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When a resolution to limit nurse anesthesia was
presented at the 1934 AMA convention, it included
language that prefigured modern-day " Truth in
Advertising " campaigns: " Many hospitals...advertise
to the public and the profession that an anesthetist
will be available; this being a misrepresentation when
such anesthetist is only a technician, while the general
assumption is that the term anesthetist implies a
physician. " 6
In 1945, the American Society of Anesthetists was
renamed the American Society of Anesthesiologists to
emphasize the scientific underpinnings of physician
anesthesia. Similar efforts to use nomenclature to
establish professional boundaries have continued on
both sides to this day.

The Physician's Role in Nurse
Anesthetist
Controversy over the role of anesthesiologists in nurse
anesthetist education has also carried over from the
early 20th century. As more physicians specialized in
anesthesiology, it became increasingly unfashionable
for doctors to train nurse anesthetists. In 1938, the
American Board of Anesthesiology (ABA) rejected the
American Board of Surgery's recommendation that the
ABA take leadership of nurse anesthetist education and
certification.9
From 1947-1964, an ASA bylaw declared it unethical
for anesthesiologists to train nurse anesthetists.
When John Adriani, MD (1907-88), Chief of Anesthesia
at Charity Hospital in New Orleans, started both an
anesthesiology residency program and a school of
nurse anesthesia to fulfill a clinical need, his ABA
certification was nearly revoked.10
When the 1970 ASA Anesthesia Manpower Study
projected a shortage of anesthesia practitioners
in the U.S., ASA leaders saw a dual need to keep
CRNAs in the workforce, and to create a new class of
anesthesiologist assistants (AAs) who would be directly
accountable to physicians. In 1976, the ASA formally

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CSA Vital Times

adopted a physician-led anesthesia care team (ACT)
model as the standard for anesthetic delivery in the
U.S.4
Around the same time, the ASA supported a new
anesthesiologist-led Faculty of Nurse Anesthesia
School (FNAS) to oversee CRNA program accreditation.
The AANA opposed this, proposing instead a CRNAdirected Council on Accreditation (COA), which the U.S.
Office of Education ultimately approved.4
To this day, controversy remains over the degree to
which anesthesiologists should be involved with CRNA
education, and the extent to which SRNAs should
be taught the same concepts and procedures as
anesthesiology residents.

A Brief Peace?
For almost a decade, the ASA and AANA engaged
in reconciliation efforts. In 1964, a joint ASA-AANA
Liaison Committee was formed. By January 1968,
a joint statement was published in both societies'
bulletins that recommended the development of " close
relations...for enhancing the quality and quantity of
available personnel...and for the overall improvement in
patient care. " 4 In 1972, an ASA-AANA Joint Statement
on Anesthesia Practice recognized the ideal standard
of anesthesiologists and nurse anesthetists working
together " as an anesthesia care team, " without
explicitly assigning physicians a supervisory role.
In 1976, the ASA officially adopted an anesthesia care
team (ACT) model that called for physician supervision
of CRNAs or AAs-a move that the AANA opposed. To
this day, the physician-directed ACT model remains
at the heart of philosophical differences between the
organizations.

Conclusion
The scientific leadership and physiological expertise
of physicians achieved through extensive education,
training, and research, has dramatically advanced



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