204327 An analysis of the anesthesia market: Relationship between the supply of physician anesthesiologists and certified registered nurse anesthetists

Sunday, November 8, 2009

Stephen Spurr, PhD, JD , Wayne State University, Detroit, MI
Xiao Xu, PhD , University of Michigan, Ann Arbor, MI
Qinghua Zhang, PhD , Peking University, Beijing, China
Amber Kennedy , University of Michigan, Ann Arbor, MI
Physician anesthesiologists (MDAs) and certified registered nurse anesthetists (CRNAs) have similar responsibilities in clinical practice, yet they differ substantially in terms of training and compensation. There has been little research on whether the overlap of services they provide results in competition between the two groups of providers or promotes more teamwork. That is, are these two groups substitutes or complements? This study seeks to examine one aspect of this complex relationship by analyzing the reciprocal linkages between the growth of MDAs and the growth of CRNAs. Data for this project came from multiple sources, including measures of the local health care market characteristics available in the Area Resource File, number of CRNAs and their earnings data from the American Association of Nurse Anesthetists, number of MDAs published by the American Medical Association in the Physician Characteristics and Distribution in the U.S., MDA salary data from the U.S. Department of Labor Bureau of Labor Statistics, and the number of accredited nurse anesthesia programs and anesthesiology residency programs. We collected such data for each state in the U.S. and the District of Columbia by year during the period of 1981-2005. Between 1981 and 2005, the total number of CRNAs in the U.S. increased from 20,223 to 28,778 (a 42.3% increase), while over the same period, the number of MDAs increased from 16,229 to 40,264 (a 148.1% increase). There was also enormous variation in the ratio of CRNAs to MDAs, ranging from 0.16 (in Indiana in 2000) to 11.46 (in South Dakota in 1983). Multivariate regression analyses will be conducted to examine the reciprocal relationship between the growth of CRNAs and MDAs, while accounting for other confounding factors that could affect the relationship between the growth of these two groups (e.g., characteristics of local health care markets). Findings from this study can advance our knowledge regarding recent trends in the supply of anesthesia providers, as well as important factors influencing the provider mix. Such information will have important health policy implications surrounding cost-effective provider mix in anesthesia practice.

Learning Objectives:
Describe the growth of physician anesthesiologists and certified registered nurse anesthetists in the U.S. during 1981-2005. Understand the reciprocal linkages between the supply of physician anesthesiologists and certified registered nurse anesthetists. Identify key factors that influence the growth of physician anesthesiologists and certified registered nurse anesthetists.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a research assistant professor at the University of Michigan Medical School. As a health economist, I have extensive experience in conducting health services research. I have presented at 4 previous APHA conferences and numerous other national scientific meetings.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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