OK
I tried to avoid this topic altogether, but had to get my 2 cents in. I am a surgeon, my mom is a CRNA working 3 days/week, and my brother is an attending anesthesiologist in CT.
First, who gives a #^$% is some CRNA is making 180k a year. My brother started at that with 5 weeks vacation, then made partner with a guarante minimum of 400k plus production. I will tell you, and I tell him that I don't think he is worth half that. He gets 13 weeks vacation/year and takes 2 in house calls/month. That is what the market pays him so that's what he gets. My other brother is an executive at EMC corp and has made millions in stock options. If you are looking for real money, get out of medicine... Also if those of you out there going into anes care about a CRNA making a buck fifty, it is peanuts in the reality of the financial world, especially out of medicine.
Second. As a senior surgical residnet at a large university program, with CRNAs and a CRNA training program I will give you my view. I will probably piss off both you anesthesiologists and CRNAs. Just coming off being chief in the ICU, I see a huge difference in the management of a number of the patients that came to the unit who had received the intraop care of a CRNA versus a good anesthesiologists. Granted, I saw a number of poorly managed sick patients by MDs too, but less so. I consistently had patients coming to the unit underresuscitated, hypothermic, hyopoperfused, loaded on epi drips etc under the management of a CRNA. I could give numerous counts. Perhaps these things are not seen by many CRNAs because they are back in the OR with another patient. I spent hours trying to catch up on fluids, correcting coags and so on. I saw this with some of the anes residents here too, but rarely. Despite my brother being an anes doc, I traditionally did not think their medical training was very strong. However, I will tell you the residents here are fairly well trained, and the anes docs actually run the CT ICU and SICU. They can tell you about the management of elevated ICP or necrotizing pancreatitis, and I think it leads to better intraop management. Give me a CRNA that can lead my rounds in the SICU and discuss the disease process of all my patients and I'll lick your ass. That is what I make the 2 year anes residents do here, so that if and when they take care of my patients in the OR they don't drop the ball. Any fool can get a patient through the OR with good looking numbers. Now, some of the CRNAs here are very good, and some of the MDs suck.
Yes, I know CRNAs have to spend at least a year in ICU care, but that is ICU nursing care. There is a huge difference. I have worked with some great ICU nurses both at Columbia and Hopkins, however even the most experienced one has never had to deal with actual clinical decision making. Many of these nurses have spent time in Cardiac ICUs only, which is very cook book care, and relatively easy patients to care for.
On another note, I think if you are at a smaller hospital, dealing with non-critically ill patients, the CRNAs do fine. For the last 10 years anesthesia spots have been filled by the bottom of the pool US grads and foreign grads. Even as a med student at hopkins I was apalled by their lack of intelligence. In that regard I have seen some CRNAs better quallified than many of these graduates. But again, go to a top university program and you will see the difference.
On another point, and I talked about this with my brother, these salarises will probably start to drop in a few years. More US grads are going into the field, and more spots are being offerred through the match. There are plenty of MDs who would work for 180k a year, so why would you chose a CRNA??? This has happenned. My brother did his prelim year at Good Sam hospital in Portland, OR. The CRNAs started moving in 15 years ago, so the MDs lowered their fees and the hospital dropped all but one of the CRNAs. The only CRNA there now runs the books for the anes docs. As an outsider, it seems to me that there should be a balance and bond between CRNAs and MDs. Despite the patient care thing, MDs should realize CRNAs allow the existence of 4 rooms, splitting fees and double billing. Something we can't do in surgery( although with a good PA you can start pulling vein in one cards case while still in another). TO the CRNAs, just think, a few years ago you were dropping foleys, scooping poo, and checking vitals. Now you double to triple your salary and no longer have to deal with the sometimes crappy floor work. Believe me, I see anes as a bit of a joke job, tons of cash for little knowledge, and an easy lifestyle. You don't erally want to know my opinion on CRNAs. Lots of graduates will enter the field over the next 10 years, alleviating the shortage. Many of these will work the job of an attending for a lot less money, and if the numbers were high enough push CRNAs out and go for AAs.
So if i pissed any of you off to bad, I'm not taking any sides, but I personally see a difference in the care more than a few times per week. That is maybe 1 out of 30-40 cases. If an anes doc is making of 300k year easy, then sure a CRNA is worth 150k. To the primary care docs out there, if you wanted to become wealthy you should have chose a different career. Well i understand you ned to live comfortably, you should do your job because you like it...
Many of my friends think I am a fool too. But, I bet your BROTHER IS NOT A FOOL WHEN IT COMES TO PROTECTING HIS TURF AND PAYING HIS DUES TO THE AMERICAN SOCIETY OF ANESTHESIOLOGY (i.e. our last line of defense).
