National CRNA independence and disruption of the status quo

[fuzzydoc303]

I have read about this issue extensively on this board, but there is one aspect that remains unclear to me. Many posters say that once CRNAs are able to practice independently at the national level, anesthesiologist salaries will decrease significantly and *good* jobs will be near impossible to come by as physicians are forced to work for CRNA salaries. However, many other posters point out that even in states where CRNAs have been able to practice independently for years (CA, OR, WA, VA, etc), great jobs still exist for physicians and salaries have not plummeted like many predicted because the additional value provided by anesthesiologists is valued and apparent. I wonder what change, if any, is reasonable to expect if (when) CRNA independence is national compared to the practice/employment environment currently seen in CRNA independent practice states?

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[ryanjmy]

Nothing really changes in opt out states. In non opt out states crnas can be supervised by any physician not necessarily an anesthesiologist. My state is a non opt out and crnas dominated the easy outpt centers.

Also it pretty standard for MDs to be involve in all high risk practices regardless of opt out status.

 

[coffeebythelake]

I have read about this issue extensively on this board, but there is one aspect that remains unclear to me. Many posters say that once CRNAs are able to practice independently at the national level, anesthesiologist salaries will decrease significantly and *good* jobs will be near impossible to come by as physicians are forced to work for CRNA salaries. However, many other posters point out that even in states where CRNAs have been able to practice independently for years (CA, OR, WA, VA, etc), great jobs still exist for physicians and salaries have not plummeted like many predicted because the additional value provided by anesthesiologists is valued and apparent. I wonder what change, if any, is reasonable to expect if (when) CRNA independence is national compared to the practice/employment environment currently seen in CRNA independent practice states?

It won't change much for physicians. Even in opt out state, these "independent crnas" are working in low acuity centers, community, and boonies. Plus the shady plastic surgery centers, dental offices, outpatient GI centers,, places that push the limits that many anesthesiologists may feel unsafe but it's all game for CRNAs who care for $ >> safety.

AANA plays the propaganda tune to boost their own ego. They want to say they practice independently but don't actually want the difficult or high risk cases. I see greater threats from private equity, insurqnce companies,, Medicare for all, and for profit hospital systems.

 

[GassYous]

Opt out states probably have more md only practices than non opt out

I am on the same page as coffee. Anyone who wants to own you and put their hand in your pocket is the problem.

 

[Endee]

Biggest threats to anesthesiology, in this order:

1) Insurance companies / No Surprises Act (ASA just joined ACEP, ACR to sue federal government over NSA implementing rules)
2) Private equity control of practices & corporate practice of medicine (Envision, TeamHealth, USAP, NAPA, etc)
3) CRNAs/scope of practice

The first two pose a much, much bigger threat than the third, although both #1 and #2 facilitate the expansion of #3.

 

[deleted941485]

Biggest threats to anesthesiology, in this order:

1) Insurance companies / No Surprises Act (ASA just joined ACEP, ACR to sue federal government over NSA implementing rules)
2) Private equity control of practices & corporate practice of medicine (Envision, TeamHealth, USAP, NAPA, etc)
3) CRNAs/scope of practice

The first two pose a much, much bigger threat than the third, although both #1 and #2 facilitate the expansion of #3.

Just saw that statement that went out from all three specialties. I wish it was all specialties that threw their hat into this suit because at the end of the day this affects all specialties.

 

[Iso4ane]

What I don't get is this. If anesthesiologist become as 'cheap' as CRNAs, who would be a better for the hospital?

 

[Zekchar]

Nothing really changes in opt out states. In non opt out states crnas can be supervised by any physician not necessarily an anesthesiologist. My state is a non opt out and crnas dominated the easy outpt centers.

Also it pretty standard for MDs to be involve in all high risk practices regardless of opt out status.

I do medical supervision. I have had to run in on multiple occasions to help my CRNAs in our endoscopy center to rescue a patient whose sats are in the 60's and is turning blue during EGDs / colons. Sometimes I wonder what happens in other places where its opt out and the CRNA doesn't have me for backup. Then I shudder.

 

[vector2]

I do medical supervision. I have had to run in on multiple occasions to help my CRNAs in our endoscopy center to rescue a patient whose sats are in the 60's and is turning blue during EGDs / colons. Sometimes I wonder what happens in other places where its opt out and the CRNA doesn't have me for backup. Then I shudder.

I have no idea what happens in endo but my buddy is a general surgeon out in the boonies (CRNA only) and he tells me whenever he gets the rare ASA 3 or 4E then he has to do the surgery and the critical care management during the case.

 

[Gilakend]

It won't change much for physicians. Even in opt out state, these "independent crnas" are working in low acuity centers, community, and boonies. Plus the shady plastic surgery centers, dental offices, outpatient GI centers,, places that push the limits that many anesthesiologists may feel unsafe but it's all game for CRNAs who care for $ >> safety.

AANA plays the propaganda tune to boost their own ego. They want to say they practice independently but don't actually want the difficult or high risk cases. I see greater threats from private equity, insurqnce companies,, Medicare for all, and for profit hospital systems.

If an anesthesiologist wanted to work rurally, is it harder to find a job typically since it is CRNA-dominated? Or would those places be happy to hire an anesthesiologist?

 

[Endee]

If an anesthesiologist wanted to work rurally, is it harder to find a job typically since it is CRNA-dominated? Or would those places be happy to hire an anesthesiologist?

CRNAs get the benefit of rural pass-through reimbursement and it’s my understanding that, still, anesthesiologists do not.

Rural Pass Through Legislation

Ensuring access to safe, physician-led anesthesia care in rural communities

www.asahq.org

 

[coffeebythelake]

CRNAs get the benefit of rural pass-through reimbursement and it’s my understanding that, still, anesthesiologists do not.

Rural Pass Through Legislation

Ensuring access to safe, physician-led anesthesia care in rural communities

www.asahq.org

The legislation makes no sense, and basically is an incentive to midlevels and a disincentive for physicians. Methinks the AANA lined some politicians pocket to make this happen

 

[kidthor]

That and the AANA markets & spins well. They sell it as if they're doing a needed service nobody else will do... and that only a big financial bonus will allow CRNAs and only CRNAs to provide this rural service (because those horrible doctors won't). Brilliant on their end.

Totally unclear how this slipped under the radar for us when created. The ASA's inability to market us and represent what we actually do for patients is frustrating. Their big innovation was the name "physician anesthesiologist", and we know how well that grand innovation worked out.