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CRNA Court Victory is a Win for Rural Hospitals

John Commins, for HealthLeaders Media, March 28, 2012

Demand for anesthesiologists has dropped, Karam says, because demand for elective procedures has dropped. "That obviously was a great deal of the profit margin that a lot of surgeons were seeing when they opened their own surgery centers. With that market dipping, it took away a lot of the profit margin and a lot of the demand," he says.

"In addition you have hospitals being far more aggressive in communities than they have been before. The consolidation of medicine has really pushed hospitals to go out in their communities, buy up these surgery centers, or at least partner with these organizations and be a stronger player in their own backyard, so that they aren't losing those profitable procedures when they are there," he says. 

Of course, many of the same economic forces that are hurting anesthesiologists are also hurting CRNAs, but Karam says CRNAs are having a "far easier" time finding work, and it all boils down to labor costs.

"They are still even higher in the locums demand market than anesthesiologists. They are in a much more comfortable position simply because what they can do, what the law allows them to do, and what they are commanding for pay," Karam says.

Perhaps the best hope for anesthesiologists is if CRNAs get too greedy.

"Paying CRNAs will change once they start to lobby and demand higher salaries," Karam says. "Once it gets up there to $250,000 or what an anesthesiologist can make, then obviously hospitals or medical groups will be more comfortable paying that money to a physician rather than an allied professional."

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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...