Thus, once a CNRA kills a patient that an anesthesiologist would have saved it will lead to quick readjustments.
My quesiton is, are CNRAs working in settings where anesthesiologists needed to get a fellowship in? What about pain, can they do this type of work?
Also, I'm not sure why everyone who writes on these boards is assuming salary figures are going to plummet soon b/c of CNRAs, from all statistics its on the rise.
To really understand your question, you have to understand a little about anesthesia staffing. Something that I am admittedly a novice at being an almost done resident, but I interviewed with many different practices so I have some idea. Maybe the more experienced attendings can chime in. There are a few given facts here.
1) Every situation is local. What is standard of anesthesia care in rural New Hampshire is different from most larger cities. The hospital and anesthesia group sets what is standard for their facility. These can change over time.
2) There simply aren't enough anesthesiologists to sit on every stool and do every anesthetic solo in our country.
3) Salary is determined by reimbursement and subsidy. This is regardless of the initials after your name. In our field they are paid the same whether a CRNA does the case solo or an MD. Many anesthesia groups are also paid by the hospital for their time spent that is not reimbursed (subsidy). This would include being on-call for OB and emergency OR cases after hours. This is also a common arrangement for other docs like some surgeons and EM where in order to retain physicians, you have to pay them. CRNA's can't say that they are 'cheaper' because they bill for less because they don't. In fact solo CRNA's can make exactly what we do. For the answer to how often does this happen, see #1. Depends on where you are at, but probably more than you'd think. In rural areas all CRNA employees are quite common and they go about their days and nights without an anesthesiologist present for miles, sometimes a whole lot of miles.
4) The fellowship thing. This is currently an issue, at least with pain, being fought at the state levels. As far as I know, Louisiana was a success in barring CRNA's from practicing pain medicine. Other states are different. Again, in New Hampshire there is an all CRNA pain group. Basically if the board of nursing says that this is OK, then it's OK until the MD groups successfully outlaw it. If you really want a fellowship that distinguishes you from a CRNA, critical care is by far the best option. Clearly medical practice, and you won't find a CRNA anywhere running an ICU.
For the rest of the fellowships, see #1. Can a CRNA do a heart solo, sure. Sick neonate, yup. Complicated OB case, yes. Again everything is local. How often is the staffing at the hospitals that do the aforementioned cases all CRNA? Not very often. Most hearts at least go to medium sized medical centers where MD's are involved in anesthesia care. NICU's and high risk OB are similar. You really feel it in an academic center where the dreaded "transfer" patient is so very common. Preterm labor, VBAC, multiple gestations, pyloric stenosis, TEF, CDH, ToF, ruptured AAA, cath lab disaster without CABG backup-they get shipped out of these small places anyways. To me. On call, where I can happily do the cases...
. Gee, I am so excited for the future of my field. Ugghhh....going back to my pre-intern year vacation now.
