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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. </p>
<p>. . . many family doctors are starting to feel like "second-class citizens."</p>
<p>. . . 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.
<p>See, it is not so clear that we really do need more primary care docs. We need more primary care practitioners, but they do not have to be doctors. CRNA’s are at the top of the pay scale for nurses, but other kinds of nurse experts can also do very well. Many nurse practitioners can replace much of the work primary care docs do. So it is not so clear that we are in dire need of more family practice and general internal medicine people. That would be the case only if one imagines no change in practice organization.</p>
<p>The irony is that primary care docs could learn to do the work of a CNRA pretty quickly- they already have the scientific background and lots of practical experience managing patients. But I don’t know what route would get them there. They would have to either do full residencies in anesthesia and become anesthesiologists, or go to nursing school and become nurses, then CNRA.</p>
<p>That’s an upsetting dilemma. But the fact is that General Practitioners do not do what Nurse Anesthesiologists do. Their responsibilities are different. So we shouldn’t compare their salaries. The Nurse Anesth is similar to an Anesthesiologist MD. That MD earns allot more than both GPs and Nurse Anesth. Salaries cannot arbitrarily be raised for GPs but they cannot be arbitrarily lessened for the Nurse Anesth. It doesn’t make sense to train GPs to do what the Nurse Anesth does because that would decrease the number of GPs for what they generally do as practitioners and put them in the operating room. The expansive issue is that there is currently a less than optimal number of GPs and in the near future there will be a need for an even greater amount (to serve the newly insured).</p>
<p>So I think the problem is how to get medical students to want to become GPs when there isn’t a financial incentive. The idea of money being an incentive isn’t pleasant, I know. Perhaps work hour differences? A hospital GP can work 10 or 11 hour shifts for 2-3 weeks and then get 1-2 weeks paid break (let that be a continuous cycle) and align cycles so that there always is a necessary number of GPs.</p>