CRNAs are quietly becoming a very lucrative field, without the physician hassles.
The generalist-specialist salary disparity is so great that specialist mid-levels pay (i.e. dermatology PAs) will soon overtake those of generalist physicians.
Further reason why students will shun primary care medicine.
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This has been a trend for awhile, in terms of specialty PAs and PCPs. Something to remember when you see the $150K derm PA is that this usually counts incentives, it requires lots of experience, and usually it is limited in terms of both job mobility and upward mobility. The $150K PCP is pretty much baseline after residency in most large medical facilities (Kaiser/VA/Group Health etc.); the California Department of Corrections is so desperate that it starts BC PCPs at $250K); upward mobility is the rule rather than the exception, and ownership opportunities are much more frequent.
I’ve noticed derm practices soliciting FP’s to be, effectively, PA’s with a larger scope of practice.
personally, i feel that is is an artificial bubble and a result of the current skewed reimbursement system.
I foresee one of two outcomes:
1)Rise of Cash Practices will lead to the downfall of Mid-Levels: As more docs drop CMS, insurance and charge (reasonable) cash prices. pts will choose to spend their $ on ACTUAL PHYSICIANS rather than a specialists midlevel (@ insurance rates)
2)The specialists RVU bubble will burst after CMS finishes chocking the life out of primary care and moves on to specialists fees as a cost savings (read: rationing) maneuver. The specialists will keep their midlevels but only as a means of survival circa FPs today.
Starting pharmacists ( PharmD ) fresh out of school, now start at $100,000/yr in retail.
I know a lot of internist friends who struggle (and struggle means taking on patient load, insurance headaches and staff turn over and prblems) make in the 160K-225K range as solo practioners. We see from 10 to 35 patients a day with an average around 27, with no predictability on what the patient load is going to be.
I was shocked recently when I had to talk to the my CPA about his bill and he was crying that he needed to raise fees since his CPAs were only pulling in 200-225K a year. They make this money with less stress, less headaches, more vacations.
I had to talk to my lawyer last year about a contract for a PA and half the conversation (at $350 hour) was him saying how bad he felt about what has been done to us physicians.
I have a brother who is a specialist and whenever we have a conversation on this topic all he does is shake his head and says “What can you do? You are in primary care.”
Why does it feel like it is ok for everyone else in the world to make money but for us physicians?
Sorry, I justed needed to rant.
I think you have summed up the answer to your problem, GENERALIZED VS SPECIALIZED. With due regard to your respected field, an anesthetist always has a life in limbo, a life which can be lost at any moment. They don’t treat respiratory infections, palpate abdomens, and prescribe vasopressors for low BP’s. CRNA’s administer anesthesia, establish and maintain an airway, and keep the patient alive. Because of this I find justification in their salaries.
I don’t think that the CRNA vs MDA issue is all about money; it’s about professionalism and accountability. I undergo frequent surgicle procedures to remove shrapanel and debride wounds (courtest of Iraq-laugh if you want to)….and the surgery is done with a block/local anesthesia. I do this without “sedation” because it’s worse than the pain; every time that I have had a CRNA, they can’t get this simple thing straight and I end up having a horrible procedure. When I had a MDA it went better (not perfect), but when things went wrong, the MDA took the blame and really tried to correct things. The CRNA always blamed everyone but herself; even when the surgeon told her that she was wrong, she was arrogant (and so were the 2 other CRNA’s that I had). Reading the above comments about how nurses (CRNA’s) are so patient-friendly makes no sense to me. Every CRNA that I have had couln’t care less about me as a patient; indeed all they seem to be concerned about is getting paid. My latest CRNA was mad that I specified no sedation for my procedure; she even went so far as to tell me that she wouldn’t give me any fentanyl for pain since I had declined the sedation. One of the OR nurses heard this and confronted her; my surgeon gave her a verbal dressing-down that everyone within 50 feet could hear. I told him that this was nothing new; in my experience CRNA’s are only interested in how much they are paid…CRNA’s don’t seem to care about a patient’s needs at all. I have had 9 surgeries, 5 CRNA’s and they were all the same: every CRNA was totally interested in her fee and didn’t care about my care at all.
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