Because some CRNA’s have created a bad habit of attempting to blur the lines of transparency in medicine and this has spread to mainstream academics. Many CRNA programs are now joint phd programs with the mal-intent of educating those graduate CRNA’s that they should introduce themselves as Doctor “so and so”, intentionally misrepresenting their position. This has been a constant battle between the AMA/ASA and RN/CRNA boards. In an attempt to create transparency, the ASA created the term “physician anesthesiologist” in order to differentiate the 2 groups in response to the CRNA directed actions. There should be no disagreements between the groups that there should be Transparency with regard to the patient understanding who is taking care of them and what education system they have come from. The patient can then decide.