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Family Practice Docs Upset That Some Nurses Earn More

Submitted by Admin on March 14, 2010, 11:03 am
certified nurse anesthetist

An article on CNNMoney.com reports "Some nurses paid more than family doctors" - and family doctors don't seem to be very happy about that:

From CNNMoney.com

"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."

And why is it necessarily wrong that a CRNA earns more than a Family Practice doctor? The entire premise of CNNMoney's article is disingenuous and intentionally inflammatory. They're comparing apples to oranges instead of apples to apples while simultaneously demeaning nurses by implying that all doctors should earn more than nurses regardless of specialty!

Certified Registered Nurse Anesthetists (CRNA) are advanced practice specialty nurses who typically have extensive critical care experience in addition to a Master's degree in Nursing and sometimes a Nursing Doctorate degree, and they've been providing anesthesia care to patients for over a century, starting with their care of Civil War casualties.

Every year CRNAs provide services to over 22 million surgical, obstetrical and trauma patients in the USA. They are qualified to dispense all kinds of anesthetics, work in all types of practice setting, and provide care for all sorts of procedures, from open heart surgery to pain management programs. [Nurse Anesthetist (CRNA): Could You Make the Grade?]

CNNMoney's article goes on to report that many Family Practice doctors are "starting to feel like "second-class citizens" because some nurses earn more than they do:

"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."

There's lots more in the article if you can stomach reading it: Full CNNMoney Article.

According to a survey published in JAMA in September 2008, only 2% of fourth-year medical students plan to work in primary care after graduation. Is it worthwhile to fight the trend?

Nurse practitioners can provide the same primary care services that physicians provide, including performing physical exams; diagnose and treat common acute illnesses and injuries; provide immunizations; manage high blood pressure, diabetes, and other chronic problems; order and interpret X-rays and other lab tests; and counsel patients on disease prevention and health care options.

The U.S. could save as much as $8.75 billion annually if Nurse Practitioners were used appropriately in the place of physicians according to one study. Nurse Practitioners not only meet basic health care needs in rural areas and inner cities -- sites not adequately served by physicians -- but deliver quality primary care to other under-served populations, such as children in school settings and the elderly. Some NPs have independent practices and can be reimbursed by Medicare, Medicaid, or other third parties. [Nurse Practitioner Career Opportunities Growing]

Mounting studies show that the quality of Nurse Practitioner care is equal to, and at times better than, comparable services by physicians, and often lower cost. So, perhaps the biggest concern for the nation's health care system should be how to encourage more nurses to become Nurse Practitioners rather than trying to convince more medical students to pick primary care!

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1 Comments »

  • gravatar_G Sherry Jones Mayo says:

    Inflammatory articles such as this, which are not only erroneous in their comparisons but divisive between health care professionals, really don't serve the patient or any of his health care team. Advanced Practice nurses take on an enormous amount of responsibility as part of a medical care team, absorbing many tasks formerly reserved for medical doctors. In an age of medical care provider shortages, discouraging and dishonoring advanced practice nurses does not contribute to a more cohesive and cooperative health care system. Are we returning to the dark ages of wearing nurses caps (sign of subservience to the physician) and jumping to attention when a physician enters a room? I've had the pleasure of working in a Detroit Trauma Center for most of my nursing career. Nurses and Doctors (away from patient beds) were on a first name basis, and have been known to round with each other at shift change and periodically during the day (to share patient care and status information), and realize that each has a different perspective regarding a patient's care and status. Perhaps the general public, and certainly the writer of the CNN article, seek a simpler time, the old days, when the selfless and altruistic angel of mercy (nurse) served as a personal assistant (handmaiden) to the doctor. But we are too highly trained, independent, and have critical thinking skills (and training) far too advanced for such nonsense. I don't know why CNN decided to quote a backward, primitive egoist who is offended at making less money than a CRNA whose specific advanced training is completely different than that of the family physician, but it sounds like a personal problem to me. And do we really want to air our dirty laundry in such a fashion? I have friends who are fabulous family practice physicians, and I saw them go from short coats (medical students) to running their own practices. They work hard and long, and none of them would ever disparage advanced practice nurses. I think the CNN interviewer either took the quote out of context (let's give him the benefit of the doubt; maybe he had a bad day), or perhaps the man was sleep-deprived or under a lot of stress. If so, I apologize for the egoist remark, but I still hold that advanced practice nurses EARN their salaries, and I wish we had more of them. From personal experience, I can tell you that the basis of nursing (to be an advocate for the patient and spend every available moment TEACHING their patients) has made the advanced practice nurses that have cared for me MUCH better than their MD counterparts. Before one surgery (and I've had many), the anesthesiologist came to my bedside, patted me on the lower leg (never came any closer) and said, "You're going to be fine." The CRNA then came in, set the chart down, stood next to me, and said, "Ok, this is what we're going to do" and explained in detail what I could expect before, during, and after the surgery. Then she actually asked if I had any questions, and answered every one of them. Having someone spend time with me is why I go to a Nurse Practitioner for my medical care. She also recognizes that as a nurse, I can be a tough patient, ask a lot of questions, and that I desire to participate in my care, treatments, medications, and so on. She thrives on that participation instead of being annoyed by it (as some MDs are wont to do), and we have a vested interest in my care, and a relationship to see that my care is thorough and appropriate. So, if you are a nurse, please read the article, and I encourage you to respond in this forum. Who knows ... maybe CNN will take note and dig a little further into the situation than they have, and apples to apples comparisons (and the due recognition for advanced practice nurses) may surface. We can only hope.

  • gravatar_Gadmin says:
    Thanks for such a well thought out response! Having been a charge nurse, then unit manager of a level 1 trauma center (and teaching hospital's) ER, I've seen doctor's with this attitude and watched some evolve (thankfully), but am afraid that the general public still perceives nurses as doctor's helpers rather than as highly educated professionals in their own right who happen to work as collegues of physicians. I can only share your hope that more practicing nurses share their opinion of the CNN article and that the article's author chances by to respond!

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