Maggie Mahar does her usual excellent job analyzing this critical issue.
Related posts:
- NICE
- A right to Medicare?
- Physician salaries
- Physician salaries and the GDP
- Reform Medicare first before focusing on the uninsured
- What happens if you lower physician salaries?
- Starting physician salaries
KevinMD.com on Facebook
{ 11 comments }
it just blows me away that those outside medicine feel it is justifiable that a CRNA makes more than a pediatrician.
There is no justification, just economics. When pediatricians are in as much economic demand as CRNA’s they will earn as much. In the meantime, avoid pediatrics if it bothers you.
Won’t you be the same person bemoaning the lack of pediatric access and damning those doctors who – gasp – actually want to make enough money to make a living?
I have children and pay out-of-pocket for the majority of their care, immunizations, orthodontics, etc..
The fact is that most people in the USA today with children simply cannot or will not afford to take care of them. They can, however, afford their cellphones, cigarettes, pickup trucks, lottery tickets, and cable television.
Too MANY children are covered by Medicaid, which woefully undercompensates physicians and hospitals alike. At least some of their parents CHOOSE not to have health insurance. Do not accept Medicaid, especially if you are a Saint. Choose instead to charitably donate services, rather than accept insurance which demeans your value.
I am quite familiar with the CRNA market. It is tight and they are in demand. The reason they are in demand is that anesthesiologists are undercompensated. Surgery centers and rural hospitals cannot secure M.D. anesthesiology coverage so they have to opt for the next best thing. The CRNA’s are hired as extenders in anesthesiology groups much like NP’s or PA’s in a family practice or surgical clinic. Their compensation increases every year with inflation, correspondingly raising the overhead of the owner physicians who then take home less every year unless they increase their volume/collections to compensate.
Anon 4:05:
“I am quite familiar with the CRNA market. It is tight and they are in demand. The reason they are in demand is that anesthesiologists are undercompensated.”
You sir, are applying simple market interpetations to a guild economy. Your assumptions are wrong.
Anesthesia salaries cannot be significantly influenced by the market as long as supply of anesthesiologists are controlled by the guild. And compensation for anesthesia services is regulated by a select committee, not the market. Nobody shops for the cheapest gas passer like you claim to shop for the cheapest/best(?) pediatrician for your child.
Anon 4:05… then why do doctors have to pay more for malpractice? Shouldnt these CRNA’s be paying the same? And why is it the doctor who gets sued, not the CRNA? Or the NP? Or the other undertrained minions who benefit from the aegis of the physician’s license? The doctors license is the cash cow on which all of these ancillaries feed. According to you, it should just be a level playing field.
Of course, when it’s a tougher case and you wnat more trained individuals, I hope you don’t end up calling a bunch of doctors offices whose phones are disconnected.
“Anesthesia salaries cannot be significantly influenced by the market as long as supply of anesthesiologists are controlled by the guild. And compensation for anesthesia services is regulated by a select committee, not the market. Nobody shops for the cheapest gas passer like you claim to shop for the cheapest/best(?) pediatrician for your child.”
Huh? What country do you live in? A select committee? I am going to guess China or Russia. NO M.D. anesthesia coverage (not CRNA coverage for that matter) would be available tomorrow if Medicare’s select committee set market rates. And the best is not often the cheapest (I choose the best).
CRNA’s typically carry much less malpractice insurance than M.D.’s, so yes, they should pay less if they get less coverage in return. Andy yes, these non-M.D.’s usually ARE sued, along with their employers (hospital or medical group).
Supply and demand does not apply very efficiently to medical services. It has it’s impact but it is modified by a lot of factors.
Most services are provided to people covered in government programs in which the fee paid is set and has had no relationship to market forces for decades.
Pediatricians, like other primary care doctors, are prone to treat their practice as other than a business. They are susceptible to non-marketplace reasoning such as taking accepting payment that too low for it to make good business sense because they want the patient to get the care.
Proceduralists with no personal professional connection to a patient is far less likely to engage in such denial of self-interest. A CRNA can engage in hard negotiations with the group that employs him or her without the confounding emotional factors of a pediatrician faced with a sick child and desparate mother who can’t pay.
Once the decision is made for the surgery, anesthesiology must be provided. Primary care is optional. Sure we all say it is needed and it is, but the consequences of not doing so are not so immediate and unbearable as, say getting cut without anesthesia.
Then the guild issue is real. My child had a minor procedure which I assumed would be done with a local administered by the surgeon–and that is what happened, but we paid about $500 to an anesthesia group for “anesthesia standby”, whatever the hell that is.
I have never paid a primary care guy to “standby”. If I use him then I pay and if I don’t use him then I don’t pay.. It takes guild power and a willingness to use it in a predatory fashion to get away with that.
Let see, maybe when an anesthesiologist comes into our group to see a psychologist, I, the psychiatrist should charge a “standby” fee. If he goes completely over the edge I will be right there. I should get paid for that, right?
Anesthesia standby can mean many things. Was there a physician/CRNA in the room? I suppose you would rather not pay firefighters unless there were a fire, or wait until an anesthesiologist could be located lest cardiopulmonary arrest ensue. I think I would have clarified this charge, but spend your money as you wish.
Lidocaine, probably with, local infiltration of the skin and maybe 7mm of subcutaneous tissue. What are the chances of an arrest? I didn’t have an ambulance follow me to the surgery in case I had an accident.
And yes, I asked. Anesthesia wasn’t in attendence in the room. They were available in the surgery center of course as several cases were going on. Would they not respond to a code if not put on retainer? Is it as bad as all that?
I didn’t spend my money as I wished. I was just sent a bill after the fact. I could refuse to pay it I suppose, but you sort of hate to get into a billing dispute with colleagues. It looks like you were pissed becuase you didn’t get courtesy. (Which I routinely extend BTW)
There are vast differences in attitudes towards money among the specialties. Some of the income differential reflects differences in the burdens and non-monetary rewards of different specialties. Some are much more stressful than others for example. But some simply reflects a higher priority on money. In some the norm is to give away a lot. Others are populated by people who wouldn’t give away the holes in their socks to their mother if they were bound by exclusive service contracts.
Comments on this entry are closed.