What's in a name?

The time has come to explore – again – whether we should align ourselves with the majority and call ourselves “anaesthesiologists” or continue to be known as “anaesthetists”, say the presidents of the three core groups representing the specialty in Australia and New Zealand.

 

Anaesthesia is the second most important medical intervention – ever.

It sounds like a big call but consider for a moment that after the management of infectious diseases (that is, public health, antibiotics, vaccination/immunisation, and antisepsis/sterilisation), anaesthesia in its various forms enables life improving and life-saving interventions to be provided to tens of millions of patients annually, radically improving their quality and duration of life safely and effectively. 
The pioneers of our specialty were predominantly medical practitioners who through innovation and the development of safer and more efficient techniques laid the foundations of what was to become today a specialty. 
 
Our specialty is based on expert training and education, ongoing research and development, and a high level of professionalism. It is important for our continued ability to progress these attributes for the care of ever-increasingly complex patients, that these standards are maintained. 
 
It is easy for the public, for politicians and decision-makers, and even for our professional peers, to underestimate how dependent safe and effective anaesthesia is upon skilled practitioners and ongoing research. 
 
There are many ways this message can be communicated via formal advocacy and lobbying, but this lacks traction if the public view is ill-informed. Media promotion and programs such as ANZCA’s National Anaesthesia Day are part of a strategy to enhance our profession’s identity in the Australian and New Zealand communities. 
 
We will continue to do these things. But maybe we need a more fundamental change to enhance our specialty’s identity with the community while also aligning our specialty’s name with a larger part of the global community. 
 
The following article is provided to inform the discussion on whether we should change the name of our specialty from anaesthesia to anaesthesiology and us from anaesthetists to anaesthesiologists. 

Professor David A Scott
President, ANZCA

 

Should we stay “anaesthetists” or could we become “anaesthesiologists”?


The most widespread term globally for doctors who practice the specialty of anaesthesia is anaesthesiologists (or anesthesiologists). This is a widely understood term and differentiates doctors in many countries from non-specialist, or even non-medical “anaesthetists”.  

In Australia and New Zealand this distinction is not as essential because our protected name (by the Australian Health Practitioner Regulation Agency or the Medical Council of New Zealand) is specialist anaesthetist. No one else is able to represent themselves using this term. 

On the other hand, a strength of the title anaesthesiologist is that an "–ology" represents a discipline based on scientific rigour and research. It is certainly our research that has led to the sophisticated, safe and effective anaesthesia that we practice today. In the community, an "–ologist" is more instantly recognised as a specialist or expert in the area of the "–ology".

In clinical practice we deliver anaesthesia. It has been historically the practice to call the provider of anaesthesia an anaesthetist. So, why should we even think about changing?
 

Some background


Discussion on the title anaesthetist versus anaesthesiologist is not new. The following examples highlight this: 

1998

In 1998, “Terminology – Anaesthetist/Anaesthesiologist” was discussed at the October ANZCA Council meeting. The following is extracted from the minutes from this meeting:

“During consideration by the August Executive of the President’s Report on the ASA Federal Executive Meeting … the revival of the anaesthetist/anaesthesiologist debate was highlighted. It was suggested that to widen discussion on this issue, information on the pro and con arguments could be included in the publications of the College, ASA and NZSA. It was agreed by the Executive that the matter of terminology should be (highlighted) at Council for further discussion.

“(It was noted) that this topic is being increasingly debated and suggested that it should be undertaken in an open forum. He noted that only the UK, Australia and New Zealand now use anaesthetist as opposed to anaesthesiologist. Following brief discussion, it was agreed that a case ‘for’ and ‘against’ should be published in the Bulletin. Dr Thompson undertook to compile an article with input from interested parties.”

No change ensued.

2004

In 2004, the then-ANZCA President Professor Michael Cousins established a taskforce chaired by Professor Guy Ludbrook to research, review and discuss broadly with the fellowship a name change to the speciality of anaesthesia to anaesthesiology and a name change from anaesthetist to anaesthesiologist. This taskforce did not make a firm recommendation for change but produced a report for ANZCA Council in September 2005 with the following recommendations in summary:
 
  • Scope of anaesthesia practice be clearly defined in our professional documents.

  • A marketing or public relations group be consulted re the need for and impact of a name change.

  • The marketing group advise on the best implementation of any such change.

  • That the first item be reviewed every two years.
     

The relevance of the first item was that the scope of practice of anaesthesia extended beyond the operating room into preoperative assessment and preparation, and into postoperative care and management, that is, perioperative care.

However, again, no change ensued.

2013

In 2013 the college undertook a survey that identified that one in 10 community members did not know that anaesthetists were doctors, and that 50 per cent thought that only some anaesthetists were doctors.

2017

In 2017 a name change for the speciality and specialists has been raised again by:
 
  • The Australian and the New Zealand societies of anaesthetists following on from discussion at the World Federation of Societies of Anaesthesiologists (WFSA) 2016 conference and the European Society of Anaesthesiology in 2017.

  • Informal discussions by ANZCA with the College of Anaesthetists of Ireland (CAI) and the Royal College of Anaesthetists (RCoA) in the UK. 

  • Feedback from ANZCA Fellows and trainees during the consultation period for the ANZCA Strategic Plan 2018-2022.

  • A specific request from Dr John Crowhurst through correspondence to the Australian Society of Anaesthetists’ Australian Anaesthetist magazine and formally to the ANZCA chief executive officer and president at the 2017 ANZCA Annual General Meeting in Brisbane.

  • In social media, an active Twitter conversation is ongoing debating the merits of a name change.

 

The international situation

 

A form of the words anaesthesiology and anaesthesiologist is used in more than 150 countries for specialists who practice anaesthesia. 
 

In particular, it is used by the WFSA and most (but not all) of its member societies including the American Society of Anesthesiologists, the Chinese Society of Anesthesiology and the European Society of Anaesthesiologists. The Hong Kong college uses anaesthesiology, as do Singapore and Malaysia.
 

Anaesthesia remains for colleges and societies typically associated with English origins, that is, UK, Ireland, the South African college (not society), Australia and New Zealand as well as few other countries. 
 

Anaesthesiology is the most frequent term used in journal titles.
 

As an example of public perception, understanding of the role of anaesthesiologists in India was generally very poor in the population especially in those without university education, although the role of anaesthesiologists in the post-operative period and in pain management was also unclear to many medical undergraduates (Mathur 2009).

 

The Australian and New Zealand situation


Throughout Australia and New Zealand, hospital department names are very variable with uses of anaesthesia, anaesthesiology, perioperative medicine and pain medicine. This variety also applies to the names of private anaesthesia groups with “anaesthetic” or “anaesthesia” being the most common.

ANZCA in 2017

The draft ANZCA Strategic Plan 2018-2022 includes the exploration of adopting anaesthesiology and anaesthesiologist for Australia and New Zealand, acknowledging that to do this there are a number of issues that need to be considered and that the appropriate amount of time need to be dedicated to such a task. 

It is not a matter that can be decided quickly and does require due diligence. Also, with the College playing a leading role in the development of a perioperative medicine qualification it is timely to consider any change in name.

ASA in 2017

The statement made this year by the WFSA (representing 130 Member societies in 150 countries) defined an anaesthesiologist as a qualified physician who has completed a nationally recognised medical residency training program in anaesthesiology. 

Anaesthesiology includes pain medicine, trauma management, resuscitation, perioperative, critical and intensive care medicine. It goes on to note that in some countries the anaesthetist is used, but this is a minority. 

The future of the speciality importantly depends on us embracing this statement and expanding our routine clinical activities outside the operating room. Administration of anaesthesia is a vital part of what we do, however it is important that the role and perception of the anaesthesiologist is that of a wider function. 

The Australian Society of Anaesthetists, like the College, understands this is a possibly contentious issue, and agrees that if a name change is to be made, it is best done together.

NZSA in 2017 

A possible change in name to anesthesiologist aligns with the increased emphasis on the perioperative care aspect of our specialty; and growing recognition of the value this brings to elevating patient care outcomes. 

It arguably better conveys our medical training and the excellence that underpins anaesthesia, highlighting the multidimensional nature of our role in medicine that goes beyond the administration of anaesthesia. 

There is also a drive by our global body the WFSA to attain internationally consistent terminology. As a specialty we should all be engaging in discussion and debate with our colleagues, and exploring the possibility of a change. 

The New Zealand Society of Anaesthetists believes that this is an issue in which it is vital that our three organisations work collaboratively, and if a name change is to occur, we need to do this collectively. 
 

Pros and cons


Positives

The potential positives of changing to anaesthesiology as a name include:
  • It reinforces for the community the breadth of the clinical nature of anaesthesia as a speciality, that is, that doctors practise and deliver anaesthesia and in a broader sense perioperative care.

  • Anaesthesiology encompasses more broadly the professional scope of the speciality including but not restricted to perioperative medicine, pain medicine, palliative care, hyperbaric medicine etcetera.

  • It better reflects the academic and scientific basis of the speciality in line with cardiology, haematology and radiology.

  • Negotiations with governments on the perioperative medicine care model and a name change to the speciality could be conducted concurrently. This would be a way of integrating both in the minds of governments who could then action health system change simultaneously.

  • Using anaesthesiology would mean there is no need to change the acronym of the College or societies.

  • A name change would be an opportunity for a marketing and communication campaign increasing the profile and knowledge of the speciality.

  • The title specialist anaesthesiologist or anaesthesiologist would be distinctly applicable to a qualified specialist medical practitioner. Any other provider of anaesthesia services might then refer to themselves as an anaesthetist with less ambiguity (noting that the subtlety of this in the public’s eyes would likely be lost without education).

Negatives

Potential negatives or challenges associated with a name change include:

External issues:

  • Engagement with all anaesthetists across the College and the Australian and New Zealand societies of anaesthetists would be imperative in gaining a united voice and recommendation.

  • Any debate about this change would need to be respectful debate and not disenfranchise or divide the speciality.

  • Engagement with health services and clinicians would have to be comprehensive.

 
Organisational for ANZCA
 

  • There would be a significant financial outlay on behalf of the College including widespread changes to resources including:   
     

    1. Policies and procedures.

    2. Curriculum.

    3. Continuing professional development.

    4. Professional documents.

    5. Other ANZCA documents and website references.
       

  • Government and regulatory body changes would need to be formally made including:
     

    • Company registration.

    • Medicare.

    • Medical Board of Australia and the Australian Health Practitioner Regulation Agency.

    • Medical Council of New Zealand.

    • A change to the protected specialist title to specialist anaesthesiologist would be required.


​​Organisational for the societies (ASA and NZSA)
 

  • There would be some similar elements to the above with respect to websites, administration and resources and including:
     

    • Policies and procedures.

    • Professional documents.

    • Company registration.


Other joint issues include:
 

  • Grandfathering and transition plans.

  • A comprehensive marketing plan as well as an engagement strategy tailored to a broad range of stakeholders should be developed and implemented.

 

Where to from here?


ANZCA, the ASA and the NZSA want to hear your thoughts and opinions. 

This is not a trivial decision, and it is recognised that this should not distract us from many of the other large and important issues we are dealing with. 

The three organisations have agreed to proceed down this line of inquiry together, noting that keeping the profession united is the most important thing for our external relationships and for our public perception.
 
A respectful discussion is the aim, and if the council and boards of all the organisations agree then we will proceed to finalise a decision with an online vote of the members of all the organisations by the end of 2018. 

Consultation with our respective memberships, ANZCA trainees and other relevant stakeholders will occur over the next few months.


Professor David A Scott
President, ANZCA

Associate Professor David M Scott
President, Australian Society of Anaesthetists

Dr David Kibblewhite
President, New Zealand Society of Anaesthetists


Reference:
Mathur et al Indian J Anaesth. 2009 Apr; 53(2): 179–186
https://www.wfsahq.org/images/UHC_Position_Statement_Final.pdf

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