What does that mean?
It means I am first a medical doctor with a degree in medicine, and second an expert in the field of anesthesia.
But the title “anesthesiologist” also means so much more than that. It represents several additional years of specialized training, thousands (yes, thousands) of hours of supervised clinical work practicing the very difficult science of patient evaluation, diagnosis, and treatment, and years in the OR, ICU, labor ward, and pain clinic — all culminating in perfecting the art of anesthesia medicine.
A needle placed here, an oxygen mask there, a half syringe of this medicine and full syringe of another, and voilà — patient is asleep and ready for surgery. Seems quite simple, no?
Of course, that is far from the truth.
It’s hardly natural to be placed in a medically induced coma and even more challenging to get through a dangerous surgery blissfully unaware. The final hurdle is to be brought back after a complex procedure safely and painlessly to an awake state of consciousness.
As a practicing anesthesiologist, I have spent countless hours at all times of the day and night learning how to successfully perform my craft under some very trying circumstances. And when in a surgical suite — and this is the most important part of why I am writing today — it is vital that each member of a surgical team knows his or her role, that all follow clear protocols, and that every single member of the team responds without hesitation at moments when there is no opportunity or time for error.
And the best, safest and most-cost effective model for anesthesia care is when a fully-trained physician is in charge of everyone in the surgical suite or care team and when there are clear and unambiguous lines of authority and decision-making.
That is why the latest move by an organized group of nurses to “rebrand” themselves is dangerous.
The organization that represents highly skilled anesthesia nurses is now formally changing their titles to call themselves “anesthesiologists,” misappropriating a term properly reserved for medical doctors who practice in the specialty.
To be clear, while these nurses are highly trained, their education is in how to administer anesthesia under a physician’s supervision. They do not make medical diagnoses, nor does their background prepare them to make independent emergency medical evaluations. They are vital to the care team, but as part of that team, not as solo actors.
In the medical profession, titles are not just names we put on our badges. Those titles convey to other members of the health care team who is responsible for what and who is ultimately in charge.
And when seconds count — when they really count — confusion in the chain of command can cost lives.
So then, why the name change?
The justification is an Orwellian one that does not bear repeating except to note that the real reason is to further a larger objective to allow nurses to independently practice anesthesia medicine and move to a system where nurses, and not fully trained anesthesiologists, are put in charge of decision-making during the administration of anesthesia.
In a complex health care system, the nurses are trying to blur the lines between themselves and physicians.
What remains crystal clear for patients is the crucial distinction of who is leading the anesthesia care team. Nothing about arbitrarily assuming a self-appointed medical title changes the Florida laws that require all anesthesia nurses to practice under the supervision of a physician.
That is the reason that all anesthesiologist doctors have 7 years of formal in-classroom didactics and thousands of hours of supervised clinical training. The administration of anesthesia medicine is complex, nuanced, and (if not done correctly) potentially dangerous or even lethal.
During a crisis, critical decisions must be made by physicians and therapies expeditiously initiated by physicians and the clinical team. Confusing titles and leadership structure ambiguities will not result in the safer outcomes that we all now routinely expect when patients are anesthetized.
Finally, this public relations gimmick is also blatantly disingenuous.
We owe our patients and the public the dignity and respect of fairly representing ourselves in front of them — and when someone says “anesthesiologist,” they think doctor, not nurse. Nursing is a noble calling — and nurses are well regarded for their centuries of contributions to patient care.
Why be so embarrassed to be called a “nurse anesthetist” that you seek out another title that everyone knows is associated with physicians?
So yes, when it comes to the administration of anesthesia medicine, titles really do matter.
Leopoldo Rodriguez, M.D., M.B.A., F.A.A.P., F.A.S.A. is the Medical Director, Surgery Center of Aventura and currently serves as President of the Florida Society of Anesthesiologists.