Introduction
When there is more than one type of profession in the same field, a discussion will always exist on whether one deserves more pay or not or if one party is worth employing. This problem has emerged with hospitals trying to determine the viability of hiring certified registered nurse anesthetists or anesthesiologist assistants. A patient undergoing a major surgical procedure is often made unconscious for the period of the surgery by the use of anesthesia. CRNAs, as well as anesthesiologists’ assistants, are trained and capable of providing anesthesia services.
A CRNA refers to an advanced practice nurse responsible for administering anesthesia for surgery and other medical procedures. On the other hand, an AA is a highly skilled professional who works under the guidance of a licensed anesthesiologist to perform anesthesia care plans. Even though their roles might be similar, a CRNA can work individually, and an anesthesiologist assistant cannot. The latter is required to always work under the direction of another anesthesiologist. Since the CRNA is not obligated to work under anyone’s supervision, there are various work opportunities in hospitals, large medical centers, and outpatient surgery clinics where they can practice. According to countrywide averages, an AA earns between $90000 and $100000 while a CRNA earns at least $140000. This paper aims to evaluate the strengths and weaknesses of the two professions and why it is viable for a hospital to invest in one by checking the return on investment.
Discussion
Cost-Benefit Analysis of CRNA and AA in Department Practices
Cost-benefit analysis is a method that helps to assess the strengths and weaknesses of the two interventions. Both CRNA and AA help to administer anesthesia treatment in hospitals (Abouleish et al., 2020). It is important to analyze the benefits and costs of the two positions (Tamura et al., 2021). Due to the ability to work individually, the CRNAs have provided anesthesia in various medical facilities in the country for a long time and consist of more than seventy percent of its providers (Abouleish et al., 2020). With the time the profession has existed, they have been able to offer not only safe but cost-effective care. For example, they support the capacity of rural hospitals to conduct surgical procedures, maintain emergency services, and provide obstetrical care to patients who may need to travel long distances for medical attention. Through compensation from Medicare, the professionals provide the needed services in rural areas, especially after the introduction of the Rural Anesthesiology Act (Abouleish et al., 2020). The program reimburses the facilities with reasonable costs of anesthesia services and allows for safe and high-quality care at a minimal cost.
The costs arise in the money spent on training and eventually employing the CRNAs and AAs. Despite the similarity of services they provide, the former are among the highest earners of every advanced practice registered nurse. They make an annual average of between one to two hundred thousand dollars (Abouleish et al., 2020). This is significantly higher amount required to maintain an anesthesiologist assistant in department practices since they offer same services and require less pay.
Cost-Benefit Analysis of the Utilization of CRNAs
Hypothetically, if a hospital employs a CRNA and pays them $200 000 annually, calculating the return on investment or ROI shows that the medical facility benefits. In 2021, a study found that about nine hundred thousand admissions are due to alcohol, and the cost can reach $3500 (Abouleish et al., 2020). If one CRNA offers services one hundred times annually, the total revenue earned for the hospital due to them is $350,000 (Abouleish et al., 2020). This is more than the initial amount invested in maintaining the professional, which is beneficial (Pinegar & Townsend, 2019). The figures are close to those of the Anesthesiologist assistant, with more net income.
Usually determined by the patient outcomes, quality care is essential in comprehending the pros and cons of utilizing alternate anesthesia provider types or delivery models to offer needed services. Cost-effective assessment, which concentrates on the most productive way of achieving a particular result, is conditioned on the premise that the care quality cannot change across options (Dexter et al., 2020). The cost of services is considered a secondary issue in the event quality varies greatly across provider types. Thus, first, there was the assessment of the proof to measure if the quality is different (Dexter et al., 2020). Even though some negative cases are publicized, anesthesia-associated mortality rates have dropped significantly during the past twenty years to around one death per 240 000 anesthetics.
Countrywide approximates of such cases in the United States from 1999 to 2005 are 1.1 per 1000000 populace annually and 8.2 per 1000000 hospital surgical discharges. The estimates of the complications for inpatients in 2005 discovered an incidence rate of 1.0 cases per 1000 admissions (Dexter et al., 2020). Amongst those who experienced medical problems, less than one percent died by discharge (Dexter et al., 2020). Novel anesthetic agents, as well as better patient monitoring, have led to improved results. The Center for Disease Control performed a pilot investigation in 1980 and discovered that the rate of negative effects with anesthesia as a contributor was about 6 per 10000 procedures (Dexter et al., 2020). The rate completely linked to anesthesia was 1.25 per 10000 procedures.
Review Literature/Evidence
Given the possible expenses of anesthesiology, providers and patients must use delivery modalities that offer cost-effective, high-quality care. Even though the CRNAs and AAs can offer similar care quality, the former are paid more (Mahoney et al., 2020). The additional medical care costs of hiring a CRNA are placed on the patients and the hospital (Mahoney et al., 2020). This does not mean that employing and maintaining an AA in a hospital is inexpensive. It costs a hospital about one hundred thousand dollars annually to hire a single AA (Germack et al., 2021). In the nursing field, the CRNAs are among the highest compensated (Germack et al., 2021). The lowest ten percent in the category earn almost $140,000, while the highest ten percent get above $170,000 per year (Germack et al., 2021). Checking the number of times they offer the anesthetic services to patients and the amount paid per visit, in the long-term, it is beneficial financially to hire an AA who is paid $40,000 less.
One might argue that the CRNAs train longer and, thus, needs more pay. However, the quality of care they offer to the patients is similar. A study discovered no major differences in the rates of anesthesia-related complications between anesthesiologists and CRNAs or the models applied (Germack et al., 2021). Researchers failed to identify the anesthesia delivery model in the study. They might utilize the usual practice at a medical facility instead of the anesthesia provider for a particular procedure to identify the delivery model (Germack et al., 2021). Sometimes the research identified those procedures which an anesthesiologist performed but failed to differentiate if the medical direction came from a CRNA.
Given the low rate of complications and mortality resulting from anesthesia-related problems, it is unsurprising that no studies indicate a great variation between anesthesiologists and CRNAs in patient outcomes. In addition to retrieving the proof from the literature, medical care claims and discharge information was utilized to evaluate adverse anesthesia results, including complications and death (Germack et al., 2021). The former were identified using the International Classification of Diseases diagnosis codes.
Evidence Table
Table 1: The table above shows the positive and negative outcomes of the two positions on the patients and the hospital
Conclusion
The paper has evaluated the strengths and weaknesses of the two professions and why it is viable for a hospital to invest in one position and not the other. The return-on-investment technique shows that a medical facility or hospital can save money by employing an AA. Hiring and maintaining a CRNA for work that an AA can accomplish for less pay is more expensive. As mentioned earlier, a CRNA stands for an advanced practice nurse obligated to administer anesthesia for surgery as well as other medical procedures. The anesthesiologist assistant is a professional who receives direction and guidance from an anesthesiologist to conduct anesthesia care plans.
This paper offers information for a hospital manager in a dilemma that can help reach a well-informed decision. An example is when it lists the amount of salary averagely earned by individuals in the two careers. The manager will have to invest approximately $140000 per year to pay the CRNA as salary, as seen in table 1. Similarly, he will have to pay an AA an estimated $90000-$100000 annually. The difficult part about deciding on the issue is that the CRNA has trained more but does the same work or tasks as the AA. Hypothetically, if a patient pays around $3000 per admission, especially those with alcohol disorder issues, and the professional attend to 100 such cases, the return is $100000. However, this could be more if the AA’s salary is used in the computation.
A study discovered no major differences in the rates of anesthesia-related complications between anesthesiologists and CRNAs or the models applied. Researchers failed to identify the anesthesia delivery model in the study. They might utilize the usual practice at a medical facility instead of the anesthesia provider for a particular procedure to identify the delivery model. Sometimes the research identified those procedures which an anesthesiologist performed but failed to differentiate if the medical direction came from a CRNA. Therefore, it would be better for a hospital to have the position of an anesthesiologist assistant than a certified registered nurse anesthetist.
References
Abouleish, A. E., Hudson, M. E., Levy, R. S., & Whitten, C. W. (2020). Industry-wide survey of academic anesthesiology departments provides up-to-date benchmarking data on surgical anesthesia productivity. Anesthesia & Analgesia, 131(3), 885–892. Web.
Dexter, F., Ledolter, J., Wong, C. A., & Hindman, B. J. (2020). Association between leniency of anesthesiologists when evaluating certified registered nurse anesthetists and didactic lectures. Health Care Management Science, 23(4), 640–648. Web.
Germack, H. D., Kandrack, R., & Martsolf, G. R. (2021). Relationship between rural hospital closures and the supply of nurse practitioners and certified registered nurse anesthetists. Nursing Outlook, 69(6), 945-952. Web.
Mahoney, C. B., Lea, J., Schumann, P. L., & Jillson, I. A. (2020). The role of job characteristics and personality is the turnover, burnout, and job satisfaction of certified registered nurse anesthetists in the United States. AANA Journal, 88(1), 39-48, 2022. Web.
Pinegar, M., & Townsend, T. (2019). The role of anesthesiology assistants in the anesthesiology patient care team. Missouri Medicine, 116(1), 63–66, 2022. Web.
Tamura, T., Sakai, T., Henker, R., & O’Donnell, J. M. (2021). Certified registered nurse anesthetist and anesthesiologist assistant education programs in the United States. Nagoya Journal of Medical Science, 83(3), 609–626. Web.