2win:
The problem of academic programs training CRNAs has been addressed ad naseaum before by the majority of posters in this forum. We have identified it as a problem in many academic medical centers and not necessarily unique to CCF. It has been a challenge to disect its components and get at the 'root' of it. With that said, and myself as a vocal opponent of such practice, suffice to say it is a combination of manpower shortage, finances and self interest.
The ultimate goal of academic centers and anesthesiology chairmen are to fulfill their mandates of providing patient care, education and research all while maintaining a financially viable dept. With that in mind, it is a challenge to maintain that balance without alternative sources of cheap labor given the cost of anesthetic care.
For example, to educate residents a dept has to provide protected didactic time to ensure academic success and meet ACGME requirements. Many 'flagship' hospitals such as the Mayo clinic, Wash U, etc use CRNAs to cover the OR while residents attend lecture. In smaller programs, CRNAs are there to provide the bulk of OR labor d/t lack of enough residents to provide coverage for all cases.
Second, as an academic chairman, you are 'graded' by the hospital board based on your ability to maintain the dept in the black. If your management style is such that it causes the dept to lose money, your job is at risk. Many would argue that if that were the case, it would make sense to fire all CRNAs and replace them with residents. It could be done but then resident education would suffer. With that said, many programs already rely on residents as a cost-cutting measure and keep their number of CRNAs low. You will also flood the market with graduates and jeopardize future job prospects.
Third, some academic anesthesiologists who are lazy actually prefer to work with nurses because they do the least amount work. They don't like to be bothered with teaching residents. This is a real problem in anesthesiology and some depts need to be purged from this plague. Some others like to teach too much to the point they teach the nurses more than the residents. Another no-no in my book.
Fourth, the unfounded bias towards AAs as a lesser-trained provided and the political weight anesthesia nurses have in many academic depts, puts pressure on academic chairmen to maintain the status quo.
Fifth, having a nurse anesthesia school affiliated with academic depts is another source of revenue for hospitals plus cheap labor since SRNAs can be thrown in a room to crank out cases while they pay tuition.
My take is that there should be no bias against one type of midlevel provider vs another. Ideally, AAs and CRNAs should be present in equal numbers in all academic depts with a physician anesthesiologist in charge at all times. Programs like case western, metrohealth and Toledo have implemented this approach and has worked very well for them.
Finally, the proliferation of CRNA schools will continue and with it will lead to the demise of the currently enjoyed position in terms of salary and demand.
The winners in this whole debable won't be CRNAs or anesthesiologists but hospitals who will enjoy the commoditization of anesthesia services and reap the financial benefits from the lack of foresight of both parties (physicians and CRNAs).
