I have been lurking on this thread for awhile and figure its time to speak up.
I am sick of people saying that private practice is going to be gone in a few years and that CRNAs are going to take all of those jobs. Personally I find that extremely insulting. Someone mentioned they did private practice and it seemed so rote and boring. I also heard that all MD only groups were going to be non existent in the next few years.
I work in the private practice arena in a community hospital. Granted we dont do the "big" cases, the CABG, lobectomy, the vascular cases, but we do the bread and butter cases, some thoracic and occasional ASA 4's for emergent bowel cases. Even though we are a community hospital we do have an ICU and do deal with extremely sick patients. I am an expert in efficency, room turnover, perioperative pain control, PONV, I do all my own anesthetics, my own labor epidurals, cesarean sections, u/s guided blocks, you name it, I do it. Personally I love it this way. I dont have to manage personnel, I just manage patients. Dont have to worry about offending anyone or having to deal with disruptive personalities, except the surgeons, who are very nice seeing as I deal with them directly and dont have anyone backstabbing me when I leave the OR (I have heard CRNAs backstab anesthesiologists once they leave the OR). I dont deal with that bullshq period, end of story, and I love it that way.
Think about it folks, if we give CRNAs all the lovely private practice gigs we are left with academics. I am sorry but I didnt go into medicine to be an academician, I wanted to work in a community hospital type of practice. I know there are a lot of folks like me and if we lose all our private practice gigs you might as well kiss anesthesia as a speciality goodbye, might as well make it a fellowship of IM or ER or some such shq.
So the way the health care business is headed is that all of us are going to get shq on and shq on hard. CRNAs think they are exempt? LOL, they are going to wish they were part of the ASAPAC in a few years. Talk to your partners who worked in Canada or Europe. These are countries with socialized medicine already, these are countries where there are no CRNAs. Doctors are going to become HUGE players in the whole health care landscape real quick if socialized medicine takes a hold. You think the government is so stupid to staff NPs and CRNAs as a majority? The govt knows that they have to keep health care safe. So they are going to cut the middlemen, or at least slash their salaries and their numbers by ALOT. But in the same respect, we as docs will also make less money but will work less hours, and there will be more positions in medical schools for more highly trained practioners with education, and less of these midlevel types. Once medicine is no longer lucrative, the draw will wane for these midlevels and like I said govt will work with docs to maintain the integrity of the system. I read an excellent article from England explaining how at the moment England has only anesthestists (docs) no CRNAs, and how the demand and number of ORs in England is beyond the possible supply of docs to cover all the ORs. So what the anesthestists in England are deciding to do is to hire people with master of science in chemistry, physics, etc who are looking for work and train them in the basics of anesthesia. The article stated that the anesthetists in England have seen the horrors of the American system of CRNAs and dont want to take the chance in hel that anything like that would occur in England so they are not going to train nurses. If anything I think the US govt will be looking at the systems of European and Canadian healthcare systems and how the efficiently operate without all these midlevel practioners and the govt is going to find a way to make sure that healthcare is safe by ensuring that high quality well educated people stay in medicine, which means that the govt is finally going to be on our side for once. I am very optimistic because I feel that once we work for the govt, the irony will be that the govt will have to work for us and will listen to what we need in order for health care to survive. I know the military system is a govt system, and I think that will in the future model what the private socialized system is like and not what the military system is like presently. If the govt fuqs with us too much, no one will enter medicine and the system will collapse once people realize that these midlevels idiots who graduated from some online RN course or community college backwoods is entirely out of their league and cannot advance a metaphor let alone a medical establishment, then the govt doesnt want that, so we are set, trust me.
