CRNAs hired by anesthesiology groups.

[RxBoy]

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CRNAs hired by anesthesiology groups instead of contracted through the hospital. I am seeing this trend more and more. In my area there are 4 major hospitals I know that are pushing the anesthesiology department for this. 1 of them already made the change.

Good or bad thing?

 

[jwk]

CRNAs hired by anesthesiology groups instead of contracted through the hospital. I am seeing this trend more and more. In my area there are 4 major hospitals I know that are pushing the anesthesiology department for this. 1 of them already made the change.

Good or bad thing?

This isn't exactly a new concept. I've been employed by private groups my entire 30+ year career. The trend that I'm most aware of is exactly opposite of what you're seeing - private groups pushing the anesthetists off onto the hospital payroll and/or the entire group ceasing to exist and the hospital employs both anesthetists and anesthesiologists.

 

[Arch Guillotti]

CRNAs hired by anesthesiology groups instead of contracted through the hospital. I am seeing this trend more and more. In my area there are 4 major hospitals I know that are pushing the anesthesiology department for this. 1 of them already made the change.

Good or bad thing?

I think it depends. If you employ the nurses you will never make as much money. If you employ them you have to deal with all their headaches and you will likely make less money but you have control over them.

 

[leaverus]

CRNAs hired by anesthesiology groups instead of contracted through the hospital. I am seeing this trend more and more. In my area there are 4 major hospitals I know that are pushing the anesthesiology department for this. 1 of them already made the change.

Good or bad thing?

it's very unusual in my state for crnas to be employed by the hospital so i'm not sure that it's a "trend" but i assume that it's the opposite in your state.

 

[deleted126335]

I think it depends. If you employ the nurses you will never make as much money. If you employ them you have to deal with all their headaches and you will likely make less money but you have control over them.

👍

Agree with above. One other potential advantage to employing them. It makes your group harder to replace- Assuming that you have solid non competes. e.g., easier to replace 10 docs than 10 docs plus 25 or so CRNAs.

 

[dr2b0804]

I think it depends. If you employ the nurses you will never make as much money. If you employ them you have to deal with all their headaches and you will likely make less money but you have control over them.

I'm not so sure about this. But then again, I've never supervised in PP.
From the outside looking in, billing 4 rooms simultaneously sounds like a good gig.

 

[dr2b0804]

CRNA's working FOR the group is what I've seen most of the time. Once the CRNA's work for the hospital, the hierarchy has been somewhat broken as is your recourse for those who fall out of line.

 

[Arch Guillotti]

I'm not so sure about this... but then again, I've never supervised in PP.
From the outside looking in, billing 4 rooms simultaneously sounds like a good gig...

Nurses are a huge expense.

 

[Consigliere]

I think it depends. If you employ the nurses you will never make as much money. If you employ them you have to deal with all their headaches and you will likely make less money but you have control over them.

This is the most important part.

 

[gasattack3]

CRNA's working FOR the group is what I've seen most of the time. Once the CRNA's work for the hospital, the hierarchy has been somewhat broken as is your recourse for those who fall out of line.

yeah, while employing them might not be the best financial model, it sure seems like it would have some practical merrits.

having the ability to hire/fire CRNA's would definitely prevent some of the BS that I see when the MD's are PP and CRNA's are hospital employees....

 

[leaverus]

anyone have experience with a situation in which both the anesthesiologists and crnas are hospital-employed? how do the dynamics work in that case?

 

[ssmallz]

yeah, while employing them might not be the best financial model, it sure seems like it would have some practical merrits.

having the ability to hire/fire CRNA's would definitely prevent some of the BS that I see when the MD's are PP and CRNA's are hospital employees....

Yeah, having dealt w/typical hospital nurses in the OR and OB, I would much rather be the employer, even if it means taking a salary hit than having them employed by the hospital. I would think there would be much less BS to deal with when you have the unilateral authority to hire and fire them.

 

[Arch Guillotti]

having the ability to hire/fire CRNA's would definitely prevent some of the BS that I see when the MD's are PP and CRNA's are hospital employees....

This has potential to be miserable. Trained assassins that do not necessarily have to answer to you. I suppose that there are certain locales where this arrangement has the possibility to work, but I think that there is a huge upside to controlling your nurses.

Yes the nurses are a headache and dealing with all of their bull**** - but the importance of being able to hire and fire them is invaluable.

If they are hospital employees they are going to whine and cry to the hospital administration if they don't get their morning break and lunch on the dot, which can create plenty of headaches for the group.

 

[pd4emergence]

There are disadvantages and advantages in crna's being employed by a group

Advantages
You control their fate. They know it. They act like it.
Harder for a hospital to replace the group. In a situation where this is a concern, it may be harder for the hospital to replace their whole anesthesia department rather than just the anesthesiologists.
Some insurers pay more to a group for employing crna's. it's not much but it's something.
You do have control of hiring and firing issues.

Disadvantages
There is a reason why hospitals don't want to employ them. It's expensive and it's not a money making proposition. Salaries are just the beginning, health insurance, hr issues, retirement plans, malpractice insurance, overtime, employees are expensive.
Because of cost most groups I've seen that employ crna's start relieving them early to get overtime costs down. This presents service issues and sets the group up for confrontations with surgeons ie the "why can't I run two rooms at 5pm on Christmas Eve" fit. Economically efficient or models don't always provide the best service from a surgeons point of view.


My Personal opinion is that if you work in an area with a good payer mix a group may be able to make it work. If the payer mix is not good and the hospital insists you should find another job. The hospital may pay the group a stipend to help support crna's but this will be an issue of contention until they find another group who will take less.