Why Not Hire a CRNA

[Noyac]

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http://csa-online.org/pdfs/AbouleishClark.pdf

Not sure if this will stimulate any discussion!

 

[pd4emergence]

Interesting article. My personal opinion is that in desirable areas with good reimbursement md only practices can work very well. Especially if everybody has a reasonable expectation of what their income should be. By everybody, I mean both doctors and administrators. If either party decides to "maximize profits" or "increase efficiency" or any of the other doublespeak for making more money then that md only practice is going to be in trouble. In areas with poor reimbursement, care team models or the dreaded supervision models will reign. There is really no other choice. In those poor reimbursement areas anesthesia services are seen are a black hole that just sucks in money even if the or as a whole accounts for most of the hospital's profits(which or's usually do).
I think another issue is the fact that there are a lot of areas that just can't recruit enough md's to staff their or's at sustainable salaries. Take my practice for example. I live in one of the worst states for reimbursement. Our payer mix overall is not that great. We still make around mgma average simply because of volume. The hospital pays the crna's and it is strictly a medical direction type of place. We also staff a few surgery centers. Between all of our places we start around 30 or's a day. There is no way we could get 30 md's here to staff those rooms. Both from a salary standpoint and from a recruitment standpoint (its just not that nice of a place to live).
From my standpoint, I miss doing my own cases, I have gotten tired of being 1 to 4 every waking moment of the day , the other day I was doing an interscalene block which was difficult because I also live in one of the fattest states and I got no less than five calls for inductions or preops or whatever else in just a few minutes. It's nuts and I am leaving. I can't wait.

 

[cincincyreds]

Interesting article. My personal opinion is that in desirable areas with good reimbursement md only practices can work very well. Especially if everybody has a reasonable expectation of what their income should be. By everybody, I mean both doctors and administrators. If either party decides to "maximize profits" or "increase efficiency" or any of the other doublespeak for making more money then that md only practice is going to be in trouble. In areas with poor reimbursement, care team models or the dreaded supervision models will reign. There is really no other choice. In those poor reimbursement areas anesthesia services are seen are a black hole that just sucks in money even if the or as a whole accounts for most of the hospital's profits(which or's usually do).
I think another issue is the fact that there are a lot of areas that just can't recruit enough md's to staff their or's at sustainable salaries. Take my practice for example. I live in one of the worst states for reimbursement. Our payer mix overall is not that great. We still make around mgma average simply because of volume. The hospital pays the crna's and it is strictly a medical direction type of place. We also staff a few surgery centers. Between all of our places we start around 30 or's a day. There is no way we could get 30 md's here to staff those rooms. Both from a salary standpoint and from a recruitment standpoint (its just not that nice of a place to live).
From my standpoint, I miss doing my own cases, I have gotten tired of being 1 to 4 every waking moment of the day , the other day I was doing an interscalene block which was difficult because I also live in one of the fattest states and I got no less than five calls for inductions or preops or whatever else in just a few minutes. It's nuts and I am leaving. I can't wait.

I don't envy you. I've only done my own cases as an attending.

 

[Mman]

Between all of our places we start around 30 or's a day. There is no way we could get 30 md's here to staff those rooms.

If you have 30 ORs to staff every day, you'd need a lot more than 30 MDs in the group if you were doing MD only. Add in bodies for people on vacation (8 weeks per year roughly) would mean at least 36 people to allow 6 on any given week to be on vacation. Take a handful of people out that were up all night on call. Doing MD only any place busy, you probably also need 1-2 people not in the OR to help with other things (floor intubations, PACU management issues, running the "board", etc). You are quickly approaching 40-45 people needed to run things on a daily basis.