1900 CRNA's to graduate next year!!!

[nradsoit3]

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Ok, I don't mean to start another CRNA vs MD debate which has already been beaten to death here before, but I definitely find these numbers rather disconcerting that I came across in a recent Grogono report http://www.grogono.com/nrmp/2003/Residencies03.pdf (scan towards the bottom). According to current enrollments and projections, there are an estimated 1900 CRNA's to be graduating next year alone-- this is TRIPLE the number graduating in 1989!!! Even in the mid 90's when the total number of anesthesia grads was 1796 and CRNA grads were only around 1000, a huge oversupply glut was created causing a precipitous drop in anesthesia interest. And unlike other fields like derm or ortho which can tightly control their numbers, it seems like there is little the field of anesthesiology can do to control their own numbers when CRNA schools keep fattening up their enrollments??? In addition, every year more and more states are allowing CRNA's to practice independently (I believe there are nearly 20 states already)- just a matter of time before they are allowed in all 50 IMHO. According to the report, around 1400 new anesthesiologists need to be trained to maintain supply and demand, but how is this possible with this CRNA surge and increased independence???

 

[Old MD]

... but how is this possible with this CRNA surge and increased independence???

I think it's not. In 15-20 years, anesthesia in most hospitals will be mostly provided by nurses. There won't be much difference in overall mortality and morbidity, there will be some measure of cost reduction. This is good. The bad is there will deifinitely be poorer care for the small number of complex patients, probably with increased M&M which likely will not be studied by the nurse groups (who are already wallowing in study after study "proving" equivalent care "patient satisfaction" lol).

I think the change is not necessarily a bad thing, it is just change.

In the overall scheme of things, because the nurses don't perform much differently than doctors for most cases, there will be just net cost savings (don't have to pay for so much advanced education of MDs).

Not going to impact hugely the health care system.

Just my 2c opinon.

 

[MDEntropy]

Patients are charged the same amount for anesthesia services regardless of who provides it.

CRNA's see independent practice as a way to increase income; theoretically their incomes will approach that of MD's. If more money were not involved, CRNA's would not be interested in indenpendent practice. More liability at the same salary --- for what???

Patients only save if reimbursement drops and CRNA's practice independently at their same salaries. This won't happen. CRNA's are going to demand more money if practicing independently - that is the whole point - it's not about ego, it's about $$$.

Differences in training MAY become more apparent as more CRNA's are created (being admitted to NA school as slightly less than the absolute cream of the crop and with less extensive ICU nursing experience).

Differences in training WILLl certainly be more apparent if all fresh NA school grads are immediately practicing without supervision. CRNA's gain a wealth of additional experience and are still on the steep slope of their learning curve in their first few years out of school. If they are going to practice unsupervised right out of the blocks either NA school gets longer and more comprehensive, or more people get hurt.

Much of this mysterious educational cost of an MD, which is not burdened by the MD, is societal. Recapturing the savings is not going to happen.

Significant cost savings??? No. Why not? it's just not this simple analysis of CRNA's make $55-75 per hour and many anesthesiologists make twice that. So if we replace all the anesthesiologists with CRNA's AND EVERYTHING ELSE REMAINS THE SAME, we will save lots of money. Everything doesn't remain the same, and labor costs are not a huge factor overall.

If every MD (all specialities) in this country took a 50% pay cut, what would be the overall (percentage) savings to the health care system? If you want to know the answer, just find the percentage of health care expenditures that go to MD salaries, then cut that number in half. It's less than you think. Changing MD labor costs is really an ineffective lever for creating savings in the US health care system. This is not even a point of debate among healthcare economists.

 

[Leukocyte]

Let me say this. I am currently decideing between GS and Anesthesia. The ONLY reason I might actually end up going for GS, is because of the "unknown" future of Anesthesiology. True that midlevels are invading almost every medical feild, but boy, NOTHING beats those CRNAs. Those dudes can actually practice WITHOUT an Anesthesiologist supervision!!!!! I mean:

Ophthalmology is doing something about Optimetrists. (Read Dr. Doan's posts) 👍
Surgical PAs, are put in their place by Surgeons , and do not function beyond the scope of a Surgical resident.

But what are Anesthesiologists actually doing to prevent CRNAs from dominating the future of Anesthesia?????? 😴

Neeeeah, I think I will go for GS. At least surgeons are aggressive, rude, condiscending, anti-social, conservative, hawkish Mo Fos that have the balls to fight whoever wants to "steal" their share of the pie. Anesthesiologists are just waaaaaaaaaaaaaay tooooooooo nice and proper.

 

[moo]

My question is, where's MacGyver?

 

[apma77]

if surgeons were very protective of their turf,,,medicare reimbursement wouldnt be so low as it is today..starting salary for most gen surgeons <$160k

crnas will get to practice unsupervised and people will start dying quick (esp the real sick ones) and then only will we get legislation to control the situation

unfortunately it will take a few deaths at the hands of crnas (and publicized on national media) for the legislators to realize this isnt as good as it seems.

until then get used to crnas going solo

 

[deltamed]

If every MD (all specialities) in this country took a 50% pay cut, what would be the overall (percentage) savings to the health care system? If you want to know the answer, just find the percentage of health care expenditures that go to MD salaries, then cut that number in half. It's less than you think. Changing MD labor costs is really an ineffective lever for creating savings in the US health care system. This is not even a point of debate among healthcare economists.

Ok lets see. There are about 600,000 physicians in the USA. They make on average $200,000/ year. That is 120 billion dollars per year. If everyone took a 50% paycut that would be savings of about 60 billion a year. Heathcare expenditures for 2003 were 1.6 trillion dollars in the USA. So we could save 3.75% on healthcare costs.

On the other hand, it is estimated the US spends 500 billion dollars per year on healthcare administrative costs (hospital admin, bean counters, HMO employees, physician lost time in billing etc). If we could cut that in half it would reduce costs by 17%. Canada has less than half the admin costs of the US as a percent of healthcare expenditures.

It is a shame the public thinks the "excessive" earnings of physicians is why healthcare is so expensive. We should try to make sure they become more educated on the matter.

 

[amnesic]

This is not exactly the news that I want to hear...

 

[Celiac Plexus]

i didn't know that crnas had that much clout. I just did a job search for crnas and found several surprising offers... all greater than 100k/yr.

In fact, one of the offers for a crna with cardiac experience offerred 140K. This seems weird considering that primary care specialties are being offerred LESS.

It seems incongruous that a person who completes college/med school/residency, and spends 100s of thousands in tuition and lost economic opportunities will make less than a crna.

Then again, if a crna can do the job of an anesthesiologist, and will accept less pay then it does make sense. Just seems like a bad precedent.

There really is no analogous job in surgery. Surgical PAs are trained to assist surgeons, but are not allowed to operate unsupervised. What exactly is the deal with crnas? Can they really run the anesthesia unsupervised? As a surgery resident, I would feel highly uncomfortable knowing that there is no anesthesiologist around to manage the gas. I would really not want to operate without an anesthesiologist. I don't care if the case is a hemmorhoidectomy. Complications with anesthesia can kill patients. I want an MD there with me to make sure that does not happen to my patient.

 

[Leukocyte]

If the public only knew that their anesthesia might not be monitored by a board certified Anesthesiologist......THAT WILL SHAKE THINGS UP IN THE CONGRESS. Don't you think? 😉......You know, the good old trick of I will not vote for you unless you make sure that my health care (anesthesia) is provided by the best of the best, kind a thing.

Ohhhhh, I would love to see those ads on the TV:

Do you know that YOUR anesthesia, might be provided by someone who is NOT AN ANESTHESIOLOGIST?......Are YOU willing to take that risk?.......Vote YES on proposition 162.

Brought to you by the American Medical Association, the American College of Surgeons, and The American Board of Anesthesiology.

........HELL YEAH!!!!!!!!!!!!!!!

 

[jwk]

Neeeeah, I think I will go for GS. At least surgeons are aggressive, rude, condiscending, anti-social, conservative, hawkish Mo Fos that have the balls to fight whoever wants to "steal" their share of the pie. Anesthesiologists are just waaaaaaaaaaaaaay tooooooooo nice and proper.

Leaving the CRNA issue out of this ---

I thought general surgery was on the way out. 🙂 You have colo-rectal surgeons taking their piece of the pie, sub-specialization for breast surgery, and god only knows what interventional radiologists will be doing next week - this week they're embolizing tumors and uterine fibroids, and placing Portacaths using ultrasound and x-ray guidance in the special procedures suite.

Don't tell me general surgeons have balls - they barely have a single slice of pie left in many places.

 

[crna2004]

We are coming. We are well trained, and able to do 99% of what MDAs do - for a fraction of the cost. The reason why so many are graduating? We are here to replace you. Good luck trying to find a anesthesiology job in 10 years as a MDA.

 

[Mr_Money]

We are coming. We are well trained, and able to do 99% of what MDAs do - for a fraction of the cost. The reason why so many are graduating? We are here to replace you. Good luck trying to find a anesthesiology job in 10 years as a MDA.

Stop huffing the nitrous nurse. You glorified technicians will never replace the real men of the OR. What happens if an insulin dependent diabetic with renal failure is coming in for a redo CABG? I'll tell you what happens in my institution: I do the case, perform the TEE and make all the decisions while the CRNA does the charting and empties the foley like a good little bitch. You will never replace an MD and I'd hire an AA any day over an idiot like yourself. Get real, inferior! 😎

 

[jwk]

We are well trained, and able to do 99% of what MDAs do...

No, you really can't. You obviously don't know how much you don't know.

 

[crna2004]

"Stop huffing the nitrous nurse. You glorified technicians will never replace the real men of the OR. What happens if an insulin dependent diabetic with renal failure is coming in for a redo CABG? I'll tell you what happens in my institution: I do the case, perform the TEE and make all the decisions while the CRNA does the charting and empties the foley like a good little bitch. You will never replace an MD and I'd hire an AA any day over an idiot like yourself. Get real, inferior!"

No doubt. However, how many cases are as you describe? 1%? .5%? Less? Sure, MDAs might always do the most complicated cases. But, will the job market support the thousands of new MDAs entering the field? I doubt it.

 

[IsoGirl2707]

If the public only knew that their anesthesia might not be monitored by a board certified Anesthesiologist......THAT WILL SHAKE THINGS UP IN THE CONGRESS. Don't you think? 😉......You know, the good old trick of I will not vote for you unless you make sure that my health care (anesthesia) is provided by the best of the best, kind a thing.

Ohhhhh, I would love to see those ads on the TV:

Do you know that YOUR anesthesia, might be provided by someone who is NOT AN ANESTHESIOLOGIST?......Are YOU willing to take that risk?.......Vote YES on proposition 162.

Brought to you by the American Medical Association, the American College of Surgeons, and The American Board of Anesthesiology.

........HELL YEAH!!!!!!!!!!!!!!!

I agree. I think if the public knew that nurses were providing their anesthesia care versus an MD during major surgery, the issue of CRNA's practicing independently would be a thing of the past. It is really not right and almost misleading that patients go and meet their surgeon, internist, OB/GYN, etc, but not their anesthesiologist. I think there should be a law stating that people should be told who will be providing their anesthesia care and as a patient you should have the choice between a CRNA and an MD. If someone chooses to have a CRNA then so be it and vice versa. But it should really be illegal to allow patients to think that they are being taken care of by an MD in the OR during surgery when they are not. Patients have every right to know who is taking care of them and have the right to choose between an anesthesiologist and a CRNA. This discussion should be a part of the whole pre-op process. Rather than arguing about turf wars between the two groups, patients should be allowed to decide who they want providing their anesthesia care, especially since they are paying for it. I would love to see the ASA press congress for these types of laws.

 

[Gator05]

We've already established that CRNA's are rather well reimbursed. And if CRNA's are granted complete independence, there will be a direct competition between MDA and CRNA for business.

Most probably, MDA's then will be reimbursed at the same rate as CRNA's. Thus, financially for payers, even assuming CRNA's produce no more complications than MDA's (a falsehood; please see A&A from 1-2 months ago), CRNA's will equal MDA's. At the surface, this is the CRNA's dream come true.

Ah, but remember the Chinese proverb; may your enemy be granted their wish. CRNA's won't offer a cheaper alternative if MDA's settle for less income, which they would be forced to do. So then what does a CRNA have to offer over an MDA, if the payer is forced to choose between the two?

Better yet, what does the CRNA have to offer the hospital itself? (Ninety-nine percent is a load of crap; anyone in the business knows this.) The MDA can advertise ICU coverage, pre- and post-operative care, tie-in with a pain practice, TEE exams, advanced neuromonitoring, FELLOWSHIP TRAINING. And marketing too...

CRNA's do receive excellent training, and are an incredibly valuable member of the healthcare team. Most OR's simply couldn't function without them today. But it's prudent to recognize one's own limitations. Better to recognize them yourself, than have a trial lawyer find them for you.

 

[Leukocyte]

If we must have professional assistants, I would rather hire a PA (AA) over a CRNA.

1) They are supervised by Anesthesiologists.
2) They are better trained (way better trained) than nurses in MEDICAL desicion making.
3) More professional, more "doctor-like", than nurses.
4) The PA profession is "linked" to the MEDICAL profession, while NURSING is a bastard child.

 

[MDEntropy]

Ok lets see. There are about 600,000 physicians in the USA. They make on average $200,000/ year. That is 120 billion dollars per year. If everyone took a 50% paycut that would be savings of about 60 billion a year. Heathcare expenditures for 2003 were 1.6 trillion dollars in the USA. So we could save 3.75% on healthcare costs.

On the other hand, it is estimated the US spends 500 billion dollars per year on healthcare administrative costs (hospital admin, bean counters, HMO employees, physician lost time in billing etc). If we could cut that in half it would reduce costs by 17%. Canada has less than half the admin costs of the US as a percent of healthcare expenditures.

It is a shame the public thinks the "excessive" earnings of physicians is why healthcare is so expensive. We should try to make sure they become more educated on the matter.

I like your analysis. The assumptions are reasonable.

In fact, actually only about 2% of healthcare expenditures go towards physician salaries.

And obviously only a small fraction (less than 10%) of that goes to anesthesiologists.

In the last decade rising drug costs have been the major factor leading to the seemingly ever increasing spending on health care.

And of course you are right about all the administrative spending.

 

[conservative]

I like your analysis. The assumptions are reasonable.

Only about 2% of healthcare expenditures go towards physician salaries.

And obviously only a small fraction (less than 10%) of that goes to anesthesiologists.

In the last decade rising drug costs have been the major factor leading to the seemingly ever increasing spending on health care.

And of course you are right about all the administrative spending.

Part of the reason administrative spending is so high is because of excessive regulatory burdens placed on hospitals and insurance companies. They just pass those costs right on through to the consumer.

 

[MacGyver]

We've already established that CRNA's are rather well reimbursed. And if CRNA's are granted complete independence, there will be a direct competition between MDA and CRNA for business.

Most probably, MDA's then will be reimbursed at the same rate as CRNA's. Thus, financially for payers, even assuming CRNA's produce no more complications than MDA's (a falsehood; please see A&A from 1-2 months ago), CRNA's will equal MDA's. At the surface, this is the CRNA's dream come true.

Ah, but remember the Chinese proverb; may your enemy be granted their wish. CRNA's won't offer a cheaper alternative if MDA's settle for less income, which they would be forced to do. So then what does a CRNA have to offer over an MDA, if the payer is forced to choose between the two?

Better yet, what does the CRNA have to offer the hospital itself? (Ninety-nine percent is a load of crap; anyone in the business knows this.) The MDA can advertise ICU coverage, pre- and post-operative care, tie-in with a pain practice, TEE exams, advanced neuromonitoring, FELLOWSHIP TRAINING. And marketing too...

CRNA's do receive excellent training, and are an incredibly valuable member of the healthcare team. Most OR's simply couldn't function without them today. But it's prudent to recognize one's own limitations. Better to recognize them yourself, than have a trial lawyer find them for you.

You dont get it. CRNAs would be happy making 100k per year. Can you say the same for MDAs? Hell no. Think about it. Even if CRNAs were only making 100k per year, they'd still be (BY FAR) the most well paid nursing discipline. NPs average 60-80k.

Direct competition between CRNAs and MDAs will price MDAs out of the market. Cost reduction would continually decrease until competition ended. Competition will end once med students decide that its not worth it to work those years of residency to make 100k or whatever and the CRNAs will "win." MDAs will still do the 5 or 10% of procedures that happen to be the most complex, but anesthesiology as we know it will cease to exist.

 

[MacGyver]

My question is, where's MacGyver?

I was cautiously observing and biding my time.

I AM MACGYVER, HEAR ME ROAR!!!

 

[MDEntropy]

You dont get it. CRNAs would be happy making 100k per year.

This isn't true. Where I am from CRNA's start at about $57/hr with full benefits and union support and can work overtime making 1.5 times their base pay rate. Getting 10 hours of overtime per week is easy amounting to working 50 hours/week and making 160K/yr. After 8 years, their pay is up to about 75 per hour.

Many CRNA's would not be happy making 100K. And some are not happy making twice this. And that is why they want independence.

Some CRNA's do not want independence because they feel they have a good deal right now and believe that the AANA's push for independence could back fire into a downwardly spiraling bidding war. We will need oversupply before that can happen.

 

[Leukocyte]

Where are the good old days when the Anesthesiologolist used to be his/her own master/mistress? 🙄

 

[deltamed]

I'm really surprised the AMA hasn't made a real effort to crush the CRNAs yet. Abilities aside, the AMA has waged war, supressed or absorbed many professions in the past that tried to take a piece of the "pie" including podiatrists, homeopaths, naturopaths, and chiropracters. Most of these efforts in the past have been largely sucessful.

I can only think the fragmentation of the physicians into specialty groups has erroded the political power of the AMA. As a united lobbying group the physicians have been excellent at keeping other healthcare practitioners from overtaking their turf. Why hasn't there been public commercials against CRNAs? Why hasn't Congress enacted new laws?

Its probably because of the immense pressure to lower healthcare costs. The public thinks that replacing doctors with midlevels will lower costs. As my analysis before suggests, this will do very little. The public doesn't know this however, and the politicians will bow to their pressure.

As physicians we have to a) make sure the public is reeducated on the midlevel issue and b) lobby to lower healthcare costs in a more effective way so the pressure will subside on our reimbursements.

 

[MDEntropy]

Even if CRNAs were only making 100k per year, they'd still be (BY FAR) the most well paid nursing discipline. NPs average 60-80k.

Unfortunatley, your analysis is flawed because you don't have a real handle on what many nurses actually bring home, as opposed to what their annualized salaries are based on their base wage. An experienced RN can easily work 50 hours a week and bring home 100K. It is nothing for an ER or ICU RN to make $40 or nearly $50 per hour and then to work a small amount of overtime and drastically supplement their income. The avg. anesthesiologist works 55 hours/wk. If a regular hospital floor RN works this much, he/she will make 100K+ even right out of nursing school making $32/hr.

Still CRNA's are the highest paid advanced practice nurses and many make 120-150K working only 40 hours per week and with full benefits. But they want to make more, plain and simple - as they are not happy making 100K.

 

[Leukocyte]

I'm really surprised the AMA hasn't made a real effort to crush the CRNAs yet. Why hasn't there been public commercials against CRNAs?

The only thing that will "crush" the CRNAs, for sure, will be PUBLIC ADS sponsored by the AMA.

When people start demanding Anesthesiologists and refusing services from CRNAs, the CRNA supply line will be shutdown forever.

This is the only way. Let the American people decide. They hold all the power.

 

[driverabu]

We are coming. We are well trained, and able to do 99% of what MDAs do - for a fraction of the cost. The reason why so many are graduating? We are here to replace you. Good luck trying to find a anesthesiology job in 10 years as a MDA.

I like that..."for a fraction of the cost." I am going to be laughing at all of the CRNAs when they have to pay the malpractice insurance premiums that the MDAs pay and when the CRNAs get sued for incompetence. Then we'll see about CRNAs doing what MDAs do "for a fraction of the cost." After you people have to pay what MDAs have to pay, you won't be as cheap to come by and then who do you think hospitals are going to prefer for relatively the same cost? CRNAs will never replace the REAL anesthesiologists.

 

[joshmir]

One thing to consider though is that with fewer CRNAs, we would have fewer lunch breaks, less vacation, and more call.

I have never met a doctor who feels like they get too much of any of the above. I imagine most gas groups try to find a comfortable medium between work and rest. if there's a national tv campaign that has every patient coming in to pre-op saying "I want my anesthesia to be provided by a doctor", this balance may be much more difficult. Will we ever be able to tell these patients "It's ok, as a doctor, I will be 'supervising'?" Hopefully.

FMGs (not USFMGs) will always be willing to fill slots in gas residencies and make good attendings even if they only get payed 100k. We've seen this over the years...most gas programs are now more comfortable taking FMGs b/c they have had to for the past few years.

The next generation of FMGs wil have much better english skills than the current ones, probably due to the expansion of satellite tv and the internet. that's why large amounts of US medical transcription is performed in the phillipines and india.

so if there will always be FMGs willing to fill gas residency spots and attending jobs (no matter what the compensation), how does that change things?

prophlactically, i don't think there will EVER be a critical mass of patients saying "I want an american doctor".

gator05 said:
"But it's prudent to recognize one's own limitations. Better to recognize them yourself, than have a trial lawyer find them for you."

i like that.

 

[nradsoit3]

I by no means profess to be an economist, however I do know from my ECON 101 class in undergrad the laws of supply and demand. Clearly, if CRNA schools keep churning out nearly 2000 a year- something has to give. One only needs to look to what happened to Anesthesia just a couple years back to understand this. The job offers slowed to a trickle and medical students knee jerk reacted away from anesthesia residency programs. If this was the only problem, then fine I say. In due time the numbers would even out and we would better target our numbers in the future. But this is not the case!
What I find most disturbing about this current state of affairs is the fact that there appears to be no control whatsoever MD's have over this situation! I do realize that mid-level providers are intruding on every field of medicine nowadays and everyone wants to "play doctor" without having to go to medical school, but in no other field is this more apparent than anesthesia.
I am even more convinced now that we are on the brink of a takeover of anesthesia by CRNA's than I was just a couple years ago. At least then, CRNA's had to be supervised by a MD and the number graduating per year was in proportion to residency graduates. In addition, when one considers that anesthesia is 30X safer than just 20 years ago this is yet perfect fodder for the CRNA lobby to further their cause. Just visit the AANA or CRNA forum on allnurses.com and see for yourself. Do we really need to train 1400 new anesthesiologists every year to handle those few complicated cases or oversee an ICU or post-op unit??? Like I said, something has to give. Besides, this is America and money talks.
To quote current salaries as evidence there is strong demand is moot. To say we need more CRNA's so we can take coffee breaks is equally so. One needs to look to the future and not the present. Actually the very near future when one takes into consideration that CRNA school is only 2 years vs. 8 years of training to become an anesthesiologist (4 yrs med school + 4 yrs residency). The turnaround time is not long at all to spit out another CRNA.
This post was not meant to be a MacGyver "the sky is falling post!". I believe these are serious issues especially for medical students who have worked hard to get where they are today. To put in another 4 years of long hours in residency that is perversely mutating into "nurses work" is disturbing to say the least. Actually, in some countries there is no such thing as an anesthesiologist- that's because the nurse gives it (so I've been told). Perhaps CRNA really will equal MD?

 

[jocwyo]

Not to mention the excess $$ spent in health care due to the threat of litigation. I think this is a large part of the reason why health care is so expensive - and getting more so. example - most cases of appendicitis can be diagnosed by a good history and physical with simple laboratory tests. CT, usually, is only necessary in complicated or unusual presentations. Yet in many of today's ER's, CT evals and other confirmatory tests are being used when, in fact, they may not really be necessary. At least this has been my experience so far.

 

[crna2004]

"I by no means profess to be an economist, however I do know from my ECON 101 class in undergrad the laws of supply and demand. Clearly, if CRNA schools keep churning out nearly 2000 a year- something has to give. One only needs to look to what happened to Anesthesia just a couple years back to understand this. The job offers slowed to a trickle and medical students knee jerk reacted away from anesthesia residency programs. If this was the only problem, then fine I say. In due time the numbers would even out and we would better target our numbers in the future. But this is not the case!
What I find most disturbing about this current state of affairs is the fact that there appears to be no control whatsoever MD's have over this situation! I do realize that mid-level providers are intruding on every field of medicine nowadays and everyone wants to "play doctor" without having to go to medical school, but in no other field is this more apparent than anesthesia.
I am even more convinced now that we are on the brink of a takeover of anesthesia by CRNA's than I was just a couple years ago. At least then, CRNA's had to be supervised by a MD and the number graduating per year was in proportion to residency graduates. In addition, when one considers that anesthesia is 30X safer than just 20 years ago this is yet perfect fodder for the CRNA lobby to further their cause. Just visit the AANA or CRNA forum on allnurses.com and see for yourself. Do we really need to train 1400 new anesthesiologists every year to handle those few complicated cases or oversee an ICU or post-op unit??? Like I said, something has to give. Besides, this is America and money talks.
To quote current salaries as evidence there is strong demand is moot. To say we need more CRNA's so we can take coffee breaks is equally so. One needs to look to the future and not the present. Actually the very near future when one takes into consideration that CRNA school is only 2 years vs. 8 years of training to become an anesthesiologist (4 yrs med school + 4 yrs residency). The turnaround time is not long at all to spit out another CRNA.
This post was not meant to be a MacGyver "the sky is falling post!". I believe these are serious issues especially for medical students who have worked hard to get where they are today. To put in another 4 years of long hours in residency that is perversely mutating into "nurses work" is disturbing to say the least. Actually, in some countries there is no such thing as an anesthesiologist- that's because the nurse gives it (so I've been told). Perhaps CRNA really will equal MD?"

Well stated. And that's exactly what I feel. The technology of anesthesia is ever increasing - and reducing the complexity of cases. As technology continues to improve, the necessity for MDAs will drop. More and more CRNAs are graduating every year, and have no difficulty securing relatively high paying jobs. There are only so many positions out there. Supply/Demand states that as more qualified care provides (be it MDAs or CRNAs) enter the marketplace, the number of jobs, and compensation for those jobs drops. This is America - and healthcare costs are going through the roof. If you can find a well trained CRNA (who is admittedly not as well trained as a MDA) who can provide 99% of the care that an MDA provides, for approximately 1/3 to 1/2 the price, it is only logical that they will increasingly provide more independant care. Now, where does that leave the MDAs? They will either see their salaries drop to the level of CRNAs, or scramble over the few remaining cases that a CRNA can not provide. In either case, YOU SHOULD NOT ENTER THIS FIELD, IF YOUR SOLE MOTIVATION IS LIFESTYLE. Enter it because you love the field, because by the time you graduate, a large amount of the salary/lifestyle will be gone.

 

[MacGyver]

An experienced RN can easily work 50 hours a week and bring home 100K. It is nothing for an ER or ICU RN to make $40 or nearly $50 per hour and then to work a small amount of overtime and drastically supplement their income. The avg. anesthesiologist works 55 hours/wk. If a regular hospital floor RN works this much, he/she will make 100K+ even right out of nursing school making $32/hr.

Educate yourself young man. The average RN makes NOWHERE NEAR 100K.

http://www.payscale.com/salary-survey/vid-45662/fid-6886

http://www.allied-physicians.com/salary_surveys/nurse-salaries.htm#nurse-salaries

The median salary for RNs is in the 40-55k range. They'd have to double their workload to pull in 100k. IN addition, although RNs dont work as many hours as MDAs, the hours are much closer than you admit.

Still CRNA's are the highest paid advanced practice nurses and many make 120-150K working only 40 hours per week and with full benefits. But they want to make more, plain and simple - as they are not happy making 100K.

You still dont get it. Lets say CRNA salaries start to decrease. Are you honenstly telling me that CRNAs would choose to leave the field making 100k so they can make 80k as an NP nurse, or 60k as a regular RN? Thats totally bogus. Yes, they'd bitch some about it, everybody bitches when they take a paycut, but when push comes to shove, virtually all of the CRNAs would choose to stay in that field making 100k, as opposed to switching nursing fields and take another 10-30% paycut. What options do the CRNAs have? Do you really think they'd choose to make 60k as an RN instead of 100k as a CRNA? You must be smoking something.

 

[Krafty]

Why don't you pick up on the hints of the masses and go back to the
PWATBRTBI people who are TOOLS but refuse to believe it SDN forum .

Like I've said before, NOBODY CARES about your opinion, so stop being like a little kid starving for attention. Aren't you a surgeon (in training) anyway?

I'm awaiting your idiotic response. So bring it biotch.

 

[jwk]

I agree. I think if the public knew that nurses were providing their anesthesia care versus an MD during major surgery, the issue of CRNA's practicing independently would be a thing of the past. It is really not right and almost misleading that patients go and meet their surgeon, internist, OB/GYN, etc, but not their anesthesiologist. I think there should be a law stating that people should be told who will be providing their anesthesia care and as a patient you should have the choice between a CRNA and an MD. If someone chooses to have a CRNA then so be it and vice versa. But it should really be illegal to allow patients to think that they are being taken care of by an MD in the OR during surgery when they are not. Patients have every right to know who is taking care of them and have the right to choose between an anesthesiologist and a CRNA. This discussion should be a part of the whole pre-op process. Rather than arguing about turf wars between the two groups, patients should be allowed to decide who they want providing their anesthesia care, especially since they are paying for it. I would love to see the ASA press congress for these types of laws.

1) The question of WHO provides the anesthesia should definitely be discussed during the pre-op visit. It's the INFORMED part of the INFORMED CONSENT process. Duh.....

2) There simply aren't nor will there be for the far forseeable future (and probably never), enough MD's to provide an MD for every anesthetic administered.

3) You'd be surprised what the public DOES know. The AANA generally does a superb job of putting out propaganda and getting their message across.

 

[jwk]

The only thing that will "crush" the CRNAs, for sure, will be PUBLIC ADS sponsored by the AMA.

When people start demanding Anesthesiologists and refusing services from CRNAs, the CRNA supply line will be shutdown forever.

This is the only way. Let the American people decide. They hold all the power.

And what would you do in the meantime?

 

[jwk]

Educate yourself young man. The average RN makes NOWHERE NEAR 100K.

http://www.payscale.com/salary-survey/vid-45662/fid-6886

http://www.allied-physicians.com/salary_surveys/nurse-salaries.htm#nurse-salaries

Good RN's can certainly approach this range. Starting salaries are in the $40-50k range. You may not find too many making $100k, but they're not as far away as you think. These stupid website salary surveys are always way off.

 

[GeddyLee]

We are coming. We are well trained, and able to do 99% of what MDAs do - for a fraction of the cost. The reason why so many are graduating? We are here to replace you. Good luck trying to find a anesthesiology job in 10 years as a MDA.

Hmm... Not to hurt any feelings here, but a lot of nurses are dumb as rocks. Looks like we've found another! Go back to cleaning bedpans and show the respect you should have for your superiors.

By the way, with you nick...I'm assuming you are graduating crna school in 2004? SO what's with the cavalier attitude? You sound like a true ***** to me.

 

[jwk]

Hmm... Not to hurt any feelings here, but a lot of nurses are dumb as rocks. Looks like we've found another! Go back to cleaning bedpans and show the respect you should have for your superiors.

By the way, with you nick...I'm assuming you are graduating crna school in 2004? SO what's with the cavalier attitude? You sound like a true ***** to me.

And you would be what? Student, resident? You're profile doesn't say much.

There are dumb people in all fields, medicine included. Why don't you stick to meaningful dialogue instead of just being insulting?

 

[GeddyLee]

And you would be what? Student, resident? You're profile doesn't say much.

There are dumb people in all fields, medicine included. Why don't you stick to meaningful dialogue instead of just being insulting?

heh...in case you haven't noticed, their isn't much "meaningful" dialogue with mid-levels. They all know they are equals to the MD's and that their scope of practice should be just as broad. Suggest otherwise and see how defensive they become.

I'm shocked that crna school only lasts 2 years. I suppose crna2004 is suggesting that MDA's just waste time for their extra 2 years of training. hey I'm not saying CRNA's shouldn't be doing lap choles and small cases.

But I do think it's pretty insulting and disrespectful for any midlevel to suggest they are the equivalent in skill and knowledge as veteran MDA's....especially if they only graduated this year.

 

[crna2004]

"heh...in case you haven't noticed, their isn't much "meaningful" dialogue with mid-levels. They all know they are equals to the MD's and that their scope of practice should be just as broad. Suggest otherwise and see how defensive they become.

I'm shocked that crna school only lasts 2 years. I suppose crna2004 is suggesting that MDA's just waste time for their extra 2 years of training. hey I'm not saying CRNA's shouldn't be doing lap choles and small cases.

But I do think it's pretty insulting and disrespectful for any midlevel to suggest they are the equivalent in skill and knowledge as veteran MDA's....especially if they only graduated this year."

Extra two years? Well, in reality, only one of those years is doing anesthesia...the other is a prelim year. And, from the tone of this forum A LOT of people are looking for "cush" (exact word) programs at which to do their transitional/prelim year. So, in reality it's only 1 additional year of anesthesia. Does it help? Absolutely. And I never made the claim that CRNAs are the equal of MDAs. If I did, please find the post. What I am saying is that increasingly those 2 years of clinical anesthesia training that CRNAs get appears to be enough for most procedures. And, as anethestic technology and minimally invasive surgery continue to progress, CRNAs will be able to independantly handle more and more procedures. I did not graduate this year - and in fact already work at a major teaching hospital. I see residents every day. The reason that I started recently posting, actually, is because of a medical student I overheard the other day talking to another medical student. He stated (and I quote) "I'm going into anesthesia because I'm lazy and want to make lots of money." It's people like that whom I can't stand. While not all MDAs are like that, it seems like the medical student interest in anesthesia at my program is at an all time high - and there appear to be MANY students interested in it for the lifestyle. I'm just saying, in my informed opinion, that current students should enter the field only if they are willing, 10 years down the road, to have to work harder, compete for jobs, and make significantly less money than they would today. If you want to bash me for stating my opinion, so be it. But, the immature behavior of several people on this board (likely medical students who honestly know jack **** about how anesthesia actually works) really demonstrates your ignorance.

 

[jwk]

heh...in case you haven't noticed, their isn't much "meaningful" dialogue with mid-levels. They all know they are equals to the MD's and that their scope of practice should be just as broad. Suggest otherwise and see how defensive they become.

I'm shocked that crna school only lasts 2 years. I suppose crna2004 is suggesting that MDA's just waste time for their extra 2 years of training. hey I'm not saying CRNA's shouldn't be doing lap choles and small cases.

But I do think it's pretty insulting and disrespectful for any midlevel to suggest they are the equivalent in skill and knowledge as veteran MDA's....especially if they only graduated this year.

There are a very few vocal anesthetists that think they're the equivalent of an MD. You're beating a dead horse - read the posts - crna2004 and I agree with you - we're NOT MD's. Is that so difficult for you to comprehend?

I know, you think we're so inferior to you that what you would consider meaningful dialogue would be beneath you.

This topic gets beaten into the ground every month or so, and especially when a new crop of interns and residents come along that think they are the ones who are going to save anesthesiology from whatever demons they think are around. Give it a rest already.

 

[IsoGirl2707]

1) The question of WHO provides the anesthesia should definitely be discussed during the pre-op visit. It's the INFORMED part of the INFORMED CONSENT process. Duh.....

2) There simply aren't nor will there be for the far forseeable future (and probably never), enough MD's to provide an MD for every anesthetic administered.

3) You'd be surprised what the public DOES know. The AANA generally does a superb job of putting out propaganda and getting their message across.

1) Don't be so sure that the informed part of the consent means that someone is told that their anesthesia will be provided by a CRNA and not an anesthesiologist, especially if you are in one of the states that allows CRNA's to practice independently. At the institution where I trained for medical school, this issue was NOT addressed at the pre-op visit. I also did surgery in a rural community where CRNA's practice without MD supervision and I spent some time with the CRNA's because I wanted to do anesthesia at that point, and it was never mentioned that their anesthesia would be provided without an anesthesiologist present. Informed consent is not always informed in the true sense of the word.

2) This has nothing to do with the point I was trying to make. My point is that patients should be informed about who is providing their anesthesia. And yes, there used to be enough MD's to provide anesthesia for patients until the shortage in the mid 90's which is why more CRNA schools were created. Obviously, there is a need for CRNA's; however, problems arise when you have CRNA's wanting to practice without MD supervision.

3) Next time you are in holding before surgery or pre-oping a patient you should ask them if they know that someone besides an anesthesiologist will be putting them to sleep and putting a tube down their throat and see what type of response you get. Some people don't mind and that is fine but alot of people do care and they want someone with an MD after their name providing their anesthesia. People should have the right to know the difference in education between the two groups and then make their choice based on that information. You are right when you say that the AANA does an excellent job of spreading their propaganda. It is up to us as physicians in every field to support one another and provide our own information to the public. I know that if someone asked me if they should goto a nurse midwife or an OB/GYN to have their baby, hands down, I would say goto an OB/GYN. The education and experience levels are miles apart. It is the same with anesthesiologists and CRNAs. It is the AMA, the ASA, surgeons, and anesthesiologists' turn to start getting this message across to patients.

 

[MacGyver]

Good RN's can certainly approach this range.

We're not talking about "good" RNs or those who work in management/supervisory roles and make a lot more money than the average RN. We're talking averages, not extremes. You cant compare the top 1% of RNs to all of MDAs.

Starting salaries are in the $40-50k range.

NO you didnt read those websites. Those were averages for all RNs with varying years of experience, NOT JUST STARTING SALARIES!

You may not find too many making $100k, but they're not as far away as you think.

Show me a link with RN average salary data thats ANYWHERE CLOSE to 100k and I'll give you a cookie.

These stupid website salary surveys are always way off.

Fine, then give me another source which backs up your point. Until then, we have no choice but to use the available data.

 

[mikeshana]

CRNA's are good only to give my my 15 minute coffee break and my 30minute lunch break

 

[Leukocyte]

Its funny how there are no posts by Anesthesia residents on this thread. I mean if you, future anesthesiologists, are not interested in the CRNA issue, then why should the rest of us who will not go into anesthesia care about YOUR profession.

When I become a GS, and have to choose between an experienced CRNA (for $100,000) and a fresh anesthesiologist (for $160,000), I will have to go with the CRNA. Sorry. When money talks, bulls*** walks.

Its your profession. Its your career. Do whatever the hell you want with it.

 

[MDEntropy]

Educate yourself young man. The average RN makes NOWHERE NEAR 100K.

http://www.payscale.com/salary-survey/vid-45662/fid-6886

http://www.allied-physicians.com/salary_surveys/nurse-salaries.htm#nurse-salaries

The median salary for RNs is in the 40-55k range. They'd have to double their workload to pull in 100k. IN addition, although RNs dont work as many hours as MDAs, the hours are much closer than you admit.



You still dont get it. Lets say CRNA salaries start to decrease. Are you honenstly telling me that CRNAs would choose to leave the field making 100k so they can make 80k as an NP nurse, or 60k as a regular RN? Thats totally bogus. Yes, they'd bitch some about it, everybody bitches when they take a paycut, but when push comes to shove, virtually all of the CRNAs would choose to stay in that field making 100k, as opposed to switching nursing fields and take another 10-30% paycut. What options do the CRNAs have? Do you really think they'd choose to make 60k as an RN instead of 100k as a CRNA? You must be smoking something.

Listen, I am not going to repeatedly argue this. So I will be brief. But I must respond because you are out of touch with reality.

Have you ever met a salaried RN that didn't sit in an office all day? Nurses are paid by the hour. Once you go over 8 hours for a day, pay tends to go up 50%, and after 12 hours, pay doubles. Nurses tend to use this to their advantage.
Salary.com or whatever is useless when you have a group that works so much over and double time. If the only information I had was from a website, I would be as ignorant as you. But I have more information than you do. That is that.

If CRNA's salaries decrease, the gap closes and the impetus for ICU/ER nurses to become CRNA's dissipates. The pay differential between critical care nurses and regular RN's is large, yet, floor RN's will do very well if they mix in double shifts etc. Just do the math. But don't ignore overtime.
40-55K...maybe for an LPN/LVN who doesn't work overtime or an RN right out of school who works 40 hours a week at small very low volume hospital in mississippi (and then he/she still makes 50+).
If you want to insist that critical care nurses only make what you say they do, that is fine. I have looked at some of your previous posts and see that you just like to blow steam anyway. You can ignore the overtime factor, but hosptials sure can't, as it has a big impact on SG&A. And with the huge shortage of nurses with no solution in sight, things will not change.

 

[MDEntropy]

Its funny how there are no posts by Anesthesia residents on this thread. I mean if you, future anesthesiologists, are not interested in the CRNA issue, then why should the rest of us who will not go into anesthesia care about YOUR profession.

When I become a GS, and have to choose between an experienced CRNA (for $100,000) and a fresh anesthesiologist (for $160,000), I will have to go with the CRNA. Sorry. When money talks, bulls*** walks.

Its your profession. Its your career. Do whatever the hell you want with it.

This post is so silly. And the funny thing is, you don't even know why it is silly. "When you become a GS and have to choose????""" What are you talking about?

 

[MDEntropy]

"heh...in case you haven't noticed, their isn't much "meaningful" dialogue with mid-levels. They all know they are equals to the MD's and that their scope of practice should be just as broad. Suggest otherwise and see how defensive they become.

I'm shocked that crna school only lasts 2 years. I suppose crna2004 is suggesting that MDA's just waste time for their extra 2 years of training. hey I'm not saying CRNA's shouldn't be doing lap choles and small cases.

But I do think it's pretty insulting and disrespectful for any midlevel to suggest they are the equivalent in skill and knowledge as veteran MDA's....especially if they only graduated this year."

Extra two years? Well, in reality, only one of those years is doing anesthesia...the other is a prelim year. And, from the tone of this forum A LOT of people are looking for "cush" (exact word) programs at which to do their transitional/prelim year. So, in reality it's only 1 additional year of anesthesia. Does it help? Absolutely. And I never made the claim that CRNAs are the equal of MDAs. If I did, please find the post. What I am saying is that increasingly those 2 years of clinical anesthesia training that CRNAs get appears to be enough for most procedures. And, as anethestic technology and minimally invasive surgery continue to progress, CRNAs will be able to independantly handle more and more procedures. I did not graduate this year - and in fact already work at a major teaching hospital. I see residents every day. The reason that I started recently posting, actually, is because of a medical student I overheard the other day talking to another medical student. He stated (and I quote) "I'm going into anesthesia because I'm lazy and want to make lots of money." It's people like that whom I can't stand. While not all MDAs are like that, it seems like the medical student interest in anesthesia at my program is at an all time high - and there appear to be MANY students interested in it for the lifestyle. I'm just saying, in my informed opinion, that current students should enter the field only if they are willing, 10 years down the road, to have to work harder, compete for jobs, and make significantly less money than they would today. If you want to bash me for stating my opinion, so be it. But, the immature behavior of several people on this board (likely medical students who honestly know jack **** about how anesthesia actually works) really demonstrates your ignorance.

Don't discount all the classroom time in NA school learning some basic medical school Pharm/Phys etc. SRNA's don't spend all of their training time in the OR. They also have very limited hours as students. Anesthesia residents do several multiples of case hours more than SRNA's. The time spent training is really not even close. To imply/assert that there is just a single year difference in training is incorrect/wrong.

 

[Krafty]

I never seem to get any response from you. I will HIJACK this thread dammit...I won't be satisfied until you


a) Admit your are truly an imbecile and a tool
b) see a


Spew some of your profoundly idiotic rhetoric in this direction, ya wuss!

Let me hear your measly whimpers (I might get banned for these posts...but then again, mac never did).