Saturday, May 7, 2016

Obamacare Is Killing The CRNA Market

The CRNA jobs market is under attack and not from our anemic medical societies like the ASA or the AMA. No, the culprit is none other than the AANA endorsed Patient Protection and Affordable Care Act, otherwise known as Obamacare. Due to the system's intense pressure to reduce costs, hospitals are having to outsource more of their labor to reduce expenditures and save money. Who knew, apparently not even the AANA, that CRNA's could be outsourced like some third rate janitorial service.

Crain's Detroit Business chronicled the termination of 66 CRNA's at two hospitals in southeast Michigan. When the hospitals, owned by St. John Providence Health System, offered the nurses a new contract, it was soundly rejected by 66 of the 74 CRNA's. Those 66 lost their jobs on January 1.

CRNA's in the Detroit area earn a median salary of $168,000. It can range from $154,000 to $182,000. This high rate of compensation is affecting how hospitals view their CRNA staffing. Says Ricardo Borrego, M.D., president of Dearborn based Anesthesia Surgical Associates, "Hospitals that employ CRNA's now view them as an expense they can't control. They are outsourcing them so they don't have to deal with the revenue side to pay them."

Imagine that. An employee who makes well over six figures who is so inflexible they refuse to work more than forty hours per week, overtime, or weekends is a source of expense irritant for their employer. It's no wonder hospitals prefer to outsource their CRNA needs to third party employers, many of them run by anesthesiologists. They are freed from the staffing issues and expenses of employing clock watching nurses. No more payroll taxes, workers comp, paid vacation time, or health benefits to deal with. Just write one check to an anesthesia staffing company and, boom, CRNA's show up at the front door. What hospital CEO wouldn't prefer that?

By contrast, employing anesthesiologists on staff who take calls, work nights and weekends, and can handle any train wreck coming in the ER without supervision is looking like a better deal all the time. Yes superficially we cost more. But anesthesiologists are worth more. It's not just about the bottom line. Anesthesiologists will keep working until their case is finished, not demand that they be relieved at the end of their shift. Our expertise makes us full partners in patient care in the operating rooms, not just another employee taking orders from the surgeons. Hospitals are beginning to see this logic, and it's in no small part due to the cost cutting enforced by Obamacare.


  1. You can replace CRNA with MDA in this article.

    You could also replace CRNA with "ACT CRNA" in this article since CRNA only models are by far the most fiscally viable in every manner AND provide MORE service for NO or less subsidy, something an ACT cannot live without.


  3. Actually Mike, AAs make more fiscal sense than CRNAs and the outcomes are comparable between them. Rarely have I encountered a CRNA who has been willing to take call, stay late, work weekends or holidays. Physicians do more and are more capable than CRNAs any day (don't quote an instance where your best CRNA was better than the worst MD). The days of CRNAs throwing their weight around are numbered with the number of states increasing the volume of AAs being generated. Your salary will go down and your own stubbornness will be your downfall.

  4. Love the spirit. Can't wait to meet some of these hard working anesthesiologists!!!!!!! 😂