" CRNAs were recruited at a higher pay than a family doctor
That's what the Yahoo headline, the page of which is no longer available, said. This is why we have a shortage of outpatient primary care physicians in this country. There is no other reason. When you can make more income as a nurse than as a doctor, the laws of economics say so.
Four year undergraduate degree + 2 year masters = $186,000These economics have nothing to do with the value of the education and everything to do with the RVU system. Incomes for medical professionals who bill in a fee for service environment are entirely dependent on the RVU scale. The RVU system highly rewards the procedural mentality of American medicine. Therefor CRNAs are highly compensated.
Four year undergraduate degree + 4 years of medical school + 12,000 hours of residency = $178,000
If you think that CRNAs would get paid $186,000 because the value they bring to medicine is any greater than is the education and responsibility that a family medicine physician brings, you're mistaken. They are paid what they are paid because the interventions they do are highly rewarded on the RVU scale. That's the only reason.
Hospitalist salaries on the other hand have left the constraints of the Medicare National Bank and their compensation is not restricted by the RVU medical model. With an average per hospitalist subsidization of $100,000 per year, hospitals have found a friend in hospitalists who bring great value to their bottom line. Which is but one reason why I am The Happy Hospitalist.
At some point, the whole idea of RVUs defining the value of each individual encounter is going to end. It has to. Because it doesn't pay for what is valued. It pays for what politics says it will. RVU is an unsustainable delivery model. If we pay for what we value, eventually the trend will reverse. If we continue not to pay for what we value, we will get exactly what we pay for: lots of CRNAs and no outpatient family medicine and internist physicians. This is market economics applying the broken RVU system. We have no outpatient internists because we have no outpatient RVUs. The market does work with great efficiency. In this case, the efficiency is not what we value, but it is what the market says it should be. We are getting exactly what we pay for and for that, we should not be surprised.
It's times like this that I'm glad I'm not only a physician, but an internist. That might come in real handy when the health care implosion, already underway, is completely unmasked by a debt that cannot be sustained by any rational measurement.
