Barriers to achieving a cost-effective workforce mix: Lessons from anesthesiology

As pressures to control health care costs increase, competition among physi cians, advanced practice nurses, and other allied health providers has also intensified. Anesthesia care is one of the most highly contested terrains, where the growth in anesthesiologist supply has far outstripped total dema nd. This article explains why the supply has grown so fast despite evidence that nurse anesthetists provide equally good care at a fraction of the cos t. Emphasis is given to payment incentives in the private sector and Medica re. Laudable attempts by the government to make Medicare payments more effi cient and equitable by lowering the economic return to physicians specializ ing in anesthesia have created a hostile work environment. Nurse anesthetis ts are being dismissed from hospitals in favor of anesthesiologists who do not appear "on the payroll" but cost society more, nonetheless. Claims of a ntitrust violations by nurse anesthetists against anesthesiologists have no t found much support in the courts for several reasons outlined in this ess ay. HMO penetration and other market forces have begun signaling new domest ic physician graduates to eschew anesthesia, but, again, Medicare payment i ncentives encourage teaching hospitals to recruit international medical gra duates to maintain graduate medical education payments. After suggesting de sirable but likely ineffective reforms involving licensure laws and hospita l organizational restructuring, the article discusses several alternative p ayment methods that would encourage hospitals and medical staffs to adopt a more cost-effective anesthesia workforce mix. Lessons for other nonphysici an per sonnel conclude the article.