when do you think we'll get a pay cut?

[ozzie20]

A lot of doctors have said that anesthesia is a specialty that will get a big pay cut soon. They all say " the CNA/AA is doing the OR work, and the anesthesiologist is in the call room napping." Although there may or may not be any truth to the last statement, staying #1 on forbes magazine's highest paying job I know won't last forever. Anyone have any opinions on when pay will decline and by how much?

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[coprolalia]

They all say " the CNA/AA is doing the OR work, and the anesthesiologist is in the call room napping."

Anyone who thinks this is an idiot. You can ask any of the attendings here about how hard they work. The only people I see lounging around and leaving at 3:00 PM are the CRNAs. More often than not, on the rare occassion when I hit the OR lounge to grab a quick cup of coffee after having already been there an hour working and before starting my first case, I see a gaggle of them sitting around eating breakfast. BREAKFAST! Who the hell has time for breakfast? I've already set up my room, seen my patient, started the IV, pre-med'ed, etc. And, I know that I'm going to be there at least until 5:00 PM churning cases while they're going to leave at 3:00 which is when their "shift" ends.

You have nothing to worry about, dude, as long as the nurses continue with their "shift mentality". And, I don't see that ending, as a cohort, anytime soon.

-copro

 

[pd4emergence]

I think you have to look at supply and demand. Right now supply is alot lower than demand for all providers. It will be that way for a long time with the baby boomers coming into their 60's. Also, the whole arguement that AA's and CRNA's are going to drive down costs and reimbursement within the near future is not valid. The AANA doesn't want to get paid any less for a lap chole they just don't want us to be there. I think whatever forbes report you are talking about that put us as the #1 money makers is not valid either. I would say that about 80% of the surgeons at my institution make more than I do (they should for as much as they work). We got a raise from CMS last year. The committee that looks at reimbursement recognized that compared to other specialties anesthesiology was underpaid and reimbursement had not kept up. It won't last forever but over the next 5-10 years there is going to be more jobs than anesthesia providers. Hopefully, that will at least keep reimbursement where it is.

 

[ozzie20]

I'm honestly glad to hear all this. Its tough to try to respectfully justify my specialty of choice as a 4th year medical student to an attending who i doubt spent any time in the OR in the last 50 years. As far as the forbes listing, it did not include subspecialties of surgery like plastics/ortho/urology, it just lumped the average of all general surgeons in america as compared to the average of all gasmen in america. With that average, given the relative shortage of anesthesiologists compared to surgeons, I can see how they would rank us 1st and surgeons 2nd.

 

[Taurus]

If CMS starts to see that delivering gas is predominately a CRNA function and that CRNA's on average are making $150k for two years worth of schooling, what do you think CMS will think? Overpaid group of people. They will slash reimbursements not because of anesthesiologists but because of CRNA's.

 

[stewiegriffinFG]

If CMS starts to see that delivering gas is predominately a CRNA function and that CRNA's on average are making $150k for two years worth of schooling, what do you think CMS will think? Overpaid group of people. They will slash reimbursements not because of anesthesiologists but because of CRNA's.

I disagree. I think reimbursement for CRNAs will decrease when supervised by physicians, but sole-anesthesiologist-provided care will be reimbursed higher. Nurses really should not be paid as much as they are for what they are doing. If CMS were to cut anesthesiologist reimbursement, there would be fewer anesthesiologists than the already low amount today, and access to proper anesthesia care will be decreased. I'm not saying that CMS has that much foresight,
but the representatives who discuss reimbursement for anesthesiologists can easily make the case for physician access. After all, if you start having increased morbidity and mortality due to improper OR-care by CRNAs, healthcare costs will increase (at the very least for increased morbidity), and that's something that CMS does NOT want.

 

[pd4emergence]

CRNA's salaries are what they are because of supply and demand. Remember that whoever is paying thier salary also gets to bill for half of the reimbursement for that case. Hospitals that pay their CRNA's lose some money on them but they also get to charge for OR time, facilities fees and a multitude other things that make keeping OR open one of the main priorities for a hospial. Lobbying for lower pay for certian providers is financial suicide for all. This is about the only thing the ASA and AANA agree on. I personally don't care what CRNA or AA's are making. I think worrying about it is a waste of time.

 

[stewiegriffinFG]

The point is not about lobbying for paycuts, it's about who should get the paycut when the government/insurance doesn't want to pay so much to providers.

 

[pd4emergence]

The point is not about lobbying for paycuts, it's about who should get the paycut when the government/insurance doesn't want to pay so much to providers.

When CMS decides that anesthesia reimbursement is too high they will cut it for everybody, not just CRNA's and AA's. Why would they pay an MD more to do a case? To them the case gets done whether a CRNA or an MD does it. There will not be preferential treatment for us.

 

[Taurus]

When CMS decides that anesthesia reimbursement is too high they will cut it for everybody, not just CRNA's and AA's. Why would they pay an MD more to do a case? To them the case gets done whether a CRNA or an MD does it. There will not be preferential treatment for us.

Bingo. If CMS sees delivering anesthesia as a nursing function, they will begin to reimburse it as such levels. CRNA's are enjoying such high salaries because they're riding on our tailcoats. I feels it's not a question if this will happen but when.

 

[coprolalia]

My boss recently told me that he expects we have only five more years of "living the good life" in anesthesia.

I doubt it.

-copro

 

[coprolalia]

CRNA's are enjoying such high salaries because they're riding on our tailcoats.

No. Wrong.

It's supply/demand. That's all. As soon as the supply catches up with the demand, salaries will stabilize or even fall for CRNAs. See pd4emergence's post above. He's got it right.

-copro

 

[Taurus]

No. Wrong.

It's supply/demand. That's all. As soon as the supply catches up with the demand, salaries will stabilize or even fall for CRNAs. See pd4emergence's post above. He's got it right.

-copro

Sure it's supply and demand. But it's also about lobbying by the anesthesiology groups to keep the reimbursement levels up. If CMS cuts anesthesia reimbursements by 30%, then everybody's salaries go down. If CRNA's keep making progress, anesthesia will be seen as a nursing function and the reimbursement levels will be adjusted accordingly. CMS can save billions of dollars if it cuts the inflated average $150k salaries of 40k CRNA's. Anesthesiologists won't be able to dodge that bullet either.

 

[coprolalia]

If CMS cuts anesthesia reimbursements by 30%, then everybody's salaries go down.

Where are you getting this misinformation? Or, are you just assuming things will happen that haven't yet happened? CMS just gave us an increase. They are not "cutting" reimbursement. Quite the contrary.

http://www.asahq.org/Newsletters/2008/01-08/washReport01_08.html

-copro

 

[toughlife]

Where are you getting this misinformation? Or, are you just assuming things will happen that haven't yet happened? CMS just gave us an increase. They are not "cutting" reimbursement. Quite the contrary.

http://www.asahq.org/Newsletters/2008/01-08/washReport01_08.html

-copro

He got it from this memo.

February 19, 2008


10.6% SGR cut set for July 1: Ask Congress for positive Medicare payment updates!

Unless Congress intervenes, anesthesiology and all of medicine will see a 10.6 percent Medicare payment cut due to the Sustainable Growth Rate formula (SGR) beginning on July 1, 2008. The cut was scheduled to take effect on Jan. 1, 2008, but P.L. 110-173 offered a temporary reprieve with a six-month 0.5 percent increase.

Congress must work soon to enact meaningful legislation that will stop the Medicare payment cuts for 18 months; extend the positive 0.5 percent update through the rest of 2008; provide a positive 2009 update that accurately reflects increases in the cost of providing medical care to our nation's seniors; and pave the way for a permanent replacement of the SGR.

 

[AZhopeful]

No. Wrong.

It's supply/demand. That's all. As soon as the supply catches up with the demand, salaries will stabilize or even fall for CRNAs. See pd4emergence's post above. He's got it right.

-copro

This is just a thought from a lowly med student, but I think it's worth interjecting at this point that your supply and demand argument must be reconsidered with the caveat that American health care delivery is not exactly a free market. Especially in the short term, I think the consequences of supply and demand are distorted when there's a central authority dictating compensation.

Just sayin'...