The controversy of CRNA vs. Anesthesiologist has been ongoing for decades. Because of the overlapping clinical roles, turf battles have been ongoing with both CRNAs and Anesthesiologists in fear that the other group will one day take over. Currently, several models of practice are in place in the United States. Although groups comprised solely of CRNAs or MDAs exist, the anesthesia team is a model commonly used. Even within the team concept, disagreement continues to exist related to staffing ratios.
In an excellent online blog post, Dr William Hass, MD, MBA (Anesthesiology Reviews; CRNAs and the Elephant in the Room) suggests that there is a third factor in the ongoing dispute over Anesthesia services management. Capitalism is a driving force in the US economy and healthcare is fertile ground for venture capital. Anesthesia management companies look past professional organizations and turf battles and evaluate anesthesia services as an opportunity to make money. Remaining in business is becoming more dependent on remaining competitive in the face of capitalism, not just fighting off the other group of providers.
Venture capitalists (Anesthesia Management Companies) offer the Hospital a contract for services. According to Dr Hass, once in charge, they seek to gain return on investment and commonly:
- Evaluation the process
- Improve the processes
- Cut costs (in anesthesia cases this almost always staff costs)
- Continue to improve process and reduce costs
- Provide a return to investors
The blog post goes on to state that improved technology improves safety allowing lesser credentialed providers to accomplish the same task with a lower overhead to the company. For example, using the ultrasound for central line placement reduces the need for an Anesthesiologist to be involved in the task.
Dr Hall goes on to describe the evolution of change from physician to technician practice:
- anesthesiologist only practices (no CRNAs/AAs); become
- anesthesia care team model practices (fewer anesthesiologists, more CRNAs/AAs); become
- collaborative anesthesia practices (fewer and fewer anesthesiologists, more and more CRNAs/AAs); become
- CRNA only practices (no anesthesiologists); become
- anesthesia professional light practices (fewer anesthesiologists, CRNAs, AAs, and more technology)
Overall, Dr. Hass presents an excellent blog posting and a must read for anybody involved in anesthesia management. A collaborative approach with both CRNAs and MDs working at the top of their license is required if the work group is to remain solvent and viable in the era of venture capitalism.
Click here to read the original blog post by Dr Hass. Return to PROCRNA to leave a comment.
Good points. We need to be more aware of the business of anesthesia. Being a good clinical anesthetist is not enough any more.
There are a lot of very good all CRNA groups, many in the smaller hospitals in rural areas. Nothing is forever. We must remain on very good terms with hospital administration. The threat of being taken over is very real.