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CRNA's: sorry not worried anymore

Discussion in 'Anesthesiology' started by dizzy21, 08.18.11.

  1. dizzy21

    dizzy21

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    114 CRNA schools in the US currently, thats about 1000 of them per year. As a resident I used to agonize about the future of our specialty.

    Who knew it would be the AANA to the rescue for us. They have mandated the opening of so many schools, enough to flood the market. Most SRNA's I talk to at my program are having to move out of state BFE for jobs. They are complaining that signing bonuses are non-existant.

    Like the 1990s for Anesthesiologists, supply will overwhelm demand, their salaries will go down.

    With the DNAP coming in 2025, thats another year of VERY EXPENSIVE CRNA school. >100K in debt for salaries that will be <100K/year, plus the added malpractice insurance that independent CRNA's will have to pay. That adds up to not a whole lot more for your average nursing salary. Plus more stress and added hours vs your typical nursing job. And the AANA has no clout to close these CRNA mills, they are huge money makers for the institutions that run them.

    These people have shot themselves in the foot. If anything we have provided the current generation of CRNA's the income and level of practice they enjoy. All it took was the AANA to get greedy.

    I will still contribute to ASA-PAC as where anesthesiologists land in this debacle I'm still not sure, but the OR will always need physicians perioperatively.

    But I at least can get comfort knowing that every time a CRNA tells me that he/she is equal to me, 15 years down the line, most will have rinky dink salaries lots of liability and debt levels that will dissuade more from entering the field. They always say they are cheaper "anesthesia providers", well they are about to get a whole lot cheaper.

    Worst comes to worse and we do get replaced (we won't), I can at least do something else as a physician and maintain a decent salary. For nurses this is as good as it gets, but it won't last long.

    Fight the good fight, contribute to the ASA-PAC, but know that in the end the AANA is doing more to hurt the CRNA practice than we ever could.
  2. Quirk11

    Quirk11

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    One needs to only follow the path of law schools, optometry schools to understand where this oversupply leads.

    If the argument is that anesthesiology is easy enough to be done by anyone than why wouldn't a bankrupt entity just hire a new CRNA grad over an experienced one, thus diminishing the job security of all CRNA's ? I don't see any winner here. The only reason I can see is what dr. doze said, that all politics is local (ie there is no strategy or cohesive plan here).

    I think Blade had a good solution. I am confident there is a strong percentage of CRNA's that don't want their field diluted or know that an effort to somehow characterize the field of anesthesiology as a non-physician field would be a disaster for many reasons. Why not work together on some level ? I think an ASA sponsored CRNA tract would make a lot of sense for the future.
  3. kazuma

    kazuma CA-3

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  4. bronx43

    bronx43 Word.

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    Uh... what does an oversupply of CRNAs have anything to do with their threat to MDs? The threat they imposed (real or imagined) is the same whether or not they over-reproduced and swung themselves out of market favor. Their making $150k or $90k is of no real significance to anyone other than them. The real question of the future lies in changes in the corporate structure of american health care, and how the market for anesthesia is in that kind of environment.
  5. Somethinologist

    Somethinologist

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    Was thinking the same thing...the fact that they will be oversupplied only serves to harm their compensation. while that makes me happy in a twisted way, it does not change the fact that some entities feel that a CRNA can do an adequate job of replacing an anesthesiologist
  6. SeoulMan

    SeoulMan

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    As an AA student I'm a bit worried. Salaries are dropping across the board for all midlevel new grads and it does make me wonder how easy it will be to pay off student loan debt that is much greater than 100,000. For all the talk of how much the ASA likes AAs, I am still not seeing a lot of new practices open up for us and I'm seeing groups taking advantage of us when it comes to pay. Unfortunately I'm learning that the ASA has just as much BS rhetoric as does the AANA.

    When I graduate I will gladly take a job in BFE, preferably if it pays well. I know my role in the OR and in the ACT. I just wish anesthesiologists would be willing to put their money where their mouth is and open up to AAs.

    As for CRNAs, they are shooting themselves in the foot, but it's only hurting AAs, too.
  7. IlDestriero

    IlDestriero Ether Man

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    The ACT model is always going to take advantage of the midlevel providers. How much you need to get paid is based on supply and demand. How much the MD makes covering 4 rooms at a time increases the less you make (x4). Why don't they cover 3 rooms and have more flexibility, better idea of what's going on, etc? Maximizing $$. If it's a management company running the show, you're both getting the shaft, while they skim the profits.
    You'll always be on the losing side of that. It's funny how different academic medicine is. You have to stay out of the red, but the goal is education, safety and efficiency over profits.
    The risk/reward/debt/income ratios are changing, for everyone. It will be a few more years before we really see what's what. All those CRNAs are dreaming if they think they're suddenly going to band together and displace MD only of ACT groups trying to bid for contracts. If anything, they'll fuel the expansion of management companies and drive everyone's compensation down even more.
  8. dizzy21

    dizzy21

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    Yes I guess I am happy in a twisted sort of way.

    But the way I see it. As compensation goes down, quality of CRNA's will go down. There AANA PAC will receive less money as >100k in debt plus a family to feed will probably take priority over professional group funding. There will be less incentive to go to anesthesia school for new recruits and less incentive to fight so hard for independence if compensation goes down across the board.

    And if they start making noise, fire the CRNA, hire another one desperate for a job. And trust me, they call MD's greedy, I'm sure your own CRNA run independent groups will fire you just as quickly as an ACT group would if they can get a cheaply compensated newly graduated CRNA moving to your neighborhood.

    I know CRNA's troll this board, you did it to yourself. Just remember, we gave you your income level and current practice. You guys are damaging your own income. Get ready for less vacations and more hours, and more lawsuits in the next 15 years. The days of 6 figure CRNA's are quickly coming to an end.
  9. Stank811

    Stank811 Junior Member

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    So there was once a little boy and on his 14th birthday he gets a horse... and everybody in the village says, "how wonderful. The boy got a horse" And the Zen master says, "we'll see." Two years later, the boy falls off the horse, breaks his leg, and everyone in the village says, "How terrible." And the Zen master says, "We'll see." Then, a war breaks out and all the young men have to go off and fight... except the boy can't cause his legs all messed up. and everybody in the village says, "How wonderful." Now the Zen master says, "We'll see."
  10. dr doze

    dr doze Neocon Gold Donor

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    Yup. Those that profess not to be worried are whistling past the graveyard.
  11. dizzy21

    dizzy21

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    Why is our specialty filled with so many chicken littles? Well if the sky is falling it's coming down on the CRNAs too. No question about that.
  12. Stank811

    Stank811 Junior Member

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    I do agree there seem to be a large number of those who are overly afraid but at the same time I feel you may have the antipodal view on the macro scale when in truth I feel it lies somewhere in the middle. At this time I don't see the use of midlevels disappearing or decreasing. I do feel they are shooting themselves in the foot when it comes to lifestyle (salary/benefits/work hrs) due to the CRNA mills everywhere which continue to appear and produce large numbers of midlevels. Also I think there will continue to be a increase use in AA with new AA schools appearing. All of which only benefits ACT practice creating a lean towards the ACT type model particularly in settings such as surgery/endo centers. As far as large hospitals I think likely there will be a push for more anesthesiologist in the OR doing the larger/complex cases, having a regional team, having an ICU presence, having a pre-op clinic, and a chronic pain team none of which they will look towards CRNAs/AAs to accomplish. All while continuing to do their own cases or supervising depending on the local arrangements.

    I feel that every field of medicine is seeing the same statement of " We are equal if not better" from their midlevel providers. I feel this has been prevalent over the past couple years in a large part due to the current political climate. Everyone hears from the government that they continue to look for ways to be cheaper while maintaining a higher quality. And then surprise multiple nurse paid studies come out saying that they are cheaper and equivalent/better than their physician counterparts. Probably not a coincidence.

    So CRNAs/AA are not going disappear, but in no way I am I worried about the future of our profession. In fact I am more excited to see how it is evolving and curious to see how it will shape up in the next decade or more. I think it looks pretty damn nice for us at this time.
  13. Quirk11

    Quirk11

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    No one has answered what the medical malpractice climate would be like in a hypothetical system dominated by mid-levels.

    The above study said we are near EM in terms of frequency and payments of lawsuit when I briefly read the article. That is emergency medicine by the way, not pathology.

    Do the lawyers just give up ? Wouldn't surgeons be easier targets ? Unless all starts become like Texas (ie the loser may pay) , I fail to see why anesthesiologists wouldn't be needed / wanted by surgons or hospitals.

    Haven't people already described how doctors are linked in lawsuits ?


  14. dizzy21

    dizzy21

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    I don't know of any case yet that has been tried where a NP or independent CRNA has been sued because refusal to refer to a physician. Or a hospital has been sued because an anesthesiologist was not available.

    Perhaps in the future a trial lawyer will try the argument that midlevels should have a physician around, but I have always thought that we shouldn't assume lawyers will bail us out of this mess.

    But like my original post, who needs lawyers when we have the AANA.

    Waiting on CRNA school #115 opening in a neighborhood near YOU!
  15. Taurus

    Taurus Paul Revere of Medicine

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    This is incorrect. I posted a while back of case where an independent NP lost a $6 million case because she did not refer a child with neuroblastoma (I think that was the diagnosis) to physicians and the child developed permanent long-term sequelae.
  16. UT_mikie

    UT_mikie Senior Member

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    Nice to see some optimism on this board finally. (sort of)
    Last edited: 08.26.11
  17. BLADEMDA

    BLADEMDA SDN Gold Donor Gold Donor

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  18. dizzy21

    dizzy21

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    I think the current CRNA's are well aware of the decline in quality of their new grads. Don't get me wrong, some CRNAs are strong, but I've seen all the mickey mouse CRNA mill students coming through with a whole lot of attitude but not much else.

    With increasing numbers of independent CRNA cases, morbidity will rise, there is no question. But litigation and malpractice has never been my point.

    The leaders at the AANA have been focusing on this inferiority complex with physicians but not putting the interest of its members first. It just blows my mind they would decimate the practice, income and lifestyle of current CRNA's just so they can run around and say they are just as good as MDs.

    Even if they gain complete equivalence to us in all states today, its not like 40000 Anesthesiologists will all of a sudden drop dead along with AA's. The surplus the AANA seeks to produce is gigantic. So much so that all current contributing members to the AANA will see an overall decline in income over their career. What kind of advocacy organization is that??

    Supply and demand, just because someone finally says you are the same as an MD doesn't mean you will get compensated as such. Is not being able to afford to send your own kids to CRNA schools worth this fight? Seems like it to the AANA.

    I'm still baffled by the leadership of that group. They've brainwashed their members into thinking they have their best interests at heart. Clearly they don't.

    As anesthesiologists created our own problems with CRNA's, looks like the AANA is busy creating problems of their own.
    Last edited: 08.26.11
  19. pgg

    pgg Laugh at me, will they? Moderator

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    The lawyers are well into their own self-made oversupply crisis, with no signs of ever slowing down - because the lawyer mills make money hand over fist. The CRNA mills are in no hurry to out the brakes on production for the same reason, and there will never be a shortage of SRNAs because becoming a midlevel is the only way to escape being a nurse.

    Perhaps we should be grateful that residency slots are subject to externally imposed and relatively inflexible limits.
  20. TecmoBowl

    TecmoBowl

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    First, read page 41.

    http://www.whitehouse.gov/sites/def...anservicesregulatoryreformplanaugust2011a.pdf

    Second, realize that we're not in a Democracy. It's a system where Nurses/Noctors get the privilege to practice MEDICINE by political means, as opposed to educational accomplishment.

    Next, know that the current Secretary Sebelius is a huge fan of CRNAs... except she doesn't want her family members cared for by them, she prefers Doctors.

    But, given that she gets to pick for everyone else, and given her past track record, what do you think?
  21. TecmoBowl

    TecmoBowl

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  22. BLADEMDA

    BLADEMDA SDN Gold Donor Gold Donor

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    A long list of individual suggestions and considerations all of which were forwarded to CMS for consideration as it develops future rulemaking:
    Many regulations requiring a “physician” to perform procedures or at least supervise them are called unnecessary by commenters because oftentimes the work can be done just as easily by Certified Registered Nurse Anesthetists (CRNAs) and other Advanced Practice Registered Nurses (APRNs).
    Similarly, this commenter wrote that current regulations, 42 CFR part 482.52(a)(4) requires unnecessary supervision by an “operating practitioner or an anesthesiologist” upping costs by increasing staff members but not safety. This commenter summed up these particular concerns by, “suggest[ing] that all regulations and interpretive guidelines issued by CMS be reviewed with the intent of removing restrictions concerning anesthesia services provided by nurse anesthetists.”
  23. BLADEMDA

    BLADEMDA SDN Gold Donor Gold Donor

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    Tecmo,

    I miss your posts. Please take a minute and share your opinion with us from time to time.
  24. RxBoy

    RxBoy

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  25. Quirk11

    Quirk11

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    The future of the physician profession in this country is up to the government. The government can and will define what it wants to create in this system for "supply" and "demand".

    In Vermont, the public option will be under trial starting soon. Yes, not all of you live in a state full of cows, rolling hills, and Canadian like vistas - but how long before this "great idea" comes to you?

    In Massachusetts, the government considered forcing providers to take so much medicaid of not work there.

    Tennessee considered some bill regarding forcing medical students to return service. (described but I have had trouble finding the links)

    Will some state government get the idea to let foreign doctors practice under restriction as Canada did ? That would surely save costs...

    Will the government "permit" a specialty like pain medicine to exist as in other first world countries? Or will they prefer a population doped up on pills and sadly addicted because its "cost efficient".

    The "mid-level" provider is in many fields. Dentists have advanced hygenists, they launched the "dental therapist" in Minnesota. Optometrists have "surgical rights" in 2 states now. Emergency medicine also can be done by non-physicians as well (http://www.healthleadersmedia.com/p...-Practitioner-Elected-Medical-Staff-President). While "mid-levels" have different practice rights, their de facto existence decreases demand for non mid-levels regardless. IE, the fact that an ED employes 10 PA's does decrease demand for a physician to some level regardless of the practice rights. Hopkins just started a GI program for non-physicians. That being said, I am not disagreeing with some of the comments of others on this board.

    Ron Paul talks about how the government will pay its debt by inflation. Ie, medicare will still pay for procedures but if inflation continues then it won't be much of a burden. What happens then ?

    15 years ago dental specialists did not make as close an income to as physician specialists, now they do. Why ? They operate closer to market forces..THEY DEFINE THE MARKET...

    Yes, supply and demand work to an extent in medicine - but not quite, otherwise primary care physicians and hospitalists would be treated better.

    We should take a look at the fundamentals of this system.

    I would argue that if a future pediatrician has more debt than a pediatric dentist, a much more brutal lifestyle / training years, and makes 1/4 as much than this career may already be in serious trouble.

    Thus, things need to change in many ways for this career to be viable in the future.

  26. BLADEMDA

    BLADEMDA SDN Gold Donor Gold Donor

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    http://www2.tbo.com/news/education-...rice-hike-for-professional-degrees-ar-254898/

    In a letter to Brogan, USF President Judy Genshaft explained that USF now turns away more nurse anesthesia applicants than it admits and market-based tuition will bring in the money it needs to possibly double enrollment next year, from 15 to 30.


    The proposed market-rate tuition is high &#8211; $57,600 for a 28-month program compared to the current $36,331 for in-state nurse anesthesia students. But that's comparable to the University of Miami, for instance, which charges nearly $62,000, a USF report says.

    And the demand for nurse anesthesiologists is so high, students who graduate are nearly guaranteed six-figure-salary jobs.
  27. bibibi

    bibibi

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    Ugh. I don't think its that easy to find a job. I actually think it is very hard!
  28. jwk

    jwk AA-C ASA-PAC Contributor

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    It's definitely not that easy in Florida at the moment. Far too many schools.
  29. dizzy21

    dizzy21

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    I think false statements such as the one above are made by all the nurse anesthesia schools that are currently making a killing off of the SRNA's.

    Its funny how SRNA's complain that CRNA school is not medical school and they should not be charged as such.

    Yet they run around saying they are pretty much physicians.

    As much as I feel that our field was sold out by the older generation of anesthesiologists, I can see why they would open up these CRNA schools as they are currently making probably more money than you could doing clinical anesthesia.

    Anyway, as much as CRNA's talk big, in the end it will be the oversaturated market and increasing malpractice that will ultimately be the biggest problems for the independent CRNA's going forward.

    You can't complain about being a stool sitter when there are 20 other CRNA's banging on the door for your job for 1/2 the salary.

    They will still be competing in a market with anesthesiologists, who work more hours and take on more liability plus all the other CRNA's coming out of the mills by the thousands.

    The job market will only get tougher for CRNAs. Definitely us as well, but the CRNA's will fare far worse.

    Thank you AANA for ruining it for everyone especially CRNAs. Great advocacy group you guys got there.
  30. Harp32Wil

    Harp32Wil

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    The real question of the future lies in changes in the corporate structure of american health care, and how the market for anesthesia is in that kind of environment
    [​IMG]
    [​IMG]
    [​IMG]
  31. jwk

    jwk AA-C ASA-PAC Contributor

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    They are indeed their own worst enemy.
  32. drpainfree

    drpainfree

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    actually, if CRNA makes 80K vs. 150K in near future, it spells out the doom of our field even faster: it gives even more financial incentive hospitals and anesthesia management companies and even mature anesthesia group to replace MD with CRNA.

    Yes, they will be a lot of them...to replace a few of us.


  33. ventilator

    ventilator

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    well said!
  34. dizzy21

    dizzy21

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    Seems like the crnas are bugging out about the Rand report. Instand corrected though. There are 115 CRNA schools now.
  35. BLADEMDA

    BLADEMDA SDN Gold Donor Gold Donor

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    You should be very worried about your future. The AANA is coming for you.;)
  36. BLADEMDA

    BLADEMDA SDN Gold Donor Gold Donor

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  37. BLADEMDA

    BLADEMDA SDN Gold Donor Gold Donor

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    Other research and data support the RTI finding that there are no differences in quality of anesthesia services delivered by CRNAs and anesthesiologists. Most recently, a study about the cost effectiveness of nurse anesthetists released in May included a comprehensive review of published studies. The review found no measurable differences in the care provided by CRNAs and anesthesiologists. Equally important, the study showed CRNA-only anesthesia care to be the most cost-effective anesthesia-delivery model.
  38. BLADEMDA

    BLADEMDA SDN Gold Donor Gold Donor

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    The mantra for CMS is COST EFFECTIVE. This means Quality comes Secondary to Cost. Morbidity and Mortality numbers will be hidden or just go unreported. The LEFT has no interest in the FACTS unless it supports their agenda.

    NPs and CRNAs will be practicing Independently all across the USA in the near future. In fact, according to the militant Nurse Anesthesia website there are over 5,000 CRNA Run practices right now across the USA.
  39. BLADEMDA

    BLADEMDA SDN Gold Donor Gold Donor

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    In business and economics, predatory pricing is the practice of selling a product or service at a very low price, intending to drive competitors out of the market, or create barriers to entry for potential new competitors. If competitors or potential competitors cannot sustain equal or lower prices without losing money, they go out of business or choose not to enter the business. The predatory merchant then has fewer competitors or is even a de facto monopoly, and hypothetically could then raise prices above what the market would otherwise bear.


    Predatory Merchant= AANA
  40. BLADEMDA

    BLADEMDA SDN Gold Donor Gold Donor

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    Certified Registered Nurse Anesthetists (CRNA) 66 up, 24 down
    A masters or clinical doctorate prepared nurse that is specially trained as a provider of anesthesia and perioperative care. Certified Registered Nurse Anesthetist (CRNA) have provided anesthesia even before the first school was founded in the the early 1900's. The recent up rise of CRNA use stems from medical institutions realizing that they are just as effective and safe as their physician counterparts while incurring half the cost. CRNAs are the sole anesthesia providers in nearly 100 percent of the rural hospitals.

    Many physicians are opposed to CRNAs because they feel their positions and thus job security is threatened and they in turn label CRNAs “mid-level” providers. As the medical community moves towards a friendlier, more cost effective and equally safe health care model, the contribution of CRNAs is invaluable.
    Recent studies have shown that Certified Registered Nurse Anesthetists (CRNA) provide anesthesia and perioperative care just as safe as their physician counterparts at half the cost. Many physicians slander the CRNA profession because the physicians realize that their own education is superfluous.
  41. hanlinting

    hanlinting

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    This study assumes that ACT model would be in place next two decades. Actually, if you read the fine print, it says if current practice model change (read more states opting out with independent practice), there will actually be a surplus of anesthesiologist and shortage of CRNA. Correct me if i am wrong. IMHO
  42. BLADEMDA

    BLADEMDA SDN Gold Donor Gold Donor

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    You are Wrong. For at least the next ten years the CRNA surplus will far exceed the Anesthesiologist surplus.

    That said, Anesthesiologists in the USA are at an all time high. 50,000 and counting!
    This is large increase of at least 20,000 over the past ten years.

    Thus, I predict the AANA victory will be a phyrric one with little celebration in terms of income.
  43. dr doze

    dr doze Neocon Gold Donor

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    Yup. They will know the victory of the successful suicide bomber.
  44. foxtrot

    foxtrot Member

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    Blade is exactly right. The new mantra for CMS is COST EFFECTIVE. This is also a large component of Obamacare. If things continue down the current path, it will no longer matter the amount of training or board certifications one has. When I practiced in a smaller town, I saw patients in the pain clinic who had never even seen a primary care doctor and were being managed by NP's. In many opt out states (in particular the Midwest), there are significant numbers of CRNA's groups practicing and making huge salaries. All of this is important because pre-medical and medical students need to know the what the future of medicine is facing, in particular anesthesia.
  45. hanlinting

    hanlinting

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    this is so depressing .... make me feel like i should apply to another field. The other day, i looked up job advertisement on gaswork website on states that has opted out. I see more postings for anesthesiologists than anesthetists and also their advertised salary are in 200-300 range while CRNA are 120-200 range. If CRNA are so effective, why are there jobs for anesthesiologists in these states at aforementioned salary? I feel like with CRNA turning into DNA, their supply will become limited and AA will likely take the role of CRNA. Do you think CRNA and docs will coexist and define their own turf like other specialties or will anesthesiology as a field will transform into one that is unrecognizable? Also, CRNA vs ologist battle has been going on since 1980s, what make this crisis different? Is there false complacency in saying that "they have been predicting death of anesthesiology for decades and look we are still here."

    If a student like me is going to anesthesiology, what are the worst scenarios that he/she should keep in mind? Are we talking about salary reduction into 250? or we talking about literally not having a job? or we talking about working as CC docs because the field has changed? Any input appreciated.
  46. BLADEMDA

    BLADEMDA SDN Gold Donor Gold Donor

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    Anesthesiology will exist as a medical specialy. I urge strong consideration for a fellowship.

    Incomes will drop over time. The field has peaked in terms of money. There are still pockets of great practices with low Medicare/Medicaid and self pay. Those practices will endure the longest. However, Obamacare will eventually even get them. Resistance is futile. Obama wants cheap, cost effective care (which means cheap as possible).

    CRNAs will not take over the fied completely. They may displace Physicans from the stool sitting role in some areas.

    Yes, income could decrease to $200 for academia and $250-275 for private practice circa 2022. The problem with that income is inflation will have eaten away at the real value of that money by then. This translates into much lower income in today's dollars.
  47. W222

    W222 2K Member

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    The sad thing that I now realize is that this will likely occur in EVERY specialty, with a few rare exceptions. No longer will medicine be run by internists/hospitalists, it will be run by NPs/PAs with almost complete independence. The ICU will be run by midlevels with some input from the CC physician (I have witnessed this taking place). The surgical specialties will resist this the most but they are going to see their reimbursement drop as certain operations are considered "too costly" and "unnecessary" (ie. knee replacements in 85 yo ASA 4s).
  48. dhb

    dhb Member Lifetime Donor

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    Sad but true
  49. stationroad

    stationroad

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    What is that going to do? Do you realize probably the small percentage of anesthesiologist practice icu full time? Its not going to increase your job prospects, or if it does very minimally. And if you want to do CCM go into internal medicine
  50. Navyanesdoc

    Navyanesdoc

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    Doesn anyone practice in California? WIth the new opt out, was wondering one question??? Are CRNA's in California required to have a DEA? Per DEA rules, I dont necessarily need one since Im only prescribing in hospital, but every place I have been required a DEA from me. Hope you can see where I begin to go with this. Passive aggressiveness- If fairness is wanted, fairness should be paid for and regulated as it is for physicians who rx.

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