The American Society of Anesthesiologists trumpeted this news all over social media yesterday. Howard University Hospital has fired eight CRNA's and replaced them with anesthesiologists. The ASA contends the facility has realized that anesthesiologists provide superior levels of care to patients as the reason for the staffing change.
But if you look at the hospital's press release, it says nothing about the poor quality of care by CRNA's at their facility as the reason for the change. It clearly states that the hospital has been in financial distress and is seeking ways to save money. It has hired an outside corporation, Paladin Healthcare Capital, to outsource its daily operations. According to the newspaper article, "The changes at Howard are a result of the ongoing effort to turn around its finances."
So the fact is that Howard didn't hire anesthesiologists to give their patients superior care. They were brought in to save money. If they cost more than the CRNA's, they probably would not have been hired due to the hospital's poor financial situation.
Think about that for a minute. The anesthesiologists were hired because they are cheaper to use than the nurses. How can that be when anesthesiologists are supposedly making six figure salaries and rank in the upper echelons among physician salaries? The answer is that CRNA's also make six figure salaries, particularly in expensive areas like Washington, D.C. In addition, the CRNA's would be considered full time employees. Full time employees have the added costs associated with full time work, like health insurance, malpractice insurance, union negotiated break times, paid time off, fixed daily schedules, and pension plans. These are all very expensive, and rising, costs that the hospital has to bear.
On the other hand, the anesthesiologists are likely to be considered independent contractors who pay for their own benefits. The anesthesiologists will have to work for every dollar they earn and be responsible for all their own financial risks, freeing the hospital from these expenses. You think the anesthesiologists will demand a morning break, lunch break, and afternoon break during the work day? Only if they want to see a lower salary and ire from the OR director. They are hired to work, not take fifteen minutes off for a bathroom break. You have to leave by 3:00 PM in the middle of a case because you don't want to miss your zumba class? You want to come back to work tomorrow?
This is indeed sobering news for anesthesiologists. No matter how much the ASA is trying to spin this as a win for us, it actually implies that hospitals value our work no greater than the CRNA's. In the future, anesthesiologists may have to get used to receiving the equivalent incomes of nurses if they want to be gainfully employed.