Re: Worries about Clinton/socialized medicine? Archived Message
Posted by Dave J on January 19, 2008, 5:22 pm, in reply to "Re: Worries about Clinton/socialized medicine?"
Henry,
Anesthesia (Radiology, Laboratory) are the three "price inelastic" professions in medicine and as a CRNA (or AA) we get to tag along. If you have a busy surgical staff who bring in a lot of work, you get lot of work. If there is a recession and fewer people are getting surgery, the surgeons bring in less work and we get less work.
UNLIKE other specialties, anesthesia (historically) could not beat the bushes for more patients. Surgeons on the other hand could. Some would add a new type of surgery or go to new places. Some would gone once a week to small rural hospitals and offer services there that would not otherwise be available. But the anesthesia providers? No surgery meant no work. Some did find new ways to make the profession less inelastic such as by really pushing labor epidurals, "Pain Management" procedures and even becoming head of the ICU department. But for nurse anesthetists, (and AAs) it is still mainly an OR profession.
Since we are so tied to the OR, our pay is dependent upon how much work comes in and what we get paid for that work. I do not see AA competition was the major factor in regards to pay in the future, I see two other factors. The first is a recession and the second is cuts in payment by Medicare and insurance companies.
Take a couple of simple procedures. EGDs and Colonoscopies. It use to be a surgeon could bring these people to the GI suite in the OR and do them with an anesthesia provider heavily sedating them. Much more comfortable for the patient than a little valium and demerol in some GI doctor's office. And Medicare and the insurance companies would pay it at the going anesthesia rates.
But then Medicare said they would not pay for "routine" procedures to be done by anesthesia. The patient had to have either an "involved" procedure or have a "health issue" that required the specific services of an anesthesia provider.
So for those patients who were just getting a screening procedure or who did not have any health problem that would satisfy the Medicare requirement, they had a the following choices. Get it done under versed and demerol and that is it. Get it done with an anesthesia provider and pay for it out of their own pockets.
Patients who KNEW what it was like to get it done under valium and demerol often said they would pay to get the sedation by an anesthesia provider. Many who were "virgins" and did not know, would elected to go with valium and demerol.
Bottom line, fewer patients coming to the GI suite in the OR, less work for the anesthesia provider, less income AND for those you did, you had to fight to get Medicare to pay for it and when they did, it was at their new reduced rate.
Then the insurance companies follow suite.
That is the future of anesthesia if we go with socialized medicine with the government rules. Patients either take less (sedation) or they pay more out of their pockets.
In regards to dental care, that is actually a good thing to get into. I have yet to run into a dentist who accepts assignment. They charge their rates, they expect to be paid in full. And if they do not, they can simply refuse to care for you again. For those who do get into a "preferred provider arrangement, I think it is because they can not attract enough patients on their own.
I still recommend anesthesia to those who are interested in it as a profession as it is a very enjoyable and satisfying job. But I really do not see with ALL of the presidential candidates promising some sort of socialized medicine the PAY remaining as high as it is.
I see it settling out around $100,000 -$125,000 with a TON of rules about billing.
I can see a time coming when in large departments, one AA or CRNA will be the "payment coordinator" and doing nothing but ensuring the care given meets the standards (requirements) of the various agencies in order to get paid.
(However, if I could go back in time and start over, I think I would go into organic chemistry and specialize in Bucky Balls! That is a whole new area of chemistry that is hardly even explored and I think it would be fun to be in on something entirely new.)
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