The Happy Hospitalist has an interesting link to a recent survey of physician income. As one might suspect, neurosurgeons come in at the top of the food chain. Their average annual salary is $571,000. However they also brought in the most money for the hospital, with an annual revenue of $2,815,650. Not bad, with a revenue to income ratio of 5:1. The general surgeons also do pretty well, with incomes averaging $321,000 and revenues of $2,112,492. The internists have a right to complain about their income. They average a salary of $186,000 but brought in revenues of $1,678,341, an almost 10:1 ratio. Seems like they are not getting their fair cut of the money brought in compared to the surgeons.
See anybody missing from this list? That's right, anesthesiologists are not counted in the survey. Why is that, you ask? Well, it's because we don't actually bring any revenue to a hospital. Instead, we siphon off money that other doctors bring in. That's the reason anesthesiologists, along with emergency physicians, radiologists, and pathologists are frequently considered the leeches of the hospital. When you consider that an anesthesiologist's salary is about 2/3 that of a general surgeon, you can see that we don't actually bring much value to a hospital's finances.
This lack of perceived value is why anesthesiology is a commodity product. Unless the anesthesiologist can bring in paying patients, like procedures for chronic pain, the hospital will always look for the cheapest anesthetist it can get away with. Radiology is in a similar boat. With X-ray films now largely in digital format, it is very easy for hospitals to outsource their film reading to a cheaper location, like India. This search for the cheapest labor is why anesthesiologists should fear the encroachment of CRNAs. As more states opt out of requiring physician oversight of CRNAs, there will be enormous financial pressure on hospitals to utilize the cheapest person able to intubate and turn on the Sevo vaporizer. No amount of lobbying by the ASA to keep CRNAs subservient to anesthesiologists will prevent hospitals from their search to maximize their profits. With the advent of ObamaCare imminent, with its millions of patients with Medicaid level reimbursement, the cheapening of anesthesia services will only accelerate.