Salaries

[freeheeler]

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In the long run, will Anesthesiology salaries stay as high as they are currently, or will they trend down as the market becomes more saturated, etc?

 

[Wahoowa]

In the long run, will Anesthesiology salaries stay as high as they are currently, or will they trend down as the market becomes more saturated, etc?

Saturated?? What do you mean by saturated? The anesthesiology market is years away from saturation. On top of that, there is a large percentage of anesthesiologists comtemplating retirement.

 

[me454555]

In the long run, will Anesthesiology salaries stay as high as they are currently, or will they trend down as the market becomes more saturated, etc?

If I could predict stuff like this I wouldn't be in medical school

 

[utlonghorn50]

I have the smae concerns myself. I am afraid the salary will decrease as more and more people go into the field.

 

[dave262]

Wheres MacGuyver? he should be all over this post.... 😱

 

[Jeff05]

this is from ---Residency Composition and Numbers Graduating
from Residencies and CRNA Schools 2002
Alan W. Grogono, MD, FRCA---

This year (2002) the number of anesthesiology residents in the PG1 year has risen again. In the last two years the total number has increased by 43% to 638 and the number of AMGs has more than doubled to 500 (78% of the total). The total in the PG1 year is approaching half of the total recruitment into the CA1 year. The growth is probably explained by an increased availability of primary care internship positions due to declining enthusiasm for primary care. By contrast the number entering the anesthesiology CA1 year is almost constant although there has been a 14%
increase in the proportion of AMGs to 1,119 out of 1,471 (76%). The number graduating from anesthesiology residencies increased moderately this year but for the next three years the total completing training is anticipated to be almost steady around 1,400. The average output for the last 14 years is 1402. The numbers graduating fell below this level in
1998. The average output for the years 1989 to 1997 was 1,582 and the average for the years 1998 to 2002 was 1,079, i.e., there was a relative excess production of 1,620 during the years 1989 to 1997 and a relative deficiency of 1,605 during the years 1998 to 2002. A steady output
of 1,402 for the last 14 years would have resulted in the numbers we now have. One conclusion must be that if this level of output has resulted in a shortage, then a continuation of the average
output of 1,402 per year cannot correct the current deficit.

so there you go. stop the panic. there will be a shortage for many years to come. even with the "threat" of CRNA's. ok ok, maybe one day the salaries will drop, and g-d forbid, anes will make as much as surgery.

 

[utlonghorn50]

That was a great post. Have other people heard similar data and/or similar interpretation of the data? Sorry to beat this into the ground, but I hate to go into a field even if I love it if there are no jobs in ten years or if the salary drops drastically due to flooding of the job market. I can already hear the responses that it should not be about the money. It is not, but unfortunately everything is expensive these days.

 

[me454555]

That was a great post. Have other people heard similar data and/or similar interpretation of the data? Sorry to beat this into the ground, but I hate to go into a field even if I love it if there are no jobs in ten years or if the salary drops drastically due to flooding of the job market. I can already hear the responses that it should not be about the money. It is not, but unfortunately everything is expensive these days.

There is no way to know what the job market will be like in 10 years. There is no way to predict what salaries will be like in 10 years. Only thing you can do is a choose a field that you enjoy enough to do for the rest of your life and let the chips fall as they may

 

[jwk]

There is no way to know what the job market will be like in 10 years. There is no way to predict what salaries will be like in 10 years. Only thing you can do is a choose a field that you enjoy enough to do for the rest of your life and let the chips fall as they may

Excellent point - if you can't stand the profession, all the money in the world won't help (it may ease the pain a little, but your day will still suck).

HOWEVER - I've been hearing the sky is falling in anesthesia for the 25 years that I've been in it, both for physicians and anesthetists. Some areas have an abundance of anesthesia providers, others have none. Regardless, good practice opportunities are available in thousands of places around the US.

 

[MechE]

Wheres MacGuyver? he should be all over this post.... 😱

I think he only pops his head in for MD vs. CRNA threads.

 

[InductionAgent]

That underscores the importance of living frugally enough until you have stashed enough of a nest egg to shield you from any sudden changes in the economics of your profession. It's always worth taking note of the fate of athletes, rock stars, businesspeople, etc. who fail to acknowledge the whimsy of fortune and wind up broke when they could have been set for life. Our profession enjoys a higher degree of stability, but nothing is absolute.

 

[Mo007]

My roommate just started working for a hospital in LA. He did his fellowship at Children's Hospital in Boston through Harvard. He was offered a lot of spots all over the country, from Houston to Cleveland to San Fransisco. All those jobs were paying well ($200K+ minmimum), and they seemed to want him sooner than he would like to.

Currently, I would say the market is wide open for this profession... and like another person pointed out, the focus should be what you enjoy more than $$$.

 

[MechE]

Do what you love and the money will come. 👍

 

[MS3NavyFS2B]

Excellent point - if you can't stand the profession, all the money in the world won't help (it may ease the pain a little, but your day will still suck).

HOWEVER - I've been hearing the sky is falling in anesthesia for the 25 years that I've been in it, both for physicians and anesthetists. Some areas have an abundance of anesthesia providers, others have none. Regardless, good practice opportunities are available in thousands of places around the US.

This one is always attempting to lump CNRAs with physicians. This cannot be done for the purposes of this discussion (or, in my opinion, any other discussion). And I hate the freakin' term "providers"--just call people what they are!

The reason is that if the number of surgeries decrease (for any reason, say single-payer health care), CNRAs and other ancillary staff with be the first to go, because their jobs--whether or not they choose to admit it--are exclusively to assistant the attending MDA. Hospitals, given the choice, will clearly go with the MDAs rather than take their chances with mid-levels, especially since the FL study showed poorer outcomes--and thus more lawsuits--with CNRAs practicing independently (i.e., without an MDA involved directly in patient care).

When patients are given the choice between a physician doing anesthesia or a nurse doing their anesthesia...it's also pretty clear who they'll choose (at least for my family and every patient I've ever met).

Futhermore, anesthesiology is a speciality with various, HIGH-paying subspecilaities--most of which (if not all) require only a year of fellowship: Pain, neuroanesthesiology, cardio, intensive care (SICU or even MICU), etc.

When the Dow hits 15,000...they'll be a massive retirement of MDAs. I can state this with much certainty. This has an interesting history that relates to the hiring freeze on MDAs that the groups themselves imposed a few years back (for fear of socialized health care decreasing surgeries). Applications, as a direct result of this, dropped dramatically during these few years, but the groups, of course, kept who they had. The massive efflux will more than compensate for any increasing interest in the years to come; plus, the demand will surely rise as the baby boomers age...

There is no reason to assume that the number of surgeries will decrease in the proximate future, for any reason, but even if they do...MDAs might be reduced to a general surgeon salary (which, let's face it, is not half bad) if they don't choose to do a fellowship (which, of course, mid-levels cannot do since their training prepares they for only very specific parts of physicians jobs, whereas physicians are trained to enter any residency after medical school).

Moral of the story...don't worry about the renumeration. It'll be there. Just make sure you like it because MDAs have the highest rate of substance abuse and the third-highest rate of suicide in medicine--following psychiarty and ophthalmology (excluding dentistry, which has the highest suicide rate of all).

 

[GSU]

Can someone provide a link to the article or tell me where to find it please?
Thanks..

 

[MS3NavyFS2B]

Can someone provide a link to the article or tell me where to find it please?
Thanks..

You can find it the same place you can find articles relevant to medicine, PubMed.

Lesson: Scientific journals do not give access to their contributions for free. In fact, access can be quite expensive, even for one article. If you are affiliated with a medical school, however, then free access to almost everything is provided via the medical library. Most hospitals that aren't affilated with medical schools usually don't purchased rights to journals.

I've provided what us in science and medicine call the "abstract," a brief synopsis of the article. Before commenting on the article, however, it is highly recommended to actually read the entire article and analyse it, paying particularly close attention to it's methods (which is a course it itself to teach).
-------------------------------------------------------------------------
Anesthesiologist Direction and Patient Outcomes
[CLINICAL INVESTIGATIONS]
Silber, Jeffrey H. M.D., Ph.D*; Kennedy, Sean K. M.D.?; Even-Shoshan, Orit M.S.?; Chen, Wei M.S.?; Koziol, Laurie F. M.S.[//]; Showan, Ann M. M.D.#; Longnecker, David E. M.D.**

Received from the Center for Outcomes Research, the Department of Anesthesiology and Critical Care Medicine, The Children?s Hospital of Philadelphia; the Departments of Anesthesia and Pediatrics, The University of Pennsylvania School of Medicine; the Department of Health Care Systems, The Wharton School and The Leonard Davis Institute of Health Economics, The University of Pennsylvania, Philadelphia, Pennsylvania.
Submitted for publication February 17, 2000.
Accepted for publication May 12, 2000.
Address reprint requests to Dr. J. H. Silber: The Children?s Hospital of Philadelphia, Center for Outcomes Research?, 3535 Market Street, Suite 1029, Philadelphia, Pennsylvania 19104. Address electronic mail to: [email protected].

Abstract
Background: Anesthesia services for surgical procedures may or may not be personally performed or medically directed by anesthesiologists. This study compares the outcomes of surgical patients whose anesthesia care was personally performed or medically directed by an anesthesiologist with the outcomes of patients whose anesthesia care was not personally performed or medically directed by an anesthesiologist.

Methods: Cases were defined as being either ?directed? or ?undirected,? depending on the type of involvement of the anesthesiologist, as determined by Health Care Financing Administration billing records. Outcome rates were adjusted to account for severity of disease and other provider characteristics using logistic regression models that included 64 patient and 42 procedure covariates, plus an additional 11 hospital characteristics often associated with quality of care. Medicare claims records were analyzed for all elderly patients in Pennsylvania who underwent general surgical or orthopedic procedures between 1991?1994. The study involved 194,430 directed and 23,010 undirected patients among 245 hospitals. Outcomes studied included death rate within 30 days of admission, in-hospital complication rate, and the failure-to-rescue rate (defined as the rate of death after complications).

Results: Adjusted odds ratios for death and failure-to-rescue were greater when care was not directed by anesthesiologists (odds ratio for death = 1.08, P < 0.04; odds ratio for failure-to-rescue = 1.10, P < 0.01), whereas complications were not increased (odds ratio for complication = 1.00, P < 0.79). This corresponds to 2.5 excess deaths/1,000 patients and 6.9 excess failures-to-rescue (deaths) per 1,000 patients with complications.

Conclusions: Both 30-day mortality rate and mortality rate after complications (failure-to-rescue) were lower when anesthesiologists directed anesthesia care. These results suggest that surgical outcomes in Medicare patients are associated with anesthesiologist direction, and may provide insight regarding potential approaches for improving surgical outcomes.

Silber JH. Kennedy SK. Even-Shoshan O. Chen W. Koziol LF. Showan AM. Longnecker DE. Anesthesiologist direction and patient outcomes.[see comment]. Anesthesiology. 93(1):152-63, 2000 Jul.
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you're welcome...

 

[InductionAgent]

The reason is that if the number of surgeries decrease (for any reason, say single-payer health care), CNRAs and other ancillary staff with be the first to go, because their jobs--whether or not they choose to admit it--are exclusively to assistant the attending MDA.

This is not true in all states. In at least one, New Hampshire, no anesthesiologist supervision of cRNAs is necessary. There are up to 28 other states in which this is true, depending on who you believe.

"HCFA officials said states now may decide whether to require that anesthesiologists or other physicians supervise CRNAs. The American Society of Anesthesiologists says only New Hampshire allows CRNAs to practice independently; the American Assn. of Nurse Anesthetists contends that 29 states do not require physician supervision."
http://www.ama-assn.org/amednews/2000/03/27/prbf0327.htm

From a 2004 report from the ASA, Montana, Iowa, Nebraska, Idaho, Minnesota, New Hampshire, New Mexico, Kansas, North Dakota, Washington, Alaska, and Oregon have all opted to allow unsupervised practice by CRNAs
http://www.mdnetlink.com/msa/ASAlegislativereport.pdf

This all sets the stage for cutting back anesthesiologist jobs if a short-sighted bottom line becomes priority#1. I hope it doesn't come to this, but the law is certainly setting that possibility in place.

 

[MS3NavyFS2B]

This is not true in all states. In at least one, New Hampshire, no anesthesiologist supervision of cRNAs is necessary. There are up to 28 other states in which this is true, depending on who you believe.

"HCFA officials said states now may decide whether to require that anesthesiologists or other physicians supervise CRNAs. The American Society of Anesthesiologists says only New Hampshire allows CRNAs to practice independently; the American Assn. of Nurse Anesthetists contends that 29 states do not require physician supervision."
http://www.ama-assn.org/amednews/2000/03/27/prbf0327.htm

From a 2004 report from the ASA, Montana, Iowa, Nebraska, Idaho, Minnesota, New Hampshire, New Mexico, Kansas, North Dakota, Washington, Alaska, and Oregon have all opted to allow unsupervised practice by CRNAs
http://www.mdnetlink.com/msa/ASAlegislativereport.pdf

This all sets the stage for cutting back anesthesiologist jobs if a short-sighted bottom line becomes priority#1. I hope it doesn't come to this, but the law is certainly setting that possibility in place.

You're absolutely correct, and especially so if Kerry gets elected.

I made it sound like that's the only reason. I should have made the point clearer that there are other factors that will ensure MDA jobs, including all of those originally posted above, the most important of which are patients. Patients are not dumb, and in these days they demand and expect nothing but the best, an MDA. Anyway, more lawsuits also effect the bottom-line...

It's funny...I just got my surgery rotation schedule and all of the anesthesiology tutorials say, "if anethesiology attending available."

 

[Tenesma]

a few things:

1) CRNAs can practice in all states without Anesthesiologist supervision... Those are state laws/requirements, however if a hospital decides to set a hospital-wide policy requiring anesthesiologist supervision, then the state can't intercede.

2) CRNAs need physician supervision (it doesnt matter if it is a psychiatrist or a radiologist) in order to get Medicare reimbursement, except for 12-13 states where those states have opted out.

3) Salaries are better than ever.... Some recent grads from my old program are getting starting salary offers of 325-350k.... and that is without the benefit of a fellowship.

4) Salaries will continue to rise because of the continued shortage, and will continue to rise even further when more of the older anesthesiologists start retiring.

5) the reason why anesthesiologists will always make more than CRNAs is primarily due to 2 things: 1) the ability to supervise multiple rooms and 2) anesthesiologists cases tend to be more complicated and therefore have higher billable units (thoracic epidural, swan, etc..)

 

[OldManDave]

About a year or more ago, maybe even 2+, I read an excerpt from an anesthesia rag that stated not only are the numbers of new anesth grads insufficient to meet future needs - as is well delineated above - but that 2 additional facotrs bode well for the continuation of of excellent anesth salaries.

1: Even though applications/entry in the physician-anesthesiologist have increased markedly, applications to the CRNA schools have not, at least at the time the article was published.

2: The population distributions of both CRNA & MD/DO anesthesiologists, due to the "lag" in folks entering both fields during the 90's, is skewed towards retirement age. I don't recall the mean ages cited, but for both it was in the mid-50s. But, in the next decade or so a disporportionate percentage of MD/DO anesth & CRNAs will be retiring leaving an even potentially larger shortage or at least a continuation of the current status.

Of course, being as things have most definitely changed in the last couple of years, the above statement is w/ the caveate that it may be out of date. But, I sure as hell hope that prediction holds true!

 

[Wahoowa]

The interesting thing is that having spoken with several aneshtesiologists, the job market for anesthesiology is quite auspicious. Several factors are in play here:

-Anesthesia interest runs on a sinusoidal wave

-The number of anesthesiology residency positions is not increasing a great deal

-You have to remember that anesthesiologists do retire

-Because of the lack of interest in the late 80's and 90's, there is a large group of anesthesiologists getting ready to retire (in the next few years, a lot of doctors will be going out + the lower numbers that entered during the dry period--due to the disproportionate numbers, more jobs will be available

-I predict that this "strong interest" in anesthesiology will start to wain pretty soon

There are too many alarmists out there that are putting too much thought and worry into this.

 

[Wahoowa]

The interesting thing is that having spoken with several aneshtesiologists, the job market for anesthesiology is quite auspicious. Several factors are in play here:

-Anesthesia interest runs on a sinusoidal wave

-The number of anesthesiology residency positions is not increasing a great deal

-The biggest part of the reason anesthesia is seeing a lot more PGY1's is because a lot of the residency programs are trending towards an anesthesiology intern year and converting to four-year programs

-You have to remember that anesthesiologists do retire

-Because of the lack of interest in the late 80's and 90's, there is a large group of anesthesiologists getting ready to retire (in the next few years, a lot of doctors will be going out + the lower numbers that entered during the dry period--due to the disproportionate numbers, more jobs will be available

-I predict that this "strong interest" in anesthesiology will start to wain pretty soon

There are too many alarmists out there that are putting too much thought and worry into this.

 

[gaseous]

Have CRNAs started forming their own groups and contracting with hospitals for anesthesiology services? As for all of the hospitals I have worked, an anesthesiologist group contracts with the hospital to provide services for the surgeries in that hospital. Therefore it would seem that even if CRNAs could/would practice independently, they would have to form their own groups or join the anesthesiologist group that serviced the hospital.

Maybe it works different in different places? I guess some places have anesthesiologists/CRNAs as staff positions where they work for the hospital not a group but I thought most places have anesthesia groups under contract.

A group that I have worked with has +/- 80 anesthesiologists and provides anesthesia services at 5 different hospitals throughout the city.

 

[InductionAgent]

Have CRNAs started forming their own groups and contracting with hospitals for anesthesiology services?

Here's a novel approach to this question: a Google search for "CRNA-only groups"

This is based on 2001 data:
"In terms of employment, 33% of CRNAs are employed by hospitals, 37% belong to physician CRNA groups, 20% belong to CRNA only groups or are self-employed, and 10% are employed by other settings e.g. ambulatory surgery centers or military."
http://bhpr.hrsa.gov/nursing/nacnep/shortagetestimony.htm

Here's a link to a page advertising CRNA services that specifically mentions CRNA-only groups
http://accesscrna.com/facilities.html

With the increasing numbers and practicing rights of CRNAs, one can reasonably expect CRNA-only groups to become more common.

 

[Tenesma]

of course there are CRNA only groups... there are also MD only groups... they don't compete for the same market or the same hospitals, for obvious reasons. The CRNA only groups usually forms in rural areas or areas with limited MD availability....

 

[jwk]

This one is always attempting to lump CNRAs with physicians. This cannot be done for the purposes of this discussion (or, in my opinion, any other discussion). And I hate the freakin' term "providers"--just call people what they are!

I guess by "this one" you mean me.

Amazing how a discussion about salaries deteriorates to anesthetist bashing once again - oh, actually it didn't until your post.

Can you PLEASE at least get the abbreviation right? It is C R N A, not CNRA as you have put in each of your posts. It's obviously not a typo since you keep repeating it.

Oh, and since you obviously haven't looked at my profile - I'm an AA, not a CRNA. So obviously I'm not attempting to lump CRNA's with MD's.

And since there are three types of anesthesia providers, in a general discussion I simply refer to "anesthesia providers" instead of saying CRNA's, AA's, and MD's.

Why do you have such a huge chip on your shoulder about mid-level providers? If you're going to be in the Navy, you're going to be surrounded by far more mid-level providers, nurses, and corpsmen than physicians. You ought to start learning now to respect them and their capabilities, because they will far outnumber you when you get out in the real world.

 

[gaseous]

Thank you for answering my question.

 

[HappyZzz]

Florida Appellate Court Invalidates
Anesthesiologist Supervision Rule

Florida Certified Registered Nurse Anesthetists (CRNAs) may now administer anesthesia for Level III office surgery without anesthesiologist supervision. In July 2004, a Florida appellate court struck down a Florida Board of Medicine (BOM) rule for Level III office surgery requiring anesthesiologist supervision of CRNAs. On September 17, 2004, the court cleared the way for the July 2004 decision to take effect. (Level III means surgery that involves, or reasonably should involve, general anesthesia or major conduction anesthesia and pre-operative sedation. Level III also includes procedures in which IV sedation is used and the patient loses consciousness and vital reflexes.)

The Florida appellate court rulings concerned the legal challenge brought by Florida CRNA Victor Ortiz. The anesthesia rule, which was implemented in 2002, forced Mr. Ortiz and many other CRNAs who had previously provided anesthesia in physicians? offices out of office practice. Most surgeons concluded that it was not economical or necessary to have both an anesthesiologist and a CRNA in their office.

The court?s July decision invalidating the restrictive rule held that the BOM exceeded its rulemaking authority by requiring an anesthesiologist to be present for Level III office surgery. The court noted that the Florida Nurse Practice Act authorizes CRNAs to provide anesthesia services in accordance with a protocol approved by the medical staff of the facility in which the services are performed. According to the court, the anesthesiologist supervision requirement also contravenes a medical practice act provision prohibiting the BOM from restricting services provided by a registered nurse under the supervision of a physician. Although the BOM argued that its rule does not restrict CRNAs, the court disagreed, stating, "[The BOM] has done indirectly what it cannot do directly."

The Florida Association of Nurse Anesthetists (FANA) previously challenged the anesthesiologist supervision requirement in a different lawsuit. FANA won that case at the administrative law judge (ALJ) level, but a different appellate court reversed the decision. Although the appellate court in the FANA lawsuit ruled that the ALJ had used the wrong standard of review (a technical legal ground), that appellate court did not question the ALJ's factual findings. In the Ortiz case, the appellate court specifically noted that the "parties agree that patient safety is not an issue in this proceeding." The appellate court in Ortiz also cited with approval the ALJ's factual finding in the FANA lawsuit that there was no evidence to indicate any significant difference in patient outcomes regardless of whether a CRNA or an anesthesiologist administered the anesthesia.

To review the appellate court's July 2004 ruling in the Ortiz case, please see the following Web link: http://www.aana.com/legal/mt/ortiz.asp.

On September 17, the court denied the BOM's motion for rehearing and the Florida Society of Anesthesiologists? "friend of the court" motion for rehearing.

The BOM may seek to appeal the court's ruling to the Florida Supreme Court. If the BOM appeals, it may also try to obtain a stay of the ruling pending the Florida Supreme Court's review of the case. Unless and until a stay is issued, the BOM anesthesiologist supervision rule is void, and CRNAs are permitted to administer anesthesia for Level III office surgery without anesthesiologist supervision.

For years, Florida CRNAs have diligently fought this unjustified anesthesiologist supervision rule. No state currently has a law or regulation in effect that mandates anesthesiologist supervision of CRNAs.

 

[HappyZzz]

--------------------------------------------------------------------------------

I thought the above post was needed here for several reasons. It can be found at www.aana.com.

CRNAs can bill directly to Medicare for services, how would they have independent contracts for anesthesia otherwise? They are also responsible, even in hospitals that utilize an overseeing MDA, for their own anesthesia practice, they are not covered under the MDA. I don't feel that it is accurate for that reason the view some of you seem to have that CRNAs need someone watching over them in anesthesia cases.

And what is this "mid-level" provider crap? CRNAs go through rigourous training just as MDs do, they have a different background of eduction, nursing, but they are still just as competent, and safe at providing anesthesia as the MDs are. In case some of you don't know, research the qualifications for CRNA applicants- they are the best of the best of nursing.

MDAs don't always get the hardest cases either. CRNAs are trained to do open hearts, transplant cases, and any other type of anesthesia cases, they are not limited in their practice.

The reason many of you are making the comments "patients want the best, an MDA" is becuase the root of this argument boils down to what the original post was about-- Money, and job security. Many states are now considering CRNAs a financial alternative to MDAs for that very reason. How can you justify earning $200k or $350K a year for your services? I know, because even as students, you are deciding which specialty you want based on money.

The reason you don't want to think CRNAs can practice independently, or believe they are your equal in the OR, is because it is a matter of job security for you. If CRNAs can do the same job, with comparable outcomes, and charge a reasonable amount for their services, they are a hugh threat to the ASA and MDAs.

There are many other flawed viewpoints here, but I think this response is enough. If you don't know enough to even spell CRNA correctly, then you don't know enough about them to argue for or against them. Just for your knowledge, I would look up the start of anesthesia and CRNA practice. Nurses having been doing anesthesia before doctors ever got involved, funny how when they got involved, the question of MD supervision became an issue.

If someone wanted MD vs. CRNA argument, here it is. Just couldn't let this one go without trying to clear up some things. Look forward to your responses.

 

[undecided05]

While I agree with previous posts that one shouldn't do anesthesia just for the money, it honestly bothers me that there are people out there who think that you should just do anesthesia and accept the salary as it comes. At least at my med school they tell us that we shouldn't care about salary (they push us to do FP,Meds, Peds), but that's just BS. This is also our livelyhood and our business. Money does matter; don't let anyone tell you otherwise. When you're out in the real world, fight for your salary just as any other businessman would.

 

[deltamed]

From what I understand CRNA's train for 2-3 years after nursing school, which takes 1-2 years if you have a BA already. So CRNAs require 3-5 years of medical education. MDAs have 4 years of med school and 4 years of residency for a minimum of 8 years.

What do you think they do in those extra 3-5 years? Sit on their asses and play golf? I don't understand how you can think are equal. That's like saying a good paralegal is equal to a good lawyer.

--------------------------------------------------------------------------------

I thought the above post was needed here for several reasons. It can be found at www.aana.com.

CRNAs can bill directly to Medicare for services, how would they have independent contracts for anesthesia otherwise? They are also responsible, even in hospitals that utilize an overseeing MDA, for their own anesthesia practice, they are not covered under the MDA. I don't feel that it is accurate for that reason the view some of you seem to have that CRNAs need someone watching over them in anesthesia cases.

And what is this "mid-level" provider crap? CRNAs go through rigourous training just as MDs do, they have a different background of eduction, nursing, but they are still just as competent, and safe at providing anesthesia as the MDs are. In case some of you don't know, research the qualifications for CRNA applicants- they are the best of the best of nursing.

MDAs don't always get the hardest cases either. CRNAs are trained to do open hearts, transplant cases, and any other type of anesthesia cases, they are not limited in their practice.

The reason many of you are making the comments "patients want the best, an MDA" is becuase the root of this argument boils down to what the original post was about-- Money, and job security. Many states are now considering CRNAs a financial alternative to MDAs for that very reason. How can you justify earning $200k or $350K a year for your services? I know, because even as students, you are deciding which specialty you want based on money.

The reason you don't want to think CRNAs can practice independently, or believe they are your equal in the OR, is because it is a matter of job security for you. If CRNAs can do the same job, with comparable outcomes, and charge a reasonable amount for their services, they are a hugh threat to the ASA and MDAs.

There are many other flawed viewpoints here, but I think this response is enough. If you don't know enough to even spell CRNA correctly, then you don't know enough about them to argue for or against them. Just for your knowledge, I would look up the start of anesthesia and CRNA practice. Nurses having been doing anesthesia before doctors ever got involved, funny how when they got involved, the question of MD supervision became an issue.

If someone wanted MD vs. CRNA argument, here it is. Just couldn't let this one go without trying to clear up some things. Look forward to your responses.

 

[HappyZzz]

Actually CRNA education is undergrad 4-5 years and grad almost 3 years, so education time ends up being approx 7-8 years. No where in my post did I say CRNA and MDA are "equal". I said they can do a comparable job with regards to anesthesia, there are some differences in their scope of practice as we all know.

I realize you go to med school, and I respect that 100%. I am not trying to take away from that accomplishment in the least. However, I think some of you need to realize CRNAs don't have to be your enemy. It is just hard to keep hearing oppinions that degrade CRNAs when many of you don't know the facts of their profession, education, job skills, then why are you suprised when CRNAs want to defend their position?

It is the age old doctor vs. nurse battle, the idea "I am the doctor, I'm over you, you do what I say." The nurse of today is being trained to think critically and function more indepedently, being completely acountable for all actions, and can give insight to patient care without always having to refer to an MD. When we all realize we should only be fighting for one side- that of the patient's best interest- then maybe our professions can complement each other instead of attack each other.

My post was simply meant to enlighten some of you that CRNAs have more knowledge and responsiblity that some of you like to think.

 

[Tenesma]

HappyZzz:

the florida situation arose for a very specific reason: a very high percentage of office-based procedures (primarily cosmetic) in a state with a very powerful board of medicine. When there was a VERY high rate of office based deaths/complications the florida board of medicine had no choice, especially when so many of those complications were anesthesia related.

The cited court decision does not in any way contest the reasoning behind the decision of the board of medicine to require anesthesiologists in those offices. Instead the court decision only finds that there is a specific legislative committee known as the "joint committee" that can make a decision on an issue which deals with BOTH nursing and physician issues. Since that committee didn't render a judgement, and only the Board of Medicine made the decision to require anesthesiologists, the appelate court was able to rule for Ortiz.

Therefore your posting regarding the florida situation is useless in this discussion....

1) CRNAs can bill directly to Medicare but require physician supervision in order to receive reimbursement, except for the 12 or so opt-out states - where they can be reimbursed without any physician supervision. However medicare only reimburses up to 85% of billed services for CRNAs (i wonder why)...

2) CRNAs don't go through the rigorous training: tell me how 1,500 hours of OR experience for a SRNA is equivalent to 10,000 hours of Anesthesia Resident OR experience??? tell me how doing an average of 700 cases as an SRNA compares to an average of 3400 cases for an anesthesia resident? tell me how a BSN and some years of critical care experience is equivalent to an MD and a year of internship? tell me how come there is a minimum requirement of 5 arterial lines and a minimum of ZERO swan-ganz catheters to be able to graduate and sit for the boards of the Council on Certification of Nurse Anesthetists, when just during med school most medical students have done more procedures.... the list goes on, so don't give me this old sob-story about "just as rigorous", cause it ain't "just as rigorous".... this is what it is: "just barely enough to keep a healthy ASAI/II alive when you graduate from CRNA school"

3) they are not limited in their practice.... that's right. They can do anything they want (according to protocols/algorithms and whatever the surgeon tells them to do).

4) many states consider CRNAs a financial alternative??? really???? which ones???? because even in the states that opted-out of the Medicare requirements of physician supervision, and thus according to you would have an incentive to hire CRNAs, are actually paying TWICE as much for Anesthesiologists..... hmmmm.....

5) CRNAs are not a threat.... other than in office-based surgeries in Florida where quite a few anesthetic complications appear to be occuring under their "rigorous" CRNA care.

6) Nurses have been doing Anesthesia first.... BORING... What an old argument which is easily refuted:
a) barbers did surgery first.... therefore barbers are equivalent to Surgeons (at least according to you and the AANA)
b) a dentist and a few physicians performed the first anesthetics, and then the responsibility went on to nurses AND medical students to perform the anesthetic under the surgeon's supervision.... AND THEN, because of the ridiculous high mortality associated with anesthesia, physicians decided to better understand the field and start managing it properly.... As well as invent capnography, pulse oximetry, electrocardiography, defibrillators, better inhaled anesthetics, better muscle relaxants, and the list goes on..


So my advice to you and all other CRNA zealots who were misguided into thinking they have anything substantial to offer to this forum is to zip it.... or at least make well-thought out points that are well-substantiated.

in the meanwhile can we close this thread because the salary issue was already clearly answered...