Should I Worry About Future of CRNAs? - page 3

by guest_57352 | 24,319 Views | 29 Comments

So I've been reading about a few things that worry me: 1. Oversaturation of CRNAs. 2. MDAs pushing back against them. 3. Insurance reimbursement going down for anesthesia. 4. The push for AAs over CRNAs. Taken together,... Read More


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    RN boom is comparable to housing because back in 2000s (from late 1990s to mid 2000) so called RN shortage was crazy to say the least--hospitals were recruiting RNs from the Philippines, Colombia, India, etc. ; Giving them Green cards, bringing them here with signing bonuses (up to $20K), paid accomodations, etc. Mt Sinai Hospital here in Miami is a case in point. They built an apartment type complex to house their nurses during the boom times. Today, it sits there empty together with a hospital they purchased.

    As far as gaswork tabulations is concerned, the earliest period I got was May 12, 2010 (when I started gathering the data) and it still showed 663. Given a month or so, the gap of -26.3% is still too big to account for seasonality.

    Another thing to consider is that when everyone thinks CRNA is a lucrative thing to enter and everyone does it--just like when everyone thinks that buying a home is a foolproof investment and I was hearing people saying, "Home prices only go up." --that was time to beware and get out.

    My Point is you should go for the profession you're passionate at so that even with a hit to your income, you wont regret doing it.

    Just my .02
  2. 0
    Quote from manusko
    Well apparently the OP has stated to the contrary. I would post a lot of questions here because this has the most active posts and would probably receive the most variety of thoughts. Not saying what you said was wrong in any way, but this is an open forum and your statement seemed a little arrogant. I value all opinions and took this as an open discussion. I am not a CRNA but I do had a vested interest in the subject as a SRNA. That being said, you probably do have a better perspective of the outlook for CRNAs but that doesn't mean everyone is wrong.
    What I should have stated is who is a CRNA or SRNA on this thread. Being an SRNA depending on where you are in your didactic training often gives you better access to what is going on with the local job market and anesthesia politics than some of us CRNAs that don't work in the academic setting.

    Was my statement arrogant? Maybe, but I really don't enjoy seeing people post on my career field that for the most part don't have any real knowledge on the subject.
  3. 0
    Quote from wtbcrna
    Here is an interesting link for anyone that thinks these political/legal fights with physicians vs. CRNAs is a new thing. http://www.aana.com/brieflookhistory.aspx. These legal bouts have been ongoing before most of our grandparents were even alive. The ASA and the AMA are still using the same basic argument they did back then.
    The amazing thing to me is how nasty some of the physician sites get. There is one that treats our educational programs like crap and tells people to pretty much demand a doctor over a CRNA. I know the opt out is a big deal and really agitated the AMA.
  4. 0
    Quote from wtbcrna
    What I should have stated is who is a CRNA or SRNA on this thread. Being an SRNA depending on where you are in your didactic training often gives you better access to what is going on with the local job market and anesthesia politics than some of us CRNAs that don't work in the academic setting.

    Was my statement arrogant? Maybe, but I really don't enjoy seeing people post on my career field that for the most part don't have any real knowledge on the subject.
    Fair enough. And I did say that you probably had the better perspective. I understand what you are saying. Like we see a highschool student or someone in a different career field giving advice about nursing or becoming a CRNA.
  5. 0
    Thanks for getting back on track.

    You can sometimes get the best advice from the most unexpected sources.
  6. 2
    I think there is no need to worry excessively about the future job market of CRNA's. The Gaswork site seasonally goes up and down. Especially around graduation time. Just as in nursing, there are areas with low demand and areas of high demand. In my area the postings on Gaswork dropped after a hospital closed. All the CRNA's from there took the posted jobs. This has probably happened in others too. The listing have come back up now. There are always jobs in anesthesia if you are willing to move. I have been practicing in anesthesia for almost 8 years, and have never heard of a CRNA who who was unemployed and completely unable to find work. The one case I know of was due to people not liking the CRNA because of their bad personality/temper; he constantly talked of the bad economy that kept him unemployed even though that was not the real reason. It only took him awhile to get a job becuase no place he had worked at would give him a good reference.

    Even if re-imbursement in medicare/medicaid gets cut, CRNA's will be on top of the pile. By this I mean that all healthcare providers will receive cuts, but when all is said in done the CRNA's will still make more than RN's or many other fields. Even if our salary is cut by an extra twenty percent compared to everyone elses we will still be very well paid. If CRNA salaries ever came remotely close to an RN's then CRNA's would stop working in anesthesia and there would be no more providers; which of course would drive the salaries back up. It would be a very easy protest to carry out with almost no financial hardship to us in that case. And there wouldnt be enough time to train AA's to replace us, they would have to beg us to come back before their classes really got started.

    There is no real way to be certain what profession will be doing well in the future. I first wanted to be an engineer when I was growing up. I grew up in an engineering community, and all of my friends dad's were unemployed. So I chose something else. At the time it looked like a very poor career choice. Though it is still a very viable profession and I probably would have been happy if I chose it.

    Supply and demand and level of acuity of patients IMO make the biggest impacts on salary. Cities that graduate lots of CRNA's have the lowest salaries in most cases with a few exceptions. Graduates tend to want to stay close to where they graduate, most schools are chosen because of their proximity to their hometown. The type of patient load also effects salary. Day surgery centers typically have very low patient acuity (healthy patients) and no call; its very easy to attract CRNA's to its regular schedule and easy patient care. High acuity trauma centers take care of very sick patients and have alot more call responsibilities, if they paid the same as surgery centers then no one would want to work there.

    The important thing is that you pick a profession you truly love or at the least will enjoy, It doesn't matter how much money you make if you hate what you do. Any area in nursing is a worthy area to work in. Especially the advanced practice areas.

    CRNA's are the oldest anesthesia providers, we will be around for awhile. If you research our history you will see that anesthesiologists didn't exist until they saw a way to make a good income, though of course even then they tried to state it was for patient safety. Initially anesthesia providers recieved no respect and they were not valued; that is actually how nurses got their "foot in the door". Many of the "studies" anesthesiologists produced to try and prove they were safer than anesthetists were smoke and mirrors. What the research protocol they used looked at had nothing at all to do with their "conclusions". One study never even analyzed CRNA's in any way, though their conclusion claimed they have proved we were less safe by comparison. There will always be politcial battles when their is money and a persons way of life to be protected. That shouldn't prevent anyone from joing the profession. Even if their are massive cuts due to the economy, everyone will be affected--but CRNA's will still be closer to the top compared to other professions. Where we might get a massive pay cut; many other professions would get unemployed. People will always need surgery, we have a skill set that will always be needed and can't be taken by someone else. Most experienced CRNA's have saved enough money that they could weather a few years of a truly bad economy; they wouldnt be happy about it but they would not go hungry or without a place to live. Not many other professions could boast to have the same ability.
    MEDBRAT08 and Dee_one like this.
  7. 0
    I wouldnt be concerned about the CRNA market. We offer a valuable service, and are cheap in comparison to MDA's. AA's are a nice idea in theory: but the oversight is so high (1 MDA to 2 AAs) which makes them not so helpful when playing the #'s game.

    So if you want to be a CRNA, that shouldnt stop you. However, I am mostly concerned by your genetic link to MH. The majority of anesthetics given are through gases that can trigger MH. If you knowingly have it: id be concerned for you. These gases leak out of our circuits, and consistently leak while doing mask inductions. I'd hate for you to have a fatal reaction. This is something to discuss with a doctor, and you can get muscle testing to see if you have the suseptibility. However I would strongly caution you: i breathe these gases all the time... I personally wouldn't risk it.
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    The supervision requirement for AAs to MDAs varies by state with some being 2:1, 4:1, and at least one state that doesn't specify a certain ratio at all. http://www.gana.org/documents/AA_fact_sheet_508.pdf. To meet the billing requirements for Medicare and the requirements of the ASA for an ACT practice an anesthesia practice has to stay at 4:1 ratio or less.
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    You realize in the last year, there have been several more staffing agencies come on board and the overall economy of the US has declined. I would take the job posting of one website and run with a conclusion. Fact is...CRNA's cost less than MDA's. Fact is...CRNA's are highly skilled and you can't have an RN substitute for what is essentially the practice of medicine, not nursing. Last of all, AA's were created by MDA's. They own them. They want them on a leash. Simply put, there are so many jobs for CRNA's out there now and always have been in small rural areas that pay amazing amounts of money. There are on average, 2 Anesthesiology Residency Programs closed each year in the last 5 years because of CRNA's. Simply put, CRNA's are independent in more and more states everyday. Whenever CRNA's get to the point of Medicare Reimbursement which is the case in many states and growing, there is no turning back. Simply put, there is no bubble for them, or if it is, the same applies to MDA's.
  10. 0
    I have two family members, one an MDA one a CRNA, who are currently practicing.

    The MDA is very cautionary/pessimistic about the future of MDAs as clinicians. They think that they're turning more and more into a supervisory/administrative position (this is their view of where MDs as-a-whole are headed. With the rise of NPs, PAs, AAs, CRNAs as the practicing clinicians, with no data showing a discrepancy in care, MDs are having more difficultly justifying their expense/debt).

    The CRNA is doing more and more every year -- and they think they work at a hospital that's on the more conservative end of the CRNA-autonomy-perspective -- and has seen their Anesthesia Dept swing from mostly MDAs to mostly CRNAs over the last couple of decades.


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