The practice of anesthesiology is the practice of medicine. People who go to medical school and do a residency in anesthesiology are best equipped to deal with anesthetic delivery because they are qualified physicians before starting four years of specialty training in anesthesia. Many also have a fifth year of subspecialty training before entering their practice. With all this training, why is it that we cannot figure out how to cover our rooms the following day at the end of the day?
If you polled 100 physician leaders, they would say their top three problems are staffing, staffing, and staffing. I would bet if you polled 100 practice managers and asked them their top three problems, they would say expenses, expenses, expenses, which is another way of saying staffing. Again, if you polled 100 CEOs and asked why profits were down this quarter, they would say costs are up, which is another way of saying staffing shortages drove up our costs.
80 to 90 percent of the cost of doing business in our business is the supply of talented labor, and labor shortages are very bad for business.
Back to the focus of this effort. Why can’t I cover my rooms? The answer is simple; you do not have enough staff. How do I get more staff? You need a strategic partnership with educational institutions to train more advanced practice providers.
Some might say let us hire more CRNAs, but since the CRNAs are in short supply and the sole advanced practice provider on the anesthesia care team in all but 17 states makes them very expensive.
Some may also say that in those states where you only have CRNAs working on the care team that the CRNAs essentially have a monopoly. Monopolies are bad for consumers and bad for businesses. The answer to this problem is to supplement the market with a competitive alternative.
You should supplement CRNA labor supply with more anesthesiologist assistants. Since labor shortage is the primary problem and lack of choice and competition is a secondary problem, you should rebalance the system so that practices are not solely dependent on CRNAs to deliver team-based care.
For example, if you were dependent on the Saudi’s for all your oil and oil prices were skyrocketing, would you help them build a new refinery? I do not think that you would. Most people would try to get their oil someplace else. Increasing the supply of anesthesiologist assistants adds labor, creates competition for jobs, and drives up quality. Competition is good; labor shortage is bad.
Remember that you cannot solve a long-term problem with a short-term solution. Sign-on bonuses, exorbitant salaries, loan repayments to attract talent and cover your rooms is not the answer.
A much smarter approach is to invest in producing more labor, not paying more for existing labor. You need a workforce development program that bridges the gap between the educational institutions and the private sector, and you train more anesthesiologist assistants.
If you supplement your workforce with anesthesiologist assistants, you could cover your rooms, get your doctors out post-call, reduce your premium pay, increase competition. You can rebalance your department by adding diversity to the anesthesia care team.
The simple answer is always the best choice. Support the increased production of anesthesiologist assistants.
Tommy Verdone is an anesthesiologist.
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