Future of CRNAs

kabarnes · Jun 4, 2005

I am just wondering how much Liability Insurance you have to carry as a CRNA. Is it less than an MDA? I would think if you lived in a state where you practiced independantly you would need comparable insurance coverage. This being said I am wondering why MDAs make so much more money. I understand that they are trained longer and are MDs and they should make more than CRNAs but why such a huge amount $400K. I mean how much do surgeons and OBs make, I thought it was around the same due to liability. Just curious

jwk · Jun 4, 2005

I am just wondering how much liability insurance you have to carry as a CRNA. Is it less than an MDA? I would think if you lived in a state where you practiced independantly you would need comparable insurance coverage. This being said I am wondering why MDAs make so much more money. I understand that they are trained longer and are MDs and they should make more than CRNAs but why such a huge amount $400K. I mean how much do surgeons and OBs make, I thought it was around the same due to liability. Just curious

Some surgeons and OB's make more, some make less. Same with anesthesiologists. Same with CRNA's and AA's. There are CRNA's out there making $400k a year - probably not a lot, but they're there. There is a huge variability in compensation, even within specialties.

As rn29306 pointed out, things like OT and call come into play, particularly in anesthesia. There are anesthetists in my own group making twice as much as the lowest paid anesthetist in my group, even though both are full-time employees. But they work a lot more. Seniority, call pay, OT, holiday pay, etc. - all of that comes into play.

Although Liability Insurance can be a big chunk, it is not some kind of mysterious number used to "equalize" incomes between medical specialties, which is what your post naively implies.

deepz · Jun 4, 2005

....... I am wondering why MDAs make so much more money. I understand that they are trained longer and are MDs and they should make more than CRNAs ......

Why should an MD make more $ to provide the exact same service? Anesthesia is anesthesia. See the Pine study.

$400K is just the tip of the iceberg; certain MDAs rake in over a million a year -- some, several million -- but do they *earn* it? I would suggest that those MDAs are stupervising a stable of CRNAs, and that the CRNAs make the millions for them. That has been my experience these past 40 years. In the heyday of the American railroad industry, this type behavior was called featherbedding, where the superfluous extra brakeman would snooze away in the caboose while being paid a full wage. Organized anesthesiology has simply changed the location of the snoozer from the caboose to the doctors lounge.

JMHO

deepz

deepz · Jun 4, 2005

I am just wondering how much liability insurance you have to carry as a CRNA. Is it less than an MDA? ......

MDAs are sued seven times more often than CRNAs. Go figure. I'd guess that says a lot about the relative safety and patient satisfaction of the two providers.

Therefore, CRNA insurance rates are generally much lower for the same limits of coverage. My own premiums have averaged less than five thousand a year over the past 25 years.

deepz

jwk · Jun 4, 2005

MDAs are sued seven times more often than CRNAs. Go figure. I'd guess that says a lot about the relative safety and patient satisfaction of the two providers.
Therefore, CRNA insurance rates are generally much lower for the same limits of coverage. My own premiums have averaged less than five thousand a year over the past 25 years.
deepz

It will be interesting to see if that changes in the next few years as more CRNA's practice independently. Remember that it's also skewed a little because by and large, CRNA's in independent practice are doing more of the bread-and-butter cases, and not doing transplants, open hearts, major neuro, spines, and other higher-risk procedures that tend to congregate in larger centers that have MD's as well as CRNA's.

badass · Jun 4, 2005

MDAs are sued seven times more often than CRNAs. Go figure. I'd guess that says a lot about the relative safety and patient satisfaction of the two providers.
Therefore, CRNA insurance rates are generally much lower for the same limits of coverage. My own premiums have averaged less than five thousand a year over the past 25 years.
deepz

I think your point implies CRNAs are seen under the same light as an MDA by malpractice attorneys.

They look for the deep pockets and to them, anyone any other than the MDA, is likely to have shallow ones. Since most of us are/will be supervised by an MDA, they will always go for the big fish first.

Now, when most of us begin to perform solo and 100% ofthe outcome is our responsability, you better believe they will figure out we are targets and they will come after us. After all, they want $$ regardsless of who it comes from.

So I think we must not be naive and believe the current low rates will remain the same forever. When we take over the MDAs, our necks will be on the line.

deepz · Jun 4, 2005

.......malpractice attorneys.
They look for the deep pockets and to them, anyone any other than the MDA, is likely to have shallow ones. .........

Not really. The insurance coverages are the same, usually 1 mill per occurence, 3 mill aggregate max per year in most States, for EACH provider.

Supervised or not, a CRNA will be named in a lawsuit even if they were only peripherally involved. Believe me, I know firsthand. Malpractice attorneys throw a wide net, then toss out the blameless and 'shallow pockets' only later on in the discovery process. Being supervised or not excuses no one from being sued. Each provider is responsible for their own actions or omissions, and they will be named in suits accordingly.

So, again, the mere fact that anesthesioloigists are sued with seven times the frequency of CRNAs would seem to say something. Draw your own conclusions. Obviously I have my own.

deepz

Nitecap · Jun 5, 2005

It will be interesting to see if that changes in the next few years as more CRNA's practice independently. Remember that it's also skewed a little because by and large, CRNA's in independent practice are doing more of the bread-and-butter cases, and not doing transplants, open hearts, major neuro, spines, and other higher-risk procedures that tend to congregate in larger centers that have MD's as well as CRNA's.

But if you really think about it. Many transplant pt's do not sue unless it is a very serious error that was committed. Most TP pt's know the risk that they have a larger chance of not making it off the table. They just want a chance. IT is the pt that does not do well after a bread and butter case that tries to sue for the big money. Im in Texas and we are all about tort reform here so it relatively safer than many states.

air · Jun 5, 2005

But if you really think about it. Many transplant pt's do not sue unless it is a very serious error that was committed. Most TP pt's know the risk that they have a larger chance of not making it off the table. They just want a chance. IT is the pt that does not do well after a bread and butter case that tries to sue for the big money. Im in Texas and we are all about tort reform here so it relatively safer than many states.

I have never heard that argument nicely fitted like that.

It makes sense, why a patient for plastic would throw a fit if the pre-op nurse misses on that IV start. But the patient coming in for major vascular or neuro would not even flinch when you probe for that A-line site just before you numb.

William_SRNA · Jun 5, 2005

There is only one standard of care when it comes to anethesia and both CRNA's and MDA's are bound to it. I am curious where you got the number showing MDA's being sued seven times more than CRNA's? MDA's are allowed to supervise 4 CRNA's and they split the medicare part B when it comes to billing, so you can see right off the bat that MDA's are making 4x the money that CRNA's are generating.

badass · Jun 5, 2005

Not really. The insurance coverages are the same, usually 1 mill per occurence, 3 mill aggregate max per year in most States, for EACH provider.
Supervised or not, a CRNA will be named in a lawsuit even if they were only peripherally involved. Believe me, I know firsthand. Malpractice attorneys throw a wide net, then toss out the blameless and 'shallow pockets' only later on in the discovery process. Being supervised or not excuses no one from being sued. Each provider is responsible for their own actions or omissions, and they will be named in suits accordingly.
So, again, the mere fact that anesthesioloigists are sued with seven times the frequency of CRNAs would seem to say something. Draw your own conclusions. Obviously I have my own.
deepz

I do have my own and it seems to me you like to toot your own horn by implying you do a better job.

If you are being supervised, they will obviously go after the boss since he takes all the responsability for your actions. That alone could account for the fact that they are sued more frequently than a CRNA.

loisane · Jun 5, 2005

If you are being supervised, they will obviously go after the boss since he takes all the responsability for your actions.

This word supersivion gives us so much trouble. It would seem obvious that if someone is supervised, the supervisor is taking responsiblity. But, no badass, that isn't how it works in the world of anesthesia. I think you are probably not a CRNA, so you are not informed about the meanings of the word "supervision" to a CRNA. There are two things to know about supervision:

First, it is a term regarding billing arrangements for Medicare patients. In this context, saying a CRNA is supervised simply means that someone else is getting part of the fee. And in exchange for that fee, that 'ologist has performed steps in the course of the anesthetic as dictated by Medicare to earn that fee. In this case, the word supervision has no relation whatsoever to responsibility in terms of scope of practice, etc. The supervised CRNA could do the next case completely independently, without seeing an 'ologist and there would be nothing wrong with that, as long as it was billed in someother, appropriate way (and assuming all state laws and institutional policies were met)

The second way the word supervision is used is in the context of state law. Some states require that a CRNA be supervised by a physician. But even in this use of the term, the supervising physician does not assume responsibility for the CRNAs actions. I know this is complicated, here is a quote that says it better than I can:

Some states require that nurse anesthetists be supervised or directed by a physician (such as a surgeon), dentist or podiatrist. Those who seek to discourage physicians from working with nurse anesthetists have incorrectly asserted that a supervising physician becomes liable for the negligent acts of the CRNA. A physician or authorized provider is not automatically liable when working with a CRNA, nor is the physician immune from liability when working with an anesthesiologist.
The principles governing the liability of a surgeon or obstetrician when working with a CRNA are the same as those governing the liability of a surgeon or obstetrician when working with an anesthesiologist. Whether or not a surgeon or obstetrician will be held liable for the negligence of the anesthetist depends on the facts of the case, not on the nature of the license of the anesthesia provider. Generally, the courts do not look at the status of the anesthesia provider, but at the degree of control the physician exercises over the anesthetist-- whether that anesthetist is a CRNA or an anesthesiologist. The issue in each case is the extent to which the physician has control over the anesthesia administrator. Thus, a court may render different conclusions for cases that involve a physician working with a CRNA -- or, for that matter, a physician working with an anesthesiologist -- if the physician controlled the CRNA in one case but not in another.
Even where state laws require physician supervision of CRNAs, there is no requirement that a supervising physician control the acts of a CRNA. State laws do not require control, and mere supervision is insufficient to make the supervisor legally responsible for the negligence of a CRNA. The CRNA is the expert in anesthesia and supervising physicians, other than anesthesiologists, are not expected to have as much knowledge of anesthesia as the CRNA.Legal Issues in Nurse Anesthesia Practice. http://www.aana.com/crna/prof/legal.asp

True, if an anesthesiologist is involved in the case there is a good chance they will share some responsibility for any adverse outcomes. But it is not automatic. Each anesthesia provider is accountable for their own professional actions. CRNAs and 'ologist are held to the same legal standard in terms of accountability. This is surprising to many, probably because we are the only nursing specialty for which this is true.

In most areas of healthcare, where care is given by both physicians and nurses, there are clear demarcations between the types of care given by the 2 groups. Anesthesia is unique in that nurses compete with physicians in all aspects of anesthesia care. The reason for this competition probably has something to do with the fact that nurse anesthetists were giving anesthesia before physicians began to specialize in the field. In anesthesia, physicians began to do what the nursing specialty was already doing. Thus, there is no distinction in the type of care given by nurse anesthetists and the type of care given by anesthesiologists. Expert testimony.Gene A. Blumenreich, JD.
AANA Journal.June 2004.;72:173-177

Sorry to go a little off topic, but this is difficult for the best of us to understand. We have to help each other get educated to the facts of the issues of our profession. So I can never pass up an opportunity to share some facts.

loisane crna