Socialized medicine, and the future of CRNAs

TraumaNurse · Feb 12, 2004

I would hope that since CRNAs are well established in this country that it could only help. However, Canada has socialized medical care and has managed to control health care spending for the most part, yet CRNAs do not exist there. MDAs do all anesthesia but they do it for a lot less! There are caps on salaries for all physicians and MDAs make significantly less than they do here in the US. So, CRNAs may benefit because they are a cost effective way to provide safe anesthesia, but they may also find their salaries capped at a much lower rate. I do think that there needs to be some kind of healthcare reform, but total government control may not be the answer. I have always felt that there is a system somewhere between what Canada has and what exists here in the US, that is a good cost effective system that still provides high quality health care for everyone! Or, I may be dreaming!

fergus51 · Feb 12, 2004

When talking about compensation, you should take into account the fact that malpractice insurance and overhead is much cheaper in Canada. Doctors still make handsome livings here.

deepz · Feb 12, 2004

.......in Canada. Doctors still make handsome livings here.

But not as much as dentists make. I understand they are exempt from the socialized pay sheme, and can still charge fee-for-service, what the market will bear. So it's the Canadian DENTISTS who sport the yachts and airplanes and hi-lux homes, not the physicians.

Go figure.

TraumaNurse · Feb 12, 2004

DeepZ,

That is quite true. I have two friends in Canada (I am also Canadian) who are dentists and they do VERY well! and yes, better than most MD's. My brother is a GP and does well only because he lives in a small town and covers the ED as well as his own practice. He works a lot of hours, but he is making as much as most surgeons! When I left Canada almost 10 years ago, there had been a couple of neurosurgeons who came to the US because the Canadian Gov capped their salary somewhere around $500,000. Not bad, but they came to the US for a starting salary of $850,000 US. It's too bad the Canada has not realized the benefits of APNs and especially CRNAs. They are not given the respect, autonomy or salary that they deserve.

yoga crna · Feb 13, 2004

It is my impression from speaking to a number of surgeons from Canada that a large amount of the anesthetics performed in Canada is by physician G.P.'s, with anesthesiologists in only the major centers. Supposedly some of the GPs are very good (by surgeon standards!!) and others are not. So it is not accurate that all anesthesia in Canada is performed by properly trained physicians.

CRNAs will do well in any type of government supported programs. But remember economics is a major part of life and we may end up with a two tier health system, with those who have some kind of coverage and those who are willing and able to pay cash for their care. The competition for the second group will be intense. Stay tuned.

YogaCRNA

fergus51 · Feb 13, 2004

It is my impression from speaking to a number of surgeons from Canada that a large amount of the anesthetics performed in Canada is by physician G.P.'s, with anesthesiologists in only the major centers. Supposedly some of the GPs are very good (by surgeon standards!!) and others are not. So it is not accurate that all anesthesia in Canada is performed by properly trained physicians.
CRNAs will do well in any type of government supported programs. But remember economics is a major part of life and we may end up with a two tier health system, with those who have some kind of coverage and those who are willing and able to pay cash for their care. The competition for the second group will be intense. Stay tuned.
YogaCRNA

I have never heard of GPs doing anesthesia and I have worked in small towns!!! I'll have to ask some others at work if they have.

Roland · Feb 13, 2004

I thought Canada (or maybe I am remembering incorrectly and it is the U.K.) had a law on the books that made it a crime for any physician to accept payment outside of the national healthcare system. I know that the Aussies, have a private AND a public plan. However, one nurse from down under posted on one of my threads that the nurses who worked in the PUBLIC sector actually made MORE money (this may not be as surprising as it first seems, I know several people who are teachers who have told me that they would have to take a 30% plus pay cut to teach at most private schools).

I actually think that we WILL be able to avoid a nationalized system at least for the next several decades. Short of Hillery Clinton getting elected and then declairing martial law and subsequent imperial rule, I believe that the AMA, attorney groups, and pharmaceutical companies would fight any such legislative attempts tooth and nail. I think it more likely that we will see an expansion of Medicaid, and or Medicare to cover more of the poor, unemployed, and children. Although, this will be bad for the deficit and bad for the rate of health care inflation (it is almost axiomatic that throwing more money after a relatively fixed supply of any product or service leads to increased inflation within that sector. Consider, for instance that in the last thirty years since the government implemented Medicare, Medicaid, Pell Grants, and student loans that the rate of inflation within those sectors of the economy have run from two to three hundred percent of the overall inflation rate), it probably will serve to increase the DEMAND for healthcare professionals.

fergus51 · Feb 13, 2004

There are private clinics in Canada, so doctors who work there are being paid privately.

CougRN · Feb 13, 2004

Just something I thought was interesting regarding these nursing professions. Something to think about later this year.

website http://www.johnkerry.com/issues/nurses/

John Kerry will ensure fair treatment for Nurse Practitioners, Clinical Nurse Specialists, Nurse Midwives and Nurse Anesthetists. Numerous studies have shown that advanced practice nurses provide safe and high quality care. It is long past time that the federal government properly recognized the crucial role that APRNs play in the American health care system. John Kerry has supported legislation to expand reimbursement opportunities for APRNs. However, he understands that there is much more to do to end the discrimination and barriers to practice that APRNs face. Too often, APRN services are not reimbursed by third party payers. They aren't on panels that set reimbursement policy or assess care. Highly restrictive limitations on APRN scope of practice persist. These barriers deny health care consumers the widest possible choice of providers. As president, John Kerry will fight for specific legislative and regulatory changes to allow APRNs to practice fully.

Kerry will raise the outrageously low Medicare reimbursement rate for nurse midwives, removing a barrier that prevents CNMs from caring for disabled women. He will fight efforts by the Department of Defense and the VA to utilize underqualifed anesthesiologist assistants as providers of anesthesia care. And John Kerry will push for a change in Medicare rules to allow home health agencies and hospices to accept referrals from nurse practitioners.

Roland · Feb 13, 2004

for Kerry if he REALLY believes that. I feel like such a whXXX, but that would be really good for this profession.

Brenna's Dad · Feb 15, 2004

The only private clinics in Canada, before I left four years ago, were for plastic surgery.

There may be some orthopedic clinics in the province of Alberta now, who are beginning experimentation with a two-tiered system for some procedures.

I never worked in a hopsital were GPs administered anesthetic, but this doesn't mean it doesn't happen. The hospital I worked at employed anesthesiologists, but apparently their numbers were in short supply and I always heard rumors of recruitment problems.

Advanced practice nurses in Canada are almost non-existent. Despite the socialization of health care, physician lobby groups control the government.

For example, two or three years ago, the nurses union in the province of BC (ALL nurses must belong to THE union if they want to practice) effectively bargained the government for a new contract with substantial pay raises. The following year, the newly legislationed government instead of abiding by the contract, instead LEGISLATED a new contract that took away the pay raise.

In comparison, the BC medical association last year effectively lobbied the same government for a substantial pay raise ($50 000/year/physician if my relatives are to be believed) and sicne the contract is up, are lobbying for a further pay raise this year.

It's just my opinion, but CRNAs will never be allowed to practice in this environment. Not until the government takes back health care and stops being controlled by physician lobby groups.