

Nick

September 12, 2021 at 11:35 pm

Yes, i will agree that Physician Anesthesiologist, is a Medical Doctor or Doctor of Osteopathy that specializes in Anesthesia. That’s it!

Nick

September 12, 2021 at 11:38 pm

So under your logic. A CRNA is the EXACt same thing as a Physician Anesthesiologist after 2-3 years of practice? Sounds pretty dumb to you I’m sure when I lose your question ghat way huh?

Nick

September 12, 2021 at 11:40 pm

Keep reading. You literally just stated something ghat was already debunked in this very string. Keep grasping though, it’s amusing.

Nick

September 12, 2021 at 11:45 pm

Again you get stuck on a title. I AM A Doctor…. Just not a physician! Oh and I’m not a dork either.. lol… don’t think I’ve heard that term used since the mid 80’s

Nick

September 12, 2021 at 11:46 pm

Yep just like a Ferrari and pinto are exactly the same car… ignorant

Nick

September 12, 2021 at 11:49 pm

Why because you say it does? Lol. Better go tell every dentist, podiatrist, audiologist, PharmD, OD, DPT ghat they too shall not use YOUR Md only term. See how far that gets you

Nick

September 12, 2021 at 11:50 pm

Thanks Mike, you hit every pint and a couple extra, that I was gettting ready to respond!

Nick

September 13, 2021 at 4:33 pm

Fortunately your anecdotes don’t shape policy.There are good and bad providers amongst each group I’ve met many MDA’s is that I wouldn’t let my dog sleep. Holding the title Physician does not make you immune to stupidity or poor practice.

Nick

September 20, 2021 at 10:30 pm

Oh my ignorant friend… in a very short time. The requirement for supervision will be permanently lifted… watch the legislation brew… Covid has brought to the legislators eyes, that it’s an unnecessary cost and hoop… FL will soon join the 29 other states that have moved into the 21st century. It can’t be avoided and we won’t allow it to be .

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