CRNAs working for a MDA group. Kind of at the mercy of the MDAs as far as what you get paid, how you work, call arrangements, retirement and vacation time, etc.
CRNAs working for a hospital. MDAs provide anesthesia supervision but everything else is through the hospital. Hospital employee, hospital benefits, hospital retirement, hospital supervisor. Call is arranged within the nurse anesthetists, independent of the MDAs.
CRNAs working fee for service. Usually no MDAs around but I have seen situations where both work as independent contractors. In one situation, the MDAs supervised the CRNAs and they split the billing, in another they each did their own cases, pretty much ignored the other and did their own billing. If just CRNAs they do their own cases, do their own billing and get all the money.
I have also seen towns where there are NO CRNAs or AAs at all and the MDAs do all their own cases. If a CRNA comes to town and tries to get credentials the MDAs freeze them out using the credentialling process. "How many central lines did you put in past year? Oh, SEVEN, we we require 10 per year to have credentials. How about epidurals? Oh 100, we we require 200." etc. They find some reason to freeze out the CRNAs and keep the town all MDA.
CRNAs working for a group or locums agency. The CRNA does the work, the group or agency collects a pretty good fee for putting the the CRNA and facility together.
Pretty much any kind of arrangement you can think of is out there somewhere.
Of course, as fees start getting reduced, you can bet everyone will expect the anesthesia provider, be it MDA, CRNA or AA to just eat the cuts. For many, it is a major concern as they have become accustomed to excellent pay and are not willing to accept just good pay.
