AANA members

deepz · Jun 6, 2006

........I have already heard from recent graduates that locums opportunities are being limited geographically by increasing supply, except in the smaller towns and most rural of locales.

Don't believe everything you hear.

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MmacFN · Jun 6, 2006

Hey Crnatomd

I understand what your saying. I think that the attrition is far greater than the increase in providers for the forseeable future. There is also the signifigant increasing need based on surgi centers popping up everywhere and the babyboomers aging.

Seems that with about 60K of mainstream anesthesia providers, between MD and CRNA and an estimate loss of 20% to retirement in the next 5 years there isnt an issue? Really, all these CRNA schools are only putting out 20 CRNAs on average every cycle (assuming everyone remains in the class which is apparently rare).

So if I just look at the CRNA current numbers, ~ 30K, 20% of that is 6K loss and there is already a shortage now. Based on the number of new schools the graduation rate may not even meet the attrition rate over the next 5 years let alone the increased demand. From reading your posts the MDA situation is easily the same if not worse when it comes to meeting attrition rates if for no other reason that the extra 1.5-2 years the residency is.

In my estimation, the AA profession would not have the ability to expand (as it currently is) if numbers were meeting need. While i see your point about supply and demand, since there is a third provider, the AA, they are simply ramping up to meet the need.

So at the end from reading the avaliable information it appears that (from a neutral standpoint) both CRNAs and MDAs should be increasing graduates by 5% a year for the next 5 JUST to meet attrition. This would not compensate for the projected increase in need but would, indeed, seem to keep up a supply vs demand structure.

Here is a good article written by the ASA which does a nice job of analyzing the numbers. I was unable to find a compareable article fromt he AANA but have no doubt one exists.

http://www.asahq.org/Newsletters/2003/11_03/grogono.html

Actually Mike, in the private hospitals I worked at before going on to academic practice, there was an increasing trend toward competition among the CRNA's at that hospital and new groups of CRNA's that functioned under a professional association. The latter approached the hospital to place its members for more work by arguing that their members were better trained and had significantly more experience that the hospitals' current group of CRNA's.
They did not receive any exclusive contract, but one of the hospitals shifted 50% of the case load to the outside group, creating a lot of acrimony between the two groups. As more and more providers emerge from training looking for work in desirable locales, you will see more of this type of competition. I suspect it is already happening to a significant degree, especially at the private hospitals in desirable locales. In the academic community, the number of positions are largely dicated by funding and the salaries tend to be lower, but with a larger benefit package being offered.
If all providers ramp up their training programs, you WILL see a glut of providers and lower salaries/income as the providers cut back their fees or demands just to secure jobs and/or hospitals start to reduce salaries or benefits simply because there are enough people willing to work for less just to work at all.
An example of this can be found in the field of ophthamology which experienced a tremendous surge of interest in the 90's and through this decade leading to a nationwide glut of ophthamologists. Three of my med school classmates who went into ophtho emerged with metro job offers with starting salaries in the $90-120K range with 4-5 year partnership tracks. Better pay in smaller communities, but not by much.
I would rather see that both sides keep their training program sizes at the current level and keep an inherent demand for anesthesia providers at a high level. As more providers flood the marketplace, you will first see locums opportunities start to dry up, and I have already heard from recent graduates that locums opportunities are being limited geographically by increasing supply, except in the smaller towns and most rural of locales.

CRNAtoMD · Jun 7, 2006

The problem I have with these projections is that they are making estimates based on population statistics and probable retirement ages. I see plenty of geriatric anesthesia providers in both the academic and private practice community who aren't looking to retire until they are on death's door. If they are enjoying what they are doing and are making a good income, why should they.

While deficits exist at this time, this is an aggregate statistic encompassing positions in areas that have traditionally remained vacant and have been filled by locums or other temporary provider practices. New surgery centers that open up also tend to just dilute a neighboring facility/hospital's business toward that surgery center, so you are not creating new business, just taking it from one facility to another. The new business is created when new surgery graduates move in to fill the void left by the exiting surgeons.

deepz, I have talked with some of the locums companies and there is a concerted effort being made to regionalize locums and decrease credentialing of new individuals looking to do locums part time. They will still work with people trying to do full time locums, but the cost of credentialing people in innumerable facilities as well as providing insurance coverage has become an increasing burden on these companies and the trend is toward regionalizing and restricting to maximize profits.

Many smaller towns that previously had difficulty attracting permanent physician staffing are now finding it easier to do so and that has also contributed to the situation. It may be just a blip on the radar screen but I've heard it from more people than I would care to hear it from.

Home Health Columnist / Guide · Jun 7, 2006

An example of this can be found in the field of ophthamology which experienced a tremendous surge of interest in the 90's and through this decade leading to a nationwide glut of ophthamologists. Three of my med school classmates who went into ophtho emerged with metro job offers with starting salaries in the $90-120K range with 4-5 year partnership tracks. Better pay in smaller communities, but not by much.

Have you seen this news piece:

Doc shortage cont.: 25% workforce are immigrated physicians;demand for care exploding

Over the next 15 years, aging baby boomers will push urologists, geriatricians and other physicians into overdrive. Their cloudy eyes alone, one study found, could boost the demand for cataract surgery by 47%.