The evolving world of anesthesia, MDA and CRNAs 1. Quick numbers and notes A. 52000 or so anesthesiologists in the US and nearly 2100 new MDAs year. B. More than 55% of MDAs are 55 plus. C. 66000 or so CRNAs nearly 2400 new CRNAs a year. D. Average comp for MD anesthesia $440000 plus E. Average for CRNAs $270000 F. PE controls roughly 20 to 30% of anesthesia. More in certain markets G. Continued territorial issues between MDAs and CRNAs H. Continued challenges with payors and reimbursement. I. The trend of growing pas and nps vs mds is a trend being seen throughout medicine. J. The position of the ASA (American Society of Anesthesiologists) is generally that anesthesia care is safest when led or overseen by physician anesthesiologists. K. The position of the AANA is generally that CRNAs should be able to practice independently of anesthesiologists. L. While the professional associations remain at odds over independent practice the general amount of dispute in the field seems to have lessened greatly over the last decade. M. The AANA was founded in 1931. The ASA dates its roots back to 1905. 2. As a CRNA one can be employed or independent. Often simpler to be employed. More upside to be independent but need to keep fully busy and find spots between the large groups where sites can afford to pay you fully on an hourly or daily basis. A lot of medicine overall has moved to employed vs independent. 3. One needs to determine if one wants to build a practice, fill in gaps or be an employee. The best estimates are that 80% or so of CRNA are employees. American Association of Nurse Anesthesiology (AANA). 4. If building a practice, 3 core stages. 1. Do everything yourself and be fully in clinical practice. Do you have a job or a business? Do you have some autonomy and independence? 2. Hire others and manage others and contracts and still work substantially or full time. 3. Fully manage others and really reduce clinical practice. 5. Some states and areas easier for CRNAs to work fully independently. We recall trailblazers in this area. 6. The pay gap has been narrowing between anesthesiologists and CRNAa. 7. There are approximately 6500 Ascs that are Medicare certified and another several thousand that are not Medicare certified. There are also several thousand hospitals. VMG Health projects significant increases in ASCs that pay subsidies. 90% hospitals pay subsidies 8. There are huge disparities between ASCs and hospitals that can afford to pay anesthesia providers well and those that can't. 9. As reimbursement tightens for anesthesia, hospitals and ASCs often need to employ or pay subsidies to manage anesthesia needs. Payor or Medicare reimbursement has not kept pace with inflation. 10. AI will have impact but not likely substantially change the need and demand for anesthesia providers for some time. Becker's Healthcare McGuireWoods LLP
