Education matters in every corner of health care. Patients know it too—more than 90% say a physician’s years of education and training are vital to optimal patient care.
Still, some organizations are pushing legislation that would weaken scope of practice laws that help protect patients and ensure high-quality care. One example is the aggressive pursuit of legislation to remove the requirement certified registered nurse anesthetists (CRNAs) be supervised by physicians.
When considering such scope-of-practice expansions, lawmakers and the public must be aware of the educational differences between physicians and nurses, as well as the increased risk to patient safety due to the inadequate training of nurse anesthetists to provide independent anesthesia care to severely ill and other high-risk patients.
The AMA is fighting scope creep, defending the practice of medicine against scope of practice expansions that threaten patient safety.
The numbers don’t lie
An anesthesiologist is a physician who practices in the specialty of anesthesiology. The anesthesiologist provides anesthesia for patients undergoing surgical, obstetric, diagnostic or therapeutic procedures while monitoring the patient’s condition and supporting vital organ functions. The anesthesiologist also diagnoses and treats acute, chronic or cancer pain, as well as provide resuscitation and medical management for patients with critical illnesses and severe injuries.
One of the most obvious things that distinguishes anesthesiologists from nurse anesthetists is the length and depth of their training.
Nurse anesthetists are advanced-practice nurses who provide a variety of anesthesia and pain medicine services. Working in a team with physicians, they administer anesthesia and monitor patients’ vital signs.
To become a nurse anesthetist, a registered nurse with either a bachelor’s of science in nursing or another baccalaureate degree must have at least one year’s experience as a critical care nurse and graduate from an accredited graduate school of nurse anesthesia. Nurse anesthetist programs run 36 months, and nurse anesthetists do not attend medical school or complete a residency.
By contrast, anesthesiologists are physicians who complete four years of medical school followed by four years of residency and often another one to two years of fellowship to study and become certified in a subspecialty, such as pain management, cardiac anesthesia, pediatric anesthesia, neuroanesthesia, obstetric anesthesia or critical care medicine. This adds up to between eight and 10 years of post-graduate education. All of that is preceded by the four years it typically takes to earn a bachelor’s degree.
In addition, whereas a nurse anesthetist will complete about 2,500 hours of hands-on clinical anesthesia care, an anesthesiologist will get 12,000–16,000 patient-care hours—about five to seven times more.
AMA President Jesse M. Ehrenfeld, MD, MPH, a tenured professor of anesthesiology and an internationally recognized leader in the field of anesthesiology knows firsthand the value that nurse anesthetists can bring to the operating room under physician supervision.
“I work with nurse anesthetists every day and they are invaluable members of our team. At the same time, they are not a replacement for anesthesiologists," he said. "When it comes to life-or-death procedures in anesthesia, anesthesiologists have the training, skill and knowledge to provide it. If I were the patient on the operating table, I would want care from an anesthesiologist or an anesthesia team led by an anesthesiologist. I would want the same for my loved ones, and I believe it is what all patients deserve.”
Stay up to date on fight against scope creep
See how the AMA defends against scope of practice expansions that threaten patient safety.
Learn more with the AMA about great resources that set the record straight for policymakers on scope of practice. The AMA is one of the only national organizations that has created hundreds of advocacy tools for medicine to use when fighting scope creep.
Nomenclature is a pain point
Today, more than ever, patients are expected to play a greater role in their health care decision-making. Yet patients are often confused about who is providing their health care.
They do, however, clearly understand the difference between anesthesiologists and nurse anesthetists. An AMA study found that 70% of patients recognized an anesthesiologist as a physician and 71% responded that a nurse anesthetist was not a physician.
Still, several state nursing boards are pushing to allow nurse anesthetists to use the title “nurse anesthesiologist.” Permitting nurse anesthetists to use that term would do nothing to clarify the distinction between the professions for the remaining 30% of the public that do not recognize the difference. Moreover, it would be misleading and would undermine the mission of protecting the health and safety of the residents of those states.
Explore further with the AMA about what sets apart physicians and nonphysicians. Also, visit AMA Advocacy in Action to find out what’s at stake in fighting scope creep and other advocacy priorities the AMA is actively working on.
