BRAVO! The fundamental problem is that our national Association, State Associations, Boards of Nursing and the membership at-large does not openly accept the logic. Until that happens, we will unfortunately never move forward.
Good question. My view is that “Dr.” is appropriate when someone has earned a doctorate, but in a clinical setting it should always be paired with clear role disclosure.
So the issue is not whether a DNP, PhD, PharmD, DPT, DDS, or other doctorate-prepared professional earned the title “doctor.” They did. The issue is whether the patient clearly understands that person’s actual profession and role.
For example, “Hi, I’m Dr. Smith. I’m a CRNA/Physician and I’ll be providing your anesthesia care today” is very different from using “Dr.” in isolation which could lead a patient to assume status.
That is why I separate “doctor” from “physician.” A doctorate earns the title doctor. MDs and DOs hold the professional title physician. The transparency piece is making sure patients hear both the credential and the role clearly.
great point. ill have to use my Dr. title more confidently when i talk to patients moving forward. Do you always introduce yourself as Dr. MacKinnon? I sometimes get nervous if the patient is a physician lol!
I absolutely never want to be mistaken for a physician. That is why I am very clear whenever I use any title. I want to take credit for my own work, and I want my profession to take credit for its own work.
That said, I have personally never used formal degree titles in the clinical environment. For me, it is not because I think the title is inappropriate or confusing to patients, neither is true. It is because I have always felt that titles can sometimes create unnecessary distance between the patient and the clinician, or make patients feel like they are somehow beneath the person caring for them. I try to personalize the interaction more, so I use my first name. That has just always fit my style.
I fully support anyone using their appropriate title, as long as they are clear and transparent about their actual professional role.
That is such a valid point. Using 'Doctor First' to establish role clarity is a great strategy. In my bedside ICU nursing, I’ve noticed that when a CRNA introduces themselves, they often focus entirely on the procedural side—explaining the general or regional plan and the side effects—without actually clarifying their title or level of care. It might be not the case with everyone but I had witnessed couple times.
What’s wrong with hierarchy? We went to school longer, assume more responsibility and liability and are accountable for more risk and decision-making. I don’t feel bad for saying that I earned my place in this hierarchy and I do take umbrage with other people using titles that suggest they have done the same when they haven’t. Physicians have been so brainwashed to be equal team members lately but in reality, we are not.
Thank you for engaging with the article. I appreciate the directness of the comment.
I respect physician training. I have never argued that physicians and CRNAs have the same educational pathway or that CRNAs are physicians. That is exactly why the modifier matters.
But longer training does not give one profession the authority to define every other profession’s identity, nor does it automatically determine legal responsibility in a given case.
A CRNA is not an extension of a physician anesthesiologist. CRNAs are licensed, credentialed, privileged, and accountable for their own clinical decisions and actions. Legal risk and accountability are tied to the actual care provided, the applicable scope of practice, delineation of privileges, facility bylaws, policies, documentation, and the practice model being used. They are not assigned simply by who trained longer or whose initials carry more perceived cultural weight.
In independent and autonomous CRNA practice models, CRNAs provide 100% of the anesthetic and anesthesia role. In medical direction or supervision models, responsibilities may be structured differently, but that still does not erase the CRNA’s professional accountability or turn the CRNA into a physician anesthesiologist’s “extender”.
The title issue is similar. “Nurse anesthesiologist” does not suggest physician status. It says nurse in the title. Res ipsa loquitur. The thing speaks for itself. The modifier identifies the professional pathway.
The ASA understood the value of modifiers when it promoted the term physician anesthesiologist years before AANA recognized nurse anesthesiologist. If physician clarifies the physician pathway, and dentist clarifies the dentist pathway, then nurse clarifies the nursing pathway.
The anesthesiologist assistant example makes the double standard even more obvious. That title places anesthesiologist directly in front of assistant, yet many of the same voices that object to nurse anesthesiologist often have no problem with anesthesiologist assistant. So apparently assistant clarifies, physician clarifies, and dentist clarifies, but nurse is uniquely confusing?
That is not a serious clarity argument.
What your comment seems to defend is not patient clarity as much as preservation of perceived professional prestige. A facility may define a decision-making structure through its practice model, bylaws, policies, privileges, and staffing design. That is not the same as saying physician initials automatically create a permanent rank order over every other licensed profession.
Physician is clear. Nurse is clear. If “physician anesthesiologist” identifies a physician practicing anesthesiology, then “nurse anesthesiologist” identifies a nurse practicing anesthesiology as a CRNA. The title does not hide the distinction; it makes the distinction explicit. At some point, the objection starts to sound less like concern that patients will be confused and more like concern that CRNAs are being described with too much professional respect.
Not wading into the details of the exact argument about wording of nurse anesthesiologist versus physician anesthesiologist. You’ve really beat that horse to death. My comment was merely about hierarchy in medicine, period. I don’t think physicians should be ashamed of the position they have earned in the hierarchy.
That is fair, and I do not think physicians should be ashamed of being physicians. Physician training is substantial, the title is earned, and the role carries real responsibility.
Where I disagree is with using “hierarchy” as a blanket justification for how every other profession should be positioned or described. There are certainly decision-making structures in health care. Facilities define those through practice models, privileges, bylaws, policies, staffing design, and applicable law. In some settings, that structure is physician-led. In others, CRNAs practice independently or autonomously. Those realities are not determined simply by initials or by a universal professional ranking system.
So my concern is not that physicians are proud of their training. They should be. My concern is when that pride turns into the assumption that other licensed professions must be linguistically or professionally subordinated to preserve physician status.
That is the distinction I am making. Respecting physician training is appropriate. Treating hierarchy as an organizing principle for everyone else’s identity is where I think the argument breaks down.
CAAs: are assistants to the anesthesiologist. They’re not claiming to be an anesthesiologist. I think. Or at least that’s how the branding appears to me. I don’t read it as they’re an anesthesiologist, what type? An assistant type. Skin to dental or nurse type.
Sure, but that’s the whole point. If people can read “anesthesiologist assistant” and understand that assistant means assistant, then they can read “nurse anesthesiologist” and understand that nurse means nurse.
The modifier is doing the same work in both titles. Assistant clarifies one role. Nurse clarifies the nursing pathway. Physician clarifies the physician pathway. Dentist clarifies the dental pathway.
The inconsistency is treating “assistant” as clear while pretending “nurse” is confusing.
The PA says “im a PA.” Not im a physician…of the assistant category.”
We should get ride of “anesthetist” because its too hard to say or spell or explain.
I guess i always consider the audience: the patient on the table doesn’t care. Really. But I always make sure they know a Crna is at the head of the bed.
I agree there is a grammatical difference. “Assistant” is the primary noun in anesthesiologist assistant. But the objection to nurse anesthesiologist is not framed as grammar. It is framed as patient confusion.
If patients can see anesthesiologist assistant and understand that assistant clarifies the role, then patients can see nurse anesthesiologist and understand that nurse clarifies the pathway.
I’m not arguing CAAs are claiming to be anesthesiologists. I’m saying the outrage is selective. Assistant clarifies. Physician clarifies. Dentist clarifies. But somehow nurse is treated as uniquely confusing.
There’s two nouns. One is the doc doing pre ops and one is the CAA pushing propofol. The term CAA is clearly here demonstrating that the CAA and the anesthesiologist are two different people.
Dental Anesthesiologist demonstrates that the DDS Is the anesthesiologist.
Nurse Anesthesiologist would be fair imo and not inaccurate.
Maybe there’s a doc anesthesiologist maybe there’s not.
The inconsistency isn’t found with CAAs. The phrase “certified anesthesiologist assistant” is predicated on the fact that there’s a doc who is the anesthesiologist. Just like PA-C means certified physician assistant.
Your argument (which I don’t object to fundamentally) doesn’t apply to CAAs.
Docs hate it (imo) because it draws equality where they desire distinction. And it leads patients to ask why they need more than one anesthesiologist. Which risks the market asking the same question. And they label it “confusion.”
I’m not sure it’s a hill to die on. I’d rather all my peers and myself be good at regional and logistic efficiency, and have repot with surgeons and be highly independent.
If the real concern is that “nurse anesthesiologist” makes patients, facilities, surgeons, or the market ask why a physician anesthesiologist is needed in every case, then the objection was never really patient confusion. It was market protection.
And I do not buy the “not a hill to die on” framing. We can be excellent at regional, efficient in the OR, trusted by surgeons, clinically independent, and still care about the language used to describe our profession. Those are not competing priorities.
Language affects policy, reimbursement, facility decisions, public perception, and professional leverage. Pretending titles do not matter while admitting the title may disrupt the market is exactly why the title matters.
So no, I am not saying the CAA comparison is the whole argument. I am saying your own explanation confirms the larger one: terms that preserve dependence are tolerated. Terms that describe CRNAs without placing them underneath another profession are treated as a threat.
Well that’s why I'm glad you’re here. You have guys like me that feel like you can call whatever you want as long as the check clears every two weeks. And then there’s guys like you. 💪🏼
I’ll go on to say: you must be excellent at regional, efficient in the OR, trusted by surgeons, clinically independent, if you care about the language used to describe our profession.
Materiel performance is a requisite for recognition. Imo.
Well there’s a difference in kind here. The CAA is the assistant. Not the anesthesiologist.
Dr. X Is the anesthesiologist receiving assistance from Mr. Bill the CAA.
I tend to agree conceptually that a CRNA (I am one) isn’t dishonest in anyway to use the term anesthesiologist. (I never do this). But the CAA isn’t presenting as the anesthesiologist. They’re presenting as the assistant. I think that comparison is a stretch. Straw man. Not to mention I don’t think CAAs are at all pleading the case to present as “anesthesiologist.”
I agree that "provider" is vague and pretty much useless in terms of patients understanding who is caring for them.
What loses me is the insistence on creating titles that don't actually reflect established credentials. A CRNA is a CRNA. A physician is a physician. A PA is a PA. A dentist is a DDS or DMD. Those credentials already tell patients something meaningful about a person's education, training, and licensure.
For one, the "dentist anesthesiologist" example is especially strange because that is not how dentists identify themselves in practice. Dentists don't graduate with a degree in "dentist anesthesiology," and they don't introduce themselves to patients as "dentist anesthesiologists." They're dentists (DDS/DMD) who may have additional specialty training. The professional identity is still dentist. In the same way, a CRNA's professional identity is CRNA.
Second, the argument that adding "nurse" in front of anesthesiologist makes everything clear doesn't really hold up. If the title needs a disclaimer and a paragraph long explanation to avoid confusion, it's probably not as transparent as claimed.
I don’t think this is necessarily a hierarchy issue, but a transparency issue, to which the solution is pretty simple: if a patient asks who is taking care of them, the answer should be your actual profession and credentials.
I agree that patients should hear the actual profession and credentials of the person taking care of them. No argument there. I’m not suggesting anyone hide the CRNA credential or pretend titles replace credentials.
Where I think we differ is that credentials and descriptors are not the same thing.
CRNA is the credential. Nurse anesthesiologist is a professional descriptor recognized by AANA. There is nothing inherently confusing about that. It says nurse in the title, and it identifies the clinical domain of anesthesiology. That is the point of the modifier.
Same concept with physician anesthesiologist. A physician license does not say “physician anesthesiologist.” It says physician. The descriptor tells the patient what clinical domain that physician is practicing in.
ASA started using physician anesthesiologist before AANA ever recognized nurse anesthesiologist. They were using “anesthesiologist” by itself, but their own 2012 research showed nearly 70% of patients did not identify anesthesiologist with physician. So they added the modifier physician to clarify the pathway.
The confusion risk is not created by nurse anesthesiologist. The modifier nurse resolves the pathway. The long explanation is only needed because opponents keep trying to make a clear title sound confusing.
Physician anesthesiologist tells you physician pathway. Dentist anesthesiologist tells you dentist pathway. Nurse anesthesiologist tells you nursing pathway as a CRNA.
The anesthesiologist assistant example is also hard to ignore. If assistant is enough for patients to understand anesthesiologist assistant, why is nurse not enough for patients to understand nurse anesthesiologist? Are patients able to hear assistant but somehow unable to hear nurse?
So yes, “I’m a CRNA” is clear to people in health care. But most patients do not know what CRNA means unless we explain it. “I’m your nurse anesthesiologist” is clear on its face. Nurse identifies the professional pathway. Anesthesiologist identifies the clinical domain.
The title itself is not confusing. The long explanation only becomes necessary because opponents have worked hard to make a clear descriptor sound confusing. The controversy is not because patients cannot understand the word nurse. It is because some people do not like the professional respect the title carries.
You keep focusing on the idea that "nurse anesthesiologist" communicates the nursing pathway, but so does CRNA. That's literally what a CRNA is. If the goal is for patients to understand that someone came through a nursing pathway rather than medical school, then introducing yourself as a CRNA already accomplishes that. What I still haven't heard is what problem is being solved. You keep explaining why you like the descriptor, but that's different from explaining why it's necessary. If a CRNA can walk into a room and say, "Hi, I'm a CRNA and I'll be providing your anesthesia today," then their role, profession, and pathway can all be explained clearly without adopting a different title. To be fair, patients don't know what a lot of healthcare credentials mean (MD vs DO, PGY 2 vs attending, etc). But we don't rename professions every time a patient doesn't immediately recognize an acronym. We explain our role.
Also the descriptor vs credential distinction isnt particularly meaningful from a patient's perspective. Patients hear titles as identifiers. They don't sit there sorting out which words are credentials, which words are descriptors, or what any of that even means. They hear a title and use it to understand who is caring for them. And again, I think the dentist example highlights my point more than yours. Dentists are dentists. They're DDSs or DMDs. Even dentists with additional anesthesia training usually don't introduce themselves as "dentist anesthesiologists." Their professional identity is still dentist. In the same way, a CRNA's professional identity is CRNA.
Ultimately I don't think this comes down to respect. CRNAs are highly trained professionals and deserve respect for the work they do. I just haven't seen a convincing argument that replacing or supplementing an already established professional identity with "nurse anesthesiologist" improves transparency for patients. If anything, the fact that we're several comments deep debating what the title means suggests it may not be as self explanatory as claimed
Unfortunately, while “nurse anesthetist” is a valid term, it is often misunderstood and even mispronounced by policymakers and healthcare stakeholders. Coupled with longstanding efforts by the ASA to emphasize the word “nurse” as a means of portraying CRNAs as less essential, some adopted “nurse anesthesiologist” as an alternative descriptor. The term was intended to more clearly communicate the nature of the services provided and the advanced expertise of CRNAs while remaining firmly rooted in the nursing profession.
So I think this actually proves the opposite of what you're trying to argue. Nothing in your comment describes a patient transparency problem. You're describing a perception problem. You say people don't understand the term anesthetist, don't fully appreciate the expertise of CRNAs/or don't view them as essential enough, etc. Whether or not those concerns are valid, they're not the same thing as patient confusion about who is providing their care.
If the ultimate goal is to help people understand what a CRNA is, then the solution is to educate people about what a CRNA is. CRNA is already an established profession with a clearly defined training pathway. I don't see why the answer is to adopt a title built around a different profession rather than simply educating patients on the one that already exists. This approach doesn't just change one title. It requires changing multiple titles and professional identities at once. Now physicians are supposed to be "physician anesthesiologists," dentists are "dentist anesthesiologists," and CRNAs are "nurse anesthesiologists." Don’t you see how strange that is? At some point it starts feeling like we're creating increasingly complicated labels to solve a problem that could be literally be directly addressed by explaining what a CRNA is.
This to me just sounds much more like an argument for increasing recognition of the CRNA profession rather than an argument for improving patient clarity. Those are two different conversations. If the issue is professional recognition, then let's be honest and call it that. Can you tell me what patient care problem we’re trying to solve that isn't already solved by introducing yourself as a CRNA and explaining your role?
If the substance of your point was correct, e.g. "strange" - they ASA would not have adopted physician anesthesiologist and the ADA would not have recognized dentist anesthesiologist.
If the goal is clarity and transparency (which impacts perception) - I'm not sure what the issue is with the point as written.
That doesn’t really follow. The fact that an organization adopts a term doesn't automatically make it the clearest or best option. That's an appeal to authority. Example: if an organization decided tomorrow that CNAs should be called "nurse associates," that alone wouldn't prove the new title improves patient understanding.
I think my point is pretty simple. If people don't understand what a CRNA is, why not educate people on what a CRNA is? I still genuinely don't see why changing terminology across multiple professions is a better solution than explaining an already established one.
I appreciate the response. I also care about transparency to patients. Patients should understand who is providing their anesthesia, what that person’s professional background is, and what role they are performing.
I also recognize that many of us view this issue through our own professional lens. A physician anesthesiologist may naturally hear these terms differently than a CRNA, just as a CRNA may hear “mid-level” or “provider” differently than a physician. That is exactly why patient-facing language should not be defined only by one profession’s internal assumptions or preferences.
Where I think the organized opposition loses me is that the concern does not seem to be transparency in any consistent way. It seems to be preserving language that places anyone who is not a physician into a dependent or lesser role. That is very different from simply making sure patients understand who is caring for them.
I use CRNA constantly, but we should be honest about what patients actually understand. CRNA is clear to some people in health care, especially in the surgical environment. Many in health care and most patients have no idea what those initials mean. The same is true for CAA. Those are credentials and regulatory shorthand. They are not plain-language descriptors for the public.
If the argument is that we should only use credentials because patients do not immediately recognize every health care acronym, then we would not use terms like emergency medicine physician, family practice physician, physician anesthesiologist, dentist anesthesiologist. We use descriptors because they help explain the role and clinical domain.
Patients understand nurse. Patients understand physician. Patients understand dentist. Patients understand assistant. They also generally understand that an anesthesiologist is involved in anesthesia care. So when we say physician anesthesiologist, dentist anesthesiologist, nurse anesthesiologist, or anesthesiologist assistant, the modifier tells them the pathway or role. That is clearer than asking them to decode initials or professional jargon.
I do not think the fact that we are debating the title means the title itself is confusing. The words themselves are not hard. Nurse means nurse. Physician means physician. Dentist means dentist. Assistant means assistant. The debate exists because opponents keep trying to make a straightforward descriptor sound confusing.
On the dentist example, dentist anesthesiologists are not just dentists who took a weekend course. They complete additional formal anesthesia residency training, typically about three years, and their professional descriptor is dentist anesthesiologist. Some may use anesthesiologist by itself, which I actually think can be less clear. Dentist anesthesiologist is clearer because it tells the patient the pathway and the clinical domain. (https://www.asda.org/)
So I agree with you on one thing: patients need the actual profession and role. My view is that “I’m your nurse anesthesiologist” does exactly that. It is not a replacement for the CRNA credential. It is a plain-language descriptor that tells the patient what pathway I come from and what clinical domain I practice in.
The only reason this takes several paragraphs is not because the title is hard for patients to understand. It is because opponents have taken a political and professional-positioning issue and framed it as a patient-confusion issue. I do not think patients are confused by “nurse anesthesiologist.” I think some professionals and their organizations are uncomfortable because the descriptor carries professional respect without placing CRNAs underneath another profession. That is the real tension.
Bradley, I appreciate the continued engagement. I think this is where the argument starts to move the goalposts a bit.
First, no one is arguing that CRNA is not an established credential. It is. The question is whether CRNA is automatically more transparent to patients than nurse anesthesiologist. I do not think it is.
CRNA is clear to people in the surgical environment. It is not clear to most patients. Patients do not come to the OR every day. Many may only have anesthesia once or twice in their life. They are not walking in with a working knowledge of anesthesia credentials, billing categories, licensure pathways, or professional acronyms.
And it is not like we have not had time to educate the public. Nurse anesthesia has been around for more than a century, and CRNA has been an established credential for decades. If the public still does not reliably understand those terms, then doing the same thing over and over while calling it transparency is not much of an argument. That is why plain language matters.
If the answer is simply “educate them on what CRNA means,” then the same logic should apply to physicians. Why did ASA move to physician anesthesiologist? Why not just say physician? Why not just say anesthesiologist and explain it? Didn't work, thats why. Every time a practitioner walks out of the room and uses a term other than <descriptor> anesthesiologist, the patient simply says my 'anesthesiologist' was great.
There is also survey data asking the public this question directly. In a national survey of more than 4,000 registered voters, respondents preferred nurse anesthesiologist over the older terminology by ~60% to 23% when asked which term best describes a professional nurse who provides anesthesia during surgery. In that same survey, the majority recognized nurse anesthesiologist as a member of the nursing profession and physician anesthesiologist as a medical doctor.
So the claim that nurse anesthesiologist is obviously confusing to patients does not really hold up. If anything, the public seems to understand the modifier logic pretty well.
So I agree with you that patients need to understand the actual profession and role. Where we disagree is that I do not think initials are inherently clearer than plain language. “I’m your nurse anesthesiologist” is clear on its face. It tells the patient the professional pathway and the clinical domain.
Mike, the goalposts haven’t moved at all. You've spent several comments explaining why patients don't know what CRNA means. I agree. Many don't. What I still haven't heard is why your solution is to rebrand an established profession rather than simply explain what a CRNA is. It takes a minute.
BRAVO! The fundamental problem is that our national Association, State Associations, Boards of Nursing and the membership at-large does not openly accept the logic. Until that happens, we will unfortunately never move forward.
You're not wrong. This is the case definitely in some states or some particular places and that has to change.
what about referring to oneself as Dr. so and so because i have a doctorate in nursing practice?
Good question. My view is that “Dr.” is appropriate when someone has earned a doctorate, but in a clinical setting it should always be paired with clear role disclosure.
So the issue is not whether a DNP, PhD, PharmD, DPT, DDS, or other doctorate-prepared professional earned the title “doctor.” They did. The issue is whether the patient clearly understands that person’s actual profession and role.
For example, “Hi, I’m Dr. Smith. I’m a CRNA/Physician and I’ll be providing your anesthesia care today” is very different from using “Dr.” in isolation which could lead a patient to assume status.
That is why I separate “doctor” from “physician.” A doctorate earns the title doctor. MDs and DOs hold the professional title physician. The transparency piece is making sure patients hear both the credential and the role clearly.
great point. ill have to use my Dr. title more confidently when i talk to patients moving forward. Do you always introduce yourself as Dr. MacKinnon? I sometimes get nervous if the patient is a physician lol!
Hey, great question.
I absolutely never want to be mistaken for a physician. That is why I am very clear whenever I use any title. I want to take credit for my own work, and I want my profession to take credit for its own work.
That said, I have personally never used formal degree titles in the clinical environment. For me, it is not because I think the title is inappropriate or confusing to patients, neither is true. It is because I have always felt that titles can sometimes create unnecessary distance between the patient and the clinician, or make patients feel like they are somehow beneath the person caring for them. I try to personalize the interaction more, so I use my first name. That has just always fit my style.
I fully support anyone using their appropriate title, as long as they are clear and transparent about their actual professional role.
That is such a valid point. Using 'Doctor First' to establish role clarity is a great strategy. In my bedside ICU nursing, I’ve noticed that when a CRNA introduces themselves, they often focus entirely on the procedural side—explaining the general or regional plan and the side effects—without actually clarifying their title or level of care. It might be not the case with everyone but I had witnessed couple times.
What’s wrong with hierarchy? We went to school longer, assume more responsibility and liability and are accountable for more risk and decision-making. I don’t feel bad for saying that I earned my place in this hierarchy and I do take umbrage with other people using titles that suggest they have done the same when they haven’t. Physicians have been so brainwashed to be equal team members lately but in reality, we are not.
Thank you for engaging with the article. I appreciate the directness of the comment.
I respect physician training. I have never argued that physicians and CRNAs have the same educational pathway or that CRNAs are physicians. That is exactly why the modifier matters.
But longer training does not give one profession the authority to define every other profession’s identity, nor does it automatically determine legal responsibility in a given case.
A CRNA is not an extension of a physician anesthesiologist. CRNAs are licensed, credentialed, privileged, and accountable for their own clinical decisions and actions. Legal risk and accountability are tied to the actual care provided, the applicable scope of practice, delineation of privileges, facility bylaws, policies, documentation, and the practice model being used. They are not assigned simply by who trained longer or whose initials carry more perceived cultural weight.
In independent and autonomous CRNA practice models, CRNAs provide 100% of the anesthetic and anesthesia role. In medical direction or supervision models, responsibilities may be structured differently, but that still does not erase the CRNA’s professional accountability or turn the CRNA into a physician anesthesiologist’s “extender”.
The title issue is similar. “Nurse anesthesiologist” does not suggest physician status. It says nurse in the title. Res ipsa loquitur. The thing speaks for itself. The modifier identifies the professional pathway.
The ASA understood the value of modifiers when it promoted the term physician anesthesiologist years before AANA recognized nurse anesthesiologist. If physician clarifies the physician pathway, and dentist clarifies the dentist pathway, then nurse clarifies the nursing pathway.
The anesthesiologist assistant example makes the double standard even more obvious. That title places anesthesiologist directly in front of assistant, yet many of the same voices that object to nurse anesthesiologist often have no problem with anesthesiologist assistant. So apparently assistant clarifies, physician clarifies, and dentist clarifies, but nurse is uniquely confusing?
That is not a serious clarity argument.
What your comment seems to defend is not patient clarity as much as preservation of perceived professional prestige. A facility may define a decision-making structure through its practice model, bylaws, policies, privileges, and staffing design. That is not the same as saying physician initials automatically create a permanent rank order over every other licensed profession.
Physician is clear. Nurse is clear. If “physician anesthesiologist” identifies a physician practicing anesthesiology, then “nurse anesthesiologist” identifies a nurse practicing anesthesiology as a CRNA. The title does not hide the distinction; it makes the distinction explicit. At some point, the objection starts to sound less like concern that patients will be confused and more like concern that CRNAs are being described with too much professional respect.
Not wading into the details of the exact argument about wording of nurse anesthesiologist versus physician anesthesiologist. You’ve really beat that horse to death. My comment was merely about hierarchy in medicine, period. I don’t think physicians should be ashamed of the position they have earned in the hierarchy.
That is fair, and I do not think physicians should be ashamed of being physicians. Physician training is substantial, the title is earned, and the role carries real responsibility.
Where I disagree is with using “hierarchy” as a blanket justification for how every other profession should be positioned or described. There are certainly decision-making structures in health care. Facilities define those through practice models, privileges, bylaws, policies, staffing design, and applicable law. In some settings, that structure is physician-led. In others, CRNAs practice independently or autonomously. Those realities are not determined simply by initials or by a universal professional ranking system.
So my concern is not that physicians are proud of their training. They should be. My concern is when that pride turns into the assumption that other licensed professions must be linguistically or professionally subordinated to preserve physician status.
That is the distinction I am making. Respecting physician training is appropriate. Treating hierarchy as an organizing principle for everyone else’s identity is where I think the argument breaks down.
CAAs: are assistants to the anesthesiologist. They’re not claiming to be an anesthesiologist. I think. Or at least that’s how the branding appears to me. I don’t read it as they’re an anesthesiologist, what type? An assistant type. Skin to dental or nurse type.
Sure, but that’s the whole point. If people can read “anesthesiologist assistant” and understand that assistant means assistant, then they can read “nurse anesthesiologist” and understand that nurse means nurse.
The modifier is doing the same work in both titles. Assistant clarifies one role. Nurse clarifies the nursing pathway. Physician clarifies the physician pathway. Dentist clarifies the dental pathway.
The inconsistency is treating “assistant” as clear while pretending “nurse” is confusing.
The PA says “im a PA.” Not im a physician…of the assistant category.”
We should get ride of “anesthetist” because its too hard to say or spell or explain.
I guess i always consider the audience: the patient on the table doesn’t care. Really. But I always make sure they know a Crna is at the head of the bed.
My peers either is good.
Other docs…depends on my mood.
I agree there is a grammatical difference. “Assistant” is the primary noun in anesthesiologist assistant. But the objection to nurse anesthesiologist is not framed as grammar. It is framed as patient confusion.
If patients can see anesthesiologist assistant and understand that assistant clarifies the role, then patients can see nurse anesthesiologist and understand that nurse clarifies the pathway.
I’m not arguing CAAs are claiming to be anesthesiologists. I’m saying the outrage is selective. Assistant clarifies. Physician clarifies. Dentist clarifies. But somehow nurse is treated as uniquely confusing.
That is the inconsistency.
There’s two nouns. One is the doc doing pre ops and one is the CAA pushing propofol. The term CAA is clearly here demonstrating that the CAA and the anesthesiologist are two different people.
Dental Anesthesiologist demonstrates that the DDS Is the anesthesiologist.
Nurse Anesthesiologist would be fair imo and not inaccurate.
Maybe there’s a doc anesthesiologist maybe there’s not.
The inconsistency isn’t found with CAAs. The phrase “certified anesthesiologist assistant” is predicated on the fact that there’s a doc who is the anesthesiologist. Just like PA-C means certified physician assistant.
Your argument (which I don’t object to fundamentally) doesn’t apply to CAAs.
Docs hate it (imo) because it draws equality where they desire distinction. And it leads patients to ask why they need more than one anesthesiologist. Which risks the market asking the same question. And they label it “confusion.”
I’m not sure it’s a hill to die on. I’d rather all my peers and myself be good at regional and logistic efficiency, and have repot with surgeons and be highly independent.
I think you just said the quiet part out loud.
If the real concern is that “nurse anesthesiologist” makes patients, facilities, surgeons, or the market ask why a physician anesthesiologist is needed in every case, then the objection was never really patient confusion. It was market protection.
And I do not buy the “not a hill to die on” framing. We can be excellent at regional, efficient in the OR, trusted by surgeons, clinically independent, and still care about the language used to describe our profession. Those are not competing priorities.
Language affects policy, reimbursement, facility decisions, public perception, and professional leverage. Pretending titles do not matter while admitting the title may disrupt the market is exactly why the title matters.
So no, I am not saying the CAA comparison is the whole argument. I am saying your own explanation confirms the larger one: terms that preserve dependence are tolerated. Terms that describe CRNAs without placing them underneath another profession are treated as a threat.
Well that’s why I'm glad you’re here. You have guys like me that feel like you can call whatever you want as long as the check clears every two weeks. And then there’s guys like you. 💪🏼
I’ll go on to say: you must be excellent at regional, efficient in the OR, trusted by surgeons, clinically independent, if you care about the language used to describe our profession.
Materiel performance is a requisite for recognition. Imo.
Well there’s a difference in kind here. The CAA is the assistant. Not the anesthesiologist.
Dr. X Is the anesthesiologist receiving assistance from Mr. Bill the CAA.
I tend to agree conceptually that a CRNA (I am one) isn’t dishonest in anyway to use the term anesthesiologist. (I never do this). But the CAA isn’t presenting as the anesthesiologist. They’re presenting as the assistant. I think that comparison is a stretch. Straw man. Not to mention I don’t think CAAs are at all pleading the case to present as “anesthesiologist.”
I agree that "provider" is vague and pretty much useless in terms of patients understanding who is caring for them.
What loses me is the insistence on creating titles that don't actually reflect established credentials. A CRNA is a CRNA. A physician is a physician. A PA is a PA. A dentist is a DDS or DMD. Those credentials already tell patients something meaningful about a person's education, training, and licensure.
For one, the "dentist anesthesiologist" example is especially strange because that is not how dentists identify themselves in practice. Dentists don't graduate with a degree in "dentist anesthesiology," and they don't introduce themselves to patients as "dentist anesthesiologists." They're dentists (DDS/DMD) who may have additional specialty training. The professional identity is still dentist. In the same way, a CRNA's professional identity is CRNA.
Second, the argument that adding "nurse" in front of anesthesiologist makes everything clear doesn't really hold up. If the title needs a disclaimer and a paragraph long explanation to avoid confusion, it's probably not as transparent as claimed.
I don’t think this is necessarily a hierarchy issue, but a transparency issue, to which the solution is pretty simple: if a patient asks who is taking care of them, the answer should be your actual profession and credentials.
Hi!
I agree that patients should hear the actual profession and credentials of the person taking care of them. No argument there. I’m not suggesting anyone hide the CRNA credential or pretend titles replace credentials.
Where I think we differ is that credentials and descriptors are not the same thing.
CRNA is the credential. Nurse anesthesiologist is a professional descriptor recognized by AANA. There is nothing inherently confusing about that. It says nurse in the title, and it identifies the clinical domain of anesthesiology. That is the point of the modifier.
Same concept with physician anesthesiologist. A physician license does not say “physician anesthesiologist.” It says physician. The descriptor tells the patient what clinical domain that physician is practicing in.
ASA started using physician anesthesiologist before AANA ever recognized nurse anesthesiologist. They were using “anesthesiologist” by itself, but their own 2012 research showed nearly 70% of patients did not identify anesthesiologist with physician. So they added the modifier physician to clarify the pathway.
The confusion risk is not created by nurse anesthesiologist. The modifier nurse resolves the pathway. The long explanation is only needed because opponents keep trying to make a clear title sound confusing.
Physician anesthesiologist tells you physician pathway. Dentist anesthesiologist tells you dentist pathway. Nurse anesthesiologist tells you nursing pathway as a CRNA.
The anesthesiologist assistant example is also hard to ignore. If assistant is enough for patients to understand anesthesiologist assistant, why is nurse not enough for patients to understand nurse anesthesiologist? Are patients able to hear assistant but somehow unable to hear nurse?
So yes, “I’m a CRNA” is clear to people in health care. But most patients do not know what CRNA means unless we explain it. “I’m your nurse anesthesiologist” is clear on its face. Nurse identifies the professional pathway. Anesthesiologist identifies the clinical domain.
The title itself is not confusing. The long explanation only becomes necessary because opponents have worked hard to make a clear descriptor sound confusing. The controversy is not because patients cannot understand the word nurse. It is because some people do not like the professional respect the title carries.
I guess we fundamentally disagree.
You keep focusing on the idea that "nurse anesthesiologist" communicates the nursing pathway, but so does CRNA. That's literally what a CRNA is. If the goal is for patients to understand that someone came through a nursing pathway rather than medical school, then introducing yourself as a CRNA already accomplishes that. What I still haven't heard is what problem is being solved. You keep explaining why you like the descriptor, but that's different from explaining why it's necessary. If a CRNA can walk into a room and say, "Hi, I'm a CRNA and I'll be providing your anesthesia today," then their role, profession, and pathway can all be explained clearly without adopting a different title. To be fair, patients don't know what a lot of healthcare credentials mean (MD vs DO, PGY 2 vs attending, etc). But we don't rename professions every time a patient doesn't immediately recognize an acronym. We explain our role.
Also the descriptor vs credential distinction isnt particularly meaningful from a patient's perspective. Patients hear titles as identifiers. They don't sit there sorting out which words are credentials, which words are descriptors, or what any of that even means. They hear a title and use it to understand who is caring for them. And again, I think the dentist example highlights my point more than yours. Dentists are dentists. They're DDSs or DMDs. Even dentists with additional anesthesia training usually don't introduce themselves as "dentist anesthesiologists." Their professional identity is still dentist. In the same way, a CRNA's professional identity is CRNA.
Ultimately I don't think this comes down to respect. CRNAs are highly trained professionals and deserve respect for the work they do. I just haven't seen a convincing argument that replacing or supplementing an already established professional identity with "nurse anesthesiologist" improves transparency for patients. If anything, the fact that we're several comments deep debating what the title means suggests it may not be as self explanatory as claimed
Unfortunately, while “nurse anesthetist” is a valid term, it is often misunderstood and even mispronounced by policymakers and healthcare stakeholders. Coupled with longstanding efforts by the ASA to emphasize the word “nurse” as a means of portraying CRNAs as less essential, some adopted “nurse anesthesiologist” as an alternative descriptor. The term was intended to more clearly communicate the nature of the services provided and the advanced expertise of CRNAs while remaining firmly rooted in the nursing profession.
So I think this actually proves the opposite of what you're trying to argue. Nothing in your comment describes a patient transparency problem. You're describing a perception problem. You say people don't understand the term anesthetist, don't fully appreciate the expertise of CRNAs/or don't view them as essential enough, etc. Whether or not those concerns are valid, they're not the same thing as patient confusion about who is providing their care.
If the ultimate goal is to help people understand what a CRNA is, then the solution is to educate people about what a CRNA is. CRNA is already an established profession with a clearly defined training pathway. I don't see why the answer is to adopt a title built around a different profession rather than simply educating patients on the one that already exists. This approach doesn't just change one title. It requires changing multiple titles and professional identities at once. Now physicians are supposed to be "physician anesthesiologists," dentists are "dentist anesthesiologists," and CRNAs are "nurse anesthesiologists." Don’t you see how strange that is? At some point it starts feeling like we're creating increasingly complicated labels to solve a problem that could be literally be directly addressed by explaining what a CRNA is.
This to me just sounds much more like an argument for increasing recognition of the CRNA profession rather than an argument for improving patient clarity. Those are two different conversations. If the issue is professional recognition, then let's be honest and call it that. Can you tell me what patient care problem we’re trying to solve that isn't already solved by introducing yourself as a CRNA and explaining your role?
If the substance of your point was correct, e.g. "strange" - they ASA would not have adopted physician anesthesiologist and the ADA would not have recognized dentist anesthesiologist.
If the goal is clarity and transparency (which impacts perception) - I'm not sure what the issue is with the point as written.
That doesn’t really follow. The fact that an organization adopts a term doesn't automatically make it the clearest or best option. That's an appeal to authority. Example: if an organization decided tomorrow that CNAs should be called "nurse associates," that alone wouldn't prove the new title improves patient understanding.
I think my point is pretty simple. If people don't understand what a CRNA is, why not educate people on what a CRNA is? I still genuinely don't see why changing terminology across multiple professions is a better solution than explaining an already established one.
I appreciate the response. I also care about transparency to patients. Patients should understand who is providing their anesthesia, what that person’s professional background is, and what role they are performing.
I also recognize that many of us view this issue through our own professional lens. A physician anesthesiologist may naturally hear these terms differently than a CRNA, just as a CRNA may hear “mid-level” or “provider” differently than a physician. That is exactly why patient-facing language should not be defined only by one profession’s internal assumptions or preferences.
Where I think the organized opposition loses me is that the concern does not seem to be transparency in any consistent way. It seems to be preserving language that places anyone who is not a physician into a dependent or lesser role. That is very different from simply making sure patients understand who is caring for them.
I use CRNA constantly, but we should be honest about what patients actually understand. CRNA is clear to some people in health care, especially in the surgical environment. Many in health care and most patients have no idea what those initials mean. The same is true for CAA. Those are credentials and regulatory shorthand. They are not plain-language descriptors for the public.
If the argument is that we should only use credentials because patients do not immediately recognize every health care acronym, then we would not use terms like emergency medicine physician, family practice physician, physician anesthesiologist, dentist anesthesiologist. We use descriptors because they help explain the role and clinical domain.
Patients understand nurse. Patients understand physician. Patients understand dentist. Patients understand assistant. They also generally understand that an anesthesiologist is involved in anesthesia care. So when we say physician anesthesiologist, dentist anesthesiologist, nurse anesthesiologist, or anesthesiologist assistant, the modifier tells them the pathway or role. That is clearer than asking them to decode initials or professional jargon.
I do not think the fact that we are debating the title means the title itself is confusing. The words themselves are not hard. Nurse means nurse. Physician means physician. Dentist means dentist. Assistant means assistant. The debate exists because opponents keep trying to make a straightforward descriptor sound confusing.
On the dentist example, dentist anesthesiologists are not just dentists who took a weekend course. They complete additional formal anesthesia residency training, typically about three years, and their professional descriptor is dentist anesthesiologist. Some may use anesthesiologist by itself, which I actually think can be less clear. Dentist anesthesiologist is clearer because it tells the patient the pathway and the clinical domain. (https://www.asda.org/)
So I agree with you on one thing: patients need the actual profession and role. My view is that “I’m your nurse anesthesiologist” does exactly that. It is not a replacement for the CRNA credential. It is a plain-language descriptor that tells the patient what pathway I come from and what clinical domain I practice in.
The only reason this takes several paragraphs is not because the title is hard for patients to understand. It is because opponents have taken a political and professional-positioning issue and framed it as a patient-confusion issue. I do not think patients are confused by “nurse anesthesiologist.” I think some professionals and their organizations are uncomfortable because the descriptor carries professional respect without placing CRNAs underneath another profession. That is the real tension.
CRNA is already an established profession. If patients don't understand what a CRNA is, why not educate them on what a CRNA is?
What patient care problem is being solved by "nurse anesthesiologist" that isn't already solved by saying, "Hi, I'm your CRNA"?
"Why not educate them" - that's been done forever. Why not just update the terms?
Bradley, I appreciate the continued engagement. I think this is where the argument starts to move the goalposts a bit.
First, no one is arguing that CRNA is not an established credential. It is. The question is whether CRNA is automatically more transparent to patients than nurse anesthesiologist. I do not think it is.
CRNA is clear to people in the surgical environment. It is not clear to most patients. Patients do not come to the OR every day. Many may only have anesthesia once or twice in their life. They are not walking in with a working knowledge of anesthesia credentials, billing categories, licensure pathways, or professional acronyms.
And it is not like we have not had time to educate the public. Nurse anesthesia has been around for more than a century, and CRNA has been an established credential for decades. If the public still does not reliably understand those terms, then doing the same thing over and over while calling it transparency is not much of an argument. That is why plain language matters.
If the answer is simply “educate them on what CRNA means,” then the same logic should apply to physicians. Why did ASA move to physician anesthesiologist? Why not just say physician? Why not just say anesthesiologist and explain it? Didn't work, thats why. Every time a practitioner walks out of the room and uses a term other than <descriptor> anesthesiologist, the patient simply says my 'anesthesiologist' was great.
There is also survey data asking the public this question directly. In a national survey of more than 4,000 registered voters, respondents preferred nurse anesthesiologist over the older terminology by ~60% to 23% when asked which term best describes a professional nurse who provides anesthesia during surgery. In that same survey, the majority recognized nurse anesthesiologist as a member of the nursing profession and physician anesthesiologist as a medical doctor.
So the claim that nurse anesthesiologist is obviously confusing to patients does not really hold up. If anything, the public seems to understand the modifier logic pretty well.
So I agree with you that patients need to understand the actual profession and role. Where we disagree is that I do not think initials are inherently clearer than plain language. “I’m your nurse anesthesiologist” is clear on its face. It tells the patient the professional pathway and the clinical domain.
Mike, the goalposts haven’t moved at all. You've spent several comments explaining why patients don't know what CRNA means. I agree. Many don't. What I still haven't heard is why your solution is to rebrand an established profession rather than simply explain what a CRNA is. It takes a minute.