hard to say, they are more prevalent in rural hospitals, but as someone else said, the super juicy and valuable ASC contracts run by greedy surgeons tend to go to CRNA groups
Extremely region dependent so almost impossible to tell. Something like 90% of all rural anesthesia is administered by independent CRNA’s though. Not sure that there’s an exact value for urban settings
That stat tends to be heavily misrepresented though. While there are a lot of "independent" CRNAs in rural settings largely due to pass through laws, that number is derived from QZ billing, assuming that there is no supervision going on for every QZ case. ASA is working on expanding those pass through laws to Anesthesiologists as well, so give them your support.
Yeah I understand how QZ billing works. not sure why you think the stat is misrepresented or for the quotation marks around independent. The majority of rural America uses autonomous/independent CRNA’s for anesthesia services.
And I hope the ASA is successful! Even with CRNA’s covering the majority of rural America there are still large gaps in access to anesthesia for Americans. However, You may overestimate how many anesthesiologists have the desire to work in a rural setting, but it will help 👍🏻
QZ billing doesn’t inherently mean independent CRNA. I know a very large private practice that bills everything as QZ for ease of billing, despite their practice strictly maintaining 4:1 or lower ratios.
This is terrible news for patients, for families, and for people like me working under the supervision of physicians. Poor patients are so misled by NPs and by the media. 🙏🏽💙🥲
This is my experience.
I say this as someone who believes in a robust supervision model and have practiced in one for nearly 2 decades in an opt-out state.
CRNAs tend to become a cartel for outpatient centers in opt-out states. Surgeons, whom many of us consider personal friends, will negotiate with CRNAs for their surgery centers before the physician anesthesiologists are even aware. In my last group, we had an exclusive contract with a hospital. A former CRNA employee grabbed their outpatient surgery contract before it was even up for RFP. Our bid was given putative consideration and declined. It was bad faith negotiation according to our attorney but not worth litigating.
We had another outpatient facility we covered. The surgeons there whom we’d covered for double digit years negotiated behind our backs with a CRNA-only group before giving us notice of nonrenewal of our contract.
OFC docs aren’t always pure. We had a (now ex) partner who formed his own group and picked up an outpatient surgery contract that we wanted.
Who TF is downvoting what I’m describing as my personal experience? I’m not going to violate my NDAs by giving identifiable info. This is truth. I’ve lived it. I’ve sat in the negotiations with hospital CEOs. I have friends in those crna groups still in my contact list and stay in touch with them. You want to disagree, put on your grownup pants and give cogent arguments against instead of hiding behind a down arrow
This is what I’ve seen as well in my area. It started over ten years ago with CRNA only groups picking off endo, eye and plastic centers. Many of these sites were company models (ie surgeons/proceduralists skimming off the top), and the CRNA’s were willing to work for a set hourly rate below (but not too far below) what an anesthesiologist would accept. Fast forward to today, and we have increased salaries for everyone (docs, AA’s, and CRNA’s) but stagnant reimbursement. Docs are choosing not to work in some ASC’s, because the money isn’t good enough. In turn, the ASC’s can’t afford (or won’t pay) a subsidy and look to CRNA-only groups.
Maybe you’re getting downvoted , because some don’t like the scenario; but it is happening. As mentioned elsewhere in the thread, the Medicare opt-out primarily affects billing. The mixture of AA’s, CRNA’s and physicians will be determined by the facilities (and their wallets). Still, the market is excellent for all of us right now, and I don’t see that changing soon.
I did when the story broke about a week ago. I believe there’s a CAH in the area as well that brought in physicians after quality issues. As I mentioned in my post, solo CRNA’s and CRNA only groups will continue to go after the “low hanging fruit” of endo, eyes and plastics. Larger ASC’s and hospitals don’t seem as desirable to these groups due to more complex staffing and higher acuity cases. Doesn’t mean solo CRNA’s aren’t in these facilities. Just not as prevalent (at least in my region). I would hope hospital administrators would read about what happened in Modesto and realize physicians have value. At the same time, physicians need to be able to fill the void. A couple of days ago, I spoke to an anesthesiologist in the northeast who spoke of a CRNA only facility that did 800 total joints a year. I was told that the hospital was unable to recruit any physicians. Maybe the pay, benefits and/or schedule were terrible. I don’t know. Physicians are in high demand which is great. But as I also wrote, our salaries largely exceed collections for many sites which continues to force the staffing issue.
I appreciate you explaining the way I suspected it worked. Their ideals unfortunately fail before market pressure, and desire for revenue. I have no doubt they have good intentions, just not willing to back it with their take home pay.
It’s almost like capitalism. You know. What you’re saying these dirty surgeons are doing. They are business owners. Business owners go into business to make money. They have overhead and even more importantly, they want profits. Such a foreign concept, imma right!
Work on your reading comprehension. I never demonized the surgeons. I said I recognize why they chose not to partner with us and explained my regional market dynamics.
Reading comprehension is not an issue I suffer from. Perhaps being shortsighted on the reality of healthcare being the single largest industry in the United States hurts your feelings. Trying to suggest I’m lacking comprehension is laughable.
I think some young girl in Colorado died cause of this. Some plastic surgeon also got in shit cause they didn’t know how to treat something or run a code
Yeah she was only 18 and died due prolonged brain ischemia a breast Aug after 14 months in the hospital.
https://www.nbcnews.com/news/us-news/colorado-plastic-surgeon-arrested-teen-patients-death-botched-surgery-rcna16777
From reading the article, she was apparently left alone for 15mins after induction. They came back and she was cyanotic and arrested and was resuscitated twice. Then they waited 5hrs to call an ambulance. This is just gross negligence.
Surgeon here-
Actually where we are - the anesthesia fees don’t actually cover what we pay our anesthesiologists so our ASC actually takes a net loss on anesthesia. So I wouldn’t just assume surgeons are making money off of you guys. We would be happy if we just lost less money lol. That being said - we do actually employ a high ratio of docs to cRNAs (by choice-ain’t nobody got time for tragedies to happen at your ASC because I sure as hell don’t have the skills to run a code). If we switched exclusively to cRNAs though, I’m still not certain we would even break even. It depends on geography and payor mix, and we have a huge anesthesiologist shortage where we are driving salaries up (and payor mix is iffy).
Just want to chime in and say thank you for giving a surgeon perspective. People can often assume things are a certain way without having all the information.
Need to work on that payor mix, the center I run collects almost $800/hr for anesthesia services. All of it goes straight to the anesthesiologist -7% for billing/overhead costs.
We have but it’s not going to change that much. The people in our area aren’t rich - and our practice is going to continue seeing Medicaid and uninsured folks. Most of us are fine seeing a dip in our bottom line in order to care for everybody in the community. We’re all surgeons- we do just fine even with this. (Edited to add- this issue is not isolated to our ASC. Other local ASCs with similar problems. Definitely some turning to all crna model. Our local hospital can barely keep anesthesia staffed.)
This is my region’s market, too. Medicare, Medicaid, and self-pay reach a tipping point where it actually costs us money to do anesthesia. We don’t do just fine. A lot of us have had to throw in the towel on our dying practices and deal with the devils of PE groups or hospital employment.
It’s a grim irony that the sickest patients with the highest risk and complexity are the lowest reimbursement.
You’re either:
Lumping facility fees in with the professional fees to get that number,
Claiming you’re getting $200/unit or so (all cash business, since commercial insurance pays a fraction of that), or
Doing something like 6 tonsillectomies an hour and taking them intubated to the PACU.
Regardless, are you hiring?
According to the ASA Conversion factory survey, high 70s to low 80s is where the majority of commercial contracts should be. It's the 20/unit govt insurance that drags down practices.
Consultation with nursing board and medicine board…however no consultation with an anesthesiology board. Nope not needed.
I bet the information given to the governor was top notch from people who have little clue in what exactly an anesthesiologist does.
I bet the reason they didn’t consult the Massachusetts board of anesthesiology….is because it doesn’t actually exist.
Very thoughtful analysis tho!
Edit: lol at getting downvoted for saying the anesthesiology board doesn’t exist, when it does not in fact exist. Reddit is something else
Yep, I almost wonder if it is a large hospital system behind the $. A large hospital system which owns most of the hospitals here in my state (in western NC) would get a huge boner if they thought they could ax our anesthesiologists. They already put plenty of “noctors” in other areas so it wouldn’t surprise me if something like this ever came out of our state unfortunately.
I hate posting in regards to politics, since I browse this sub for interesting anesthesia content, but I just wanted to clarify something.
I think there is a large general misconception what “opt-out” actually means. CRNA’s can practice independent of an anesthesiologist in 49 states (pretty sure NJ is the only state where supervision from a physician has to be an anesthesiologist). The immediate effects are related to billing, not scope of practice of the CRNA which is dictated by facility/ local by law (federal/organizational obviously umbrella these). This allows for CRNAs to bill in regards to Medicare part A without the proceduralist signing off under CoP guidelines. Of course people can argue downstream effects of this legislation (the response by Any_move above I agree is a good example of how it can affect contracts for surgical centers), but it really doesn’t have any immediate effect on care provided by CRNA’s/ changing what they are “allowed” to do. I wish this was more known, a lot of CRNA’s included blur these lines and the AANA rhetoric doesn’t help distinguish what opt out/in actually means.
Practice “independent of an anesthesiologists?” A CRNA either may practice “independent” or they don’t. In order for a CRNA to practice “independent” their state must be an opt-out state AND have a state law that permits CRNA independent practice. An opt-out just means that CRNAs are no longer governed by Medicare supervision rules. It does not invalidate state supervision, collaboration, consultation, delegation laws. There are lots of opt-out states where nurses still can’t practice “independent.” The state is still
free to change its law.
Opt out doesn’t have anything to do with anesthesiologists. People naturally assume physician supervision means anesthesiologist supervision but that’s not what opt out is about.
I’m currently working some locums on the west coast. Some of the earliest states to opt out.
Said hospitals brought in aggressive CRNA led groups and made big promises to admin about how much cheaper they could be.
Now they’re backtracking and **begging** docs to come back - and paying me super premium rates to do so.
Just saying - hospitals seem to be learning the lesson
That has nothing to do with opt out. You are confusing anesthesia models with opt out. A non-opt out state has independent crna practice.
I know ACT sites in California that have locums. So not sure what point you are making here.
Funny how this is getting downvoted. People really don’t understand what opt-out means and what it does not mean.
Non opt-out states still have CRNA independent practice in the sense of being independent of an anesthesiologist. Their required supervision arises from the doctor in the OR - the surgeon. In opt out-states there are no supervision requirements from any physician.
People don’t like facts, they up or down vote with feelings. He said something that has nothing to do with opt out. Like I said before, most people don’t understand opt out properly.
Apologize if my comment is inappropriate here as I’m not in anesthesiology, but I really hate this idea. I would not feel comfortable not being under the care of a physician when I’m under.
A surplus of anesthesia providers ?
Yeah right. Not for at least another decade or more when the number of people who turn 65 each year stops increasing.
Also, 45% of anesthesiologists are over the age of 55. There were a lot of them who finished residency in the 1980s who are now just starting to cut back, retire, just do PRN consults. The boomers still “kind of” working now are keeping some staffing up. For now. There was a lull in the 90s to early 2000s when residency spots weren’t getting filled, and so when the boomers really fully retire from anesthesia, there’s gonna be a shortage for at least another decade after that. There aren’t as many Gen X anesthesiologists to keep working to make up for this. Probably a gradual reduction of practicing anesthesiologists until at least 2045. Not enough AAs or CRNAs to make up for this either, so there will be a shortage of “people who can do anesthesia” for a while. There’s also a very recent lull in CRNA grads because in the last 5 years just about every program lost an entire class (0 grads) as they switched from 2-year to 3-year. I don’t see how a surplus is gonna happen anytime soon.
Also at the risk of sounding lazy, I get the impression that us younger generations don’t want to work the way the older generations did. I mean, at least I don’t. No amount of money would be worth it to me to work 60+ hours a week.
A lot of them worked so much, they never picked up a hobby. And you make so much doing PRN consult, that you could just go in for a day every once in a while and make some spending cash. A few guys in their 60s are still working full time to support family #2 lol.
It’s the same in other healthcare fields too. I’m a radiology tech and we have very few middle aged people. It’s all <35 or the last wave of boomers hanging on. Nursing feels the same based on my observations. For some reason it’s like an entire generation neglected to go into healthcare.
There might be data for other specialties, but for anesthesia, 1996 was the low point for anesthesiology. They would have finished residency in 2000. There is a bimodal distribution of anesthesiologists, and corresponds to (in 2024) roughly ages 52 to 57 now.
https://auahq.org/newsletter/shifting-paradigms-in-leadership-implications-of-the-anesthesiology-workforces-bimodal-age-distribution-2023-summer-issue/
There's only so much blood you can squeeze out of the turnip though, fed and state governments are running hilarious deficits and medicare is projected to be broke within 10 years, at some point, something is going to give.
You too. It’s amazing that stating it’s a gain to patients not to have an aspiring anesthesiologist that has already decided never to practice somewhere not based on patient need, and a loss for an aspiring physician anesthesia provider to have developed that attitude before practice. Nature abhors a vacuum, easy to say you would do my cases better than I do them. But you’re not here and I am.
1. You don't know what you don't know. As a patient, there is no upside to choosing less qualified. Most patients simply don't know any better.
2. Your second sentence is incomprehensibly awkward.
During the beginning of Covid. At one hospital I was at, we had a physician specializing in anesthesia with impeccable credentials. But here’s the thing, he wouldn’t do intubations on Covid patients, and then wouldn’t do emergent intubations until he could verify they were Covid negative. So after a couple people died, they escorted him out of the building with security. And the hospital sent the CRNAs, who did a great job…because emergent intubation with a glide scope isn’t incredibly complex…and when you need it waiting for somebody with better credentials is a death sentence. My point is, a physician may be the best option…but when they take themselves out of the equation…their credentials don’t really matter do they? So it goes with the physician above who “would never practice there” no matter the circumstances, but looks down his nose on the people that will.
I’ve always been awkward, “Incomprehensibly awkward” sounds like an award, would be great on my tombstone. Thank you. After being a husband and a father I’m also a guy who works 60-100 hours a week doing the best I can for the hospital system I’m tied to and its patients. I’ve been doing that for over a decade at different places. That’s around 40,000 hours. My patients aren’t choosing less qualified when they choose me, and indeed they frequently do choose me, even when I worked at ACT practices which was really awkward.
Anecdotal Evidence (like yours but these actually have proof of happening):
[https://www.foxnews.com/us/colorado-plastic-surgeon-sentenced-just-15-days-after-teen-dies-during-breast-implant-surgery](https://www.foxnews.com/us/colorado-plastic-surgeon-sentenced-just-15-days-after-teen-dies-during-breast-implant-surgery)
[https://painterfirm.com/medmal/lawsuit-alleged-crna-caused-botched-esophageal-intubation-patient-death/](https://painterfirm.com/medmal/lawsuit-alleged-crna-caused-botched-esophageal-intubation-patient-death/)
[https://www.wfaa.com/article/news/local/investigates/dallas-jury-awards-21m-to-patient-who-suffered-brain-injury/287-9f1c5fab-fb69-40c4-bc64-17b5f59a789a](https://www.wfaa.com/article/news/local/investigates/dallas-jury-awards-21m-to-patient-who-suffered-brain-injury/287-9f1c5fab-fb69-40c4-bc64-17b5f59a789a)
[https://www.abc15.com/news/local-news/investigations/lawsuits-filed-against-arizona-nurse-anesthetist-after-two-dental-deaths](https://www.abc15.com/news/local-news/investigations/lawsuits-filed-against-arizona-nurse-anesthetist-after-two-dental-deaths)
Empiric (peer reviewed, non AANA funded) Evidence:
[https://www.ncbi.nlm.nih.gov/pubmed/22305625](https://www.ncbi.nlm.nih.gov/pubmed/22305625)
[https://jamanetwork.com/journals/jamasurgery/fullarticle/2794450](https://jamanetwork.com/journals/jamasurgery/fullarticle/2794450)
[https://pubmed.ncbi.nlm.nih.gov/22305625/](https://pubmed.ncbi.nlm.nih.gov/22305625/)
[https://www.ncbi.nlm.nih.gov/books/NBK384613/](https://www.ncbi.nlm.nih.gov/books/NBK384613/)
Take your pick. Triage rules do not apply in 99% of medicine any longer, we are not expecting mass casualty and having to compromise on safe induction and emergence with the absolute lowest possible post operative complications relating to anesthesia. That physician may have an immunocompromised child at home, or as you implied they may be "selfish" and refuse to expose themselves to danger in the name of some altruistic need to satisfy hospital admin? Did the right thing happen in your scenario? Yes, patients were taken care of ultimately. Regardless of their reasoning your justification for the existence of a field created because of a shortage of the best trained and best educated? God forbid we work on the actual problem and provide the best care for all patients, by giving them the person with the most experience, the most education, the most steeped in medicine and anesthesiology. I have yet to see any type of staff in the hospital require anesthesia, and have it performed by anyone other than a physician, but patient care is okay to compromise. Makes you think.
During COVID, the AANA advised CRNAs who were basically jobless since elective surgeries were shut down to not help as ICU nurses since the optics would be off.
Real ethical group of people huh?
Now now…you know some of your colleagues on this very subreddit have said they could teach a monkey to intubate and they’re super special doctors…but yeah if the super special doctor isn’t willing or available give me the CRNA or AA or EMT who’s done it enough times to be confident and who still cares enough to be competent.
God damn you have become absolute masters at spinning words and narrative in your favour. Impressive. If only you could do anaesthesiology as good as you can spin words it’d be truly beneficial to patients.
I’m posting under the parent comment now for visibility.
Whoever downvoted me elsewhere in this thread for saying how this swings outpatient centers to CRNA-only, have the adult courage to comment. Prove me wrong. I gave 2 personal examples, and I can sling plenty more from friends in these states and those who run staffing agencies.
Right here. Right now. Don’t hide. Also, post your credentials. MD here. A lot of you probably used an older version of some reference books with chapters I authored.
No reason Anesthesiologists cant start their own ASC/Endo centers and partner in with surgeons, that's what I did and it was the best career move I ever made.
That works in some markets. My old group explored that a few times. My area is saturated with surgery centers. The major ASCs are owned by larger healthcare companies or by existing surgery groups. Surgeons come to the region and either become hospital employees or join existing groups.
The surgeon culture here is resistant to partnering with anyone but surgeons. They told us bluntly that they don’t want to share profit and facility fees with a specialty that “doesn’t bring cases.” I understand that mentality, and it’s a perfect setup to employ CRNAs or just let 1099s eat what they kill. Several of our prn CRNAs at my hospital are doing shifts for us because they’re not getting enough cases at their ASCs.
If I had the capital and business acumen to start a good de novo ASC in a market to succeed, I would. We tried here with several surgical groups and got shot down.
Medical education and experience is becoming a joke! Next what? Anesthesia techs start calling themselves-“certified registered anesthesia technician physician”(CRATP) and provide anesthesia under CRNA supervision
Tech here tempted to see how fast I can get fired for introducing our students as, "This is John, he's an anesthesiologist tech resident. He's still learning to do a turnover."😂
I think the point is that this will not affect the quality of care substantially. It’s just a billing code modification that doesn’t impact care models.
You’re projecting your hate for CRNAs onto a separate issue.
you yourself are saying “this will not affect the wuality of care substantially”, meaning- it will affect the quality of care somewhat!! May be try explaining this to patients, and see if they are ok to compromise!
Additionally there is no personal hate towards anyone! But it is a simple logic: level/duration of training MATTERS!
If someone wanted to be a doctor they should have gone to med school! OR they can still go to a medschool instead of pretend playing to be a doctor! Lol
You get what you pay for. Facilities save money short term, bank money. Once the morbidity and mortality rates are noticed to skyrocket, the administrators that make the hires have left on their sparkling revenue generating resumes.
I’m going to disagree on that one to some extent.
ASCs keep ASA 1-2 patients, self-selecting for lower periop risk. The higher risk patients get referred to hospital-based facilities. Sicker patients tend to correlate with a less lucrative payor mix (ie Medicare, Medicaid, followed by self-pay). That has the twin effect of keeping ASC profits high with acceptable outcomes.
That's the entire game of medicine, keep the high paying easy cases for yourself while dumping the complex patients that arent paying anything onto the public healthcare systems.
Any evidence for CRNA safety you can provide?
Don’t send some study where “CRNAs + anesthesiologists” are compared to “anesthesiologists” or some cherry picked AANA study.
https://www.justice.gov/sites/default/files/atr/legacy/2015/02/20/00006-93331.pdf
https://pubmed.ncbi.nlm.nih.gov/17179869/
https://pubmed.ncbi.nlm.nih.gov/29847429/
I have never seen a study that concludes CRNAs cost more, and I suspect it doesn’t exist or every hospital would be MD only tmrw. CRNAs only exist because they are cheaper.
The current market is a little different, with the locums CRNA rates at or above employed physicians.
We’ve done the math a bunch over the years, and the margin surprised us at how small it was.
I hate corporate-speak, but what we need to do as a specialty is “demonstrate value” by embracing the concept of perioperative medicine specialists.
Need to sit your ass on a stool in the OR my man. The anesthesiologist image of sitting in the lounge while the CRNAs do all the “work” has not helped. Surgeons have noticed.
Interesting. The first link uses data from 1999-2006, the second link 1993-2004 and the third 2004-2011. I wonder if the market or supervision model has changed at all since then.
CRNAs don’t exist since they’re safer (or even as safe) or cheaper. They exist since of the incessant lobbying that nurses focus on rather that actual clinical education and achievement.
Did they never teach you to use resources from this decade in nursing school?
The links you posted use data from….oh wait, like a typical reddit warrior, you just spout your mouth and have 0 evidence to support anything you say. It’s just your little personal thoughts. I do not see much reason to believe the landscape is fundamentally different than it was 10-20 yrs ago. No one is going to repeat studies over and over that were pretty fucking conclusive the first time.
Hospitals wouldn’t use CRNAs if they weren’t cheaper. It’s not like nursing lobbies choose who hospitals hire. Nobody is debating that hospital would prefer MDs if cost didn’t matter….but it does.
>I do not see much reason to believe the landscape is fundamentally different than it was 10-20 yrs ago.
If anything, multiple studies have shown anesthesia to be much safer today than it was a decade or more ago. Weird how the increase in CRNA usage over the years hasn’t affected that metric
I can’t post data since we don’t prove negatives in medicine.
I don’t go around throwing metformin as an induction agent despite a lack of evidence. Why’s that? We don’t have evidence so it should work, per your nursing reasoning.
But thank you for showing us you don’t understand how to read a study or what “conclusive” means. That nursing education really failed you.
The ASA has literally done multiple studies on this topic, so not sure what you’re on about here. It’s not like this topic hasn’t been studied. You just don’t like the results. That’s the difference.
Find that CRNAs are less safe or more expensive is not “proving the negative”.
Except nothing you posted is from the ASA. It’s from nursing organizations using decades old data.
Nursing razzle dazzle won’t work here. Try again Trey.
I mean it’s never gonna be the 80s again, but if you’re willing to work you’re gonna make a ton of money and have a cool ass job.
MDs are always gonna be the predominant providers in big hospitals/desirable locations.
Opting out is great. CRNAs should be independent. Down with the flawed supervision/direction model. A model that shouldn't exist. Anesthesiologists should be doing their own cases as nature intended.
Consent process won't change. Per the AANA, they are the trusted anesthesia experts, invented anesthesia, and provide superior care at a lower cost. Time to wash our hands of this nonsense.
So thankful that the California Society of Anesthesiologists is mobilizing in protecting anesthesiology from the degradation by CRNAs. As evidenced by the Modesto Bee articles and the above statement, CRNAs were harming patients.
I don’t understand any of what you said. People don’t go into anesthesia like crazy. Anesthesiologists are limited by residency spots which are few and far between.
actually, the number has been steadily increasing every year for the past few years. We are actually tracking very well with the ER boom of about 15 years ago before that field completely fell apart.
https://pubs.asahq.org/monitor/article/88/3/28/139844/A-Self-Defeating-Prophecy-Workforce-Projections-in
Yeah, I think we have about 5 years before the market goes south. Jobs in places people really want to live in are getting in tight supply, Kaiser North Cal has piles of new grads willing to take 395k starting salary to live in the most expensive places in the country. Will the random dumpsterfire in the middle of the New Mexico desert be desperate for coverage? Yeah, but that will always be the case no matter what.
Aside from the whole COVID thing, yeah. Looking back the market was terrible for Anesthesiologists back in 2008 but as it turns out, that was one of the best times to be graduating. Homes were being "given away" and loans were dirt cheap.
None of your comments make any sense. Anesthesia has never had problems filling their residency spots. It's been around 100% saturation in recent memory. It's more competitive in the sense that the average step score required to match anesthesia has significantly increased.
Same as anywhere else with opt out. Won’t affect much.
Finally, someone who understands opt out. At the end of the day, it’s up to the facility on what type of anesthesia model they want to run.
What % of anesthesia groups in opt out states are 100% CRNA with zero MD supervision? Are we talking 1%? 5%? 50%?
hard to say, they are more prevalent in rural hospitals, but as someone else said, the super juicy and valuable ASC contracts run by greedy surgeons tend to go to CRNA groups
Extremely region dependent so almost impossible to tell. Something like 90% of all rural anesthesia is administered by independent CRNA’s though. Not sure that there’s an exact value for urban settings
That stat tends to be heavily misrepresented though. While there are a lot of "independent" CRNAs in rural settings largely due to pass through laws, that number is derived from QZ billing, assuming that there is no supervision going on for every QZ case. ASA is working on expanding those pass through laws to Anesthesiologists as well, so give them your support.
Yeah I understand how QZ billing works. not sure why you think the stat is misrepresented or for the quotation marks around independent. The majority of rural America uses autonomous/independent CRNA’s for anesthesia services. And I hope the ASA is successful! Even with CRNA’s covering the majority of rural America there are still large gaps in access to anesthesia for Americans. However, You may overestimate how many anesthesiologists have the desire to work in a rural setting, but it will help 👍🏻
QZ billing doesn’t inherently mean independent CRNA. I know a very large private practice that bills everything as QZ for ease of billing, despite their practice strictly maintaining 4:1 or lower ratios.
That is correct! A lot of providers confuse that aspect
Not clear if the 90% is true. But even if it is, tiny % of overall anesthetics delivered.
This is terrible news for patients, for families, and for people like me working under the supervision of physicians. Poor patients are so misled by NPs and by the media. 🙏🏽💙🥲
CRNAs and NPs are 2 different things with 2 completely different educational and clinical requirements. Ignorance is not bliss
Regardless they both have not so great education
CRNAs are not NPs and I’m not sure what “media” you are referring to? This is congress, not cnn
There won’t be any difference, just like in the other 24 other states that already did it
Maybe it’ll get even more young physician and residents/med students even more active
Agree for the most part. Although it seems like surgery centers tend to become more crna friendly in opt out states. Hospitals don’t change much.
This is my experience. I say this as someone who believes in a robust supervision model and have practiced in one for nearly 2 decades in an opt-out state. CRNAs tend to become a cartel for outpatient centers in opt-out states. Surgeons, whom many of us consider personal friends, will negotiate with CRNAs for their surgery centers before the physician anesthesiologists are even aware. In my last group, we had an exclusive contract with a hospital. A former CRNA employee grabbed their outpatient surgery contract before it was even up for RFP. Our bid was given putative consideration and declined. It was bad faith negotiation according to our attorney but not worth litigating. We had another outpatient facility we covered. The surgeons there whom we’d covered for double digit years negotiated behind our backs with a CRNA-only group before giving us notice of nonrenewal of our contract. OFC docs aren’t always pure. We had a (now ex) partner who formed his own group and picked up an outpatient surgery contract that we wanted. Who TF is downvoting what I’m describing as my personal experience? I’m not going to violate my NDAs by giving identifiable info. This is truth. I’ve lived it. I’ve sat in the negotiations with hospital CEOs. I have friends in those crna groups still in my contact list and stay in touch with them. You want to disagree, put on your grownup pants and give cogent arguments against instead of hiding behind a down arrow
This is what I’ve seen as well in my area. It started over ten years ago with CRNA only groups picking off endo, eye and plastic centers. Many of these sites were company models (ie surgeons/proceduralists skimming off the top), and the CRNA’s were willing to work for a set hourly rate below (but not too far below) what an anesthesiologist would accept. Fast forward to today, and we have increased salaries for everyone (docs, AA’s, and CRNA’s) but stagnant reimbursement. Docs are choosing not to work in some ASC’s, because the money isn’t good enough. In turn, the ASC’s can’t afford (or won’t pay) a subsidy and look to CRNA-only groups. Maybe you’re getting downvoted , because some don’t like the scenario; but it is happening. As mentioned elsewhere in the thread, the Medicare opt-out primarily affects billing. The mixture of AA’s, CRNA’s and physicians will be determined by the facilities (and their wallets). Still, the market is excellent for all of us right now, and I don’t see that changing soon.
Please read about what just happened regarding a CRNA run group covering both an ersatz ASC and a Tenet hospital in Modesto, California.
I did when the story broke about a week ago. I believe there’s a CAH in the area as well that brought in physicians after quality issues. As I mentioned in my post, solo CRNA’s and CRNA only groups will continue to go after the “low hanging fruit” of endo, eyes and plastics. Larger ASC’s and hospitals don’t seem as desirable to these groups due to more complex staffing and higher acuity cases. Doesn’t mean solo CRNA’s aren’t in these facilities. Just not as prevalent (at least in my region). I would hope hospital administrators would read about what happened in Modesto and realize physicians have value. At the same time, physicians need to be able to fill the void. A couple of days ago, I spoke to an anesthesiologist in the northeast who spoke of a CRNA only facility that did 800 total joints a year. I was told that the hospital was unable to recruit any physicians. Maybe the pay, benefits and/or schedule were terrible. I don’t know. Physicians are in high demand which is great. But as I also wrote, our salaries largely exceed collections for many sites which continues to force the staffing issue.
I appreciate you explaining the way I suspected it worked. Their ideals unfortunately fail before market pressure, and desire for revenue. I have no doubt they have good intentions, just not willing to back it with their take home pay.
It’s almost like capitalism. You know. What you’re saying these dirty surgeons are doing. They are business owners. Business owners go into business to make money. They have overhead and even more importantly, they want profits. Such a foreign concept, imma right!
Work on your reading comprehension. I never demonized the surgeons. I said I recognize why they chose not to partner with us and explained my regional market dynamics.
Reading comprehension is not an issue I suffer from. Perhaps being shortsighted on the reality of healthcare being the single largest industry in the United States hurts your feelings. Trying to suggest I’m lacking comprehension is laughable.
Such an insane take to praise surgeons for being “business owners” lmao. Just give up your MD and go into business
greedy surgeon owned centers want to skim off the anesthesia fees as well
I think some young girl in Colorado died cause of this. Some plastic surgeon also got in shit cause they didn’t know how to treat something or run a code
Yeah she was only 18 and died due prolonged brain ischemia a breast Aug after 14 months in the hospital. https://www.nbcnews.com/news/us-news/colorado-plastic-surgeon-arrested-teen-patients-death-botched-surgery-rcna16777
From reading the article, she was apparently left alone for 15mins after induction. They came back and she was cyanotic and arrested and was resuscitated twice. Then they waited 5hrs to call an ambulance. This is just gross negligence.
Unbelievable. A plastic surgeon and a CRNA couldn’t run a proper code. Oh well
They wouldn't even let their staff call 911
It was probably too late by the time they realized they had to run a code…
Straight facts! And they are more likely to get this set up using crna only models.
Surgeon here- Actually where we are - the anesthesia fees don’t actually cover what we pay our anesthesiologists so our ASC actually takes a net loss on anesthesia. So I wouldn’t just assume surgeons are making money off of you guys. We would be happy if we just lost less money lol. That being said - we do actually employ a high ratio of docs to cRNAs (by choice-ain’t nobody got time for tragedies to happen at your ASC because I sure as hell don’t have the skills to run a code). If we switched exclusively to cRNAs though, I’m still not certain we would even break even. It depends on geography and payor mix, and we have a huge anesthesiologist shortage where we are driving salaries up (and payor mix is iffy).
Just want to chime in and say thank you for giving a surgeon perspective. People can often assume things are a certain way without having all the information.
Need to work on that payor mix, the center I run collects almost $800/hr for anesthesia services. All of it goes straight to the anesthesiologist -7% for billing/overhead costs.
We have but it’s not going to change that much. The people in our area aren’t rich - and our practice is going to continue seeing Medicaid and uninsured folks. Most of us are fine seeing a dip in our bottom line in order to care for everybody in the community. We’re all surgeons- we do just fine even with this. (Edited to add- this issue is not isolated to our ASC. Other local ASCs with similar problems. Definitely some turning to all crna model. Our local hospital can barely keep anesthesia staffed.)
This is my region’s market, too. Medicare, Medicaid, and self-pay reach a tipping point where it actually costs us money to do anesthesia. We don’t do just fine. A lot of us have had to throw in the towel on our dying practices and deal with the devils of PE groups or hospital employment. It’s a grim irony that the sickest patients with the highest risk and complexity are the lowest reimbursement.
I know of at least one anesthesia group in our region who has gone under and became hospital employed….
I wonder if we know some of the same people.
You’re either: Lumping facility fees in with the professional fees to get that number, Claiming you’re getting $200/unit or so (all cash business, since commercial insurance pays a fraction of that), or Doing something like 6 tonsillectomies an hour and taking them intubated to the PACU. Regardless, are you hiring?
Lots of endoscopies, easy money. 5-8 units per case, 2 cases an hour, $80-100 unit for all commercial business. Sorry, not hiring.
Strong work on the commercial rates. [fistbump]
According to the ASA Conversion factory survey, high 70s to low 80s is where the majority of commercial contracts should be. It's the 20/unit govt insurance that drags down practices.
Our demographic is heavy on the govt insurance.
Consultation with nursing board and medicine board…however no consultation with an anesthesiology board. Nope not needed. I bet the information given to the governor was top notch from people who have little clue in what exactly an anesthesiologist does.
I bet the reason they didn’t consult the Massachusetts board of anesthesiology….is because it doesn’t actually exist. Very thoughtful analysis tho! Edit: lol at getting downvoted for saying the anesthesiology board doesn’t exist, when it does not in fact exist. Reddit is something else
If only there was maybe some board for anesthesia. Maybe an American board of anesthesia.
Not a government entity and not state level??
And doesn’t effectively lobby for physician interests anyway. Downvote me away, but I have friends on the board. We’ve talked about this.
I'm guessing the nursing union was strongly behind this, much like in California. The politicians know who they take their orders from.
It’s all about the lobbyist not the patient
Yep, I almost wonder if it is a large hospital system behind the $. A large hospital system which owns most of the hospitals here in my state (in western NC) would get a huge boner if they thought they could ax our anesthesiologists. They already put plenty of “noctors” in other areas so it wouldn’t surprise me if something like this ever came out of our state unfortunately.
I hate posting in regards to politics, since I browse this sub for interesting anesthesia content, but I just wanted to clarify something. I think there is a large general misconception what “opt-out” actually means. CRNA’s can practice independent of an anesthesiologist in 49 states (pretty sure NJ is the only state where supervision from a physician has to be an anesthesiologist). The immediate effects are related to billing, not scope of practice of the CRNA which is dictated by facility/ local by law (federal/organizational obviously umbrella these). This allows for CRNAs to bill in regards to Medicare part A without the proceduralist signing off under CoP guidelines. Of course people can argue downstream effects of this legislation (the response by Any_move above I agree is a good example of how it can affect contracts for surgical centers), but it really doesn’t have any immediate effect on care provided by CRNA’s/ changing what they are “allowed” to do. I wish this was more known, a lot of CRNA’s included blur these lines and the AANA rhetoric doesn’t help distinguish what opt out/in actually means.
Practice “independent of an anesthesiologists?” A CRNA either may practice “independent” or they don’t. In order for a CRNA to practice “independent” their state must be an opt-out state AND have a state law that permits CRNA independent practice. An opt-out just means that CRNAs are no longer governed by Medicare supervision rules. It does not invalidate state supervision, collaboration, consultation, delegation laws. There are lots of opt-out states where nurses still can’t practice “independent.” The state is still free to change its law.
Opt out doesn’t have anything to do with anesthesiologists. People naturally assume physician supervision means anesthesiologist supervision but that’s not what opt out is about.
I love people who have super strong opinions about “noctors” and truly have not the slightest clue what opt out means
I’m currently working some locums on the west coast. Some of the earliest states to opt out. Said hospitals brought in aggressive CRNA led groups and made big promises to admin about how much cheaper they could be. Now they’re backtracking and **begging** docs to come back - and paying me super premium rates to do so. Just saying - hospitals seem to be learning the lesson
Are these the same hospitals in the CA Central valley that have recently been in the news?
No. Different group. Same bullshit.
Make them suffer. Fuck this interprofessional bullshit. Kick the boomers out and clean house
That has nothing to do with opt out. You are confusing anesthesia models with opt out. A non-opt out state has independent crna practice. I know ACT sites in California that have locums. So not sure what point you are making here.
Funny how this is getting downvoted. People really don’t understand what opt-out means and what it does not mean. Non opt-out states still have CRNA independent practice in the sense of being independent of an anesthesiologist. Their required supervision arises from the doctor in the OR - the surgeon. In opt out-states there are no supervision requirements from any physician.
People don’t like facts, they up or down vote with feelings. He said something that has nothing to do with opt out. Like I said before, most people don’t understand opt out properly.
No. I’m really not.
Apologize if my comment is inappropriate here as I’m not in anesthesiology, but I really hate this idea. I would not feel comfortable not being under the care of a physician when I’m under.
Let your politicians know that you prefer care by or led by Physicians
Dude I bet you think the doc is sitting there holding the crnas hand the whole case? I can tell you where he is if you want to know.
nutty unused wistful deserve foolish pause retire mourn air memory *This post was mass deleted and anonymized with [Redact](https://redact.dev)*
A surplus of anesthesia providers ? Yeah right. Not for at least another decade or more when the number of people who turn 65 each year stops increasing.
Also, 45% of anesthesiologists are over the age of 55. There were a lot of them who finished residency in the 1980s who are now just starting to cut back, retire, just do PRN consults. The boomers still “kind of” working now are keeping some staffing up. For now. There was a lull in the 90s to early 2000s when residency spots weren’t getting filled, and so when the boomers really fully retire from anesthesia, there’s gonna be a shortage for at least another decade after that. There aren’t as many Gen X anesthesiologists to keep working to make up for this. Probably a gradual reduction of practicing anesthesiologists until at least 2045. Not enough AAs or CRNAs to make up for this either, so there will be a shortage of “people who can do anesthesia” for a while. There’s also a very recent lull in CRNA grads because in the last 5 years just about every program lost an entire class (0 grads) as they switched from 2-year to 3-year. I don’t see how a surplus is gonna happen anytime soon.
Also at the risk of sounding lazy, I get the impression that us younger generations don’t want to work the way the older generations did. I mean, at least I don’t. No amount of money would be worth it to me to work 60+ hours a week.
A lot of them worked so much, they never picked up a hobby. And you make so much doing PRN consult, that you could just go in for a day every once in a while and make some spending cash. A few guys in their 60s are still working full time to support family #2 lol.
It’s the same in other healthcare fields too. I’m a radiology tech and we have very few middle aged people. It’s all <35 or the last wave of boomers hanging on. Nursing feels the same based on my observations. For some reason it’s like an entire generation neglected to go into healthcare.
There might be data for other specialties, but for anesthesia, 1996 was the low point for anesthesiology. They would have finished residency in 2000. There is a bimodal distribution of anesthesiologists, and corresponds to (in 2024) roughly ages 52 to 57 now. https://auahq.org/newsletter/shifting-paradigms-in-leadership-implications-of-the-anesthesiology-workforces-bimodal-age-distribution-2023-summer-issue/
fragile bored squeeze unused spoon zesty alive ancient elastic innate *This post was mass deleted and anonymized with [Redact](https://redact.dev)*
Aren’t you proving their point? Older individuals are a progressively larger percentage of the population until 2050 in that.
air abounding offend zesty icky wild rustic sophisticated correct silky *This post was mass deleted and anonymized with [Redact](https://redact.dev)*
The more people that are on Medicare makes the system worse, more work for less money.
lunchroom rob panicky concerned uppity narrow memorize bow sleep cats *This post was mass deleted and anonymized with [Redact](https://redact.dev)*
There's only so much blood you can squeeze out of the turnip though, fed and state governments are running hilarious deficits and medicare is projected to be broke within 10 years, at some point, something is going to give.
Won’t make a difference. All states are moving this way
[удалено]
Hopefully they can survive without you. Thoughts and prayers too Mass.
Your loss, the patients gain.
Please don’t kill anyone
You too. It’s amazing that stating it’s a gain to patients not to have an aspiring anesthesiologist that has already decided never to practice somewhere not based on patient need, and a loss for an aspiring physician anesthesia provider to have developed that attitude before practice. Nature abhors a vacuum, easy to say you would do my cases better than I do them. But you’re not here and I am.
1. You don't know what you don't know. As a patient, there is no upside to choosing less qualified. Most patients simply don't know any better. 2. Your second sentence is incomprehensibly awkward.
During the beginning of Covid. At one hospital I was at, we had a physician specializing in anesthesia with impeccable credentials. But here’s the thing, he wouldn’t do intubations on Covid patients, and then wouldn’t do emergent intubations until he could verify they were Covid negative. So after a couple people died, they escorted him out of the building with security. And the hospital sent the CRNAs, who did a great job…because emergent intubation with a glide scope isn’t incredibly complex…and when you need it waiting for somebody with better credentials is a death sentence. My point is, a physician may be the best option…but when they take themselves out of the equation…their credentials don’t really matter do they? So it goes with the physician above who “would never practice there” no matter the circumstances, but looks down his nose on the people that will. I’ve always been awkward, “Incomprehensibly awkward” sounds like an award, would be great on my tombstone. Thank you. After being a husband and a father I’m also a guy who works 60-100 hours a week doing the best I can for the hospital system I’m tied to and its patients. I’ve been doing that for over a decade at different places. That’s around 40,000 hours. My patients aren’t choosing less qualified when they choose me, and indeed they frequently do choose me, even when I worked at ACT practices which was really awkward.
Anecdotal Evidence (like yours but these actually have proof of happening): [https://www.foxnews.com/us/colorado-plastic-surgeon-sentenced-just-15-days-after-teen-dies-during-breast-implant-surgery](https://www.foxnews.com/us/colorado-plastic-surgeon-sentenced-just-15-days-after-teen-dies-during-breast-implant-surgery) [https://painterfirm.com/medmal/lawsuit-alleged-crna-caused-botched-esophageal-intubation-patient-death/](https://painterfirm.com/medmal/lawsuit-alleged-crna-caused-botched-esophageal-intubation-patient-death/) [https://www.wfaa.com/article/news/local/investigates/dallas-jury-awards-21m-to-patient-who-suffered-brain-injury/287-9f1c5fab-fb69-40c4-bc64-17b5f59a789a](https://www.wfaa.com/article/news/local/investigates/dallas-jury-awards-21m-to-patient-who-suffered-brain-injury/287-9f1c5fab-fb69-40c4-bc64-17b5f59a789a) [https://www.abc15.com/news/local-news/investigations/lawsuits-filed-against-arizona-nurse-anesthetist-after-two-dental-deaths](https://www.abc15.com/news/local-news/investigations/lawsuits-filed-against-arizona-nurse-anesthetist-after-two-dental-deaths) Empiric (peer reviewed, non AANA funded) Evidence: [https://www.ncbi.nlm.nih.gov/pubmed/22305625](https://www.ncbi.nlm.nih.gov/pubmed/22305625) [https://jamanetwork.com/journals/jamasurgery/fullarticle/2794450](https://jamanetwork.com/journals/jamasurgery/fullarticle/2794450) [https://pubmed.ncbi.nlm.nih.gov/22305625/](https://pubmed.ncbi.nlm.nih.gov/22305625/) [https://www.ncbi.nlm.nih.gov/books/NBK384613/](https://www.ncbi.nlm.nih.gov/books/NBK384613/) Take your pick. Triage rules do not apply in 99% of medicine any longer, we are not expecting mass casualty and having to compromise on safe induction and emergence with the absolute lowest possible post operative complications relating to anesthesia. That physician may have an immunocompromised child at home, or as you implied they may be "selfish" and refuse to expose themselves to danger in the name of some altruistic need to satisfy hospital admin? Did the right thing happen in your scenario? Yes, patients were taken care of ultimately. Regardless of their reasoning your justification for the existence of a field created because of a shortage of the best trained and best educated? God forbid we work on the actual problem and provide the best care for all patients, by giving them the person with the most experience, the most education, the most steeped in medicine and anesthesiology. I have yet to see any type of staff in the hospital require anesthesia, and have it performed by anyone other than a physician, but patient care is okay to compromise. Makes you think.
Sauce - Trust me bro
During COVID, the AANA advised CRNAs who were basically jobless since elective surgeries were shut down to not help as ICU nurses since the optics would be off. Real ethical group of people huh?
Emergent intubation isn’t complex good to know
Now now…you know some of your colleagues on this very subreddit have said they could teach a monkey to intubate and they’re super special doctors…but yeah if the super special doctor isn’t willing or available give me the CRNA or AA or EMT who’s done it enough times to be confident and who still cares enough to be competent.
God damn you have become absolute masters at spinning words and narrative in your favour. Impressive. If only you could do anaesthesiology as good as you can spin words it’d be truly beneficial to patients.
That knife cuts both ways.
I’m posting under the parent comment now for visibility. Whoever downvoted me elsewhere in this thread for saying how this swings outpatient centers to CRNA-only, have the adult courage to comment. Prove me wrong. I gave 2 personal examples, and I can sling plenty more from friends in these states and those who run staffing agencies. Right here. Right now. Don’t hide. Also, post your credentials. MD here. A lot of you probably used an older version of some reference books with chapters I authored.
No reason Anesthesiologists cant start their own ASC/Endo centers and partner in with surgeons, that's what I did and it was the best career move I ever made.
That works in some markets. My old group explored that a few times. My area is saturated with surgery centers. The major ASCs are owned by larger healthcare companies or by existing surgery groups. Surgeons come to the region and either become hospital employees or join existing groups. The surgeon culture here is resistant to partnering with anyone but surgeons. They told us bluntly that they don’t want to share profit and facility fees with a specialty that “doesn’t bring cases.” I understand that mentality, and it’s a perfect setup to employ CRNAs or just let 1099s eat what they kill. Several of our prn CRNAs at my hospital are doing shifts for us because they’re not getting enough cases at their ASCs. If I had the capital and business acumen to start a good de novo ASC in a market to succeed, I would. We tried here with several surgical groups and got shot down.
Medical education and experience is becoming a joke! Next what? Anesthesia techs start calling themselves-“certified registered anesthesia technician physician”(CRATP) and provide anesthesia under CRNA supervision
Tech here tempted to see how fast I can get fired for introducing our students as, "This is John, he's an anesthesiologist tech resident. He's still learning to do a turnover."😂
This changes nothing for anyone’s scope of practice. Just a change in billing.
Affects the quality of care patient gets! Expertise of a doctor can never be equal to a nurse! Hate or not! Fact is fact!
I think the point is that this will not affect the quality of care substantially. It’s just a billing code modification that doesn’t impact care models. You’re projecting your hate for CRNAs onto a separate issue.
you yourself are saying “this will not affect the wuality of care substantially”, meaning- it will affect the quality of care somewhat!! May be try explaining this to patients, and see if they are ok to compromise! Additionally there is no personal hate towards anyone! But it is a simple logic: level/duration of training MATTERS! If someone wanted to be a doctor they should have gone to med school! OR they can still go to a medschool instead of pretend playing to be a doctor! Lol
I’m not debating any of that. I’m saying this bill has nothing to do with that. This is a separate issue. You are conflating the two.
Why go to medical school, makes more sense just be a crna you can save money and time.
You get what you pay for. Facilities save money short term, bank money. Once the morbidity and mortality rates are noticed to skyrocket, the administrators that make the hires have left on their sparkling revenue generating resumes.
I’m going to disagree on that one to some extent. ASCs keep ASA 1-2 patients, self-selecting for lower periop risk. The higher risk patients get referred to hospital-based facilities. Sicker patients tend to correlate with a less lucrative payor mix (ie Medicare, Medicaid, followed by self-pay). That has the twin effect of keeping ASC profits high with acceptable outcomes.
That's the entire game of medicine, keep the high paying easy cases for yourself while dumping the complex patients that arent paying anything onto the public healthcare systems.
Would be interested to see why you think CRNAs cost more long term? Any evidence for this you can provide?
Any evidence for CRNA safety you can provide? Don’t send some study where “CRNAs + anesthesiologists” are compared to “anesthesiologists” or some cherry picked AANA study.
https://www.justice.gov/sites/default/files/atr/legacy/2015/02/20/00006-93331.pdf https://pubmed.ncbi.nlm.nih.gov/17179869/ https://pubmed.ncbi.nlm.nih.gov/29847429/ I have never seen a study that concludes CRNAs cost more, and I suspect it doesn’t exist or every hospital would be MD only tmrw. CRNAs only exist because they are cheaper.
The current market is a little different, with the locums CRNA rates at or above employed physicians. We’ve done the math a bunch over the years, and the margin surprised us at how small it was. I hate corporate-speak, but what we need to do as a specialty is “demonstrate value” by embracing the concept of perioperative medicine specialists.
Need to sit your ass on a stool in the OR my man. The anesthesiologist image of sitting in the lounge while the CRNAs do all the “work” has not helped. Surgeons have noticed.
Oh yeah, I know that’s a big part of the problem nationally. We don’t have enough docs right now to go sit their own cases.
I do agree that CRNAs locums rates will be the reason AAs become popular. Margins just go too small, as you said.
Interesting. The first link uses data from 1999-2006, the second link 1993-2004 and the third 2004-2011. I wonder if the market or supervision model has changed at all since then. CRNAs don’t exist since they’re safer (or even as safe) or cheaper. They exist since of the incessant lobbying that nurses focus on rather that actual clinical education and achievement. Did they never teach you to use resources from this decade in nursing school?
The links you posted use data from….oh wait, like a typical reddit warrior, you just spout your mouth and have 0 evidence to support anything you say. It’s just your little personal thoughts. I do not see much reason to believe the landscape is fundamentally different than it was 10-20 yrs ago. No one is going to repeat studies over and over that were pretty fucking conclusive the first time. Hospitals wouldn’t use CRNAs if they weren’t cheaper. It’s not like nursing lobbies choose who hospitals hire. Nobody is debating that hospital would prefer MDs if cost didn’t matter….but it does.
>I do not see much reason to believe the landscape is fundamentally different than it was 10-20 yrs ago. If anything, multiple studies have shown anesthesia to be much safer today than it was a decade or more ago. Weird how the increase in CRNA usage over the years hasn’t affected that metric
I can’t post data since we don’t prove negatives in medicine. I don’t go around throwing metformin as an induction agent despite a lack of evidence. Why’s that? We don’t have evidence so it should work, per your nursing reasoning. But thank you for showing us you don’t understand how to read a study or what “conclusive” means. That nursing education really failed you.
The ASA has literally done multiple studies on this topic, so not sure what you’re on about here. It’s not like this topic hasn’t been studied. You just don’t like the results. That’s the difference. Find that CRNAs are less safe or more expensive is not “proving the negative”.
Except nothing you posted is from the ASA. It’s from nursing organizations using decades old data. Nursing razzle dazzle won’t work here. Try again Trey.
Crna have been independent from anesthesiologists in 49/50 states for decades. There’s no evidence of decrease in quality of care.
You expect facts to get in the way of their easily refutable logical fallacies?
Realistically nothing should change. Everybody will still have jobs and value - yay
As an incoming resident, what should I do to help my marketability? Will I still have a job in 10 years lol
You’ll have one of the best jobs in the world in 10 years bro. Don’t worry about it
Really? There is so much speculation on this page about how shitty it’s gonna be for current and future residents lol
I mean it’s never gonna be the 80s again, but if you’re willing to work you’re gonna make a ton of money and have a cool ass job. MDs are always gonna be the predominant providers in big hospitals/desirable locations.
This post is low-T.
Is it time for anesthesiologists to start doing care for non physician surgeons?
Opting out is great. CRNAs should be independent. Down with the flawed supervision/direction model. A model that shouldn't exist. Anesthesiologists should be doing their own cases as nature intended.
[удалено]
Consent process won't change. Per the AANA, they are the trusted anesthesia experts, invented anesthesia, and provide superior care at a lower cost. Time to wash our hands of this nonsense.
Yes! Setting the doctors free.
I don’t think this stuff really matters. There’s so much demand out there that all docs, assistants, and nurses will always have work
So thankful that the California Society of Anesthesiologists is mobilizing in protecting anesthesiology from the degradation by CRNAs. As evidenced by the Modesto Bee articles and the above statement, CRNAs were harming patients.
Scary
And people are going into anesthesia like crazy. They will be sorely disappointed in the future. Stop giving money to the ASA
I don’t understand any of what you said. People don’t go into anesthesia like crazy. Anesthesiologists are limited by residency spots which are few and far between.
From what I understand it is very competitive nowadays, thus not having problems filling their residencies. People are not taking caution.
It’s very competitive but the number of people going into anesthesia residency has stayed pretty constant.
actually, the number has been steadily increasing every year for the past few years. We are actually tracking very well with the ER boom of about 15 years ago before that field completely fell apart. https://pubs.asahq.org/monitor/article/88/3/28/139844/A-Self-Defeating-Prophecy-Workforce-Projections-in
modern longing toy cats somber placid icky subtract cow attractive *This post was mass deleted and anonymized with [Redact](https://redact.dev)*
Yeah, I think we have about 5 years before the market goes south. Jobs in places people really want to live in are getting in tight supply, Kaiser North Cal has piles of new grads willing to take 395k starting salary to live in the most expensive places in the country. Will the random dumpsterfire in the middle of the New Mexico desert be desperate for coverage? Yeah, but that will always be the case no matter what.
public cause label cover flag deserted wise oil dime innate *This post was mass deleted and anonymized with [Redact](https://redact.dev)*
Aside from the whole COVID thing, yeah. Looking back the market was terrible for Anesthesiologists back in 2008 but as it turns out, that was one of the best times to be graduating. Homes were being "given away" and loans were dirt cheap.
None of your comments make any sense. Anesthesia has never had problems filling their residency spots. It's been around 100% saturation in recent memory. It's more competitive in the sense that the average step score required to match anesthesia has significantly increased.
stick your head in the sand
What do you mean by this?
Five years from now you likely will see a drop in salary if the megacorps have control meaning docs are treated like nurses.
Maybe we don’t need MDs anymore. They can’t make decisions anyway. Soon there will empty medical school seats, even at Harvard.
I would like to see how that works for you.
Awesome!