The next 20-30 years

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ctsicu

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So I am a young physician that has just started practice a year ago. Just looking at the last 20 years it is astounding the foothold that mid levels have gained. What I don't quite get Is why. The population hasn't increased THAT much that there should be such a ridiculous shortage. Anyway what is going to happen to me for my career? I am disheartened and scared...thoughts??
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There is no real physician shortage (in major metro areas).

The shortage is growing in rural areas.

The gap in income between physicians and mid-levels will continue to narrow. Before many NPs made around $60-70K. I see NPs making 80-100K. FP's will continue to make 120-200K depending on practice structure.

Specialist salaries will take nose dives. Honestly, I see anesthesiologist salaries going downward to the mid 200s. Sure you can "hustle" and make in the 300s, maybe 400s. But if you want a life outside the operating room and don't want to hustle, be prepared for these salaries.

Physicians salaries will always be "good enough" for the public. But in reality, adjusted for inflation, we will never see the 1980s golden year of income.
 
If physicians and advanced practice nurses become "equivalent" in every respect (including compensation), then I think we'll see a precipitous decline in medical school enrollment. You would have to be a complete ****** to choose the medical school route under those conditions. There are HUGE differences in the rigor of professional education and the extent of competency assessment between a certified advanced practice nurse and a board certified physician.

Option A:
- college degree with easier coursework in science
- FOUR hour competency exam at end of college
- easier exam for entrance into professional school (e.g., GRE for advanced practice nursing)
- lower GPA requirement for admission
- 4 years of advanced practice coursework and training
- 4 hour competency exam at end of advanced practice curriculum

Option B:
- college degree with harder coursework in science
- more challenging entrance exam for professional school (i.e., MCAT for medical school)
- higher GPA requirement for admission to professional school
- 4 years of medical school
- FORTY ONE hours of competency examinations by the end of medical school (USMLE I-III)
- one year of internship
- 3 to 6 years of residency
- 4 hours written specialty board examination at end of residency
- 1 hour oral specialty board examination at end of residency

If the pay and privileges are the same for options A and B, what ***** would choose the latter path? Let's see here...I can choose path A, which is cheaper and easier or I can choose path B, which is more expensive and far more difficult. In either case, I'll make the same money, work the same hours, and get the same level of respect and privileges. Oh, such an easy decision! I'll choose path B!

Yeah. Riiiiight.

There are serious consequences for this advanced practice nursing political movement. If APNs successfully legislate "equivalence" to physicians in every respect, the physician shortage in this country will become exponentially worse...

Why? Because no rational person will go into medicine anymore and very few people will stay in the profession unless they absolutely have to. We'll see a huge brain drain away from medicine to other fields.

Frankly, I find the whole APN political movement in this country to be farcical. This country is truly going to s&*t. We can't solve any major problem in a reasonable manner. Everything is short term and myopic. No long term solutions are seriously entertained. We always look for the Band-Aid, instead of addressing the fundamental problem in earnest. The simplest and best solution to the physician shortage in this country is (drum roll for a truly shocking revelation)...TO TRAIN MORE PHYSICIANS!

Plain and simple. Is this the solution that our brilliant politicians have chosen? Of course not!

No, they hatched a better plan! Let's focus our energy on midlevel providers and expand their scope of practice. Nevermind the fact that they have lower barriers to entry, receive a fraction of the training, and have a much easier licensing examination process. That stuff is irrelevant! Education, clinical training, competency exams...eh, who cares!

What a f*&king joke.

Just my $0.02
 
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EtherBunny said:
If physicians and advanced practice nurses become "equivalent" in every respect (including compensation), then I think we'll see a precipitous decline in medical school enrollment. You would have to be a complete ****** to choose the medical school route under those conditions. There are HUGE differences in the rigor of professional education and the extent of competency assessment between a certified advanced practice nurse and a board certified physician.

Option A:
- college degree with easier coursework in science
- FOUR hour competency exam at end of college
- easier exam for entrance into professional school (e.g., GRE for advanced practice nursing)
- lower GPA requirement for admission
- 4 years of advanced practice coursework and training
- 4 hour competency exam at end of advanced practice curriculum

Option B:
- college degree with harder coursework in science
- more challenging entrance exam for professional school (i.e., MCAT for medical school)
- higher GPA requirement for admission to professional school
- 4 years of medical school
- FORTY ONE hours of competency examinations by the end of medical school (USMLE I-III)
- one year of internship
- 3 to 6 years of residency
- 4 hours written specialty board examination at end of residency
- 1 hour oral specialty board examination at end of residency

If the pay and privileges are the same for options A and B, what ***** would choose the latter path? Let's see here...I can choose path A, which is cheaper and easier or I can choose path B, which is more expensive and far more difficult. In either case, I'll make the same money, work the same hours, and get the same level of respect and privileges. Oh, such an easy decision! I'll choose path B!

Yeah. Riiiiight.

There are serious consequences for this advanced practice nursing political movement. If APNs successfully legislate "equivalence" to physicians in every respect, the physician shortage in this country will become exponentially worse...

Why? Because no rational person will go into medicine anymore and very few people will stay in the profession unless they absolutely have to. We'll see a huge brain drain away from medicine to other fields.

Frankly, I find the whole APN political movement in this country to be farcical. This country is truly going to s&*t. We can't solve any major problem in a reasonable manner. Everything is short term and myopic. No long term solutions are seriously entertained. We always look for the Band-Aid, instead of addressing the fundamental problem in earnest. The simplest and best solution to the physician shortage in this country is (drum roll for a truly shocking revelation)...TO TRAIN MORE PHYSICIANS!

Plain and simple. Is this the solution that our brilliant politicians have chosen? Of course not!

No, they hatched a better plan! Let's focus our energy on midlevel providers and expand their scope of practice. Nevermind the fact that they have lower barriers to entry, receive a fraction of the training, and have a much easier licensing examination process. That stuff is irrelevant! Education, clinical training, competency exams...eh, who cares!

What a f*&king joke.

Just my $0.02
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I have a sickening feeling that when CRNAs are allowed to be solo across the board, for any case, anywhere, the real loser will be the patient (and increased M&M). How sad is it that I have to expect a significant number of people to die (or be killed) before things would really sink through to the lawyers that run the show? And that's assuming some of those lawyers have a conscience or soul...
 
Ether - You really think it could get to the point where medical schools can't fill all their seats? That's just such an unrealistic scenario IMO. If that ever becomes reality, that would be indicative of such strongly deterrent factors in medicine that there would be much bigger problems to worry about. As long as doctors make six figures, on average, with the potential for very high incomes, medical school admissions will continue to be competitive. You grossly underestimate the number of naive, idealistic college students who think they don't need to worry about money as long as it is "enough to live on," and the number of people who see medicine as one of the most stable professions. (In terms of job stability, choosing where you work and choosing hours, medicine really is compared to business-type jobs, though nothing is perfect.)
 
- mid 200s is a very decent amount of money. Being greedy is not a good thing. Money doesn't grow on trees - our pay comes out of people's pockets.
- there is no evidence to suggest that the use of CRNAs worsens outcomes.
 
Noegrus said:
- mid 200s is a very decent amount of money. Being greedy is not a good thing. Money doesn't grow on trees - our pay comes out of people's pockets.
- there is no evidence to suggest that the use of CRNAs worsens outcomes.
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can you provide evidence of the lack of evidence that CRNAs worsen outcomes? If I may, are you suggesting that the mid-level political movement is morally and pragmatically sound( even though they have far less training) because doctors make "enough" money? If you are becoming a doc ( or are a doc), where are your cajones?
 
CityLights said:
Ether - You really think it could get to the point where medical schools can't fill all their seats? That's just such an unrealistic scenario IMO. If that ever becomes reality, that would be indicative of such strongly deterrent factors in medicine that there would be much bigger problems to worry about. As long as doctors make six figures, on average, with the potential for very high incomes, medical school admissions will continue to be competitive. You grossly underestimate the number of naive, idealistic college students who think they don't need to worry about money as long as it is "enough to live on," and the number of people who see medicine as one of the most stable professions. (In terms of job stability, choosing where you work and choosing hours, medicine really is compared to business-type jobs, though nothing is perfect.)
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im disappointed you didn't bring up how many pre-allos would eat a poop hot dog to get into med school.
 
Noegrus said:
- mid 200s is a very decent amount of money. Being greedy is not a good thing. Money doesn't grow on trees - our pay comes out of people's pockets.
- there is no evidence to suggest that the use of CRNAs worsens outcomes.
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"Blah, blah, blah" - Noegrus
 
Noegrus said:
- mid 200s is a very decent amount of money. Being greedy is not a good thing. Money doesn't grow on trees - our pay comes out of people's pockets.
- there is no evidence to suggest that the use of CRNAs worsens outcomes.
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I hope you never negotiate a contract in your life. :p

I kid, I kid. :)
 
ctsicu said:
So I am a young physician that has just started practice a year ago. Just looking at the last 20 years it is astounding the foothold that mid levels have gained. What I don't quite get Is why. The population hasn't increased THAT much that there should be such a ridiculous shortage. Anyway what is going to happen to me for my career? I am disheartened and scared...thoughts??
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this:



mid 200s is a very decent amount of money. Being greedy is not a good thing. Money doesn't grow on trees - our pay comes out of people's pockets.
-[B] there is no evidence to suggest that the use of CRNAs worsens outcomes[/B].
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and other "just roll over and take it" attitudes of past generations of anesthesiologists
 
obamacare will destroy anesthesiology in the next 10. why worry about 20 to 30? lol
 
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CityLights said:
Ether - You really think it could get to the point where medical schools can't fill all their seats? That's just such an unrealistic scenario IMO. If that ever becomes reality, that would be indicative of such strongly deterrent factors in medicine that there would be much bigger problems to worry about. As long as doctors make six figures, on average, with the potential for very high incomes, medical school admissions will continue to be competitive. You grossly underestimate the number of naive, idealistic college students who think they don't need to worry about money as long as it is "enough to live on," and the number of people who see medicine as one of the most stable professions. (In terms of job stability, choosing where you work and choosing hours, medicine really is compared to business-type jobs, though nothing is perfect.)
Click to expand...

If the average salary of advanced practice nurses is approximately $200,000 (or even higher)--i.e., on par with physician salaries--why would a person attend medical school?

If the route to becoming an advanced practice nurse is shorter, cheaper, and easier, why would a person attend medical school?

If advanced practice nurses have the same privileges and scope of practice as physicians, why would a person attend medical school?

The problem is that the political agenda of nursing (to make advanced practice nurses completely equivalent to physicians) is starting to extend well beyond the boundaries of primary care. It's spilling over into the specialties. We're seeing "residencies" for APNs in gastroenterology, dermatology, pain management, and intensive care. CRNAs will soon all have "doctorates," and some of these individuals will be practicing independently with a scope of practice and income that is on par with anesthesiologists.

What is the political end point for advanced practice nursing? To achieve complete equivalence to physicians. They want to achieve this goal despite the fact that they have far less professional education, lower academic standards for admission, and much easier assessments of professional competence than physicians.

If full equivalence is achieved, do you really think that pre-meds will "blindly" pursue medicine, when a much easier, cheaper, and shorter route exists to achieve the same end point?

I know this sounds like the usual doom and gloom nonsense on SDN, but the advanced practice nursing crap is ridiculous. It pisses me off. Like all of the other physicians on this board, I have worked my ass off to become a full-fledged physician. The fact that people who took a much easier route in life are fighting for equal clinical privileges is infuriating. I mean, nurses are now considered the "most trusted professionals," despite the fact that the political arm of nursing is ACTIVELY DECEIVING the public, claiming that the professional education and standards of advanced practice nurses are "equivalent" to that of physicians.

Unbelievable.
 
Strong political lobbying is extremely effective in the U.S. While 30,000 anesthesiologists aren't nearly numerous enough to guarantee (or reestablish) scope of practice limitations, the bulk of the existing physician population would be.

Perhaps as other specialties see these changes effecting their practice, an organized, cross-specialty campaign could occur.
 
gasattack3 said:
Strong political lobbying is extremely effective in the U.S. While 30,000 anesthesiologists aren't nearly numerous enough to guarantee (or reestablish) scope of practice limitations, the bulk of the existing physician population would be.

Perhaps as other specialties see these changes effecting their practice, an organized, cross-specialty campaign could occur.
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Every specialty feels that every other specialty is overpaid. When the Medicare opt out provision came up several states medical boards actually supported the opt out.

ASAPAC is the largest in terms of dollars of medical specialty PACs for 4 years running.

Why is it less effective than we would like? Two reasons IMO: 1. It is now the pound of cure when the ounce of prevention was not done. 2. They are dwarfed by the American Hospital Association who strongly supports the agenda of APNs. Throw in the massive economic pressures that exist in health care, and I feel we are destined to lose. Only questions are how badly and how soon. I still give every year to ASAPAC and state society PAC. I encourage everyone to do the same. Fighting this battle effectively can delay and mitigate the damage that is being done to our specialty. Picking the right practice can insulate you for many years.
 
dkim186 said:
obamacare will destroy anesthesiology in the next 10. why worry about 20 to 30? lol
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I wonder what Obama (or any member of Congress) would say if asked whom he would like to manage his anesthesia given a trauma or serious medical condition: CRNA or anesthesiologist?

;)
 
Random MS said:
I wonder what Obama (or any member of Congress) would say if asked whom he would like to manage his anesthesia given a trauma or serious medical condition: CRNA or anesthesiologist?

;)
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The real question is who Billy piece of **** Clinton will ask for? If it was me I'd tell him to f*ck off, there's a freshly minted CRNA who would love to run his anesthetic without supervision...
 
NightNight said:
The real question is who Billy piece of **** Clinton will ask for? If it was me I'd tell him to f*ck off, there's a freshly minted CRNA who would love to run his anesthetic without supervision...
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Billy Clinton likely has some kickass medical insurance too, don't forget. his insurance might reimburse relatively well.
 
Noegrus said:
I wishhhhhhhhh!!! :love:
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noegrus wants to practice commie medicine, don't you, Noegrus? C'mon , don't be a hypocrite...work for $30 a month as a physician in Cuba...see how you like that. Afterall, that amount is enough ( to live)...isnt it?
 
wjs010 said:
noegrus wants to practice commie medicine, don't you, Noegrus? C'mon , don't be a hypocrite...work for $30 a month as a physician in Cuba...see how you like that. Afterall, that amount is enough ( to live)...isnt it?
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Please opine about these issues when you actually get admitted to a medical school and learn something about clinical medicine and the organization of medical care in this country. Till then, please concentrate on your undergrad courses.
 
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Noegrus said:
Please opine about these issues when you actually get admitted to a medical school and learn something about clinical medicine and the organization of medical care in this country. Till then, please concentrate on your undergrad courses.
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lawl.

oh premeds.
 
Oh I also have it on good authority that bill piece of **** Clinton travels everywhere with a personal physician!!
 
ctsicu said:
I think noegrus IS a crna
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Are you sure I am not the scrub nurse?
Here's a picture of me at work.

4223820125_d1f16835ab.jpg
 
the one thing that needs to be remembered about midlevels besides that they are dangerous bc they have a lack of knowledge and training is that they can not be sued. So they will never be on the same level. they are sorta like the state of america right now... want all the benefits with out the work and love are socialist government that backs them
 
I can't tell whether I'm more distracted by the cleavage above or the fact that she's about to inject somebody with what appears to be Valvoline 10W30.
 
There are a lot of idiots on SDN but only one is on my ignore list. I'm so glad we have the private forum to discuss certain issues.

Anyone can open an accont and claim to be anything or anyone on the public side.
 
i know a crna that makes 200 for a m-f no call positon doing her own cases w 6 weeks vacation. i also know a crna that shares a job w an md... two weeks on, two weeks off for each. call every night but very rare to get called in.... md=crna at that hospital.
i know this is anecdotal evidence and may be rare now but i think it will be more common in the future... and this is not a super friendly crna state.
the resistance to hire more crnas is by the older surgeons here.... the younger group is very procrna. they will not fight for anes mds when they hear they can buy a robot if we replace all mds w crnas
 
BLADEMDA said:
There are a lot of idiots on SDN but only one is on my ignore list. I'm so glad we have the private forum to discuss certain issues.

Anyone can open an accont and claim to be anything or anyone on the public side.
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Ignored??????
...and here I was, finalizing names for babies we were gonna have together. *sigh*
 
I think it's coming to that graduating anesthesiologists will have to do multiple, advanced fellowships (pedi hearts for example) and become very specialized in specific niches to remain contenders in this field. Being a generalist may just not cut it anymore. Otherwise, from the current interview trail at least, it seems that most programs are trying to move a bit away from the operating room and focusing on a greater expansion of perioperative medicine in their training.
 
AnesThrow said:
I think it's coming to that graduating anesthesiologists will have to do multiple, advanced fellowships (pedi hearts for example) and become very specialized in specific niches to remain contenders in this field. Being a generalist may just not cut it anymore. Otherwise, from the current interview trail at least, it seems that most programs are trying to move a bit away from the operating room and focusing on a greater expansion of perioperative medicine in their training.
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That's because programs are clueless about real world anesthesia.
 
AnesThrow said:
I think it's coming to that graduating anesthesiologists will have to do multiple, advanced fellowships (pedi hearts for example) and become very specialized in specific niches to remain contenders in this field. Being a generalist may just not cut it anymore. Otherwise, from the current interview trail at least, it seems that most programs are trying to move a bit away from the operating room and focusing on a greater expansion of perioperative medicine in their training.
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Yeah, who knows what's going to happen with this field, including the requisite training for it. I think we'll eventually become very similar to anesthesiologists in other peer countries (Britain, Australia, maybe Canada). Most of the guys in those countries have very extensive training in all aspects of anesthesia, with the exception of pain. They do so much ICU that they have the equivalent of a critical care fellowship in the U.S. Plus, they do a TON of cardiac, to the extent that they have the equivalent of a cardiac fellowship, with the TEE skills to boot.

Anesthesiologists play an absolutely central role in perioperative medicine in every other industrialized country that we consider to be a peer of the United States. It's crazy to think that we're somehow going to different. We'll likely evolve with the times and adapt as necessary.

It does suck, though. Because OR anesthesia is a lot of fun. I certainly enjoy it. But it sounds like our role in OR anesthesia may become increasingly marginalized over the next 20 years or so--we'll probably just play a supervisory role.
 
Noegrus said:
- mid 200s is a very decent amount of money. Being greedy is not a good thing. Money doesn't grow on trees - our pay comes out of people's pockets.
- there is no evidence to suggest that the use of CRNAs worsens outcomes.
Click to expand...

Oh really?

Here is a study posted on this board a few weeks ago:

Anesthesiologist direction and patient outcomes.
Silber JH, Kennedy SK, Even-Shoshan O, Chen W, Koziol LF, Showan AM, Longnecker DE.
SourceCenter for Outcomes Research, the Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, PA 19104, USA. [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. (Key words: Anesthesiologists; anesthesia care team; quality of care; mortality; failure-to-rescue; complication; Medicare; general surgery; orthopedics.)
 
Noegrus said:
Please opine about these issues when you actually get admitted to a medical school and learn something about clinical medicine and the organization of medical care in this country. Till then, please concentrate on your undergrad courses.
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it's cool..if you want to avoid my proposition. I will complain about crna's just as much..even when im in med school and beyond..lol it doesn't matter. Even when Im in a non anesthesia specialty, i'll still complain about them. The reason is because I feel sorry for the docs that busted their nuts to practice anesthesia. It doesn't seem fair that the USA has to opt for worse care, because it's cheaper. Do we really not care about the patients anymore? All of the crap about making healthcare cheaper since 2010 and yet no media coverage of the crna fight to take MDs' jobs. Jeez, I wonder why that is? lol...lobbyist gonna lobby.
 
Ignatius J said:
Oh really?

Here is a study posted on this board a few weeks ago:

Anesthesiologist direction and patient outcomes.
Silber JH, Kennedy SK, Even-Shoshan O, Chen W, Koziol LF, Showan AM, Longnecker DE.
SourceCenter for Outcomes Research, the Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, PA 19104, USA. [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. (Key words: Anesthesiologists; anesthesia care team; quality of care; mortality; failure-to-rescue; complication; Medicare; general surgery; orthopedics.)
Click to expand...

No Harm Found When Nurse Anesthetists Work Without Supervision By Physicians


http://content.healthaffairs.org/co...ey=ezh7UYKLtCyLY&keytype=ref&siteid=healthaff

The AANA Propaganda machine has refuted the Silber study many times. Please take the AANA/CRNA discussion to the midlevel forum. I have hundreds (?thousand) posts on the subject including the Silber study.
 
Editorial

Who Should Provide Anesthesia Care?

Published: September 6, 2010

NY Times Editorial


Can a highly trained nurse deliver anesthetics as well as a physician who has specialized in anesthesiology, or does the nurse require close medical supervision? That issue emerges from two recent studies and from California’s decision last year to join 14 other states in freeing the nurses from a federal requirement that they be supervised by a physician. Colorado seems poised to join the group.

The issue is potentially important to patients and to health care reformers seeking to restrain costs and reduce reliance on high-priced medical specialists.

The two studies — hotly disputed by the American Society of Anesthesiologists — essentially concluded that there is no significant difference in the quality of care when the anesthetic is delivered by a certified registered nurse anesthetist or by an anesthesiologist. The studies were paid for by the professional association for the nurses, a potential conflict of interest, but were conducted by researchers at respected organizations.

Analysts at the Research Triangle Institute found that there was no evidence of increased deaths or complications in 14 states that had opted out of requiring that a physician (usually an anesthesiologist or the operating surgeon) supervise the nurse anesthetists. The analysts recommended that nurse anesthetists be allowed to work without supervision in all states. Researchers at the Lewin Group judged nurse anesthetists acting without supervision as the most cost-effective way to deliver anesthesia care.

Anesthesia has gotten remarkably safe in recent decades, with roughly one death occurring in every 200,000 to 300,000 cases in which anesthetics are administered during surgery, childbirth or other procedures.

There is not much difference between the two professions in the amount of training they get in administering and monitoring anesthetics. Where the anesthesiologists have a big advantage is in their much longer and broader medical training that, many doctors say, may better equip them to handle complex cases and the rare emergencies that can develop from anesthesia.

From a patient’s point of view, it would seem preferable to have a broadly trained anesthesiologist perform or supervise anesthesia services, but, in truth, the risk is minuscule either way.

Fifteen states have exempted the nurse anesthetists from a Medicare requirement that they be supervised by a physician. California’s move is being challenged in court by physician groups on procedural technicalities. The state’s reasoning, which appears sound, is that patients in areas short on anesthesiologists would lose access to surgery and childbirth services if no one else could deliver the anesthetic. The final decision ultimately rests with the hospitals on how best to serve their patients.

In the long run, there also could be savings to the health care system if nurses delivered more of the care. It costs more than six times as much to train an anesthesiologist as a nurse anesthetist, and anesthesiologists earn twice as much a year, on average, as the nurses do ($150,000 for nurse anesthetists and $337,000 for anesthesiologists, according to a Rand Corporation analysis). Those costs are absorbed by various institutions and public programs within the health care system. As health reformers seek ways to curb medical spending, they need to consider whether this is a safe place to do it.
 
What are the 15 states which allow crnas to practice independently?
 
http://www.rrstar.com/news/x1959343...ly-of-physicians-in-critical-condition?zc_p=0



Basically this article staes that there is going to be a shortage of physicians, but since it takes too long to train physicians the gap will be filled with midlevel providers. :rolleyes:

By the numbers
90K Shortage of doctors by 2020
45K Shortage of primary-care physicians
46K Shortage of surgeons and specialists
250K Physicians likely to retire in a decade
32M Americans entering the health care system in 2014
 
kazuma said:
http://www.rrstar.com/news/x1959343...ly-of-physicians-in-critical-condition?zc_p=0



Basically this article staes that there is going to be a shortage of physicians, but since it takes too long to train physicians the gap will be filled with midlevel providers. :rolleyes:

By the numbers
90K Shortage of doctors by 2020
45K Shortage of primary-care physicians
46K Shortage of surgeons and specialists
250K Physicians likely to retire in a decade
32M Americans entering the health care system in 2014
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Yeeeep. Cuz raising physician numbers is not cost effective. At the end of the day, it will all come down to economics. Which is another argument in favor of a single-payer system - when you let the market determine who gets paid what, then the system in inherently imbalanced. Whoever can come up with a cheaper solution will be entertained. That is exactly how markets work. :)
 
kazuma said:
http://www.rrstar.com/news/x1959343...ly-of-physicians-in-critical-condition?zc_p=0



Basically this article staes that there is going to be a shortage of physicians, but since it takes too long to train physicians the gap will be filled with midlevel providers. :rolleyes:

By the numbers
90K Shortage of doctors by 2020
45K Shortage of primary-care physicians
46K Shortage of surgeons and specialists
250K Physicians likely to retire in a decade
32M Americans entering the health care system in 2014
Click to expand...

Also, a lot of very sick, previously uninsurable or underinsured will be entering the system in 2014. Maybe this is good for anesthesiologists, but definitely very bad for cost.
 
Noegrus said:
Yeeeep. Cuz raising physician numbers is not cost effective. At the end of the day, it will all come down to economics. Which is another argument in favor of a single-payer system - when you let the market determine who gets paid what, then the system in inherently imbalanced. Whoever can come up with a cheaper solution will be entertained. That is exactly how markets work. :)
Click to expand...

The patients save NO MONEY by having crnas.
The government saves an insignificant amount of money subsidizing the training of crnas vs MDs.
 
GypsySongman said:
The patients save NO MONEY by having crnas.
The government saves an insignificant amount of money subsidizing the training of crnas vs MDs.
Click to expand...

They save some money in CRNA wages as compared to anesthesiologist wages.

They pay up in terms of efficency, productivity, utilization, value of associated services that an anesthesiologist can provide, cost of complications, cost of litigation, etc.

I can't prove it. But I believe it to be true.
 
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