People here are responding to a hospital that fired anesthesiologists with a plan to go CRNA only. With emphatic CEO and private equity support. A natural inclination, since in fact CRNAs don't save a lot of money with high salaries and high demands, is for people here to say move MD only. Lest we forget, CRNAs make more than most primary care physicians. This hospital, wayyyy out in the sticks of being 45 minutes from two major cities (and two very well respected training programs where they likely could fairly comfortably recruit more anesthesiologists for decades to come) had enough anesthesiologists to maintain what the ASA has embraced, and what we've come to accept, as a safe and stable 3:1 or 4:1 supervision model. They moved to a fireman model, keeping 1 anesthesiologist around largely as a puppet.
Yes, you're right, there aren't enough MDs. But let's assume your group actually wanted to move MD only. In 10 years, if you actually wanted to, my guess is you could at least staff 50% of your rooms with physicians if you wanted to. But your pay would be cut. And your culture would change. And your CRNAs wouldn't understand and would likely leave in protest. Because at the root of it all, CRNAs (because of the AANA...) and MDs see the anesthesia world in almost entirely opposing views. Your hospital may not even support it as they wouldn't be billing for a CRNA in those rooms where you placed MDs, because as we've already established CRNAs are expensive.
Or maybe you try to hire more MDs, and fail. But assuredly you won't try. You'll maintain the model you have, as long as you possibly can, because it's worked for you in the past and it's working for you right now. Also, I'm not criticizing you directly. I hope you realize that. You can extrapolate your group to every group who supervises CRNAs or AAs across the country. You can include academic departments.
The ASA has embraced supervision, because they have no other choice really, and it's the commonly accepted model. It also, interestingly enough, makes it very easy for hospitals to replace anesthesiologists. You simply remove them from the equation. After all, the anesthesiologist is the only one in that completely screwed up equation that sees the value they bring to the table. The CRNA doesn't. Read the words of the CEO in the article. He surely doesn't. Private equity? Not a chance. You're out the second they're able to replace you. They don't even need to recruit more staff to stool sit those rooms. They already have all those CRNAs.
Why will primary care survive, and perhaps even thrive, in a US that's becoming completely flooded with lackluster midlevel care? Because those physicians see their own patients. They don't supervise 4 PAs/NPs all day, every day. The setup doesn't allow them to be removed so easily. Also, patients will call, and oftentimes, wait to see THEIR doctor. The physician, not the doctor nurse. The patients are awake, and aware enough to see a difference, and request MD level care. Our patients are asleep, anesthesia is safe and it's easy to cover up small mistakes here and there that may not affect mortality, though no one will really look that hard anyway because medicine realizes that study is so stupid and unfair that it won't ever be rightly conducted.
Again, no criticism direced at you. I'm just hating the game, playa.
