Interesting job outlook perspective

[toughlife]

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I'm impressed that you would accept 50K/yr. I'll admit...I don't know any CRNA's who would accept 25K/yr so YOU'RE HIRED and the CRNA can go back to nursing and make 60K/yr!

Well, yeah but being the slick dude I am, I would quickly get me a job as a general practitioner and go back to making my $100K+ a year and be happy. And since I am bilingual I can move to TX and quickly find me a job too. Maybe even take yours. 😉 Think you can compete with me?

 

[Cyndee MSN NP]

OH, I see. So you are saying that if all anesthesiologists were 1) employed by hospitals (most of them aren't) and 2) were replaced by independently practicing CRNA's who were also employed by hospitals (even a smaller percentage of CRNA's who practice independently are hospital employees) then that entity which is THE HOSPITAL would make more money. Great, the hospital makes more money. But who really cares if the hospital makes more money? Do you as an NP care? Certainly, patients don't care? The hospital CEO, CFO and COO care because they are now getting bigger bonuses. But where is the value creation? I mean, there is no savings in your example, money has simply been moved around. There is no savings to patients, there is no savings to the health care system. Hmm, that explanation doesn't provide any real economic driving force for the gas docs to be replaced by CRNA's. So Cyndee, I guess I would like you to give me a more detailed and perhaps clearer example because this one doesn't even work for econ 101. Please try again.

Cyndee, I am serious here. Please show me some savings, some value creation, some economic benefit. I am really hoping you can shed some light on this issue. Thanks again in advance.

Let's talk about NP's (since that's what I am) and the economic advantage of hiring one.

NP salary: 70K/yr (NP generates 70K/month)
Benefits: 20K/yr (that's pretty generous)
NP pays for self in less than 2 months. After the overhead is paid, then the doctor/owner pockets the extra cash.

PCP salary: 150K/yr (generates 70K/month)
Benefits: at least 50K/yr (malpractice insurance is more expensive than NP's which averages $800/yr)
PCP pays for self in 3 months.

If you were the owner of that clinic, which one would you hire? Do you have any friends who own their own clinics? If so, then surely, they can fill you in on the economic advantages of hiring mid-level practitioners. There is a clinic here that fired 4 family practice docs and replaced them with FNP's. That practice is finally in the black and the owners are trying to figure out what took them so long!

Also, Medicare and Medicaid reimburses NP's at 15% less than they reimburse docs for the same service. We can save the taxpayers millions. If a physician works on site with the NP, then you can bill as "incident to" and get full reimbursement for services. That doesn't save the insurance companies money, but it generates more $$$ for the doctor/owner. Do you honestly not know that?

 

[Cyndee MSN NP]

Well you most certainly could be. Your profile says you have attended school in Colorado, and now work in CC. These two areas have a large mexican population so it was not far fetched to assume you could be MA.

Are you asking me out on a date now?

I'm not asking you on a DATE...I want to kick you A-- in racquetball/tennis!

Something else...I don't recall a large population of Mexicans residing in Boulder.

 

[toughlife]

I'm not asking you on a DATE...I want to kick you A-- in racquetball/tennis!

Something else...I don't recall a large population of Mexicans residing in Boulder.

are you even attractive enough for me to want to play a game of tennis with you?

 

[Cyndee MSN NP]

Well, yeah but being the slick dude I am, I would quickly get me a job as a general practitioner and go back to making my $100K+ a year and be happy. And since I am bilingual I can move to TX and quickly find me a job too. Maybe even take yours. 😉 Think you can compete with me?

Compete with you? I might consider HIRING you! Check out the laws in TX dude...NP's can OWN their own practice. Not every nurse is down and out and desperate to work for a doctor - HA HA!

I'm going to bed now. It's been nice chatting with everyone. This has been very entertaining! 😴

 

[toughlife]

Compete with you? I might consider HIRING you! Check out the laws in TX dude...NP's can OWN their own practice. Not every nurse is down and out and desperate to work for a doctor - HA HA!

I'm going to bed now. It's been nice chatting with everyone. This has been very entertaining! 😴

That will be $250K.

 

[Cyndee MSN NP]

are you even attractive enough for me to want to play a game of tennis with you?

HA HA! I used to work as a pharmaceutical sales rep and you KNOW what they look like! Would it be better to get your a-- kicked by an ATTRACTIVE FEMALE? Do you want me to send you a PICTURE or something? What do YOU look like?

 

[Cyndee MSN NP]

That will be $250K.

SORRY! The PCP's around here are getting in the low 100's. Besides, why would I want to pay a doctor that kind of money when I can get a mid-level for half? I'm a Jew...we don't pay retail for ANYTHING!

 

[toughlife]

HA HA! I used to work as a pharmaceutical sales rep and you KNOW what they look like! Would it be better to get your a-- kicked by an ATTRACTIVE FEMALE? Do you want me to send you a PICTURE or something? What do YOU look like?

I will PM you my email so you can send me your picture and I will see you in Houston on Jan 21st.

I am 5'11", 157, brown hair, brown eyes, olive skin, athletic.

 

[toughlife]

SORRY! The PCP's around here are getting in the low 100's. Besides, why would I want to pay a doctor that kind of money when I can get a mid-level for half? I'm a Jew...we don't pay retail for ANYTHING!

That's because those docs suck and with me you are getting a top-of the line doc baby.

I am not a jew but I am an equal opportunity employer.

 

[MDEntropy]

Let's talk about NP's (since that's what I am) and the economic advantage of hiring one.

NP salary: 70K/yr (NP generates 70K/month)
Benefits: 20K/yr (that's pretty generous)
NP pays for self in less than 2 months. After the overhead is paid, then the doctor/owner pockets the extra cash.

PCP salary: 150K/yr (generates 70K/month)
Benefits: at least 50K/yr (malpractice insurance is more expensive than NP's which averages $800/yr)
PCP pays for self in 3 months.

If you were the owner of that clinic, which one would you hire? Do you have any friends who own their own clinics? If so, then surely, they can fill you in on the economic advantages of hiring mid-level practitioners. There is a clinic here that fired 4 family practice docs and replaced them with FNP's. That practice is finally in the black and the owners are trying to figure out what took them so long!

Also, Medicare and Medicaid reimburses NP's at 15% less than they reimburse docs for the same service. We can save the taxpayers millions. If a physician works on site with the NP, then you can bill as "incident to" and get full reimbursement for services. That doesn't save the insurance companies money, but it generates more $$$ for the doctor/owner. Do you honestly not know that?

So with your example, you finally show some savings. Yes, but it is only when you point out that NP's are reimbursed less by medicare. This results in savings for the patient and the healthcare system. This is in stark contrast to the 'apparent' savings from your econ 101 example. Sure NP's may be cheap labor for the owner of a practice, but they do little to relieve the pressures on patients and the system. Even if 20% of all patients seen by NP's are medicare/caid the relative overall savings too all patients is a paultry 3%. Who cares what this amounts to nominally, it is a small percentage difference. The same argument can be made for CRNA's. They can provide a great economic benefit to the anesthesia groups that hire them, if they work independently, but they do nothing for the system. All of this assumes equality of care between the two groups and you falsely stated earlier that every study has shown docs and nurses to be equal or nurses slightly better. There are several recent studies in the anethesia literature that have results contrary to this. I am not going to say these studies are right but with savings that are so lean (3%), to have any type of economic advantage argument, those recent studies better be very wrong - and this is unlikely.

Econ 101 - when you talk about an 'economic advantage', you must be clear about your perspective. To broadly argue value creation you need to take a societal perspective, in which case the argument for nurses is very weak in a absolute best case scenario.

Or did you not know this? They don't teach this in the MSN program. I think they should. Then again, maybe they shouldn't. They can just repeatedly reiterate propoganda that can then be passed along to docs like many of the zippy ones on this board who believe anything they can be spoon fed.

 

[MDEntropy]

|

 

[militarymd]

ECONOMICS 101:

HOSPITAL PAYS DOCTOR $300,000/YR
HOSPITAL PAYS CRNA $150,000/YR FOR SAME SERVICE
= savings of $150,000 per year for each anesthesiologist replaced by CRNA 😀

If only it were that simple, then there would be NO anesthesiologists.

 

[jetproppilot]

If only it were that simple, then there would be NO anesthesiologists.

I'm thinking we've all been had. Again.

After some thought, its funny how this Cyndee MSN NP shows up...antagonistic, condescending...the name is almost too perfect, like it was evoked to elicit a response from us, along with her dialogue.
Funny how shes an expert in tennis, just like Justin was (remember him/her?)

Jet the FBI profiler is now suspecting that Cyndee is in fact a bitter white female...only she is a make-believe identity created by someone else with a more sinister motive...to bash, cause antagonism, evoke nasty responses, etc.

And I also suspect some of the recent screen names may be the work of the same person.

 

[ear-ache]

Let's talk about NP's (since that's what I am) and the economic advantage of hiring one.

NP salary: 70K/yr (NP generates 70K/month)
Benefits: 20K/yr (that's pretty generous)
NP pays for self in less than 2 months. After the overhead is paid, then the doctor/owner pockets the extra cash.

PCP salary: 150K/yr (generates 70K/month)
Benefits: at least 50K/yr (malpractice insurance is more expensive than NP's which averages $800/yr)
PCP pays for self in 3 months.

If you were the owner of that clinic, which one would you hire? Do you have any friends who own their own clinics? If so, then surely, they can fill you in on the economic advantages of hiring mid-level practitioners. There is a clinic here that fired 4 family practice docs and replaced them with FNP's. That practice is finally in the black and the owners are trying to figure out what took them so long!

Also, Medicare and Medicaid reimburses NP's at 15% less than they reimburse docs for the same service. We can save the taxpayers millions. If a physician works on site with the NP, then you can bill as "incident to" and get full reimbursement for services. That doesn't save the insurance companies money, but it generates more $$$ for the doctor/owner. Do you honestly not know that?

There is a FP practice where I lived that experimented with a NP’s (they had a hard time recruiting MD’s), but they are not hiring anymore NP’s because they increased the workload on the MD's. If the NP's were seeing anything complex, they would grab an MD to consult. This would create a patient back log and the clinic would run latter with cranky patients. And if the NP overstepped their knowledge base and got burned, that patient would often get admitted, resulting in more MD inpatient visits before and after clinic (they did not use hospitalists). In a nutshell, the physicians ended up working longer clinic hours and seeing more inpatients – ultimately not cost effective for this practice.

Cyndee, as a former NP student going through medical school, I hoped that my training would make medical school less straining. I am humbled daily on just how little medicine I know, how I will never be able to learn it all, and just how fallible I am.

 

[jwk]

Geez, 24 hours and about 5 pages of new posts, all because of Cyndee, the doc-wannabee.

Very impressive how a brand-new NP comes onto three BB's (SDN, allnurses, and PA) and knows absolutely EVERYTHING, not just about her OWN job, but about all of the ins and outs of ANESTHESIA as well.

Cyndee, I can't ban you from this board, but hopefully vent or Dave will with all your abusive trolling crap. Oh, and if it pops up on my board where I AM the moderator, I have a magic delete button that works really well.

 

[Cyndee MSN NP]

And we're tired of nurses trying to equal us.

And we're tired of doctors trying to equal GOD!

 

[Cyndee MSN NP]

Geez, 24 hours and about 5 pages of new posts, all because of Cyndee, the doc-wannabee.

Very impressive how a brand-new NP comes onto three BB's (SDN, allnurses, and PA) and knows absolutely EVERYTHING, not just about her OWN job, but about all of the ins and outs of ANESTHESIA as well.

Cyndee, I can't ban you from this board, but hopefully vent or Dave will with all your abusive trolling crap. Oh, and if it pops up on my board where I AM the moderator, I have a magic delete button that works really well.

You are sooooo weak...stifle the RN b/c the docs can't deal with controversy! LET'S JUST BAN HER FROM OUR BOARD!

 

[Soon2BENT]

). I'm 5'10 and weight 142 pounds.

fat

 

[Cyndee MSN NP]

fat

I'm FAT??? HA HA HA! Did you not notice I'm 5'10"! I WEAR A SIZE 6. I'm extremely athletic and I'm also an EXPERT in krav maga - I'll take you down any day!

 

[Cyndee MSN NP]

I'm thinking we've all been had. Again.

After some thought, its funny how this Cyndee MSN NP shows up...antagonistic, condescending...the name is almost too perfect, like it was evoked to elicit a response from us, along with her dialogue.
Funny how shes an expert in tennis, just like Justin was (remember him/her?)

Jet the FBI profiler is now suspecting that Cyndee is in fact a bitter white female...only she is a make-believe identity created by someone else with a more sinister motive...to bash, cause antagonism, evoke nasty responses, etc.

And I also suspect some of the recent screen names may be the work of the same person.

Okay Mr. Psychic...I made up my identity so I could get on here and piss off a bunch of doctors! You're nothing but a bunch of WIMPS! Oh yeah...I'm also an expert in krav maga (you probably don't even know what that is DOCTOR). I can kick every one of your ASSES!

 

[Cyndee MSN NP]

fat

Oh yeah...MD = Penis Extender

 

[Cyndee MSN NP]

Cyndee, I see that you are arguing with many people on this forum this evening, but I must say, given your above post, I am very glad you are here. I personally find economics to be an interesting yet very complicated subject. I personally have had much difficulty really understanding the economics of medicine, even when I try to digest it in small pieces.

Cyndee, please expain to me the economic benefit of CRNA's replacing anesthesiologists. You know, I just don't get it. Now, let me be forthcoming and say that this is something I have asked about before. I think I even started a thread once about this, but whenever I ask, people get quiet. But since it obviously is very clear to you ("it's economics stupid"), can you please explain it to me? Almost everyone here seems to believe that 'it is economics', so maybe it is true, and if you can explain it to me, using somewhat realistic numbers, that would be great. It is true that economics is generally absent from medical school curricula so perhaps that explains why I just don't get, but I don't know if that's really it. I look forward to your explanation. Thanks in advance for contributing to the forum.

How did you get your picture on your profile? I want to put my picture on mine too, so people won't think I'm the stereotypical UGLY FAT ASSED RN!

 

[Cyndee MSN NP]

I will PM you my email so you can send me your picture and I will see you in Houston on Jan 21st.

I am 5'11", 157, brown hair, brown eyes, olive skin, athletic.

Let me get this straight...you're 5'11", 157 lbs and you're a MAN? Someone needs to shove a few twinkies down your throat!

 

[Cyndee MSN NP]

are you even attractive enough for me to want to play a game of tennis with you?

Are YOU even attractive enough for ME to even REPLY TO YOUR POSTS? Oh wait a minute...you're a DOCTOR - we all know what THEY look like! Good thing you went to MED SCHOOL, that way you can pick up the chicks.

I don't want to play you in tennis...I want to kick your ass in racquetball, because then I can smack you around with the ball a few times! HA HA HA
______________________________________________

What's a Jewish "10"?

A "2" with 8 million dollars!

 

[Cyndee MSN NP]

So with your example, you finally show some savings. Yes, but it is only when you point out that NP's are reimbursed less by medicare. This results in savings for the patient and the healthcare system. This is in stark contrast to the 'apparent' savings from your econ 101 example. Sure NP's may be cheap labor for the owner of a practice, but they do little to relieve the pressures on patients and the system. Even if 20% of all patients seen by NP's are medicare/caid the relative overall savings too all patients is a paultry 3%. Who cares what this amounts to nominally, it is a small percentage difference. The same argument can be made for CRNA's. They can provide a great economic benefit to the anesthesia groups that hire them, if they work independently, but they do nothing for the system. All of this assumes equality of care between the two groups and you falsely stated earlier that every study has shown docs and nurses to be equal or nurses slightly better. There are several recent studies in the anethesia literature that have results contrary to this. I am not going to say these studies are right but with savings that are so lean (3%), to have any type of economic advantage argument, those recent studies better be very wrong - and this is unlikely.

Econ 101 - when you talk about an 'economic advantage', you must be clear about your perspective. To broadly argue value creation you need to take a societal perspective, in which case the argument for nurses is very weak in a absolute best case scenario.

Or did you not know this? They don't teach this in the MSN program. I think they should. Then again, maybe they shouldn't. They can just repeatedly reiterate propoganda that can then be passed along to docs like many of the zippy ones on this board who believe anything they can be spoon fed.

The only thing I'm NOT an expert in is accounting. But, a SIXTH GRADER can figure out you can make more bucks off of a mid-level provider. The insurance companies are STARTING TO FIGURE IT OUT TOO! Deal with it or move to another country!

 

[Cyndee MSN NP]

I will PM you my email so you can send me your picture and I will see you in Houston on Jan 21st.

I am 5'11", 157, brown hair, brown eyes, olive skin, athletic.

Still waiting for your email







I want to see YOUR PICTURE SKINNY DOC!

Oh yeah...better send it soon, b/c I've already received a nasty message from the moderator informing me that he/she is going to give me ONE and ONLY ONE warning! TOO FUNNY - YA'LL CAN'T TAKE THE HEAT!

I'll just make up a new screen name...can't get rid of me THAT easily!

 

[toughlife]

[email protected] ok send me your pic.



I want to see YOUR PICTURE SKINNY DOC!

Oh yeah...better send it soon, b/c I've already received a nasty message from the moderator informing me that he/she is going to give me ONE and ONLY ONE warning! TOO FUNNY - YA'LL CAN'T TAKE THE HEAT!

I'll just make up a new screen name...can't get rid of me THAT easily! [/QUOTE]

 

[Scrub MD]

as a former NP student going through medical school, I hoped that my training would make medical school less straining. I am humbled daily on just how little medicine I know

👍

 

[toughlife]

Why is it that the anesthesiology forum seems to always be plagued with midlevels or impostors trying to start some fight?

I noticed it happens way too much in our forum and not as much in others.

 

[sleepwithme]

Because Crna's come in there and start fights.
CRNA's are super-nurses, but they are not doctors. inferiority stems from doing 2 years of bull**** for a nursing degree, compared to anesthesia doing 4 years with licensing exams, being proficient in pediatrics, OB/GYN, and answering medical quetsiosn for family members. CRNA's wipe the asses of their family members, the extent of their training

 

[ear-ache]

I'll just make up a new screen name...can't get rid of me THAT easily!

Good idea! I was just thinking how you didn't have enough letters after your screen name. Oh, and make sure to list them again under the "user title" in case we missed them the first time.

Again, your trolling is just hurting our nursing profession. Nothing positive will come of this, except perhaps temporarily suppressing your own inadequacies. Please stop.

 

[powermd]

Why is it that the anesthesiology forum seems to always be plagued with midlevels or impostors trying to start some fight?

I noticed it happens way too much in our forum and not as much in others.

Because some of them:

1. Know not their limitations as non-MDs.
2. Think that being a successful anesthetist is all that matters in the field of anesthesiology. MD training/experience/intelligence/wisdom is superfluous. I bet some would seriously debate the importance of continued research in the field.
3. Are encouraged by their own inflated salaries, and the desparate opt-out state's legislative practices.

 

[jwk]

Because some of them:

1. Know not their limitations as non-MDs.
2. Think that being a successful anesthetist is all that matters in the field of anesthesiology. MD training/experience/intelligence/wisdom is superfluous. I bet some would seriously debate the importance of continued research in the field.
3. Are encouraged by their own inflated salaries, and the desparate opt-out state's legislative practices.

The person stirring the pot here is a NP, not a CRNA.

 

[Gimlet]

The person stirring the pot here is a NP, not a CRNA.

That's what baffles me! She's not even trolling about anesthesia-related issues...she just wants to get her rocks off on a mid-level vs. doctor debate, and she probably could tell that the anesthesia board gets a little testy when these issues come up.

 

[zippy2u]

I have to confess, this Cyndee woman is gettin' Zip aroused. This chick is full of piss and vinegar, athletic, hard-bodied, 5'-10'', 140s, practices krav maga ( I don't know what this is but it sounds like some lethal a$$ shiit), probably a firecracker in the bedroom. Damm Shazamm, Jetman put a stat FBI profiler checkeroo on her true sexual orientation despite the fact that she's married. Toughlife gets to play racquetball with her and she'll probably show up in a shorty tennis outfit with no briefs. Cyndee, can I be your little subservient towel boy for this event? Regards--------- Zippy

 

[militarymd]

Please post a pic. I really want to see now.

 

[fishtolive]

this proves once again what i was told as a third year by a wise attending...

"giving nurses these pseudo-degrees (CRNA, NP, MSN) is B UL LSH I T and makes them think they are equals and not the worker bees they are meant to be. they should be called "nurse" when you the doctor need something and give the occassional "how's your father" to the single doctors who need one after a long day of work and thinking, something nurses generally steer clear of."

i thought he was just being a jerk but a few solid months in the hospital changed my opinion...as has this message board (which is apparently now plagued with MD-wannabes).

sad, sad, sad.

 

[oldManDO2009]

Cyndee, as a former NP student going through medical school, I hoped that my training would make medical school less straining. I am humbled daily on just how little medicine I know, how I will never be able to learn it all, and just how fallible I am.[/QUOTE]

I have been arguing that point non-stop - my nursing background has been of little value as I enter my first year....

 

[MDEntropy]

The only thing I'm NOT an expert in is accounting. But, a SIXTH GRADER can figure out you can make more bucks off of a mid-level provider. The insurance companies are STARTING TO FIGURE IT OUT TOO! Deal with it or move to another country!

What a quality response. FYI, this isn't really accounting we are talking about, just like looking at chest x-rays isn't really dermatology. Just guessing here but possibly because you have been trained to function as an employee, you don't think perspective is important for these issues (i.e. if there is savings, who is saving, and is value actually created). This makes all the difference. W could delve much deeper into this topic but it is pretty evident to me that you don't have much to add, thus explaining your condescending remarks in bold print which are not accompanied by anything of substance. How dissapointing.

On a separate note, if an NP salary is ~70K/year why are you making at least 50% more than that ( this question is just based on looking at things you have said in several different posts.)?

 

[jetproppilot]

Please post a pic. I really want to see now.

A DROOLING SMILEY???

HAHAHHAHAHAHAHHAHAHAHAHAHAHAHHAHAAH

 

[cloud9]

Please post a pic. I really want to see now.

Awesome smiley!!! I'm jealous.

 

[militarymd]

Took a few days off...had some free time with the computer

 

[Cyndee MSN NP]

What a quality response. FYI, this isn't really accounting we are talking about, just like looking at chest x-rays isn't really dermatology. Just guessing here but possibly because you have been trained to function as an employee, you don't think perspective is important for these issues (i.e. if there is savings, who is saving, and is value actually created). This makes all the difference. W could delve much deeper into this topic but it is pretty evident to me that you don't have much to add, thus explaining your condescending remarks in bold print which are not accompanied by anything of substance. How dissapointing.

On a separate note, if an NP salary is ~70K/year why are you making at least 50% more than that ( this question is just based on looking at things you have said in several different posts.)?

First off, NP salaries are almost half that of CRNA's, so you're probably referring to a post regarding CRNA's. Once again, when Medicare/Medicaid reimburses a mid-level 15% less than they reimburse doctors, the government saves money (same with insurance companies). When a doctor employees a mid-level and pays them half what they would another physician, they make more money off that provider. I honestly don't understand how you don't get it, b/c there are a hell of a lot of doctors out there who DO get it and that's why they prefer to hire mid-levels. Who benefits in that situation? The owner (duh)!

 

[Cyndee MSN NP]

Please post a pic. I really want to see now.

I WANT to post a picture, but I can't figure out how to do it. Post your e-mail and I'll send it now.

 

[Cyndee MSN NP]

Please post a pic. I really want to see now.

I THINK I did this right...we'll see

 

[militarymd]

I WANT to post a picture, but I can't figure out how to do it. Post your e-mail and I'll send it now.

something like this....

 

[militarymd]

I THINK I did this right...we'll see

click on the "manage attachments" button

 

[Cyndee MSN NP]

Took a few days off...had some free time with the computer

Where the heck is my attachment? I don't get it?

 

[Cyndee MSN NP]

click on the "manage attachments" button

I did and I'm uploaded it, everything...it's not working!