Is Anesthesia in any danger?

[HEME-ONC]

Is anesthesia in any danger of becoming a dying field. There are now asistants to the asistants that are all going to be doing the same work. are anesthesiologist still finding work or are they being slowly replaced be the CRNA's.
Thanks

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[Drakensoul]

Welcome to MDA vs. CRNA thread number 9187238e13.

There are seriously like 10 other threads of the exact same topic in the first two or three pages of the thread list.

 

[Fermata]

I am curious about all this debate, though.

I don't see 1,000,000 threads in the peds forum about Peds NP's.

 

[Mr_Money]

Anesthesiologists are easily finding jobs wherever they want. This is not a problem, only another version of "the sky is falling!"

 

[MacGyver]

Is anesthesia in any danger of becoming a dying field. There are now asistants to the asistants that are all going to be doing the same work. are anesthesiologist still finding work or are they being slowly replaced be the CRNA's.
Thanks

Long term, the number of MDAs in this country is going to be slashed. They will be relegated only to the most complex of surgeries/gas procedures.

I think MDAs are going to end up as a very small specialty, similar to something like a pediatric neuroradiologist (although MDAs wont have to go thru fellowship training). Only a very few residency slots to go around. Becoming an MDA wont be an option for the vast majority of med students in the long term future.

The MDAs that actually can get a residency slot will be able to find a job, but theres no way in hell the job market long term will support the current number of new MDA grads every year.

 

[MacGyver]

Anesthesiologists are easily finding jobs wherever they want. This is not a problem, only another version of "the sky is falling!"

Right now? Yes.

Take off your myopic gas glasses and start getting an appreciation for the long term future.

 

[Mr_Money]

Right now? Yes.

Take off your myopic gas glasses and start getting an appreciation for the long term future.

Yeah, okay We all don't have a crystal ball like you do, MacGyver.

 

[gaseous]

MacGyver, glad to see that you have promptly returned to the forum in the heat of another MDA vs. CRNA battle.

 

[MacGyver]

Yeah, okay We all don't have a crystal ball like you do, MacGyver.

You dont need a crystal ball, you need common sense.

Tell me why Congress or state legislatures will listen to MDAs in the future when CRNAs control 90% of the gas market? They ALREADY control almost 70% of the market. Even the most die-hard opponents of my position ADMIT PUBLICLY that a CRNA can do 90% of what an MDA does. Their idiotic assertion is that since MDAs can do 10% more than a CRNA, that there will always be jobs for MDAs. Thats such a short sighted viewpoint for a number of reasons, but mostly its stupid from a lobbying/representation perspective.

Right now, MDAs still have some say over what happens in the gas field in terms of lobbying efforts to state legislatures and Congress, but thats quickly changing. If CRNAs continue to take up increasing market share, eventually they will reach critical mass and THEY will become the authority of the gas profession that the legislators will cater to. Your representative will tell you "I have sympathy for your position, but your group is a minor player in the field now. Others have taken over as primary representation of your profession."

Thats going to be a real kick in the ass.

 

[MacGyver]

MacGyver, glad to see that you have promptly returned to the forum in the heat of another MDA vs. CRNA battle.

Dont worry, I'm sure you've got at least 20 years before your voice is lost and the CRNAs become the voice of the anesthesiology profession. Make your money now and then cash out before it gets too bad. Thats what all your colleagues are doing, so what the hell.

 

[Tenesma]

MacGyver...

before you start throwing out numbers, i suggest you do some research

1) there are 35,000 practicing anesthesiologists and there are 32,000 practicing CRNAs... so how do they control 70% of the market? Are you falsely elevating the current AANA statement that "60% of anesthetics are provided by CRNAs"??? that statement is slightly misleading since 85% of those anesthetics are actually medically supervised by anesthesiologists.
And how will CRNAs control 90% of the market when in fact, MD programs graduate about 1200 residents/year and CRNA programs graduate about 900CRNAs/year... so your numbers don't add up... the only way your numbers could ever add up is IF: MD programs cut their residency spots and CRNAs increase their output... Neither of which is going to happen ANY time soon.

2) "there is no way the job market can support the number of MDAs graduating": again, you have no sense of what the literature shows (and I am quoting from the Mayo Clinical Proceedings 2003, the Cleveland Clinic Study 2002 and the Medicare reviews of 2000 and 2001). In fact, all three of those reviews/studies show that there will be a shortage of 3000-4,500 MD Anesthesiologists by 2005 and double that shortage by 2015. And the estimated retirement rate is currently 300/year and is expected to be 800/year by 2010.

3) and CRNAs won't be able to take advantage of the glut of anesthesiologists for two reasons A) the huge shortage of people going into nursing (which is a pre-requisite to become a CRNA) B) the unwillingness of CRNA programs to expand or multiply due to the advantages of the current and future supply/demand issues.

so MacGyver - either you start posting realistic numbers and continue to provide arguments based on research and studies, or you can continue to be viewed as a cook who likes to spread fear and is not to be respected (or put on ignore lists).

 

[GASCRNA]

Ohoh Mr. Money is on Probation !

 

[Mr_Money]

Ohoh Mr. Money is on Probation !

What an astute observation! You get one gold star........

By the way, I really don't give a **** about my probationary status.

 

[painmanager]

yeah, what up now macguyver? Tenesma always comes through with the thunder, good work. I think Mac was abused by an anesthesiologist or something when he was younger. I've never seen anyone with a bigger grudge against a certain medical specialty, not even other people from medical schools.

 

[MacGyver]

2) In fact, all three of those reviews/studies show that there will be a shortage of 3000-4,500 MD Anesthesiologists by 2005 and double that shortage by 2015. And the estimated retirement rate is currently 300/year and is expected to be 800/year by 2010.

So what? 10 years ago there were multiple studies showing doctor surplus.

Those studies arent worth the paper they are printed on. Pure guesswork and nothing more.

3) and CRNAs won't be able to take advantage of the glut of anesthesiologists for two reasons A) the huge shortage of people going into nursing (which is a pre-requisite to become a CRNA)

The overall number of people going into nursing is irrelevant. The only relevant item is what % of the nursing population wants to become CRNAs. This group is increasing steadily every year.

B) the unwillingness of CRNA programs to expand or multiply due to the advantages of the current and future supply/demand issues.

As for your comments about an imposed shortage of CRNA schools, its not that clearcut.

A link from the CRNA website indicates that they ENCOURAGE new schools of nurse anesthetists! Yes, thats right:

http://www.aana.com/education/na_program.asp

Like to Establish a New Nurse Anesthesia Education Program?
Send for your information packet now!

The information packet sent to those interested in establishing a nurse anesthesia education program includes:

A list of programs currently accredited by the Council on Accreditation of Nurse Anesthesia Educational Programs (COA).
A white paper on nurse anesthesia education.
Questions and Answers about a career in nurse anesthesia.
Demographic information related to anesthesia care in your state.
COA's policy and procedure Eligibility for Accreditation.
COA's policy and procedure Capability Review for Accreditation.
An article from the April 1998 issue of the Journal of the American Association of Nurse Anesthetists, entitled, "An economic analysis of the investment in nurse anesthesia education," by Kathleen Fagerlund, CRNA, PhD.
An article from the July-August 2000 issue of Nursing Economics entitled, "Alternative Cost-Effective Anesthesia Care Teams," by Jerry Cromwell, PhD and Karen Snyder, MA.
A Publications/Products Catalog from the American Association of Nurse Anesthetists. (You can purchase a manual from the AANA, Primer for Developing a Nurse Anesthesia Program, Item #1025, which is available for $50.)


Send for your information packet now!!
Send an e-mail to: [email protected]

Here's an interesting tidbit from the national CRNA website:

Also of interest is the fact that approximately eight nurse anesthetists can be educated for the cost of one anesthesiologist. Competitively, this gives CRNAs an advantage over anesthesiologists in a scenario where manpower supply and costs to the government and society are issues.

This is EXACTLY WHY residency slots for MDAs are going to be slashed in the long term future.

If universal care comes along, it will happen immediately, but even if it doesnt happen, long term the government is going to realize that it can save BILLIONS of dollars by funding CRNAs over MDAs in education.

Even you will admit that a CRNA can do 90% of what an MDA does. Spending 8 times the money to get a person who can only do 10% more than another individual just wont fly.

MD programs graduate about 1200 residents/year and CRNA programs graduate about 900CRNAs/year...

Where did you get those numbers?

There are 92 accredited CRNA programs out there.

http://www.aana.com/coa/accreditedprograms.asp?State=all

Each program graduates about 15-20 people per year, so thats approx 1400-1800 graduates PER YEAR, not 900. Thats a lot more than the MDAs produce each year.

 

[jwk]

There are 92 accredited CRNA programs out there.

http://www.aana.com/coa/accreditedprograms.asp?State=all

Each program graduates about 15-20 people per year, so thats approx 1400-1800 graduates PER YEAR, not 900. Thats a lot more than the MDAs produce each year.

Some of those programs have 6-8 students per class. And they don't all make it through. 900-1000 a year is much closer to the real number than your 1400-1800 assumption. The CRNA's don't want to pump out that many graduates - they're afraid of diluting their own numbers. Heck, they're scared to death of the 40-50 AA's graduating each year.

 

[VentdependenT]

Go into internal medicine for three years. That should make you so sick of the wards, scut, and social issues that you'd head for gas even if you only made $50,000 a year.

Bottom line, go for what you like. Macgyver thanks for contributing!

 

[Tollway]

Ventdependent sums it up precisely.


McGyver- Why do you hang out on our forums??? Please go away

 

[juddson]

From reading CRNA websites and from the relative paucity of action on the part of the ASA, as well as recent state and medicare initiatives re. CRNA's and MDA, I think MacGyver is on the money.

The biggest issue is spingle payor and universal healthcare. Two issues are important: First, a decrease in reimbursements will drive MDA's out of the "bread and butter" work and into intensivist work (but for less money) as CRNA's will be happier with reimbursements. Second, decreased income across the board will necessitate something in the way of medical education subsidies for those willing to become doctors. Because CRNA's are MUCH cheaper to educate, these subsidies will not be as generous for MDA programs, rendering them largely unviable.

No hard facts to back this up (after all, we don't YET have universal healthcare), but I think those who think critically about this issue have to at least take these predictions seriously.

Judd

 

[gaseous]

Its been a long time since I read one of these threads because it always seems to be the same people bringing up the same points.

My question is why???

If you are one of these people, I would love to hear your well thought out response.

1. Are you worried that people are planning on going to become MDA's and you think that its such a terrible fault that you can't bere to sit idly by and let it be? If so, I'm glad to see there are people out there that care about my pocketbook. I think its pretty noble. I sure don't care about anybody else's pocketbook.

2. Are you a prospective Anesthesia resident and hope you can drum up enough negative feeling about the field that you will scare people away thus giving you a better shot a getting a position? hmm...

3. Are you some nerdy 13yo who has nothing better to do than look up statistics so that people will think you are enlightened? never can tell....

4. Maybe none of the above. But if you are none of the above, I just can't figure out the logic except one really being a misplaced lawyer just looking to debate. I personally love to debate, unfortunately, this issue is like abortion, people just see it in different ways. And if you want to debate about the future, could you do me a favor? Can you tell me which stocks will be hot in the next 20 years so that I start arranging my portfolio? If you can predict one thing, who knows, you may be able to predict it all.

(In conclusion: If I find myself out of work in 20 years, I will look back at this time and think to myself, "If only I had listened to the enlightened ones....Oh what has my life become???" I will really have mud of my face then. But until then, I'm not holding my breath.)

 

[MacGyver]

1. Are you worried that people are planning on going to become MDA's and you think that its such a terrible fault that you can't bere to sit idly by and let it be? If so, I'm glad to see there are people out there that care about my pocketbook. I think its pretty noble. I sure don't care about anybody else's pocketbook.

You still dont get it. What happens in anesthesiology affects other fields.

When the psychologists successfully lobbied for script rights, one of their PRIMARY arguments was that people with less training (i.e. PAs, NPs, CRNAs) script drugs all the time so why not extend those script rights to psychologists?

The fields of medicine are interrelated. What happens to opthalmology in Oklahoma affects neurosurgery in New York. Its time for doctors to wake up and smell the coffee. You dont run your own little fiefdom anymore. Midlevels have used a divide and conquer approach and its worked fantastically for them, because ER docs in California thought that what happened in Florida was irrelevant to them. FPs in Washington thought that PAs in North Carolina being allowed to run their own clinics would never affect them.

its EXACTLY this kind of myopic shortsightedness that has allowed the midlevels to expand scope rights year after year, state after state.

 

[HEME-ONC]

THanks

 

[wasatch]

I am a 2nd year med student interested in GAS. I have been reading many posts and wonder what kind of relationship exists between the CRNA group of people and the MDA group? Do they get along? Or is their a power trip that exists on either side?

 

[gaseous]

Macgyver,

(Note I'm not being sarcastic)

As a future practicing Anesthesiologist what do you want me to do? I can give money to the ASA. I will in the future anyway. I'm not sure if thats going to help.

Would you rather me picket in front of the white house?

Go on strike?

Go into Politics???

Actively bash CRNA on forums????

I'm dying to know what I can do so that you as a "neuosurgeon in washington" won't have to be affected by the CRNAs.

 

[conservative]

We should make it a requirement that before someone resurrects a topic (especially one that has been beaten like a dead horse) that they please search the thread index. With this particular topic you wouldn't have to search far before finding a recent thread. I'd bet MacGyver is in every one of them at least once.

 

[gaseous]

sorry for keeping it going. The whole issue is ridiculous and sometimes it is hard for me not to egg it on a little.

 

[joshmir]

Mac-

You certainly put up with a lot of abuse on this forum. If people are so hostile towards you, why do you still feel the need to educate, alucidate, set things straight, etc?

I'm not judging you, I'm just curious about your motivations on this CRNA, downward-spiral-of-MDs issue.

Somebody asked this question earlier, albiet in a semi-sarcastic way. Please respond as to your personal motivations for your efforts.

If you do respond, people may take you much more seriously, If you don't, it's likely even those who appreciate your perspectives (and read this post) will become skeptical.

Peace.