Skip to main content
×
Home
    • Aa
    • Aa

Cooperation and conflict between very similar occupations: the case of anesthesia

  • David E. Kalist (a1), Noelle A. Molinari (a2) and Stephen J. Spurr (a3)
Abstract
Abstract

This article examines the features of a labor market in which there are two professional groups that both cooperate and directly compete with each other: certified registered nurse anesthetists (CRNAs) and anesthesiologists (MDAs). We examine how the relative numbers of these two types of anesthesia providers, and differences in regulation, affect the earnings of CRNAs, and the extent of supervision of CRNAs by MDAs. We find that both the earnings, and the likelihood of medical supervision of CRNAs, are closely determined by their market share. As the market share of CRNAs increases from 0% to 50%, the gains to MDAs from restricting competition increase; over this range the likelihood that CRNAs are supervised increases and their expected earnings decline. However, as the CRNAs’ market share increases beyond 50%, the costs to MDAs of anticompetitive measures become too large, therefore, the probability of supervision declines, and the earnings of CRNAs increase.

Copyright
Corresponding author
*Correspondence to: Stephen J. Spurr, Professor of Economics, Department of Economics, 2115 FAB, Wayne State University, 656 West Kirby, Detroit, MI 48202-3622, USA. Email: sspurr@wayne.edu
References
Hide All
Adams A. F. III, Ekelund R. B. Jr., Jackson J. D. (2003), ‘Occupational licensing of a credence good: the regulation of midwifery’, Southern Economic Journal, 69(3): 659675.
American Association of Nurse Anesthetists (2003), ‘Fact Sheet Regarding Anesthesiologist Assistants’, unpublished memorandum, Park Ridge, Illinois.
American Medical Group Association (2003), AMGA Medical Group Compensation and Productivity Survey, Alexandria, Virginia: AMGA.
American Society of Anesthesiologists (1990), ‘Summary of Results, Membership Survey, February 23, 1990’, unpublished data, Park Ridge, Illinois.
Bashaw D. J. Heywood J. S. (2001), ‘The gender earnings gap for US physicians: has equality been achieved?’, Labour, 15(3): 371391.
Bradford B. C. (1999), ‘HCFA Announces 1999 Anesthesia Medicare Conversion Factor Increases and Other Changes’, AANA News Bulletin, Park Ridge, Illinois: AANA.
Broadston L. S. (2001), ‘Reimbursement for anesthesia services’, in A Professional Study and Resource Guide for the CRNA, Park Ridge, Illinois: AANA Publishing, Inc.
Cromwell J. (1999), ‘Barriers to achieving a cost-effective workforce mix: lessons from anesthesiology’, Journal of Health Politics, Policy and Law, 24(6): 13311361.
Dueker M. J., Jacox A. K., Kalist D. E. Spurr S. J. (2005), ‘The practice boundaries of advanced practice nurses: an economic and legal analysis’, Journal of Regulatory Economics, 27(3): 309330.
Ehrenberg R. G. Smith R. S. (2009), Modern Labor Economics: Theory and Public Policy, 10th edn, Boston, Mass: Pearson Addison-Wesley.
Fallacaro M. D. Ruiz-Law T. (2004), ‘Distribution of US anesthesia providers and services’, AANA Journal, 72(1): 914.
Goldsmith A. (1989), ‘Dental hygienists’ wages: the role of human capital and institutional factors’, Quarterly Review of Economics and Business, 29: 5667.
Institute of Medicine (1999), To Err is Human: Building a Safer Health System, Washington, DC: National Academy Press.
Jones C. B. Gates M. (2004), ‘Gender-based wage differentials in a predominantly female profession: observations from nursing’, Economics of Education Review, 23: 615631.
Josefson D. (2000), ‘Unsupervised nurses may soon give anesthetics’, West Journal of Medicine, 172(6): 360361.
Kalist D. E. (2002), ‘The gender earnings gap in the RN labor market’, Nursing Economics, 20(4): 155162.
Kelly R. W. Pereles S. A. (1995), ‘Gender influences on earnings of obstetrician-gynecologists’, Obstetrics and Gynecology, 86(1): 112118.
Klein J. D. (1997), ‘When will managed care come to anesthesia?’, Journal of Health Care Finance, 23(3): 6286.
Michels K. A. (1992), ‘New HCFA carrier manual instructions on medicare payment’, Journal of American Association of Nurse Anesthetists, 60(3): 233236.
The New York Times (2000), ‘In This Doctor-vs.-Nurse Debate, Long, Deep Breaths’. Personal Business, New York, New York, October 8, 2000, at 9.
Orkin F. K. (1995), ‘Work force planning for anesthesia care’, International Anesthesiology Clinics, 33(4): 69101.
Peltzman S. (1976), ‘Toward a more general theory of regulation’, Journal of Law and Economics, 19(2): 211240.
Physician Payment Review Commission (1993), ‘Annual Report to Congress 1993’, Washington, DC.
Poirier N. B. (2004), ‘Opting out: liability and policy implications of eliminating the medicare CRNA supervision requirement’, Journal of Legal Medicine, 25: 229248.
Rassuli A. Roy R. (1986), ‘Sex discrimination in the audiology profession: it explains two-thirds of the $9500 difference between male and female earnings’, American Journal of Economics and Sociology, 45(2): 189200.
Rosenbach M. L., Ammering C. J. (1993), ‘Payment Options for the Anesthesia Care Team’, Report to the Physician Payment Review Commission Under Contract, Waltham, MA, Center for Health Economics Research.
Rosenbach M. Cromwell J. (1989), ‘When do anesthesiologists delegate?’, Medical Care, 27(5): 453465.
Sass T. R. Nichols M. W. (1996), ‘Scope-of-practice regulation: physician control and the wages of non-physician health-care professionals’, Journal of Regulatory Economics, 9: 6181.
Smith D. M. (2002), ‘Pay and productivity differences between male and female veterinarians’, Industrial and Labor Relations Review, 55(3): 493511.
Stigler G. J. (1971), ‘The theory of economic regulation’, Bell Journal of Economics, 2(1): 321.
Tobin M. H. (2001), ‘State governmental regulation of nurse anesthesia practice’, in S. D. Foster and M. Faat-Callahan (eds), A Professional Study and Resource Guide for the CRNA, Park Ridge, Illinois: AANA Publishing, Inc., 111131.
US Department of Health and Human Services (HHS) (1990), Study of Nurse Anesthetist Manpower Needs, Washington, DC: US Department of Health and Human Services (HHS).
US General Accounting Office (1992), Medicare: Payments for Medically Directed Anesthesia Services Should Be Reduced, Washington, DC: US Government Printing Office, GAO/HRD-92-95: 1–28.
Wooldridge J. M. (2003), Introductory Econometrics: A Modern Approach, 2e, Mason, OH: Southwestern/Thomson Learning.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Health Economics, Policy and Law
  • ISSN: 1744-1331
  • EISSN: 1744-134X
  • URL: /core/journals/health-economics-policy-and-law
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Metrics

Full text views

Total number of HTML views: 5
Total number of PDF views: 31 *
Loading metrics...

Abstract views

Total abstract views: 264 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 22nd October 2017. This data will be updated every 24 hours.