I think the decline, is more related to other factors such the dropping payment rates than to the actions of one man. Anesthesiology, Pathology and Radiology are the three professions that have a "fixed" customer base as generally can not go out and hustle up more patients. They must rely on other physicians to bring in the business. Therefore when a payer, such as Medicare, cuts the payment rates they feel it directly in the pocket book and there is little they an do to maintain their income.
You also have pretty much everyone wanting to use "cheaper" providers. If where once you had an MDA, they want CRNAs. Where once they had CRNAs, they now want "conscious sedation nurses." Where once people used demerol and versed, they now want to use propofol despite the anesthesia people insisting only MDAs/CRNAs should be using it.
There is also the issue of call. Other specialists are on call only for cases within their specialty and they have the ability to decide to do it off hours as an emergency or put in on the schedule for the next day or down the road. The anesthesia provider on the other hand is on call for all specialities and must do the case when decided by the surgeon. So where an each specialist may have to do one emergency a week, the anesthesia provider has to do them all. That ends up being called out almost every night on call. This generation is not like previous, quality of life is an important factor in their decision as to profession. They do not want to be busting their butts at work all the time.
However, then end result is neither the ASA or AANA and their respective training programs are turning out enough providers for current replacement or future needs. A crunch is coming and you need look no further than nursing to see what happens when you get to crunch time.
Believe it or not, they are graduating nurses from two year associate degree programs with LESS than two years of schooling. It does not matter if they graduate and have never done an IV or put in an NG, it is all about credits. If they get the required credits they graduate. Then they take the national written exam and if they pass, they become RNs. Then they get a job and have to do an "internship" to learn all the stuff they should have gotten in school. They lack the didactic education of the four year degree nurse and the clinical experience of the three year diploma nurses. (And all of those programs were closed down years ago.) What we are getting is "quickie" nurses along the same lines of the "90 day wonder" officers in World War II. The crunch is here and they are churning out bodies.
We have not yet hit the crunch with in the field of anesthesia. We either admit a crunch is coming and accept AAs now and ensure they are WELL TRAINED or we do like nursing and wait, then turn out poorly trained providers.
So my fellow CRNAs can yell all they want about money, but until they come up with some solution that is viable they may as well try to stop a flood with a sponge.
