Hospital Primarily Using MDA's Instead of CRNA's? - page 2

I had a clinical rotation in this relatively small hospital, and noticed that they primarily use MDA's. When I asked the OR nurses if there were any CRNA's, they said the hospital only employs two... Read More

  1. by   URgettingsleepy
    You can lead a horse to water but you can't make it drink.

    Especially when the farms are filled with A$A cash. UR
  2. by   Sheri257
    Quote from URgettingsleepy
    You can lead a horse to water but you can't make it drink.

    Especially when the farms are filled with A$A cash. UR
    So are you saying the ASA throws cash at hospitals to keep MDA's? If so, how does that work? Or is it simply a matter of keeping other docs happy who bring the biz?

  3. by   gaspassah
    some hospitals may offer a small monetary incentive to the group and allow the group to recoup the other funds from billing insurance and medicaid/care.
    or a comibination of pay and shared billiing.
    some surgeons refuse to work with crnas. so if some of your big money generating surgeons refuse to work with crnas and go elsewhere then the hosptial loses. so they give in and hire mds. even at a greater cost.
    politics play as big a role as economics in many cases.
    d
  4. by   TraumaNurse
    It's all about politics and not necessarily economics. Common sense and politics do not always go together!
  5. by   NGACRNA
    This sometimes depends on patient payer mix. If there's any "industry" nearby, and / or most people have private insurance, then who'll see Physician Anesthesiologists doing cases. If it's all medicare/caid and self-pay (no insurance) you'll find more CRNAs. Just look at the difference in doing an Epidural for L&D BlueCross can pay 4-6 times what medicaid pays.

    Also, some hospitals have an academic affiliation with some institution of higher learning. In many of these cases the physicians' salaries will be augmented by funds from the college.

    So, there are economics involved in the politics.
  6. by   imenid37
    I work in a small hospital (abt. 80 beds). We have a few CRNA's and mostly MDA's. I am a nurse in Ob and I know only the MDA's do our ob cases. I am not sure if this is hospital policy or what. The MDA's, except for one, are all grumpy. One guy even tells the moms they are "lucky" to be able to get an epidural. Ha! It really makes me miss the CRNA's who we had when I worked in Baltimore who did our epidurals and C/Sections.
  7. by   RN4NICU
    Quote from lizz
    So besides MD favoritism, what could those reasons be? I guess I just don't understand why they would spend more money for the same service under any circumstances.

    If the MDAs are an independent group, they work IN the hospital, not FOR it. They bill the patient directly, but have privileges to practice at the hospital, just like the other docs do. Therefore, the hospital does not pay them anything. It just grants them the ability to practice there - similar to the surgeons.
  8. by   Sheri257
    Quote from NGACRNA
    This sometimes depends on patient payer mix. If there's any "industry" nearby, and / or most people have private insurance, then who'll see Physician Anesthesiologists doing cases. If it's all medicare/caid and self-pay (no insurance) you'll find more CRNAs. Just look at the difference in doing an Epidural for L&D BlueCross can pay 4-6 times what medicaid pays.

    Also, some hospitals have an academic affiliation with some institution of higher learning. In many of these cases the physicians' salaries will be augmented by funds from the college.

    So, there are economics involved in the politics.
    This is a semi-rural area with a fairly large indigent population. There's not much "industry" nearby. I don't know for sure, but I'd bet they have more medicare/medicaid than private insurance. They also don't have any affiliation with any universities.

    Quote from RN4NICU
    If the MDAs are an independent group, they work IN the hospital, not FOR it. They bill the patient directly, but have privileges to practice at the hospital, just like the other docs do. Therefore, the hospital does not pay them anything. It just grants them the ability to practice there - similar to the surgeons.
    Ah ... ok. That could explain it. Thanks for the insight.

  9. by   NGACRNA
    [QUOTE=lizz]This is a semi-rural area with a fairly large indigent population. There's not much "industry" nearby. I don't know for sure, but I'd bet they have more medicare/medicaid than private insurance. They also don't have any affiliation with any universities.

    One other thought comes to mind. It has to do with where someone can get a position. I am NOT casting aspersions about abillity. About 11-12 years ago there was a "glut" of Anesthesiologists. Some "settled" for positions earing close to the same as CRNAs. Many formed groups. If this is a low-pay area, I'm amazed that there's an MD group. I'd think some would be looking for broader pastures, but hey, if they're happy, I'm happy. (my "quotes" come from articles I remember reading from the period).
  10. by   Sheri257
    Quote from NGACRNA
    One other thought comes to mind. It has to do with where someone can get a position. I am NOT casting aspersions about abillity. About 11-12 years ago there was a "glut" of Anesthesiologists. Some "settled" for positions earing close to the same as CRNAs. Many formed groups. If this is a low-pay area, I'm amazed that there's an MD group. I'd think some would be looking for broader pastures, but hey, if they're happy, I'm happy. (my "quotes" come from articles I remember reading from the period).
    Well, this particular area is growing fast. But it still has a long, long way to go before it becomes a wealthy suburb like Orange County, CA or someplace like that.

    Who knows? As another poster pointed out, they too live in a rural area where a hospital is dominated by MDA's. Since CRNA's now do 65 percent of the surgeries, maybe your scenario is correct.


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