AOA statement on American Association of Nurse Anesthetists name change, title misappropriation and the importance of physician-led care

More than 35 osteopathic medical organizations have signed on in support of the following statement produced by the American Osteopathic Association. A full listing of supporting organizations is viewable below the statement.

Position statement: In response to the recent announcement that the American Association of Nurse Anesthetists (AANA) has changed its name to the “American Association of Nurse Anesthesiology,” the American Osteopathic Association reiterates the deep concerns expressed in our May 28, 2021 statement opposing the American Academy of Physician Assistants’ title change.

Efforts by non-physician clinicians to obfuscate their credentials through title misappropriation serve to mislead the public regarding their education, training and qualifications. The AOA calls for truth in advertising, intellectual honesty and transparency through the use of consistent and clearly discernible professional designations for all healthcare professionals so that patients can clearly understand the qualifications and roles of their providers.

“Anesthesiology” is a discipline and specialty within the House of Medicine practiced by “Anesthesiologists,” denoting physician-level of care and thus, are terms which should be reserved for physicians.

We encourage and call for organized, collaborative discussions among stakeholder organizations in the Physician, Nursing and Physician Assistant communities to find common ground on these important topics that are in the best interest of patients. Such discussions have begun and have occurred between the AOA and some organizations, and we welcome others to join these important conversations.

CHICAGO—The American Osteopathic Association (AOA), which proudly represents its professional family of more than 168,000 osteopathic physicians (DOs) and medical students nationwide, remains committed to the physician-led, team-based model of care.

A physician-led team ensures that professionals who have earned the right to practice medicine through completion of medical school and accredited residency/fellowship training in their chosen specialty/subspecialty and who have achieved board certification in their chosen specialty/subspecialty are adequately and uniquely prepared to be licensed to practice medicine. Only DOs and MDs can be licensed to practice medicine. “Physician-led” should not mean “physician-optional.”

The AOA and the DOs and osteopathic medical students whom we serve value the important contributions made to our healthcare system by our non-physician colleagues. Certified Registered Nurse Anesthetists (CRNAs), Physician Assistants (PAs) and others have worked tirelessly alongside physicians to care for patients prior to and throughout the COVID-19 pandemic, often under suboptimal and emergency conditions that put their own health and safety at risk. Osteopathic physicians have gladly worked side by side with non-physician clinicians; we commend their selfless service.

Non-physician clinicians, including CRNAs and PAs, are an integral part of physician-led healthcare teams. Healthy discussions and collaboration regarding safe and appropriate skill set substitution, roles and responsibilities are in order, and we welcome them. However, non-physician clinicians’ use of misleading professional titles, such as “Nurse Anesthesiologist” and “Doctor” in a clinical setting by non-physicians imply to patients that a physician (DO or MD) is caring for them. Although such efforts may serve to advance the professional standing of non-physicians, it is done so at the expense of clear and transparent communication with our shared patients.

There are important and substantive differences between the education and training requirements for physicians and non-physician clinicians. Physicians across the United States, osteopathic (DO) and allopathic (MD) alike, must meet rigorous requirements for education, postdoctoral training and testing and then practice in supervised environments that afford progressively greater autonomy before ultimately becoming eligible to treat patients on their own through licensure competency assessment and rigorous board certification standards. These requirements ensure that all patients are treated safely and with the same standards of care.

A Certified Registered Nurse Anesthetist’s (CRNA) training requires a minimum of a two-year master’s degree¹ following their bachelor’s degree. In stark contrast to physicians, no postgraduate training is required. Anesthesiologists complete a four-year medical school curriculum, followed by four years of supervised residency training². Anesthesiologists also sit for rigorous board certification examinations to demonstrate their knowledge and competence in this complex medical specialty. These steps confirm the physician commitment to the public interest and patient safety.

The AANA’s new name, the American Association of Nurse Anesthesiology, creates confusion between the CRNA credentials and those of physicians practicing anesthesiology, commonly known as “anesthesiologists.”

Over the past several years, individual CRNAs and their state chapters have begun a push to re-brand themselves as anesthesiologists through title misappropriation rather than through education and training. After the AANA adopted a position statement in 2018 to allow CRNAs to use the descriptor “nurse anesthesiologist,” the Florida Board of Nursing agreed to allow John McDonough, a Florida CRNA and professor of nursing at the University of North Florida, to use the “nurse anesthesiologist” title in 2019. In the same year, the New Hampshire Board of Nursing decided to allow CRNAs to call themselves “nurse anesthesiologists.” However, the state Supreme Court rejected the change earlier this year. In addition, in 2020, the Idaho Board of Nursing adopted a position statement in support of the “nurse anesthesiologist” descriptor for CRNAs. A group calling itself the “Committee for Proper Recognition for CRNAs” maintains a website (nurseanesthesiologistinfo.com) dedicated to these and similar efforts to misinform the public regarding CRNA credentials. These title-change efforts have not been accompanied by any corresponding change in educational or training requirements.

The AOA reaffirms that all patients deserve access to high-quality, physician-led medical care. The House of Medicine needs to collectively support the practice of medicine and work to ensure physician leadership remains integral to patient care. We are calling on our peers in the healthcare community to join together with policymakers to support policies that recognize the importance of the physician-led team-based model, ensuring that physicians, the only professionals with comprehensive medical education and training that are eligible for licensure to practice medicine, are appropriately distinguished from non-physicians and are adequately involved in the care of this nation’s sick and injured.

¹https://www.aana.com/membership/become-a-crna/crna-fact-sheet
²https://www.asahq.org/education-and-career/career-resources/anesthesia-as-a-career

Supporting Affiliate Organizations:

American College of Osteopathic Emergency Physicians
American College of Osteopathic Neurologists and Psychiatrists
American College of Osteopathic Obstetricians and Gynecologists
American College of Osteopathic Pediatricians
American College of Osteopathic Surgeons
American Osteopathic Academy of Addiction Medicine
American Osteopathic Academy of Orthopedics
American Osteopathic College of Anesthesiologists
American Osteopathic College of Dermatology
American Osteopathic College of Occupational & Preventive Medicine
American Osteopathic College of Pathologists
American Osteopathic College of Radiology
Arizona Osteopathic Medical Association
Florida Osteopathic Medical Association
Georgia Osteopathic Medical Association
Idaho Osteopathic Physicians Association
Illinois Osteopathic Medical Society
Indiana Osteopathic Association
Iowa Osteopathic Medical Association
Kansas Association of Osteopathic Medicine
Kentucky Osteopathic Medical Association
Louisiana Osteopathic Medical Association
Maine Osteopathic Association
Maryland Association of Osteopathic Physicians
Massachusetts Osteopathic Society
Michigan Osteopathic Association
Minnesota Osteopathic Medical Society
Missouri Association of Osteopathic Physicians and Surgeons
New Hampshire Osteopathic Association
New York State Osteopathic Medical Society
Ohio Osteopathic Association
Oklahoma Osteopathic Association
Osteopathic Physicians & Surgeons of Oregon
Pennsylvania Osteopathic Medical Association
Rhode Island Society of Osteopathic Physicians & Surgeons
South Carolina Osteopathic Medical Society
Texas Osteopathic Medical Association
Virginia Osteopathic Medical Association
Wisconsin Association of Osteopathic Physicians and Surgeons