Study Shows CRNA-Only Anesthesia Delivery Most Cost Effective

Jun 22, 2010 Full story: AANA Journal 40

A Certified Registered Nurse Anesthetist acting as the sole anesthesia provider is the most cost effective model of anesthesia delivery, according to a new study conducted by Virginia-based The Lewin Group and published in the May/June 2010 issue of the Journal of Nursing Economics .

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stanley

Napoleon, OH

#22 Nov 11, 2010
salaries are that high due to demand for services not due to the association with Md's.
Anesthesia Provider

Winchester, VA

#23 Nov 14, 2010
CRNA salary has nothing to do with mds.... Mds are extremely overpaid... Nurse anesthetists are a economic safe way to provide anesthesia when compared to moneyologist.
AnesthesiaDoc

Sarasota, FL

#24 Nov 16, 2010
We live in a very cost conscious environment. Obviously CRNAs are cheaper than MDs. I work in a large mixed practice. There is no doubt in my mind that most cases can be done well by CRNA.
CRNAs and MDs come on a bell curve: Some are better than others; and the bell curves overlap, i.e. our better CRNAs are better than some of my not so great MD partners.
But we have to also understand that CRNAs trained to do the majority of cases while MDs trained to do all cases under all circumstances and find lateral think solutions based on a more in depth understanding of physiology and pharmacoloy.
If certain MDs choose to do only simple cases and avoid live long learning they devalue themselves and really should not be surprised when they get confused with, or replaced by, CRNAs/AAs.
In todays environment no reasonable anesthesiologist can expect to continue earning their full income by simply doing cases. Our expertise is needed in OR management, patient evaluation, hospital/resource management and to continue pushing the edge of konowledge. We can't rest on the laurels of our forefathers.
A team approach with CRNAs/AAs and MDs is here and will stay for the forseeable future.
To those patients living in states where their govenor has opted ut of "nurse supervised" anesthesia care, i.e. CRNAs can "practice medicine without MD input" I would suggest to ask you congressman why they allowed this practice for their constitutents when they themselves insist on MD-only anesthesia at Walter Reed (1st hand account from friend there!) Many CRNAs are great, and while a great CRNA is probably better than a bad anesthesiologist, a team approach is really the best.
And for those who say that CRNAs are cheaper: How come the "cheap CRNAs" bill the same fees as the "expensive anesthesiologists" ?
stanley

Shelbyville, KY

#25 Nov 17, 2010
I must agree, with the life long learning and pushing the envelope, I must respectfully disagree in regards to the type of cases, CRNA's provide anesthesia for every kind of case, there is not one type in which CRNA's do not perform.
In regards to practicing medicine this was settled over 80 years ago when I a nurse perform anesthesia it is a function of nursing, when you, a doctor perform anesthesia then it is medicine. Anesthesia is both a field of medicine and nursing, maybe strange but that is the way it is.
As for the billing CRNA's can bill 100% of Medicare, but usually get paid 20-30% less from private insurers. Other costs are lack of hospital subsidies, and less cost in training (we pay for all of ours from day one nursing school through anesthesia).
when things go wrong

Pittsburgh, PA

#26 Nov 17, 2010
anesthesia can be delivered by CRNA; but when things go wrong, do you really want a NURSE (as opposed to a physician) to make crucial decisions?? thinking people want an anesthesiologist.
stanley

Shelbyville, KY

#27 Nov 17, 2010
When it goes wrong in a rural setting who do think handles it? Thinking people think about what they are saying. BTW mortality and Morbidity are no higher in these rural hospitals.
Anesthesia Provider

Winchester, VA

#28 Nov 17, 2010
When things go wrong ... CRNAs do EVERYTHING an md does and often times does it better... Next time you post a tired opinion... Try using some EBP to back up unfounded comments.
A-Team

Fort Dodge, IA

#29 Nov 29, 2010
This thread is very unfortunate. I am a MDA. I have had some bad experiences with CRNAs to be sure. However, it has overwhelmingly been a positive experience. Why doesn't everyone admit that any monkey can sit in "The Chair" turning a few dials and recording railroad tracks? I think the negativity of the thread and debate in general is due to guilt over this fact along with insecurities and chips on the shoulders of both sides. Anesthesia pays well in general because of the rare terror events that arise. These are almost all life saving events if done well. By working multiple rooms everyday, my exposure to these events is proportionally increased. Outcome studies will never be effective and demonstrating statistically significant different outcomes. it is not a valid argument, especially for the rare patient or family member with a bad outcome. Just last week we had an unexpected difficult intubation in a 2 year old. The VERY GOOD, HIGHLY QUALIFIED CRNA had never done a pediatric fiberoptic intubation. The crisis went smoothly because we worked together. How much is that worth? Said another way, how much was that one child's life worth?

My wife is from Austria. There are no CRNAs there. There is also not an MDA there that makes as much as a CRNA here. Outcomes are no worse once again. So, are USA CRNAs really cost effective. If you are going to keep making that argument, be careful what you wish for.
stanley

Napoleon, OH

#30 Nov 29, 2010
The only reason that that highly experienced CRNA had not done a FOI on a child was due to restrictions on practice, I perform epidural and SAB and PNB all day long in rural hospitals, the moment I enter a larger facility I am not allowed, not incapable Not allowed, these restrictions are a real problem to CRNA practice. I have worked with anesthesiologists and CRNA's and it all goes well as long as we get off of our high horses and work as a team, but my counter question what if that child had been at a rural facility without the experience? Are these restrictions worth the life of a child?

As for the studies not being a valid argument I cannot disagree more, these are what we base our care and practice on, we cannot discard them if it is inconvenient, find me a study (other then silber) that demonstrates the superiority of the care team as it is constructed now and I will be the first to sign the ACT statement, but it is not there.
safe anesthesia

Pittsburgh, PA

#31 Dec 21, 2010
do patientd want a nurse (crna) doing their anesthesia? methinks not...at least if they know the truth..........period
DRBNMD

Cold Lake, Canada

#32 Mar 29, 2011
James wrote:
Of course a nursing journal is going to say that CRNA's are "cost-effective". It would be even more cost effective to have some OR nurse who has experience just do the anesthesia, cheaper is better? I didn;t have a problem with CRNA's until I started to hear a noisy few rant: "CRNA's are just as qualified as anesthesiologists"....... .you hear this on the net and maybe in a group of CRNA's, but never in a group that includes MD's.
Sad truth is, in an "Anesthesia Pimp Team" model, the CRNA may be better than the "MD" because the "MD" has sold out and betrayed his/her duty to the patient. Such a "physician" abandoned honest work to make more money by pimping out "physician extenders."

No matter the quality of your training, if you don't do the job and stay with the patient, you will lose your skills.

A CRNA is not as qualified as an anesthesiologist who actually does his/her job, like in an MD-only practice, or the U.K. But in a ACT model, the CRNA is probably better, because s/he actually stays with the patient and works!

That's why I left the U.S.A.'s third-world model of anesthesia delivery behind and took a pay cut to work in a British-style system. Bad for the wallet, but easier on the soul. I can say unequivocally that I am so much better as a physician after five years of actually practicing anesthesiology!

Anesthesiology is the practice of Medicine in the U.K., Canada, and Aus/NZ. In the USA, not so much. I miss my country, but not the Anesthesia Pimp Team model.

Cheers!
DRBNMD

Cold Lake, Canada

#33 Mar 29, 2011
stanley wrote:
The only reason that that highly experienced CRNA had not done a FOI on a child was due to restrictions on practice, I perform epidural and SAB and PNB all day long in rural hospitals, the moment I enter a larger facility I am not allowed, not incapable Not allowed, these restrictions are a real problem to CRNA practice. I have worked with anesthesiologists and CRNA's and it all goes well as long as we get off of our high horses and work as a team, but my counter question what if that child had been at a rural facility without the experience? Are these restrictions worth the life of a child?
As for the studies not being a valid argument I cannot disagree more, these are what we base our care and practice on, we cannot discard them if it is inconvenient, find me a study (other then silber) that demonstrates the superiority of the care team as it is constructed now and I will be the first to sign the ACT statement, but it is not there.
The Anesthesia Care Team, like the rest of the way Anesthesia is organized in the U.S., is a money-wasting scam. In Commonwealth countries, physicians deliver anesthesia at a lower cost and with safety equal to that of the U.S. Anesthesia Pimping Team, physician-based practices, and nurse-based practices.

Of course, standards of training in a Commonwealth system (five-year residencies, tougher exam standards, etc.) are much higher than in third-world systems like the U.S. one.

MDA's and CRNA's are both meek little shoe-shine boys/girls, bent over by the surgeons in the U.S., and nowhere near as good as anaesthetists (doctors who SIT WITH THE PATIENT) in any Commonwealth country!

I know. I started in the U.S., and it took me years to catch up when I decided to come clean and start earning my living instead of pimping.

You all are way behind the rest of the Anglosphere. Come to grips that in terms of Anesthesiology, the American system stinks!
Anesthesia Provider

Winchester, VA

#34 Apr 2, 2011
Glad you have all the anesthesia figured out... You wanker
jeezuguys

Pittsfield, MA

#35 Apr 5, 2011
I am a new grad nurse contemplating pursuing the CRNA route. Yes, I want to make a good living...no I am not a crack-whore ("avoid crna"- maybe you should pee in a cup so we can figure out which meds you've been swiping or what disease you have caught as "a professional prostitute"). Is everyone who posts here REALLY a grown up with an education?

Insults aside, who can guide me to a real RCT that demonstrates the difference in outcomes between anesthesia provided by a CRNA, ACT, and MDA. The studies that I have found show very similar rates of mortality, but each study has shortcomings that could indicate manipulation of data.

Cinshik has a great point. If CRNA's are not competing with MDA salaries, their compensation will certainly be reduced.

If patient safety is priority #1 then the ACT model must be preserved (according to the potentially crappy studies that I have read).

If anyone out there who is not on drugs, manic, or suicidal could steer me towards some good data, I would be very grateful. Thanks
stanley

Napoleon, OH

#36 Apr 6, 2011
sorry no such RCT exists, however real life shows no greater M&M in opt out states then non opt and the majority of studies indicate CRNA anesthesia is as safe as MD anesthesia, no study shows that the ACT as construed by the ASA is safer, just more expensive. If you are looking for certainty there is none in anything new information enters medicine every day changing our understanding and practice see prophylactic antibiotics, low dose dopamine, changes in CPR, et al. There is NO certainty.
CRNA

Coronado Ntl Forest, AZ

#37 Jul 13, 2011
Yep, see it all day long in the hospital. MDs with their enormous egos terrified of losing their millions of dollars if an RN encroaches on their territory...

Better wise up, docs, our lobby is much, much larger and the legislatures of many states agree with nurses and the public when we say:

DOCTORS ARE OVERPRICED

You are raping patients of their money, and guess what? We're going to make it easier on them. No more yachts or $5M houses.

I seriously want to slap the sh&t out of doctors for being such liars when it comes to CRNAs - they KNOW for a fact we can do the job just as well as they can do it.

Your time is short, docs. VERY SHORT. Deal with it and get the hell out of our way.
jwern

New Orleans, LA

#38 Sep 30, 2011
All I ever hear is that CRNAs are just as safe as Anesthesiologists. That CRNAs have the same complication rate. Well there may be a big reason for that no one has addressed. Do CRNAs ever really work on complex cases by themselves? Is there ever a liver or heart transplant that only has a CRNA working or without physician supervision? How bout a 20lb tumor ressection? Or repair of Tetralogy of Fallot in a premie? Or a whipple? If CRNAs are pretty much only unsupervised in uncomplicated procedures, wouldn't the date be vastly skewed? I'm not trying to make a point here. An honest question to which I do not know the answer that someone may be able to answer.
jwern_NotAnesMD

New Orleans, LA

#39 Sep 30, 2011
To CRNA in Tucson, Go to medical school, work your ass off 15x harder than you can ever possibly imagine in a constantly cut-throat ridiculously high stress environment for 4 years, graduate with $300,000 worth of debt and not a penny to your name, then go to 5 years of residency, where you work even harder, where there is even more stress, all during those 5 years getting paid less than every single nurse in the hospital and someone with a high school diploma, all while struggling to make the payments on your $300,000 worth of debt, and then tell me MDs make too much money. No Anesthesiologist is walking around with a yacht or 5 million dollar house, unless they inherited it or married rich. They are not struggling to make-ends-meat 10 years after residency, but they're not owning 5 million dollar houses. You're thinking of Doctors in about 4 of the ridiculous number of specialties. You have no idea what you are talking about. If the path were as easy as nursing school, doctor's would not deserve it. But let me ask you a question: would you want to live in a world where only nurses provided health care? Your child has a serious illness, you're telling me a specialized nurse taking care of her is enough for you? Doctors are necessary and until they make med school $10,000 a year and someone waves a magic wand that doesn't transport you to a world of pain-staking stress and work for practically a decade, plus a lifetime of hard work, doctors deserve what they make. If anything primary care physicians are getting unfairly compensated.
It was Written

United States

#40 Mar 12, 2013
Just take basic intelligence. CRNAs are mostly dumb as dornails! They would never get through the MCAT and into medical school let alone finish and pass their USMLEs. The D students of high school think that they can legislate their way into infependent practice. If you're stupid you're stupid. You don't suddenly become a genius. I agree with DRBNMD to an extent. Those states that allow independent practice, essentially allowing morons to put patients lives at risk are worse than the third world.
stanley

Washington Court House, OH

#41 Mar 12, 2013
You mean "doornails", and "independent". I agree if you are stupid you are stupid, stupid as not doing a spell check before lambasting a group that has shown the ability to deliver anesthesia safely for 100 years. Yup, you are smart.

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