Market and competition updated

[opa beleza?]

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CRNAS

1. How many CRNAs are there in practice now?

28,000 (allnursingschools.com/faqs/crna.php)
The American Association of Nurse Anesthetists' 2002 Membership Survey reported that 40% of CRNAs are employed as group employees, 33% are hospital employees, 13% are independent contractors, 6% are owners or partners in a practice, and 4% practice in the military or government.

2. How many CRNAs graduate and enter practice each year?

According to the Council on Accreditation of Nurse Anesthesia Educational Programs (COA), enrollment in nurse anesthesia programs has doubled from 900 to 1,900 since 1999

Currently, we have 99 anesthesia programs in the U.S. and the projected nurse anesthesia graduates are expected to be >2000 by 2007. (Michigan Study below)
They are growing faster than we:😱

3. How many CRNAs will retire within 20 years?

The average practicing CRNA is 48 years old.

According to an AANA 2005 survey, 61% of the CRNA in Michigan are greater than 45 years old and the national median age is 49 years old. Approximately 38% of this active CRNA workforce will be eligible for retirement in the next 5 years, aggravating the current shortage of nurse anesthetists. (Per CRNA study in Michigan link below)


4. How many CRNA schools are there?

~100

5. Length of incubation....training?

24-36 months (allnursingschools.com/faqs/crna.php)


Anesthesiologists

1. How many anesthesiologists are currently in practice?

37,000 -- ASAHQ

2. How many anesthesiologists enter practice each year?

1,200 -- ASAHQ

3. How many anesthesiologists will retire within 20 years?

"In 2000, 27% of Anesthesiologists were aged 55 years or older" OK: so
today they are 62 years or older, they are going to retire soon. Thats like
10,000 anesthesiologists that will retire within the next few years -- with
only 1,200 graduating annually.
Issues of Concern for the Aging Anesthesiologist
Jonathan D. Katz, MD, Anesthesia-Analgesia
Yale University School of Medicine, New Haven, Connecticut


Surgical Volume

1. What is the current number of anesthetics performed annually currently?

28 Million - 40 Million (allnursingschools.com/faqs/crna.php)
2. How many anesthetics will be performed anually in 20 years?

The number of individuals older than 65 years is projected to increase by more than 50% from year 2000 to 2020. (To like 50M)
Overall, the rates of general surgery increased and were highest for those 65 years and older. It was 3 times higher than those individual aged 15 – 44 years and 1.6 times higher than those persons aged 45 – 65 years. (Michigan Study link below)

If you look at the age distribution 30-40 million people betweeen 55 and 75 now. By 2025 there will be 60-70 million -- nearly double the surgical volume in just that age group.
Look for yourself:
http://www.census.gov/cgi-bin/ipc/id...out=s&ymax=200

Read about the future surgical population and anesthesia provider population between now and 2020 and CRNA retirement (Michigan based study)

http://www2.msufame.msu.edu/index.ph...printAb&ID=623


Some Questions:

1. Can anesthesia provider attenuation offset the total number of graduates 3500-4000 per year (CRNA +MDA)
2. Will the surgical population in the next 20 years provide enough business for everyone, or will there be an oversupply of providers -- assuming the worst case senario CRNA full autonomy?

If people could contribute and make corrections where needed in the same format this could become a useful sticky at some point about the future market forces.👍

 

[opa beleza?]

Sorry the links are dead here is the CRNA paper:


MSU/FAME Community Research Forum

The Projected CRNA Retirement in Michigan over the Next Twenty Years

Submitter: Berg, Deborah
Email: [email protected]
Insitution: Hurley
Specialty: ANESTH
Submit As: Nurse
Type: Study
Format: Poster
Preferred Time:

1. Laura Acosta, Masters
2. Lulu Weber, Masters
3. Patricia Klask, Masters
4. Scott Spiridigliozzi, Masters

Introduction: Certified registered nurse anesthetists (CRNA) are the sole providers of anesthesia in nearly half of all hospitals and provide more than 65% of all anesthesia services in the country. The average practicing CRNA is 48 years old. Based on this statistical data, an estimated 32% of practicing CRNAs will retire within the next decade.1 Despite the six-figure salaries, hospitals are struggling to recruit nurses trained to administer anesthesia. There is a well documented imbalance in the supply of anesthesia providers and demand for anesthesia services. Many recent research studies have dealt with the supply of anesthesia providers or inflow to the profession such as: the number of anesthesia programs, the number of graduates, and why nurses chose this career. Fewer studies have been done on the outflow from anesthesia practice such as death, disability, leaving for other reasons, retirement and transfer to part time status. The retirement trends of CRNAs in Michigan have not been studied in the past ten years while inflow to and outflow from the anesthesia profession has changed greatly. The literature review examined a number of today’s issues facing the future of CRNA practice within the present health system. Environmental and ethical issues related to the shortage were discussed. Although it is not immediately alarming at this time, several factors were identified that aggravated the existing shortage of anesthesia providers. The U.S. population is projected to grow from 275 to 325 million by the year 2020, an 18% increase in population.2 The aging of the baby boomers will lead to new challenges for the U.S. health care system because they make up the fastest-growing segment of U.S. population. The number of individuals older than 65 years is projected to increase by more than 50% from year 2000 to 2020.3 This unprecedented population aging trend has profound effects on disability rates and demands on the health care system. As the U.S. population grows in number and increases in age, the demands on the medical system will undoubtedly increase. Liu et al projected a dramatic increase in workload in the next 20 years largely as a result of the aging population using a random sample of 300,000 discharges from U.S. hospitals each year.2 The sampling frame included hospitals and ambulatory surgery centers. Overall, the rates of general surgery increased and were highest for those 65 years and older. It was 3 times higher than those individual aged 15 – 44 years and 1.6 times higher than those persons aged 45 – 65 years.2 These issues facing an increased general surgery is not simply workload but also the ratio of workload to workforce. The volume of outpatient surgical procedures has significantly risen over the volume of inpatient procedures. An increased in utilization of outpatient surgical facilities increases the demand for CRNA services. There has been a great focus on the supply of anesthesia providers for the predicted future needs of health care. The concern of decreased anesthesia providers in the 1980’s prompted the American Association of Nurse Anesthesia to establish a National Commission on Nurse Anesthesia Education. The commission addressed the marked decline in the number of nursing anesthesia program from 1975 to 2000 as a result of closure of 112 educational programs. The number of graduates dropped from 1,063 to 592 in the late 1980’s.4 The effort of anesthesia educators have made a notable difference in today’s supply issues. Currently, we have 99 anesthesia programs in the U.S. and the projected nurse anesthesia graduates are expected to be >2000 by 2007.5 The increase in the numbers of nurse anesthesia graduates is encouraging for the supply of anesthesia providers. However, the retirement of current CRNA can also significantly impact the supply of anesthesia providers. According to an AANA 2005 survey, 61% of the CRNA in Michigan are greater than 45 years old and the national median age is 49 years old.6 Approximately 38% of this active CRNA workforce will be eligible for retirement in the next 5 years, aggravating the current shortage of nurse anesthetists.7 No recent literature could be found on the outflow and retirement of Michigan’s CRNAs. A study of retirement trends will provide more accurate statistical data of the supply needs for CRNAs in Michigan.

Methods: A pilot study was conducted and 15 practicing CRNAs evaluated the survey questions as relevant, accurate, and having content validity. Minor modification was made based on their feedback before the study was conducted. IRB approval was granted for a survey study and a sample of 1178 practicing CRNAs in Michigan age 40 years and older were included. The mailing list was provided by the American Association of Nurse Anesthetists (AANA). A questionnaire type survey was distributed to the CRNAs throughout the state of Michigan via U.S. mail. A cover letter invited participation, explained the purpose of the study and indicated that return of the questionnaire implied consent. The CRNA was asked about their primary place of work, years in practice as a CRNA, average hours worked per week, and anticipated future retirement. Open ended questions were asked to cover any specific areas not included in the survey. A self-addressed stamped envelope was included for easy return.

Results: There are 1546 CRNAs in Michigan, and 1178 are age 40 and older with 1-50 years of experience as a CRNA. Due to high rate of return, only one mailing survey was utilized. The response of those CRNAs surveyed was 529 of 1178. Of the respondents, 37.4% were male and 61.8 were female with the mean age of 50 years. The age of the oldest practicing CRNA respondent was 86 and as expected the youngest was 40. The primary employment of the majority of CRNAs were at the mid-size hospital (101-499 beds) 51%, large hospital (>500 beds) 23%, small hospital (<100 beds) 9%, ambulatory setting 8%, locum tenums 7%, and office 2%. Many CRNAs were employed in more than one setting. Some CRNAs reported a second place of employment including hospital based 16.6%, locum Tenums 11.3%, ambulatory 6.8%, and office based 4.3%. The current average amount of overtime was 8 hours/week. The mean age for anticipated retirement was 61.7 years and the oldest response was 87 years. After retirement, the average CRNAs plan on working 14.5 hours with the maximum of 40 hours. The reasons for continuing to provide anesthesia after retirement were due to maintaining friends and social contact 58%, maintain skills 35%, monetary 5%, benefits and filling local employment needs 1%. After retirement, 32.1% of the CRNAs indicated that they plan on volunteering to provide anesthesia for medical mission. When surveyed about relocation plans after retirement, 38.4% will relocate on seasonal basis, 14.6% permanently, and 1.3% as locum tenums. It was found that 6.6% of the CRNAs were planning to relocate outside Michigan before retirement, 22.5% after retirement, 39.5% were undecided, and 26.7% were not planning of relocating at all.

Conclusion: The retirement of CRNAs will increase the gap between the demand for anesthesia services and providers working to deliver anesthesia services in Michigan. The average age of our respondents was 50.3, and the average age of predicted retirement is 61.7. The population surveyed represents 75% of the practicing CRNAs in Michigan. In the next 11 years 55% of those surveyed plan on retiring, this represents 42% of the workforce in Michigan. As we hypothesized at the beginning of this survey, the outflow from the workforce is much greater than the inflow and greater than previously expected. Many of the respondents reported that they will continue to work part time after retirement, but due to plans to relocate out of state, unpredictability of hours worked, and variability of workplace setting, it is difficult to gauge the retirees’ contribution to the workforce. Our results show, however that 65.4% of the retirees plan to provide anesthesia after retirement and estimating an average of 14.5 hours of anesthesia care per week. The reasons the respondents choose to keep working after retirement were varied and unique. Some included: “I just love my job in anesthesia,” “remain active,” “supplement income,” “maintain skills,” “to educate and mentor young nurses who enter our specialty,” and “have purpose, self fulfillment.” There were many positive comments and only one perceived negative comment from the respondents as to why they were retiring, it was stated “operating rooms are depressing.” After receiving comments from respondents, some weaknesses of this survey were pointed out. The CRNAs surveyed were asked to predict retirement age and these numbers are subject to change based on socio-economic factors, death, disability, and health issues inherent in an aging population. An inherent weaknesses of this study is the difficulty in self-reporting which can be impacted by responses such as “undecided,” “don’t know,” and “haven’t thought about it.” An interesting correlation that became apparent was those who were older and female were more likely to work after retirement. This may be due to the longer life span of females compared to males. Females are more likely to have gaps in employment due to childbearing and raising a family which gave them less opportunity to accumulate retirement funds. The older population will have had fewer years working at today’s higher rate of pay, and thus need to work longer to supplement income in the retirement years. Based on the result of this research, we have some recommendations for future studies. Actuarial methods could be used to predict death and disability to more accurately reflect outflow from CRNA practice. Studies are recommended to update inflow patterns to the CRNA profession including inflow of students, moving in and out of the State of Michigan, and those who work as interstate travelers. Another issue to consider is the change in educational programs in the State. These changes include opening and closing of anesthesia programs, the change in the length of programs, and the move toward requiring a clinical doctorate for practice. As predicted, by the previously cited study, the outflow from CRNA practice in Michigan will be greater than the inflow. The exact numbers are not known, but if responses of the 529 respondents are any indication, the outflow from the profession will be substantial. The current literature states there will be a 32% deficit, and the response to our survey predicts a 42% deficit. The impact may be somewhat modulated by the responses of CRNAs planning to provide anesthesia services part time after retirement.

 

[opa beleza?]

Here is the population data:

View attachment Slide1.jpg

View attachment Slide2.jpg

 

[EtherMD]

I hate statistics when they lie. The above statistics may hold true for Michigan but not necessarily the rest of the USA. Many of my CRNA's work part-time and are in their 60's. I plan on working part-time until my late 60's.

With Anesthesia Part-time work is common in the warmer climates and we see a lot of providers in their 60's and early 70's. I predict that is the trend and there will be no shortage in the most desirable locations. Unfortunately, I don't think most of Michigan qualifies as desirable in the winter.

In addition, this data does NOTHING to show why Medicare won't pay Anesthesia as a NURSING Field. If this happens, hundreds more CRNA Schools will open (24 months in duration?) and many Residency Programs will close.


The key to this battle is containing the AANA and replacing CRNA's when possible with AA's.

 

[opa beleza?]

Not trying to paint or spin a picture here, I'm just saying lets get all the facts on the table.

 

[EtherMD]

Not trying to paint or spin a picture here, I'm just saying lets get all the facts on the table.

Not saying you are "spinning" anything. I am just pointint out how multiple statistics are used to "influence" an argument. The AANA is using these statistics to start many more CRNA programs and increase the size of existing ones. The AANA knows it needs "numbers" to dominate the market place. The ONLY thing in the way is getting enough "older" CRNA's to get their DNAP/PhD so the schools have enough faculty.

Economically and Politically the AANA war machine is ready to go. Why not throw a wrench into this machine and show them that ANESTHESIOLOGISTS will not "go quietly into the night."

 

[core0]

Not trying to paint or spin a picture here, I'm just saying lets get all the facts on the table.

I also would question the numbers of both providers. The nursing numbers typically show anyone trained as a CRNA not those actually working in the profession. I'm not sure what the numbers are for CRNA's, but the numbers for NP's show that as little as 40% of NP's trained as NP's are working in that capacity. There are probably more CRNA's working as CRNA's due to the salary difference between RN's and CRNA's which is greater than that for NP's and CRNA's, but that would be a guess. The anesthesiology numbers would presumably be better.

David Carpenter, PA-C

 

[Coastie]

This talk of them providing 65% of all anesthetics and being sole providers in over half the hospitals is a pure, outrageous lie.

90% of the 40 million anesthetics are delivered or supervised by a doctor, with only 10% done CRNA solo. Of the 90%, docs do 35% solo, 55% ACT.

We need to show those lies for what they truly are. Why do you think they start every single article with that "statistic"? It's the foundation upon which all of their arguments are built.

 

[EtherMD]

This talk of them providing 65% of all anesthetics and being sole providers in over half the hospitals is a pure, outrageous lie.

90% of the 40 million anesthetics are delivered or supervised by a doctor, with only 10% done CRNA solo. Of the 90%, docs do 35% solo, 55% ACT.

We need to show those lies for what they truly are. Why do you think they start every single article with that "statistic"? It's the foundation upon which all of their arguments are built.

I agree. LESS than 10% of Anesthetics in the USA Are provided by a SOLO CRNA. More than 90% of all cases are supervised/directed by an Anesthesiologist.

The AANA is a TRUE propoganda machine intent on winning the $$$ battle at all costs. The organization is pure rhetoric and most new CRNA's need years before solo practice becomes possible.

The reality is the ASA has no interest in doing anything that will mess up the status quo at this time. IF (in 5-7 years) the AANA actually gets more Independence for its membership maybe there will be a response. The ASA prefers to react to problems after they occur; a poor strategy.