Where Do CRNA's Make More Money Than Anesthesiologists?

In my last post I looked at the Rasmussen College's web tool for comparing the buying power of an anesthesiologist's income across different states. However, since the data is based on the government's Bureau of Labor Statistics, the site can also be used to compare the income of other jobs. Let's just randomly pick one now okay? How about...CRNA's.

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You might think that the incomes of CRNA's and anesthesiologists would roughly parallel each other in each state. But this is clearly not the case. If we search under CRNA, it's easy to see how the rank of income levels is far different from physicians.

Whereas anesthesiologists' incomes for California, New York, and Illinois are clustered close to the bottom of the country according to the BLS, CRNA's working in those states rank much higher. In fact, California CRNA's make it into the top ten in the country in income for their profession.

If you then rank the incomes based on buying power, again the big blue states fall down the list due to their higher taxes and cost of living.

But if you look at the top of the rankings, Nevada and Wisconsin show substantial income and buying power. The average CRNA salary of $221,000 in Nevada translates to an equivalent of $225,000 when adjusted for cost of living. In Wisconsin, a $200,000 salary becomes $215,000 due to its extremely low cost of living.

How substantial is a cost of living adjusted salary of $215,000? In fact it is greater than the average adjusted income of anesthesiologists living in CT, IL, MD, DC, NJ, MA, CA, NY, and MS. These expensive (not counting Mississippi) coastal states pay their anesthesiologists less than CRNA's who reside in cheaper states like WI and NV. In addition, CRNA's in Nevada make competitive incomes, within $10,000, of anesthesiologists in these other states: MN, VT, WA, VA, DE, NH, CO, AK.

With all the extra liability and reimbursement issues that anesthesiologists face, it makes one wonder why we didn't just become nurse anesthetists. It's pretty clear from the government's own statistics that the income disparity hardly justifies the extra responsibilities of having an M.D. appended to the back of our names.

Where Should Anesthesiologists Live?

Where is the perfect place for anesthesiologists to practice? If all you care about is money, there is a new salary comparison tool to guide you. Using data from the federal government's Bureau of Labor Statistics, Rasmussen College has developed a website to compare the buying power of your salary across all fifty states.

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I made a screen shot of the Rasmussen result for anesthesiologists. First a couple of quirks. The salaries for anesthesiologists that the BLS uses seem to be a lot lower than the Medscape survey of physician salaries released earlier this year. Medscape reported that anesthesiologists made on average $338,000 last year, while the BLS seem to list anesthesiologists as making only in the mid to low $200's. Because Medscape's survey is based on doctors self reporting their own incomes, there may be a bit of a bias towards high income earners being more eager to participate.

It's surprising that anesthesiologists in the big coastal states of New York and California make among the lowest incomes in the country, ranking only 47 and 48, respectively. Illinois, another big population state, did even worse coming in at 49 while the poorest state in the union, Mississippi, unsurprisingly offered the least amount of money for anesthesia services. In the graph I also highlighted the other populous states of Florida and Texas.

The interesting picture appears when these numbers take cost of living into account. The high tax and high cost states of CA and NY stay stuck at the bottom. IL, due to its lower cost of living, rises slightly in the rankings. TX rises due to its low tax environment while FL drops because of its higher cost of living compared to TX. The high income low tax states like Kansas increase their buying power even more. Is it any wonder doctors tend to skew conservative and Republican? While money is nice though, the Midwestern states don't get to celebrate Christmas like we do out here on the left coast.

What you get for your money

To continue my train of thought on the Wall Street Journal opinion piece from yesterday. The United States spends 17% of its GDP on health care but what do we get for it? I would bet we take care of more sick patients than any other industrialized country in the world. By sick I don't mean just acutely ill, but also chronically ill. We have the highest rate of obesity in the world. We probably have more people with coronary artery disease, diabetes, hypertension, cancer, congenital defects, renal and liver failure, alcoholism, and drug abuse than any other first world country. We take care of more extremely premature infants, and more centenarians than any other advanced nation. Just in the last month I saw an orthopedic surgeon put in a new hip on a 95 year old patient, a gastroenterologist perform an ERCP on a 103 year old, and another gastroenterologist put in a PEG on a demented 92 year old. All those patients got million dollar workups and consultations during their hospital stays. How many other countries in the world can boast that claim?

In this country, where every life, even the unborn, is considered precious, we are going to have to spend more money than anybody else. Our societal expectations, along with our legal obligations, ensures that we will spend top dollar to treat everybody equally. Nobody gets short shrift on health care regardless of their ability, or inability, to pay. Whether they are citizens, legal residents, or illegal immigrants, all patients who walk through the emergency room doors get treated equally.

So what if Japan only spends 8% of its GDP on health care. Or that South Korea spends 6%. I've been to hospitals in Asia. They spend less but they also get less. Most rooms are like the old hospital suites we used to have here, 2-4 patients per room or more. Sure you can have a private room, but you'll pay more for it. They are extremely understaffed. If you want a nurse's attention, you better hire your own private nurse. If the patient doesn't get better, they don't usually call the first malpractice lawyer they see on a TV commercial.

Perhaps spending 17% of our GDP for health care is commensurate with our quality of care for our given patient population. We spend more because we need more. We have sicker patients than most other industrialized countries. Other first world countries in general are healthier than us, with lower rates of obesity, alcoholism, and drug abuse. They can afford to spend less on their health care. If we want to improve the quality of our health care, given our country's health status, perhaps we need to spend even more, not less.