Why don't CRNA's like AA's

jwk · May 20, 2004

Let me equate this to something you should be able to relate to if you are an RN.
there is currently a shortage of RN's. To fix this shortage, I am going to allow anyone who is interested to become an RN. I am going to require them to have no experience and i am going to only give them positions in the ICU upon completion of their program. At the same time, i am going to cut the pay of current ICU RNs and additionally I am going to place restrictions on the practice of ICU RNs, so that I do not have to administrate more than one kind of provider.
This is what is happening to CRNAs in some markets. AAs move in, the MDAs don't want to supervise two types of providers, so they limit the practice of CRNAs to equal the practice of AAs in that facility. Later taht year, administration asks the question why are we paying CRNAs more if they are doing the same limitted job of the AA? CRNA salaries fall, and CRNA practice deteriorates. Over time, this has the potential to become the norm in big hospital practice. It would not take many AAs in a hospital to bring about a change like this.
IMHO this is one of the reasons CRNAs are less than friendly in supporting the practice of AAs.

I'd love to see even one specific example of how a CRNA's compensation has been cut due to AA's. Not the generalizations such as "they're lower in Georgia because of AA's". I know lots of CRNA's in Georgia in both hospital and group practices making $150k+, some much more than that, particularly those in smaller hospitals or working locum tenens. For a part of the country with a substantially lower cost of living than the Northeast or the West Coast, I would bet very few of your colleagues are complaining about their standard of living in Georgia.

TheBigBadDog · May 20, 2004

i'd love to see even one specific example of how a crna's compensation has been cut due to aa's. not the generalizations such as "they're lower in georgia because of aa's". i know lots of crna's in georgia in both hospital and group practices making $150k+, some much more than that, particularly those in smaller hospitals or working locum tenens. for a part of the country with a substantially lower cost of living than the northeast or the west coast, i would bet very few of your colleagues are complaining about their standard of living in georgia.

i don't think that you have sufficiently grasped the economics of this issue. the only thing that determines the price (salary) is supply (of providers) and demand (for the services). assuming that demand remains constant and the supply is increased the price (salary) will decrease. the amount of the salary decrease is determined by the slope and shape of the demand and supply curves.

the supply is determined by a number of factors, but the barrier to entry into the market is probably the most important factor. what is a barrier to entry? it is something that prevents other would be suppliers of the service from competing against you. licenses, education, and experience are three of the most common and useful barriers that are used in the usa to prevent competition. if erode the barriers you will see lots of new entries into the market who are willing to provide this service, hence direct competition!

new crna schools maybe a bigger threat to the existing salaries of crnas, but if the difficulty of achieving a crna certification, license, etc. are maintained then many of the would new competitors will not become a crna.

there is one overriding economic principle that will affect crnas salaries, especially if it suddenly becomes easier to become a service provider, "excess profits breeds ruinous competion"! that means that the salaries of crnas climb higher more competitors will want to enter the market until there is glut of competitor and jobs will become scarce and wages will fall.

these are basic economic that effect all professions. anyone who has a profession or a job should always be concerned about competition between service providers. i think the ama has shown that it understands these ideas, and it is willing and able to come up with ways to avoid competition. remember for the service provider competition is always bad!

jwk · May 20, 2004

JWK,
I am not familiar with georgia law as it pertains to the use of AA's, however if Georgia law only allows for physicians to supervise 2 AA's or CRNA's than there is no financial benefit to using AA's unless they are willing to work for less than a CRNA. If this is a fact then you can see why CRNA's are against the use of AA's as it diminishes our earning potential? Because in markets that use AA's, MDA's will not want to employ CRNA's because of higher pay. Please check and make sure you are correct about Georgia law. I thought is was the same as federal law for medicare reimbursement?

Georgia law allows two PA's/AA's per physician, but they may supervise/medically direct up to four anesthetists (AA's or CRNA's) at the same time, as also allowed by federal law.

jwk · May 20, 2004

i don't think that you have sufficiently grasped the economics of this issue. the only thing that determines the price (salary) is supply (of providers) and demand (for the services). assuming that demand remains constant and the supply is increased the price (salary) will decrease. the amount of the salary decrease is determined by the slope and shape of the demand and supply curves.
the supply is determined by a number of factors, but the barrier to entry into the market is probably the most important factor. what is a barrier to entry? it is something that prevents other would be suppliers of the service from competing against you. licenses, education, and experience are three of the most common and useful barriers that are used in the usa to prevent competition. if erode the barriers you will see lots of new entries into the market who are willing to provide this service, hence direct competition!
new crna schools maybe a bigger threat to the existing salaries of crnas, but if the difficulty of achieving a crna certification, license, etc. are maintained then many of the would new competitors will not become a crna.
there is one overriding economic principle that will affect crnas salaries, especially if it suddenly becomes easier to become a service provider, "excess profits breeds ruinous competion"! that means that the salaries of crnas climb higher more competitors will want to enter the market until there is glut of competitor and jobs will become scarce and wages will fall.
these are basic economic that effect all professions. anyone who has a profession or a job should always be concerned about competition between service providers. i think the ama has shown that it understands these ideas, and it is willing and able to come up with ways to avoid competition. remember for the service provider competition is always bad!

thanks for the economics lesson. although your basic assumption concept about supply and demand is fine, your logic in this particular situation is flawed in that demand for anesthesia providers has outstripped supply for years, and will for the forseeable future. if there is a concern about oversupply of providers, i don't think the aana would be pushing for new schools. it wouldn't be in their own best interests.

at least we're getting to the real meat of the matter - competition. let's stop pretending its a patient safety issue - it never has been.

Sheri257 · May 20, 2004

Thanks for the economics lesson. Although your basic assumption concept about supply and demand is fine, your logic in this particular situation is flawed in that demand for anesthesia providers has outstripped supply for years, and will for the forseeable future. If there is a concern about oversupply of providers, I don't think the AANA would be pushing for new schools. It wouldn't be in their own best interests.
At least we're getting to the real meat of the matter - competition. Let's stop pretending its a patient safety issue - it never has been.

I agree, especially with the last part of your post. I've always wondered if there's actually room for everyone, since projected demand for all medical services is expected to grow substantially with the aging baby boom generation, the largest segment of the population.

Maybe CRNA salaries won't go up as much as they would like, but certainly it's possible that salaries won't go down either, even with AA competition.

ep71 · May 20, 2004

yes techs nursing assistants, medical assistants etc... This is why I asked the question. I won't get into the whose education is more "rigorous" battle because it is a no win argument. I do agree that some AA's might feel "insulted" by having a CRNA supervise them. but then many CRNA's probably feel the same way when MDA's "supervise" them and restrict their practice though it is not required. It seems to me that this is a logical and economical step. So I ask again are there any real reasons why a CRNA can't supervise an AA? I freely admit I do not know much about this subject. enlighten me guys! :)

That was one of the most ridiculous, illogical statements that I have ever read. CNA's are a part of the nursing system. What techs that aren't apart of the nursing system do nurses supervise? It would be stupid for a person with a masters to supervise another person with a masters. You can't compare doctorate supervision with master on master supervision. It's just silly.

TheBigBadDog · May 20, 2004

Thanks for the economics lesson. Although your basic assumption concept about supply and demand is fine, your logic in this particular situation is flawed in that demand for anesthesia providers has outstripped supply for years, and will for the forseeable future. If there is a concern about oversupply of providers, I don't think the AANA would be pushing for new schools. It wouldn't be in their own best interests.
At least we're getting to the real meat of the matter - competition. Let's stop pretending its a patient safety issue - it never has been.

My logic was not flawed, I merely excluded a discussion about the demand because it detracts from the focus of the discussion, supply of providers. But it would not affect the outcome of the analysis, even if the demand increases, if supply increases the net result would be LOWER wages. Why? Because if the supply had been held constant and the demand increased then wages would have went yet higher. So, your original idea that somehow AAs don't affect the wages of CRNAs is absolutely wrong.

Most everything in healthcare is about money and competition, concern about patient safety issues are always secondary. Patient safety issues are the smoke screen that healthcare providers use to keep thier wages high. That's why there are licenses to perform healthcare procedures, to limit competition! Licenses are a basic barrier to entry into a labor market. Patient safety is how you justify the license, just like a plumber, real estate agent, lawyer, etc. needs a license to protect your safety

If you really are interested in solving the shortage of healthcare providers for anesthesia provide H1-B1 visas to MDAs, and they will flood the US market with more MDAs then you could shake a stick at. How many foriegn doctors do you think would be willing to work in the US for over $300,000 per year? But the AMA has enacted laws in all 50 states as barriers to prevent this from happening, so that they can control the supply of doctors and keep thier wages artificially high!

The AANA just need to learn from the AMA and employ the same types of tactics, or they will suffer the consequences, lower wages! CRNAs and the AANA need to determine how to limit the practice of AAs, by requiring additional training or experiences of AAs to make them comparable to AAs or preventing them from practicing all together. REMEMBER COMPETITION IS ALWAYS BAD FOR THE SELLER (service provider)! Otherwise, the CRNAs are building a sand castle on the beach, and someday a wave of AAs will come into the market place and knock down thier castle of gold!

smk1, LPN · May 20, 2004

That was one of the most ridiculous, illogical statements that I have ever read. CNA's are a part of the nursing system. What techs that aren't apart of the nursing system do nurses supervise? It would be stupid for a person with a masters to supervise another person with a masters. You can't compare doctorate supervision with master on master supervision. It's just silly.

EP71 you need to get a grip! :rolleyes: You asked if nurses supervise anyone else, so i gave you examples where they do. by the way medical assistants are not nurses but are supervised by them in my area and yes some MA programs are associates same as some RN programs. So the analogy does fit. In any case I was not rude to you so why the personal attacks? If you can't say something nice..... In any case thanks to all those who are managing to answer questions and post new ideas in a polite manner. It really shows your professionalism.

TheBigBadDog · May 20, 2004

i agree, especially with the last part of your post. i've always wondered if there's actually room for everyone, since projected demand for all medical services is expected to grow substantially with the aging baby boom generation, the largest segment of the population.
maybe crna salaries won't go up as much as they would like, but certainly it's possible that salaries won't go down either, even with aa competition.

the biggest problem with the current battle between the mdas, crnas, and the aas is that no one group controls the supply of service providers. generally, groups regulate the supply of providers for that service, for instance, most professional groups have large input into the requirements for training, new schools, and licenses. they will try to avoid widespread shortages, because other people outside their field will undertake means to alleviate the shortage. currently, mdas are using the excuse that there is a shortage of providers as a means to manipulate the market by changing the rules on whom can provide service and under what conditions.

the mdas and crnas may find themselves competing to add more providers to solve the current shortage but without planning. they may over supply the market with providers since each group will be trying to add members to gain political power and control. if each group adds providers and demand remains the same they may find their market in an over supply and falling wages. in my opinion, this is the recipe for disaster for all three groups; it defines the theorem that "excess profits breeds ruinous competion".

user69 · May 20, 2004

the mdas and crnas may find themselves competing to add more providers to solve the current shortage but without planning. they may over supply the market with providers since each group will be trying to add members to gain political power and control. if each group adds providers and demand remains the same they may find their market in an over supply and falling wages. in my opinion, this is the recipe for disaster for all three groups; it defines the theorem that "excess profits breeds ruinous competion".

i agree with your logic and the principals that you have put forth. i am more concerned with the ramping up of new crna schools than i am about the existing two aa schools or rumored third. as for mda flooding the market we have little control over that. but the huge expense and time to make it through the mda programs should be a hedge against them flooding the market.

Sheri257 · May 20, 2004

if each group adds providers and demand remains the same they may find their market in an over supply and falling wages. in my opinion, this is the recipe for disaster for all three groups; it defines the theorem that "excess profits breeds ruinous competion".

agreed. but, the question is: will demand the remain the same?

of course, no one can predict the marketplace. but with the aging baby boom generation, there's a good chance that demand will probably increase.

:eek:

user69 · May 20, 2004

Agreed. But, the question is: Will demand the remain the same?
Of course, no one can predict the marketplace. But with the aging baby boom generation, there's a good chance that demand will probably increase.

At least increase for the next 25 years (for me)