Future of CRNAs

Focker, CRNA · Jun 3, 2005

This has no factual basis, its just my conjecture, but it seems to me that since there is predicted to be a general nursing shortage for the duration of the oncoming glut of aging babyboomers, and because one must become a nurse before becoming a CRNA, that their would also be a shortage of CRNAs.

I know that doesnt take anymore than one factor , the general nursing shortage, into consideration, but I would think that has a large effect on the number of CRNAs.

Kiwi, BSN, RN · Jun 3, 2005

I am a SRNA and today I heard one of my program heads discuss with one of the anesthesia attendings about anesthesiology and where it will be in the future and the attending mentioned that anesthesia residency programs will, in the next year, begin their expansion into more of the perioperative arena and carve out a niche in this area. He said in the future MDAs will spend a lot of time in the SICU and will be trained to become heads of this units

I cannot speak for the trends in the general US, but all the "anesthesiology" residents at the med school in Louisville are enrolled in the department of "perioperative medicine". When I first met one of the residents, I asked why he did not have "department of anesthesiology" on his lab coat. It is because they are in training to not only deliver anesthesia, but also to manage critical care units, etc. The residents here are varied individuals with different goals. I know of one in particular who used to be an OBGYN who stopped delivering babies because of the incredible liability. He is currently enrolled in the perioperative residency program. There is also another new grad anesthesiologist who is now head of the neuro ICU dept at the university hospital. At that hospital, there are three trauma ICUs that are headed by anesthesiologists. I must add that they do a great job at it. I shadowed for a day in the SICU at the hospital and it was managed very smoothly (there are no open positions in any of these three units because everybody loves their job!) The anesthesiologist on that unit was helpful in identifying the medical needs of the patients as well as consulting.

What surprised me, however, was to hear my program head say that more and more CRNAs, as well as PAs, will be put into the work force to the point that the market will be saturated.

My question for this statement is -- where is the supply coming from? In Kentucky, there is only one nurse anesthesia school that graduates ten CRNAs on a yearly basis. I've only met one CRNA who graduated from this school in particular; everyone else was imported from another state. It just seems like there are so few nurse anesthesia programs to create the conditions for a saturated market.

loisane · Jun 3, 2005

I am encouraged to learn that anesthesiology programs are evolving into perioperative medicine. I came to this conclusion myself some time ago, but it was just grounded in my own personal opinion and philosophy. It just seems a more appropriate use of medical talents and skills to me. I had a discussion with a resident here a year or two ago where this came up. The idea just didn't resonate with that individual.

Of course I don't know if the goals and values of these programs will correspond with mine. The way I see it, anesthesiologists should be making medical decisions and medically managing patients, not supervising CRNAs. CRNAs should be making nursing decisions involved with the delivery of anesthesia. If during the course of that anesthetic the patient develops a need for medical intervention beyond what the surgeon can deliver, the CRNA can certianly recognize this and make a request for anesthesiologist consultation at that time. This current business we have of routine supervision of every little detail is an enormous waste of both sides talents and abilities.

I am keenly aware that this is not neccessarily what anesthesiology programs have in mind just because they have changed the name and focus of a program. But I can sure do everything within my power to encourage growth in this direction!

On the subject of shortages-this is due to market forces, an inescapable fact of our capitalistic system. Depending on who you listen to, this shortage was forecast to peak in 2006, or 2010, or maybe later. Education programs have doubled their numbers of graduates compared to about 5 years ago. We had 80 programs, and that number has grown to about 100. Over time that is bound to have an effect.

We have always had cycles of shortages and oversupply. The trick is in predicting when the pendulum swings from one to the other. But never make the mistake of thinking that either situation will last forever, history says that just doesn't happen.

loisane crna

William_SRNA · Jun 3, 2005

"CRNAs should be making nursing decisions involved with the delivery of anesthesia. If during the course of that anesthetic the patient develops a need for medical intervention beyond what the surgeon can deliver, the CRNA can certianly recognize this and make a request for anesthesiologist consultation at that time."
The CRNA might need to make an anesthesia consult but that doesn't mean they need an anesthesiologist.

Pete495 · Jun 3, 2005

Is that all Anes. providers do is push propofol and fluids? Damn, maybe somebody should have let me know before I got into this.

Just remember this was one person's opinion, and anes. providers are certainly worth the salt that they are paid.

badass · Jun 3, 2005

Is that all Anes. providers do is push propofol and fluids? Damn, maybe somebody should have let me know before I got into this.
Just remember this was one person's opinion, and anes. providers are certainly worth the salt that they are paid.

This comment came from the attending in his attempt to explain the need for expansion of anesthesia residencies and I guess to explain why in the future the MDA will be mostly out of the OR given it is not economically viable for him to be there at all times.

Nitecap · Jun 3, 2005

I cannot speak for the trends in the general US, but all the "anesthesiology" residents at the med school in Louisville are enrolled in the department of "perioperative medicine". When I first met one of the residents, I asked why he did not have "department of anesthesiology" on his lab coat. It is because they are in training to not only deliver anesthesia, but also to manage critical care units, etc. The residents here are varied individuals with different goals. I know of one in particular who used to be an OBGYN who stopped delivering babies because of the incredible liability. He is currently enrolled in the perioperative residency program. There is also another new grad anesthesiologist who is now head of the neuro ICU dept at the university hospital. At that hospital, there are three trauma ICUs that are headed by anesthesiologists. I must add that they do a great job at it. I shadowed for a day in the SICU at the hospital and it was managed very smoothly (there are no open positions in any of these three units because everybody loves their job!) The anesthesiologist on that unit was helpful in identifying the medical needs of the patients as well as consulting.
My question for this statement is -- where is the supply coming from? In Kentucky, there is only one nurse anesthesia school that graduates ten CRNAs on a yearly basis. I've only met one CRNA who graduated from this school in particular; everyone else was imported from another state. It just seems like there are so few nurse anesthesia programs to create the conditions for a saturated market.

Though many residents are entering the critical care arena most are not and many do fellowships in CT surgery and critical care so they can do both.

Where are all these CRNA's coming from you ask. Look at all the new programs popping up eveywhere and others increasing numbers.

TCU -accepting 60 plus and eventually want to up to 100

TWU - accepts 100 and will up if can

New Programs in Arkansa, 2 in florida, Louisiana trying to get another program.

Opening up a CRNA program especially at a private instistution generates much revenue for these schools for instance . Say a program accepts 60 students at average of 40k for the program. SO each class brings in 2.5-3million in revenue for school. Many programs at universities profit little or barely break even. Then most of these grads will prob. eventually be financial supporters of the program and school generating even more money. Put the students in existing buildings so no new building costs. Of course you have to pay new instructors but not to many due to auditorium style class rooms. Then the students do clinicals at satellite facilities and more or less get training for little to know cost from the school. And the CRNA's / MDA's in a certain group training you eventually get a ton of free labor once you are running cases by yourself. CRNA students financially benefit both the schools and training sites.

This brings a question up: Are these programs really interested in helping out the anesthesia shortage or are they just trying to cash in on a money making oppurtunity. What will happen when and if the market becomes to saturated. Will the AANA stop giving new charters or accrediting new programs. Will they request that the larger numbered programs decrease the number of students they enroll. Will they place any restrictions at all on programs to attempt to balance out supply and demand so that salaries dont plummet.

I am just an SRNA and not sure how accrediting bodies regulate these types of things so please inform me. It just seems if the trend continues in 2 yrs we will have 120 programs then in 2 more 135 and on and on... It seems to me that the AANA would feel pressure from within if members salaries begin to decrease drastically do to flooding of the market allowed by the very professional org. you belong to.

Hope this post doesnt offend anyone. Please if anyone has and info on these types of things such as the AANA's regulating power of programs to effect supply and demand please do inform me. I mean if they can increase numbers to help the shortage it seems they could decrease numbers to prevent or thwart a surplus.

thanks.

CRNA, DNSc · Jun 3, 2005

The AANA or the Council on Accreditation DO NOT "regulate" the number of students or the number of programs. An individual program in conjunction with its academic partner and/or clinical affiliate sites determines what the capacity of the program is based on the available resources. The programs did increase the number of students in response to the increased professional demand not in response to some "directive or regulation". The demand for anesthesia services is increasing and the average age of majority of practicing CRNAs is about 48 with the largest portion of CRNAs between 45 and 55 years old. Over the next 10 years as these CRNAs begin to decrease their hours or retire there will be a need to someone to take their place. We would prefer that someone to be a highly educated, well trained CRNA (which is today's SRNA) so I am quite sure that the concern about having a job after graduation is moot. As for salaries- I don't expect to see the dramatic rise we saw in the 1990's but I would not be worried about being able to pay the bills.

loisane · Jun 3, 2005

What will happen when and if the market becomes to saturated. Will the AANA stop giving new charters or accrediting new programs. Will they request that the larger numbered programs decrease the number of students they enroll. Will they place any restrictions at all on programs to attempt to balance out supply and demand so that salaries dont plummet.

I am glad you asked, because this is a common misconception. Here is my understanding, perhaps others will provide additional details. The AANA does not have anything to do with accrediting programs or determining workforce size. Obviously, they are interested in workforce, and have supported studies of projections. But they don't have any control over it.

Nurse anesthesia has an autonomous body (who receives their authority from the US Department of Education) that accredits nurse anesthesia programs. The Council on Accreditation's job is to develop standards and then decide if a program meets those standards.

The number of programs, and workforce numbers are all determined by market forces. That is why we have cycles of shortage and oversupply. During times of shortage schools, faculty and other interested parties are motivated to make changes to fill the need. This is no different than when any business recognizes a need for a product, and designs a way to fill that need. Motivation can come from various sources-professional pride, and yes, money-after all this is America, that is our system.

In previous cycles things naturally reverse when the workforce exceeds the need. Jobs get hard to find, there is less interest in going to school, and programs receive fewer applications. Ask some CRNAs who graduated in the 80-90s what things were like, those people are still around.

I don't want to rain on anyone's parade, but I think it is very similar to a description I heard from a Wallstreet analyst a few years back. He said "These young people have never known anything other than a bull market. We are bound to have a bear market sometime, and some of them are going to be quite shocked".

Nurse anesthesia is a fabulous place to be. I love it and wouldn't change professions for any reason you can name. None of this should be taken as negative. But it speaks very clearly to why there is far more to consider than the money.

And who know when this shortage will reverse? For all I know it might outlast all of our lifetimes.

loisane crna

sunnyjohn · Jun 3, 2005

I am posting in this thread so I can follow along. Interesting info.

lmdscd · Jun 3, 2005

I am posting in this thread so I can follow along. Interesting info.

Where I live, the nurses only make about $20 or less per hour than the CRNA's and they don't have the responsibility of a CRNA. It is making some of the CRNA's angry because the nurses keep asking for raises and the CRNA's are not getting raises as often as the nurses if they get one at all.