CRNA's: sorry not worried anymore

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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.

This is interesting reading 3 years later.

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This is interesting reading 3 years later.

Yeah, it really is. CRNA salaries are still high. MDA salaries are still high. There still seems to be a shortage for both.

For those of you who seem so excited at the prospect of the CRNA market becoming saturated, you do realize that, unless there is a reversal in the trend towards CRNA independent practice, that outcome would affect MDA salaries. Whenever there is a push to lower the cost of a good/service, the person/group with the lower cost, or more cost–effective, good/service will have the stronger market position. Econ 101. Incomes for most people in the country have been flat or declining for decades, local governments are going broke as tax revenues are drying up, and there is already a push to lower the cost of healthcare and increase accessibility. More states are opting out to allow for CRNA independence. Do you really think a saturated CRNA market, in that greater context, will not affect the MDA market? That's like saying that a surplus of clothing products from china will not affect the demand for similar, American–made, clothing products that are 2.5X more expensive. Sure, a small group of high income earners will pay the extra money, but in the broader context of the nation as a whole, most will opt for the cheaper option – especially since most people continue to be squeezed financially.
 
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Yeah, it really is. CRNA salaries are still high. MDA salaries are still high. There still seems to be a shortage for both.

For those of you who seem so excited at the prospect of the CRNA market becoming saturated, you do realize that, unless there is a reversal in the trend towards CRNA independent practice, that outcome would affect MDA salaries. Whenever there is a push to lower the cost of a good/service, the person/group with the lower cost, or more cost–effective, good/service will have the stronger market position. Econ 101. Incomes for most people in the country have been flat or declining for decades, local governments are going broke as tax revenues are drying up, and there is already a push to lower the cost of healthcare and increase accessibility. More states are opting out to allow for CRNA independence. Do you really think a saturated CRNA market, in that greater context, will not affect the MDA market? That's like saying that a surplus of clothing products from china will not affect the demand for similar, American–made, clothing products that are 2.5X more expensive. Sure, a small group of high income earners will pay the extra money, but in the broader context of the nation as a whole, most will opt for the cheaper option – especially since most people continue to be squeezed financially.

Tell us something we don't know. Such as... your background.

by use of "MDA", I'm going to assume, not medicine
 
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Yeah, it really is. CRNA salaries are still high. MDA salaries are still high. There still seems to be a shortage for both.

For those of you who seem so excited at the prospect of the CRNA market becoming saturated, you do realize that, unless there is a reversal in the trend towards CRNA independent practice, that outcome would affect MDA salaries. Whenever there is a push to lower the cost of a good/service, the person/group with the lower cost, or more cost–effective, good/service will have the stronger market position. Econ 101. Incomes for most people in the country have been flat or declining for decades, local governments are going broke as tax revenues are drying up, and there is already a push to lower the cost of healthcare and increase accessibility. More states are opting out to allow for CRNA independence. Do you really think a saturated CRNA market, in that greater context, will not affect the MDA market? That's like saying that a surplus of clothing products from china will not affect the demand for similar, American–made, clothing products that are 2.5X more expensive. Sure, a small group of high income earners will pay the extra money, but in the broader context of the nation as a whole, most will opt for the cheaper option – especially since most people continue to be squeezed financially.
Your dirty little secret that needs to be widely disseminated is that independently practicing CRNAs are NOT a cheaper alternative. That's a lie - plain and simple.
 
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Yeah, it really is. CRNA salaries are still high. MDA salaries are still high. There still seems to be a shortage for both.

For those of you who seem so excited at the prospect of the CRNA market becoming saturated, you do realize that, unless there is a reversal in the trend towards CRNA independent practice, that outcome would affect MDA salaries. Whenever there is a push to lower the cost of a good/service, the person/group with the lower cost, or more cost–effective, good/service will have the stronger market position. Econ 101. Incomes for most people in the country have been flat or declining for decades, local governments are going broke as tax revenues are drying up, and there is already a push to lower the cost of healthcare and increase accessibility. More states are opting out to allow for CRNA independence. Do you really think a saturated CRNA market, in that greater context, will not affect the MDA market? That's like saying that a surplus of clothing products from china will not affect the demand for similar, American–made, clothing products that are 2.5X more expensive. Sure, a small group of high income earners will pay the extra money, but in the broader context of the nation as a whole, most will opt for the cheaper option – especially since most people continue to be squeezed financially.

An inferior product always costs more in the long run, whether it's a car, electronics, or an unsupervised CRNA. When hospitals start seeing worse outcomes and the reimbursement hits on the horizon that come along with that (not to mention the lawsuit costs), that will be apparent to even the stingiest of bean counters.
 
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An inferior product always costs more in the long run, whether it's a car, electronics, or an unsupervised CRNA. When hospitals start seeing worse outcomes and the reimbursement hits on the horizon that come along with that (not to mention the lawsuit costs), that will be apparent to even the stingiest of bean counters.

I do not agree. It depends also on how much the inferior product costs.
 
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Prove it to the public, not to me. :)

Problem is, a truly double-blinded, prospective and unbiased study would be unethical to perform.

"Sorry, as part of our study, you get the newly minted cRNA over there fresh out of a rigorous sRNA program. Please tell her about your chest pain and home oxygen."
 
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I think in the case of CRNAs that is a pretty stupid thing to say considering they will kill people.

Even if someone dies, there is a certain cost connected to that death that can be quantified. That sounds harsh, but it is true. There will be a lawsuit and a settlement.

The real question: what is the increased risk of having a CRNA perform a procedure instead of an Anesthesiologist (if there is an increased risk at all)? If that risk is tiny, then it is actually in the interest of the "bean counters" to employ CRNAs over Anesthesiologists since they will cost 2-2.5x less. In the long run, the increased financial risk (e.g. increased probability of a death multiplied by the probability of a bad court outcome multiplied by the increased malpractice insurance premiums) has to outweigh the cost savings from employing CRNAs.

But, a more important question: what factors will impact the demand for the service of anesthesia? If Joe Layman and Bob Treasurer look at their dwindling bank account or tax revenue stream, and read some studies, propaganda or not, that indicate negligible differences in outcomes; they may well decide CRNA is the way to go. This is, of course, a simplification meant to highlight a bigger phenomena. But the principle has been repeated time and again. When money is tight, the mass of people go to the cheaper option if, as they see it, the trade-off is negligible. There could well be a bifurcation in healthcare between a small "high luxury" group treated by anesthesiologists and a much larger "bargain" group for the masses. In any case, a surplus in lower cost providers will impact the demand for high–cost providers, unless there is some sort of clear legal barrier (e.g. that prevents low–cost providers from practicing independently).

An inferior product always costs more in the long run, whether it's a car, electronics, or an unsupervised CRNA.

This is simply not true. One example is cheap CPUs as compared to high–quality Intel chips. Think: cell phones and tablet computers. They cost less in the short run and in the long run, due to Moore's Law.
 
MD Anesthesiology.
Ah, you mean an anesthesiologist. MDA is the Muscular Dystrophy Association - a fine group, but not related to anesthesiologists.

Do you call a surgeon an MDS? Do you call a pathologist an MDP? Do you call a dermatologist an MDD?

Case closed.
 
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Even if someone dies, there is a certain cost connected to that death that can be quantified. That sounds harsh, but it is true. There will be a lawsuit and a settlement.

The real question: what is the increased risk of having a CRNA perform a procedure instead of an Anesthesiologist (if there is an increased risk at all)? If that risk is tiny, then it is actually in the interest of the "bean counters" to employ CRNAs over Anesthesiologists since they will cost 2-2.5x less. In the long run, the increased financial risk (e.g. increased probability of a death multiplied by the probability of a bad court outcome multiplied by the increased malpractice insurance premiums) has to outweigh the cost savings from employing CRNAs.

But, a more important question: what factors will impact the demand for the service of anesthesia? If Joe Layman and Bob Treasurer look at their dwindling bank account or tax revenue stream, and read some studies, propaganda or not, that indicate negligible differences in outcomes; they may well decide CRNA is the way to go. This is, of course, a simplification meant to highlight a bigger phenomena. But the principle has been repeated time and again. When money is tight, the mass of people go to the cheaper option if, as they see it, the trade-off is negligible. There could well be a bifurcation in healthcare between a small "high luxury" group treated by anesthesiologists and a much larger "bargain" group for the masses. In any case, a surplus in lower cost providers will impact the demand for high–cost providers, unless there is some sort of clear legal barrier (e.g. that prevents low–cost providers from practicing independently).



This is simply not true. One example is cheap CPUs as compared to high–quality Intel chips. Think: cell phones and tablet computers. They cost less in the short run and in the long run, due to Moore's Law.
Where on earth did you get the stupid idea that CRNAs cost "2-2.5x less" than an anesthesiologist?
 
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Even if someone dies, there is a certain cost connected to that death that can be quantified. That sounds harsh, but it is true. There will be a lawsuit and a settlement.

The real question: what is the increased risk of having a CRNA perform a procedure instead of an Anesthesiologist (if there is an increased risk at all)? If that risk is tiny, then it is actually in the interest of the "bean counters" to employ CRNAs over Anesthesiologists since they will cost 2-2.5x less. In the long run, the increased financial risk (e.g. increased probability of a death multiplied by the probability of a bad court outcome multiplied by the increased malpractice insurance premiums) has to outweigh the cost savings from employing CRNAs.

But, a more important question: what factors will impact the demand for the service of anesthesia? If Joe Layman and Bob Treasurer look at their dwindling bank account or tax revenue stream, and read some studies, propaganda or not, that indicate negligible differences in outcomes; they may well decide CRNA is the way to go. This is, of course, a simplification meant to highlight a bigger phenomena. But the principle has been repeated time and again. When money is tight, the mass of people go to the cheaper option if, as they see it, the trade-off is negligible. There could well be a bifurcation in healthcare between a small "high luxury" group treated by anesthesiologists and a much larger "bargain" group for the masses. In any case, a surplus in lower cost providers will impact the demand for high–cost providers, unless there is some sort of clear legal barrier (e.g. that prevents low–cost providers from practicing independently).



This is simply not true. One example is cheap CPUs as compared to high–quality Intel chips. Think: cell phones and tablet computers. They cost less in the short run and in the long run, due to Moore's Law.

Cheap CPUs don't generally kill people if they malfunction.

More like comparing a corvair to... Pretty much any other car.
 
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Clinic 21..... Live by the sword and die by it. Whose to say you as a Crna are a cheaper option. Why not directly hire icu nurses and supervise them in the OR. Pay them 60-70k a year run the or like an ICU. I bet we can coax the numbers to match your study. Save the Crnas for sick ASA 3-5 cases and supervise.
 
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If that risk is tiny, then it is actually in the interest of the "bean counters" to employ CRNAs over Anesthesiologists since they will cost 2-2.5x less.
Why are you posting here, if you're not reading the replies?

jwk corrected you in post #106 above, why are you repeating this falsehood?

Could it be the purpose of your visit is to repeat the lie often enough in the hopes that some will start to believe it?
 
Even if someone dies, there is a certain cost connected to that death that can be quantified. That sounds harsh, but it is true. There will be a lawsuit and a settlement.

The real question: what is the increased risk of having a CRNA perform a procedure instead of an Anesthesiologist (if there is an increased risk at all)? ....<DEFINATELY INCREAED RISK>....If that risk is tiny, then it is actually in the interest of the "bean counters" to employ CRNAs over Anesthesiologists since they will cost 2-2.5x less...<WHAT? DO YOU KNOW WHAT YOUR ARE TALKING ABOUT?>.... In the long run, the increased financial risk (e.g. increased probability of a death multiplied by the probability of a bad court outcome multiplied by the increased malpractice insurance premiums) has to outweigh the cost savings from employing CRNAs....<SO....YOU DON'T CARE ABOUT YOUR PATIENTS>...? WHAT A DUMB A$$ STATEMENT.

But, a more important question: what factors will impact the demand for the service of anesthesia? If Joe Layman and Bob Treasurer look at their dwindling bank account or tax revenue stream, and read some studies, propaganda or not, that indicate negligible differences in outcomes; they may well decide CRNA is the way to go. This is, of course, a simplification meant to highlight a bigger phenomena. But the principle has been repeated time and again. When money is tight, the mass of people go to the cheaper option if, as they see it, the trade-off is negligible. There could well be a bifurcation in healthcare between a small "high luxury" group treated by anesthesiologists and a much larger "bargain" group for the masses. In any case, a surplus in lower cost providers will impact the demand for high–cost providers, unless there is some sort of clear legal barrier (e.g. that prevents low–cost providers from practicing independently). <BLAH, BLAH,BLAH, GAWD... ! UNTIL YOU ARE OVER YOUR HEAD AND SOMEONE DIES WHO SHOULDN'T HAVE...! TO BE BLIND IS TO BE BLINDSIDED>

I don't usually engage in this debate because you are nowhere in my line of thought. I have supervise(d) CRNAs and I am currently an AA instructor.

You shoot yourself in the foot all the time. If we fully merge to an ACT model... who do you think we are going to pick and who do you think we are going to support aggressively at the legislative level?
 
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Whose to say you as a Crna are a cheaper option.

I'm not a CRNA.

Where on earth did you get the stupid idea that CRNAs cost "2-2.5x less" than an anesthesiologist?

I used this data. Perhaps there is a more consistent or reliable source? I would be very interested.
Anesthesiology: Median $443,859
http://www.bls.gov/ooh/healthcare/physicians-and-surgeons.htm#tab-5
CRNA: Median $157,140
http://www.bls.gov/ooh/healthcare/n...se-midwives-and-nurse-practitioners.htm#tab-5

That's about a 2.8x difference in median income – if those numbers are accurate statistics.
 
Why are you posting here, if you're not reading the replies?

jwk corrected you in post #106 above, why are you repeating this falsehood?

Could it be the purpose of your visit is to repeat the lie often enough in the hopes that some will start to believe it?

[/QUOTE]
 
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I'm not a CRNA.



I used this data. Perhaps there is a more consistent or reliable source? I would be very interested.
Anesthesiology: Median $443,859
http://www.bls.gov/ooh/healthcare/physicians-and-surgeons.htm#tab-5
CRNA: Median $157,140
http://www.bls.gov/ooh/healthcare/n...se-midwives-and-nurse-practitioners.htm#tab-5

That's about a 2.8x difference in median income – if those numbers are accurate statistics.

You are nonesense. We don't live on the 40 hr work week "I need out by 3 pm rule".
Clueless.
Sometimes we work 24+ hours straight... never knowing when the next aortic rupture or massive trauma is coming in through the door.

I had plenty of training in those scenarios...100+ hours a week sometimes... it involved what's called a RESIDENCY IN ANESTHESIOLOGY. You wouldn't know what that means now would you?
 
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Cheap CPUs don't generally kill people if they malfunction.

More like comparing a corvair to... Pretty much any other car.

You specifically said that:
An inferior product always costs more in the long run, whether it's a car, electronics, or an unsupervised CRNA.

I'm merely pointing out that your statement is not true, and using one of your examples ("electronics") to point out a case where you are wrong (i.e. CPUs).
 
I had plenty of training in those scenarios...100+ hours a week sometimes... it involved what's called a RESIDENCY IN ANESTHESIOLOGY. You wouldn't know what that means now would you?

Why wouldn't I know what a residency means? It's a simple term, in the dictionary: "a period of advanced training in a medical specialty that normally follows graduation from medical school and licensing to practice medicine."
http://www.merriam-webster.com/dictionary/residency
 
You are nonesense. We don't live on the 40 hr work week "I need out by 3 pm rule".
Clueless.
Sometimes we work 24+ hours straight... never knowing when the next aortic rupture or massive trauma is coming in through the door.

Perhaps you are clueless. You seem to think I'm a nurse or CRNA. I'm not. By the way, how is it healthy for patients to have sleep–deprived medical residents performing anesthesia on them in the OR. That sounds like a lawsuit just waiting to happen.
 
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I'm actually curious about this. How often do sleep–deprived residents make some sort of fatal error and kill a patient?
 
Perhaps you are clueless. You seem to think I'm a nurse or CRNA. I'm not. By the way, how is it healthy for patients to have sleep–deprived medical residents performing anesthesia on them in the OR. That sounds like a lawsuit just waiting to happen.

Then why are you here trying to claim differences btw/ an anesthesiologist and a CRNA? Tell me why? You are even further clueless if you are neither.

Residency is training to handle anything that comes at you at ANY time. You get that through mentorship of a veteran anesthesia doc in an academic hospital that does everything. If I was to throw a newly minted CRNA or AA for a 3:45am Jehova's witness coagulopathic AAA rupture... it would be a very different scenario than the newly graduated Anesthesiologist who has been learning how to cope with sleep deprevasion and high level acuity for 4 years. In the back of his mind, the intrinsic and extrinsic pathways would be going through his head. After all you know... those ruptured AAAs aren't ever ELECTIVELY scheduled. So how often do you actually do the case supervised unless you are actually putting in the hours. You want the BEST qualified person taking care of you at that moment, especially if it was you or your family member... I can tell you it's NOT a solo practicing CRNA who is trying to learn it on the fly.
 
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Then why are you here trying to claim differences btw/ an anesthesiologist and a CRNA? Tell me why? You are even further clueless if you are neither.

You don't need to be a practitioner of a field to understand the economics of that field. In fact, often, a trained economist is better at understanding how certain variables can impact a particular market than the people working in that job market (due to a deep understanding of how markets, in general, work).

AAA rupture... it would be a very different scenario than the newly graduated Anesthesiologist who has been learning how to cope with sleep deprevasion and high level acuity for 4 years.

How many patients had to die for that anesthesiologist to learn to cope with extreme sleep deprivation while delivering anesthesia?

You want the BEST qualified person taking care of you at that moment, especially if it was you or your family member... and I can tell you it's NOT a solo practicing CRNA who is trying to learn it on the fly.

Wouldn't it be more accurate to say that you want the best qualified person that you can afford? Most people in the country don't make anything near the salary of an anesthesiologist. Or, are you focused only on serving the super wealthy?
 
stop feeding this pathetic troll

Yeah you are probably right :thumbup:
but since he's come on here stirring up some mud...

How many patients had to die for that anesthesiologist to learn to cope with extreme sleep deprivation while delivering anesthesia?

Again... you are demonstrating your lack of knowledge of what a residency is. Residency is supervised by well rested attendings doing 12 hour shfits.

Wouldn't it be more accurate to say that you want the best qualified person that you can afford? Most people in the country don't make anything near the salary of an anesthesiologist. Or, are you focused only on serving the super wealthy?

So you are saying that if you can't "afford" an anesthesiologists that MAKES A DIFFERENCE if you LIVE or DIE... then you rather DIE?

What do you call this? Natural selection? I'm all for it.

Sorry man. You sound like the fowl stench of those who are trying to take over the care of our Vets who have fought for our right to be here and have this debate.

If you are truly being ignorant, then I can't blame you. You don't know different. Know that this is a physician forum and we believe in our patients rights to get the best care they deserve. Be well informed before posting here.

Out for realzzzz this time.
 
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Again... you are demonstrating your lack of knowledge of what a residency is. Residency is supervised by well rested attendings doing 12 hour shfits.

It still sounds like a situation ripe for error and malpractice suits.

So you are saying that if you can't "afford" an anesthesiologists that MAKES A DIFFERENCE if you LIVE or DIE... then you rather DIE?

What do you call this? Natural selection? I'm all for it.

Sorry man. You sound like the fowl stench of those who are trying to take over the care of our Vets who have fought for our right to be here and have this debate.

If you are truly being ignorant, then I can't blame you. You don't know different. Know that this is a physician forum and we believe in our patients rights to get the best care they deserve. Be well informed before posting here.

What I'm saying is that it's great to get the best care you can, but not everyone can afford that. So, if you can't afford the "best" care, then it's good to have other options (as opposed to no options at all). Unfortunately, an increasing proportion of the population is winding up financially strapped down. Not a good reality for the country, but, nevertheless, a reality. Because of that reality, there is going to be an increasing demand for lower cost providers. This is especially true since the participation rate is expected to go up – especially among those who, before, could not afford any healthcare. People will still need surgeries and medical procedures. But, in the context of that reality, there will be a need for lower cost providers; and, most likely, demand will shift toward lower–cost providers out of necessity.

You seem to think of it as all or nothing (get the best care you can or none at all – and do away with any provider who doesn't have all of the training, and associated cost, of an MD). It sounds much more like you are simply trying to maximize your own income by cornering a market, and by providing medical treatment at as high a cost as possible to a small group of wealthy people, than it sounds like you are trying to help patients "get the best care they deserve."

This time, I'm out. :)
 
You specifically said that:


I'm merely pointing out that your statement is not true, and using one of your examples ("electronics") to point out a case where you are wrong (i.e. CPUs).

Why are you attributing what Man o War said to me?

Stop it. If you're not a CRNA, then you're an SRNA. Grow up.
 
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It still sounds like a situation ripe for error and malpractice suits.



What I'm saying is that it's great to get the best care you can, but not everyone can afford that. So, if you can't afford the "best" care, then it's good to have other options (as opposed to no options at all). Unfortunately, an increasing proportion of the population is winding up financially strapped down. Not a good reality for the country, but, nevertheless, a reality. Because of that reality, there is going to be an increasing demand for lower cost providers. This is especially true since the participation rate is expected to go up – especially among those who, before, could not afford any healthcare. People will still need surgeries and medical procedures. But, in the context of that reality, there will be a need for lower cost providers; and, most likely, demand will shift toward lower–cost providers out of necessity.

You seem to think of it as all or nothing (get the best care you can or none at all – and do away with any provider who doesn't have all of the training, and associated cost, of an MD). It sounds much more like you are simply trying to maximize your own income by cornering a market, and by providing medical treatment at as high a cost as possible to a small group of wealthy people, than it sounds like you are trying to help patients "get the best care they deserve."

This time, I'm out. :)
You just don't get it. Even if CRNAs were lower cost, that has never translated into lower fees for the patient. It might matter for the employer, but still we haven't seen many employers firing all their anesthesiologists and going CRNA-only, not even in opt-out states, suggesting that it's not worth the risk. Capisci?

If this were a truly free market and what mattered the most were anesthesia fees, all these middlemen employers would have disappeared and been replaced by independent groups, not the other way round. Why? Because I, as an anesthesiologist, can provide the same service at a lower cost if I don't have the 40% overhead of paying all the bean counters and blood suckers. So your theory is wrong. These parasites flourish exactly because they are able to negotiate and extract higher anesthesia fees from the other blood suckers, the insurance companies, so in the end the patient ends up paying more. Same goes for big hospitals buying out medical practices in the Obamacare era; the fees always go up, not down. This is not a free market, so your theories don't work in it. ;)
 
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The Richest CRNA in America is an owner of an AMC which utilizes Anesthesiologists. Some of his contracts are MD only, medical direction or the AANA collaborative model but all utilize Anesthesiologists. Mr. Neal would lose contracts if he went CRNA only so instead, he stretches the ratios to the limit in order to maximize his profit.


NORTHSTAR ANESTHESIA:
OUR STORY
Having been involved in anesthesia care for over 20 years, Dr. Phil Eichenholz and CRNA Neil Neal both saw firsthand the frustrations and daily drama caused by today’s anesthesia care model.
 
The Richest CRNA in America is an owner of an AMC which utilizes Anesthesiologists. Some of his contracts are MD only, medical direction or the AANA collaborative model but all utilize Anesthesiologists. Mr. Neal would lose contracts if he went CRNA only so instead, he stretches the ratios to the limit in order to maximize his profit.


NORTHSTAR ANESTHESIA:
OUR STORY
Having been involved in anesthesia care for over 20 years, Dr. Phil Eichenholz and CRNA Neil Neal both saw firsthand the frustrations and daily drama caused by today’s anesthesia care model.


Yes this is what is happening. No hospital has the guts to go with a CRNA only model. They know they need highly trained Anesthesiologists around to handle the difficult cases and the emergencies. But they are trying to stretch the supervision model to its limit. The Anesthesiologist ends up supervising 4 rooms, running around like a chicken with its head cut off, as a preop scutworker and fireman. The call burden on the Anesthesiologists in the group is oppressive. The pressure on Salaries continues. This leads to depression, burnout, and dissatisfaction among the Anesthesiologists. The joy of caring for patients has been squeezed out of the career.

When you are taking a job with an AMC one of the most important questions to ask is what is the ratio of CRNAs to Anesthesiologists. If the ratio is high, stay far far away from the job.
 
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Thanks for bumping this great thread.
To clarify as you don't seem to know, an independent CRNA will not save the patient, or the insurance company, any money. Just looking at average income data doesn't show the reality of rural or independent CRNA practice. So that part of their argument is false. They are cheaper to create as they pay for their own training, that's true.
A rural low volume hospital may need to have CRNA only coverage because the volume is so low and the hospital is so poor that they cannot find an anesthesiologist that wants to work for low income, say $200k, but a CRNA will. They also get paid more for their Mcare services as well at those hospitals, but that's another topic.
If you want to have CRNA lead care have at it, and good luck. Those of us that work with them daily know that there is huge variability in CRNA skills and knowledge and that the average CRNA will not offer nearly the same level of care as an anesthesiologist. And they know it as well. Most CRNAs are happy with their care team arrangement, and many of the vocal militant types don't really want the safety net pulled either, because nothing is stopping them from leaving their evil care team practice and working independently or nearly independently in another place. That's one of the things we screen for in applicants. It's a good job with fair pay, predictable shift work hours, etc. BUT you'll always be closely supervised and will follow the plan. If you want minimal supervision, etc. this ain't the place for you and it's not going to change.


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Il Destriero
 
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It still sounds like a situation ripe for error and malpractice suits.

Couple things:

1) The salary of the anesthetist providing the service does not change the charge to CMS/insurance/the patient. The only people that see the cost savings are the people who run the hospitals. It'd be nice to think that they would pass that savings on to the consumer, but we both know that's not true. That money goes straight to the people running the hospital.

2) Sleep deprivation is a situation ripe for error, but so are multiple handoffs between providers. The jury is still out on which is worse. Personally I think shift work is the way to go, because sleep deprivation is no joke, but shift work is dependent on appropriate signouts which we are a long way from accomplishing successfully.

3) Economic pressures are real and I respect that. But our jobs as physicians (particularly as anesthesiologists) is not to figure out the cheapest way to provide care. We provide the best care we can, and other people with a lot more economic knowledge and a lot less medical knowledge (and compassion) try to tell us what we can or can't do. Sometimes we win, a lot of times they win. It's important to have checks and balances but that's not my primary concern.

4) I, too, am curious as to your status. You sound like a health care administrator, or maybe a family member of a CRNA?
 
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This is simply not true. One example is cheap CPUs as compared to high–quality Intel chips. Think: cell phones and tablet computers. They cost less in the short run and in the long run, due to Moore's Law.[/QUOTE]

Wow, you got me. I'll make sure to write this down so that next time I see a transplant patient I can explain this to them, find the nearest CRNA, and let them have at it. I'm sure the patient will understand why I'm leaving them in the care of a nurse who is grossly unprepared to get them safely through surgery when I put it to them this way!!
 
Even if someone dies, there is a certain cost connected to that death that can be quantified. That sounds harsh, but it is true. There will be a lawsuit and a settlement.

The real question: what is the increased risk of having a CRNA perform a procedure instead of an Anesthesiologist (if there is an increased risk at all)? If that risk is tiny, then it is actually in the interest of the "bean counters" to employ CRNAs over Anesthesiologists since they will cost 2-2.5x less. In the long run, the increased financial risk (e.g. increased probability of a death multiplied by the probability of a bad court outcome multiplied by the increased malpractice insurance premiums) has to outweigh the cost savings from employing CRNAs.

But, a more important question: what factors will impact the demand for the service of anesthesia? If Joe Layman and Bob Treasurer look at their dwindling bank account or tax revenue stream, and read some studies, propaganda or not, that indicate negligible differences in outcomes; they may well decide CRNA is the way to go. This is, of course, a simplification meant to highlight a bigger phenomena. But the principle has been repeated time and again. When money is tight, the mass of people go to the cheaper option if, as they see it, the trade-off is negligible. There could well be a bifurcation in healthcare between a small "high luxury" group treated by anesthesiologists and a much larger "bargain" group for the masses. In any case, a surplus in lower cost providers will impact the demand for high–cost providers, unless there is some sort of clear legal barrier (e.g. that prevents low–cost providers from practicing independently).

And THIS right here is the heart of the matter. The VA would be *****ic to let people with this mindset treat patients without supervision. It's just abhorrent.
 
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