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CRNA Court Victory is a Win for Rural Hospitals

John Commins, for HealthLeaders Media, March 28, 2012

Besides, this case isn't about patient safety, or even access to care. It's about money.

The savings in compensation costs and the money generated by additional procedures could be considerable for rural hospitals. Merritt Hawkins & Associates, the Dallas, TX-based national physician recruiting firm, says that first-year financial packages for anesthesiologists range from $275,000 to $350,000, while CRNAs earn around $200,000.

"Obviously the return on investment is there. It's a simpler search. There are more CRNAs in the marketplace than there are anesthesiologists," says Sam A. Karam, division vice president for Merritt Hawkins. "From a sheer dollars-and-cents standpoint it always makes sense to have CRNAs. Now, that is the main reason we have seen CRNAs being more in demand."

Karam says anesthesiologists were once among the most-highly sought after medical specialists. That is no longer the case.

"From a demand perspective, is it difficult to find anesthesiologists today? No. That's a stark change from just a few years ago when the demand for them was extremely high," he says. "You will find some that actually aren't even working in permanent positions. They're working locum jobs to stay afloat."

CRNAs are not the main reason for the slowing demand for anesthesiologists. Larger factors, including the long-sputtering economy and the anticipated changes that will come with healthcare reform, have "flip-flopped" market demand away from specialists and towards primary care docs.

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2 comments on "CRNA Court Victory is a Win for Rural Hospitals"


16788087 (3/29/2012 at 2:25 PM)
excellent comment by Barry. I would like to add, one thing often overlooked in the conversation about utility/cost of 'CRNA vs. Anesthesiologist' is much of the value add that physician anesthesiologists can bring to the 'service' of anesthesia that nurses, by definition, cannot. Examples being; most MD Anesthesiologists are well trained and experienced with providing ultrasound guided regional anesthesia, training and experience in acute post op pain management, ability to act as a physician consultant with deep understanding of the wide breath and depth of disease states, training and experience in the use of ultrasound for cardiac evaluation, training and experience in managing a patients' preoperative evaluation, and thus saving dollars and improving outcomes. There are many functions anesthesiologists, trained and encultured as physicians, can perform that nurses, by their training and culture cannot, is not within their scope of practice, or are not comfortable with. The challenge for the specialty of anesthesiology, and especially for older generation anesthesiologists, is to show our value perioperatively and OUTside of the operating room. As noted, precision medicine is making the technical practice of anesthesiology to be a lower level function as compared to how anesthesia was practiced decades ago-thus, O.R anesthesia is being disintermediated away from needing physicians. However, there is much within the purvue of Perioperative medicine that physician anesthesiologists are uniquely qualified to do, and should step up to do, so as not to make this specialty obsolete.

Barry W. Brasfield, M.D. (3/28/2012 at 6:31 PM)
The relationships between anesthesiologists and CRNAs represent what Clayton Christiansen ("The Innovator's Prescription")would classify as a "disruptive innovation": anesthesiologists, through research and training, have rendered anesthesia care so safe that it is virtually impossible to statistically demonstrate any difference in the "quality of care." Therefore, provision of anesthesia is no longer an "intuitive" medical service, but a "precision" medical service. The marketplace will continue to adjust to this development over the next decade or more...