Sunday, July 18, 2010

Anesthesia Class 2012 & The Saber-Tooth Tiger

Just two more sets of exams to grade (renal physiology) and I’m done teaching for this academic year! I will have all of August and the first week of September off. Teaching science (physics, biochemistry, molecular biology, anatomy and physiology of all body systems) in a leading nurse anesthesia program is a rewarding challenge that I’ve taken on for thirty-six years now, partly because the students are so appreciative.

On Thursday during a break in the final lecture, the students surprised me with a cake and a gift. The students will be moving into the second year of the three-year master degree program in nurse anesthesia (thus the “Class of 2012” on the cake), and I will greet the next wave of fledglings in September.

Typically the students commemorate our last academic interaction with references to things I often say when teaching. Something I often mention when lecturing is the “saber-tooth tiger.” Look closely at the upper left corner of the cake and you will see the figure of a tiger (closest thing the students could find to a saber-tooth tiger).

I offer an attack by a saber-tooth tiger as an example of a natural stress situation in response to which the actions of stress hormones and sympathetic nervous fight-or-flight behavior are adaptive. The medical dilemma is that we have ice-age bodies but live in a modern age in which the stressor is job loss, debt, divorce, or a traffic jam – not a saber-tooth tiger attack! The physiological stress responses that have evolved (e.g., increased blood glucose and fatty acids, increased cardiac output) do not help us survive modern stressors but instead, combined with over-plentiful calories and sedentary lifestyle, lead to our demise (diabetes mellitus, atherosclerosis and cardiovascular accidents)! So there are lots of references to saber-tooth tigers and their prey when I’m lecturing on sympathetic nervous system and hormone effects like those of glucocorticoids and catecholamines. Hence, there is a tiger (and a bear for good measure) on the cake.

On a more practical level, the students have demonstrated their observational acuity by bestowing upon me a new lab coat. (My old lab coats reflect the many years I’ve been teaching.) The lab coat is exactly the style I like, and unlike any I ever had before, is beautifully embroidered with my name.

I will think of the class of 2012 whenever I look at the animal figures from the cake or whenever I put on my new lab coat. This coat will be donned for the first time on September 9th, when the shepherding of students through the process of building a scientific foundation for their profession in anesthesia begins again.

Sunday, March 14, 2010

Why Shouldn't Specialist Nurses Be Paid More Than Family Doctors?

Recently I encountered the following headline on the web: “Specialist nurses paid higher salaries than family doctors.” Knowing that my students graduate to become the highest paid members of the nursing profession, I suspected that the “specialist nurses” were CRNAs (Certified Registered Nurse Anesthetists). Yes, I was right – the article is referring to CRNAs. But this article is misleading and reflects a bias that is crying out for comment. Here is the article followed by my thoughts.

Specialist nurses paid higher salaries than family doctors
Parija Kavilanz, senior writer, On Thursday March 11, 2010, 2:32 pm EST

Despite the growing shortage of family doctors in the United States, medical centers last year offered higher salaries and incentives to specialist nurses than to primary care doctors, according to an annual survey of physicians' salaries.

Primary care doctors were offered an average base salary of $173,000 in 2009 compared to an average base salary of $189,000 offered to certified nurse anesthetists, or CRNAs, according to the latest numbers from Merritt Hawkins & Associates, a physician recruiting and consulting firm.

And the firm's projections for 2010 indicate that the average base salary for family physicians will be about $178,000 compared to $186,000 for CRNAs.

CRNAs are advanced practice nurses who administer anesthesia to patients. An important distinction between CRNAs and anesthesiologist is that when anesthesia is administered by a nurse anesthetist, it is still recognized as the practice of nursing rather than a practice of medicine

"It's the fourth year in a row that CRNAs were recruited at a higher pay than a family doctor," said Kurt Mosley, staffing expert with Merritt Hawkins & Associates.

CRNA salaries have trended higher as the number of surgical procedures picked up pace over the past few years, fueling demand for anesthesiologists and anesthetists.

Mosley said medical doctors and specialists, including anesthesiologists, typically have four to five years more of medical training than CRNAs. After spending a lot of time speaking with physicians around the country, he said many family doctors are starting to feel like "second-class citizens."

This type of income disparity "won't make them feel better," he said. Most primary care doctors say they're already struggling to make ends meet as their costs rise faster than what Medicare and private insurers are paying them .

Looking at these compensation trends, the biggest concern for the nation's health care system is how to encourage more medical students to pick primary care as their specialty at a time when the nation is already facing a shortage of about 60,000 primary care doctors.

"The demand for primary care doctors will increase twofold when health reform happens and millions of more Americans have access to health care," said Mosley. "Who is going to triage these patients? It's not the neurologist or pulmonologist. It has to be the primary care doctor."

The American Association of Nurse Anesthetists (AANA) maintains that CRNAs are being fairly compensated.

"From our perspective, we are fairly compensated for the level of responsibility that we shoulder," said Lisa Thiemann, senior director of professional services with the AANA.

"We are at the head of the patient's bed. We deliver anesthesia and we keep the patient safe," said Thiemann, who has been a CRNA for 14 years.

"Once nurses and physicians arrive at anesthesia training, we use the same textbooks and same cases. The training is not too different between the two groups," she said. "We all deliver anesthesia the same way."

Copyright © 2010 Cable News Network and Time Inc. and their affiliated companies. All Rights Reserved.
How dare any nurses make more money than any doctors! Take note that apples are being compared with oranges, because the services provided by primary care physicians versus anesthetists are vastly different. Logically the salary of nurse anesthetists should be compared with that of anesthesiologists because both groups provide basically the same services. Likewise, the salary of primary care physicians (also called family doctors) should be compared with that of nurse practitioners who provide basically the same services. I “Googled” the missing 2009 average base salaries to make the comparisons shown below.

2009 Average Base Salaries

Anesthesiologist  $317,000
Nurse Anesthetist  $186,000

Primary Care Physician $173,000
Nurse Practitioner  $83,000

Note that nurse anesthetists are more cost effective than anesthesiologists, and nurse practitioners cost less than primary care physicians.
Nurses are upgrading their knowledge and skills and filling an increasing need. In many rural areas, nurse anesthetists are the sole providers of anesthesia. And as an instructor who continues to teach physiology and related sciences to future nurse anesthetists for the thirty-seventh year, I can tell you that the textbooks are the same as those in medical school. The same mountaintop is reached despite the somewhat different paths taken.
Maybe doctors think they should always make more money than any and all nurses and that nurses should always be subservient to them. But doctors and nurses are healthcare professionals in their own right, and it’s in the best interest of the patients that they compete in the market place like everyone else. Maybe the public should be asking whether the big discrepancy in remuneration to specialist MDs versus specialist RNs for the same work is warranted?

Certified Registered Nurse Anesthetist (CRNA)
For many, the nurse practitioner is The Doctor

Sunday, March 7, 2010

Recently I have rekindled the artistic spark of my girlhood.  Here is "Illinois Winter Magic."