politics & job scarcity

  1. Okay, I've got two issues I'm wondering about---

    Five years from now, does anyone have any insight/information to support the notion that there could actually be a glut of CRNA's on the market? Or, let's say, if all the schools doubled their entering classes this year, would there still be a shortage i five years? I've not seen any statistics on this. Perhaps those of you in class may have heard something from an instructor?

    Secondly, are there any worries that legislation could drastically change/lower pay? This interest to do so rooted in the healthcare mess we are in. I would reference what happened to the home health care nursing as a result of changes in gov. reimbursement that occurred a few years ago, which made HH nursing go from somewhat rewarding in pay to not at all.

    Any ideas or insights would be interesting to hear about. THANKS!
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  2. 71 Comments

  3. by   kmchugh
    Originally posted by Espresso girl!
    Okay, I've got two issues I'm wondering about---

    Five years from now, does anyone have any insight/information to support the notion that there could actually be a glut of CRNA's on the market? Or, let's say, if all the schools doubled their entering classes this year, would there still be a shortage i five years? I've not seen any statistics on this. Perhaps those of you in class may have heard something from an instructor?

    Secondly, are there any worries that legislation could drastically change/lower pay? This interest to do so rooted in the healthcare mess we are in. I would reference what happened to the home health care nursing as a result of changes in gov. reimbursement that occurred a few years ago, which made HH nursing go from somewhat rewarding in pay to not at all.

    Any ideas or insights would be interesting to hear about. THANKS!
    Espresso

    First, five years from now, there will NOT be a glut of CRNA's. I just cannot forsee any cirucumstance where that would be true. I've said elsewhere, and will repeat, the average age of current CRNA's is rising, and something like more than 50% are 45 and older. CRNA's are currently retiring at a rate faster than the schools are putting out graduates.

    The only way that CRNA salaries could fall would be if medicare rates for anesthesia reimbursement fell, lowering the amount of money made by EVERYONE in anesthesia. While CRNA salaries may seem high to those outside of anesthesia, they are actually quite reasonable when you consider the economics of hiring a CRNA to a group. If a CRNA works for a combined MD/CRNA group, under current regulations, one MDA can supervise something like five to seven CRNA's. Now, lets say the group is paying each of those CRNA's $150K. On average, an anesthesia group can bill something like $250K for each anesthesia provider working full time. (No, there are no differences in what can be billed for a case performed by an MDA over a case performed by a CRNA. The rate is the same.) So, with 5 full time CRNA's each being paid $150K, the group still is making a profit of about $75K (when you consider benefits received by CRNA's on top of salary.) per CRNA.

    That's for CRNA's that work in MDA owned groups. CRNA's that practice independently, or are partners in all CRNA groups of course, are making quite a bit more money, in one way or another. I have also heard (though I have not found any yet) that some MDA owned groups are now offering a full partnership track to some CRNA's. By making they partners, the CRNA's are generally earning more, and there is a strong incentive for the CRNA to stick around.

    Kevin McHugh, CRNA
  4. by   nilepoc
    have I got the reference for you. Your question ties in nicely with a lit review I have been doing.

    Read this report on the lasting shortage of anesthesia providers. You should find it illuminating.

    Craig
  5. by   Espresso girl!
    Thanks guys for the informative, insightful information. I am printing out the 16 page article you linked, as I type, and look forward to checking it out.

    Being the analytical person I am, I continue to look at all angles. I like to play devil's advocate to try and invoke all aspects
    So, let's say a group can bill say, 250k and net 75k. The area that still concerns me is that this may at some point be deemed as "fat" that can be cut out of the insurance process, be it government or private. Certainly, the entire insurance game is a dynamic creature.

    Any thoughts on this? I am really suspicious about all insurance matters as our system continues to go south!
  6. by   kmchugh
    Again, no Espresso Girl, I don't see that the government will see this as "fat" that can be trimmed. If anything, I suspect CRNA and MDA salaries will go up, not down, in the future.

    Kevin McHugh
  7. by   MICU RN
    Esppreso Girl:
    I too am concerned about future trends concerning anesth. work oppotunities; however, we must take chances in life and I think it is pretty safe to believe that the jobs will be there. At least that is what all these studies are showing. In addition, when i have talked to crna's who have been practicing a long time, they have all told me that they have been hearing rumors for years that crna's opportunities would eventually decrease and they mentioned that just the opposite has occurred. So go for it, and remember sometimes too much analysis can equal paralysis. I know for me, it is either go to crna school or get out of bedside nursing all together.
  8. by   Roland
    towards socialized healthcare (such as what Oregon is now implementing). Does anyone know what the salary ranges are for "anesthesia professionals" in countries like the UK and Canada which have had this system for sometime now? I heard a report on NPR last week which in essence said that the movement towards the Democratic party is inevitiable (given current demographic trends especially with regard to immigration). I think it reasonable to assume that if the Democrats DO obtain such control that the transition to such a system will likely soon follow.
  9. by   ICUBecky
    i honestly don't see socialized health care happening in the united states very soon. they (our political system) have been arguing it over for years and years. it's not gonna happen...IMHO.
  10. by   Espresso girl!
    Who can fill us in on what's going on in Oregon with respect to "socialized medicine" Which changes are taking place, when, and what effect is this supposed to have on CRNA's, RN icu pay, etc.? THANKS!

    Espresso Girl
  11. by   London88
    Roland

    Canada and the UK do not have nurse anesthetists.
  12. by   Roland
    give anesthesia or do MD's (MDA's)? Also, do you happen to know what "average" wages are for RN's (or their equivalent) in US dollars. I don't think that socialized medicine will necessarily happen in the next twenty years, or is even a definitive probability. However, I do think it is a legitimate POSSIBILITY. Therefore, it is logical to evaluate this contingency for possible ramifications to this profession.
    Last edit by Roland on Oct 28, '02
  13. by   Roland
    also my questions. From the little research I've done it seems that Canadian RN's earn around $20.00 per hour (in Canadian dollars). From several other threads that I've read (including the one immediately above) it seems that in most other countries that advanced practice nurses in general, and CRNA's in particular are a rarity. To me this is counterintuitive as I would think that the health care rationing which almost always TEND to ensue under socialized health care would PROMOTE cost saving measures such as the use of NP's. I can only conclude that there are even stronger countervaling forces such as tradition, and or the strength of doctor unions which prevent this from happening (or maybe I've acquired incorrect, or incomplete information and there are indeed CRNA's ect).

    As to the Oregon health plan here is one of the better articles that I found on the subject (I wish I knew how to cut and paste on this board so I didn't have to type the darn thing!):

    Bold New Health Plan in Oregon:

    Salem, Ore. Oct 09 2002

    (AP) Every man, woman and child in Oregon would receive full medical insurance with no co-payments, no deductibles - under a measure on the Nov 5 ballot that would create the first universal health care plan in the nation.

    The question is wether Orgonians are willing to pay higher taxes for a plan so generous it would cover even acupuncture and massage therapy.

    "What we are proposing is ambitious and audacious, but we believe the health care system now is in crisis," said Mark Lindgren, spokesman for the Health Care for ll Oregon campaign, sponsor of Measure 23.

    Under the existing system, he said an estimated 423,000 of Oregon's 3.3 million residents have no health insurance- about 70,000 of them children. Nationally, the number of uninsured is about 41 million.

    The Oregon plan would be financed by a new payroll tax of up to 11.5 percent on businesses and an increase in personal income taxes. The top rate would rise from its current 9 percent to as high as 17 percent.

    No independent polls have been released on the measure, but it is facing strong opposition from business, insurance, and health care industry groups, who fear it will lead to runaway spending and wreak the state's economy.

    "It's the richest benefits package known to man," said J.L. Wilson head of the Oregon chapter of the National Federation of Independent Business. "Under this bill, you would have to pay for people to go to a massage therapist four days a week because it's deemed medically necessary."

    Lindgren put the cost $19 billion a year- more than the entire crrent state bdget of about $16 illion. About $7 billion of the cost would be covered by the payroll tas, and $4.9 billion by higher income taxes. The rest would come from shifting state and federal health care dollars to the new universal system.

    Oregon has gained a reputation for tackling difficult health related issues n recent years. Voters in 1996 approved the nations only law allowing physician assisted suicide. In 1998 the approved the medicinal use of marijuana. In 1989, the Legislature enacted a groundbreaking health plan that extended insurance to thousands of poor people; the stat drew up a master list of hundreds of diseases and treatments, ranking them in order of importance, then drew a cutoff line below which the state would not provide coverage.

    Measure 23 is backed by th Cleveland based Universal Health Care Action Network, wose spokeswoman Rachel Deolia sees the Oregon effort as picking up where Hillary Rodham Clinton left off a decade ago with her push for universal health care."

    Supporters hope passage of Oregon's measure will lead to similar efforts in other states.

    People in Oregon would not be required to get rid of their private or group insurance, but most would probably do so since they would be paying for the universal sysem anyway, Lindgren said.

    He said that while many people would pay higher taxes, much of that would be offset because thy would no longer have to pay premiums, or copayments deductibles and other out of pocket health costs.

    Opponents say the residency requirement is so loose that seriously ill people without insurance would move to Oregon just to take advantage of the program. New arrivals would merely have to declare their intention to live here.

    "It would take more to get a hunting license in Oregon than it would take to get access to full health benefits," said the NFIB's Wilson.

    Opponents also warn that it would cover all treatment deemed "medically necessary" by any state licensed, certified or registered health care practitioner. Also, the measure does not contain any limits on coverage and does not spell out whether there would be ny exclusions for experimental procedures or devices.

    Lindgren said those points were deliberately left vague so that a 15 member state board that would be created to oversee the program could make those decisions later.

    He disputed warnings of runaway costs. Among other things, he said, people who lack insurance are a drain on the sytem because they often leave minor conditions untreated until they become major problems requiring expensive emergeny room treatment.

    Barney Speight, a former state health administrator, warned that Measure 23 is bad medicine. "It might be able to achieve universal health coverage in the short term," he said, "but in the long term it could destroy Oregon's economy."
    Last edit by Roland on Oct 30, '02
  14. by   Qwiigley
    If those people living in Oregon pass this law; free health care. They will be soooooo sorry. There will be so many people moving there. They already don't like Californians much, how would they like to be swamped with people from all other 49 states?
    Not a good idea.

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