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

Published online by Cambridge University Press:  25 June 2010

David E. Kalist
Affiliation:
Associate Professor, Department of Economics, Shippensburg University, Shippensburg, PA, USA
Noelle A. Molinari
Affiliation:
Research Economist, Department of Economics, Wayne State University, Detroit, MI, USA
Stephen J. Spurr*
Affiliation:
Professor of Economics, Department of Economics, Wayne State University, Detroit, MI, USA
*
*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

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.

Type
Articles
Copyright
Copyright © Cambridge University Press 2010

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References

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.Google Scholar
American Association of Nurse Anesthetists (2003), ‘Fact Sheet Regarding Anesthesiologist Assistants’, unpublished memorandum, Park Ridge, Illinois.Google Scholar
American Medical Group Association (2003), AMGA Medical Group Compensation and Productivity Survey, Alexandria, Virginia: AMGA.Google Scholar
American Society of Anesthesiologists (1990), ‘Summary of Results, Membership Survey, February 23, 1990’, unpublished data, Park Ridge, Illinois.Google Scholar
Bashaw, D. J.Heywood, J. S. (2001), ‘The gender earnings gap for US physicians: has equality been achieved?’, Labour, 15(3): 371391.Google Scholar
Bradford, B. C. (1999), ‘HCFA Announces 1999 Anesthesia Medicare Conversion Factor Increases and Other Changes’, AANA News Bulletin, Park Ridge, Illinois: AANA.Google Scholar
Broadston, L. S. (2001), ‘Reimbursement for anesthesia services’, in A Professional Study and Resource Guide for the CRNA, Park Ridge, Illinois: AANA Publishing, Inc.Google Scholar
Cromwell, J. (1999), ‘Barriers to achieving a cost-effective workforce mix: lessons from anesthesiology’, Journal of Health Politics, Policy and Law, 24(6): 13311361.Google Scholar
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.Google Scholar
Ehrenberg, R. G.Smith, R. S. (2009), Modern Labor Economics: Theory and Public Policy, 10th edn, Boston, Mass: Pearson Addison-Wesley.Google Scholar
Fallacaro, M. D.Ruiz-Law, T. (2004), ‘Distribution of US anesthesia providers and services’, AANA Journal, 72(1): 914.Google Scholar
Goldsmith, A. (1989), ‘Dental hygienists’ wages: the role of human capital and institutional factors’, Quarterly Review of Economics and Business, 29: 5667.Google Scholar
Institute of Medicine (1999), To Err is Human: Building a Safer Health System, Washington, DC: National Academy Press.Google Scholar
Jones, C. B.Gates, M. (2004), ‘Gender-based wage differentials in a predominantly female profession: observations from nursing’, Economics of Education Review, 23: 615631.Google Scholar
Josefson, D. (2000), ‘Unsupervised nurses may soon give anesthetics’, West Journal of Medicine, 172(6): 360361.Google Scholar
Kalist, D. E. (2002), ‘The gender earnings gap in the RN labor market’, Nursing Economics, 20(4): 155162.Google Scholar
Kelly, R. W.Pereles, S. A. (1995), ‘Gender influences on earnings of obstetrician-gynecologists’, Obstetrics and Gynecology, 86(1): 112118.Google Scholar
Klein, J. D. (1997), ‘When will managed care come to anesthesia?’, Journal of Health Care Finance, 23(3): 6286.Google Scholar
Michels, K. A. (1992), ‘New HCFA carrier manual instructions on medicare payment’, Journal of American Association of Nurse Anesthetists, 60(3): 233236.Google Scholar
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.Google Scholar
Orkin, F. K. (1995), ‘Work force planning for anesthesia care’, International Anesthesiology Clinics, 33(4): 69101.Google Scholar
Peltzman, S. (1976), ‘Toward a more general theory of regulation’, Journal of Law and Economics, 19(2): 211240.Google Scholar
Physician Payment Review Commission (1993), ‘Annual Report to Congress 1993’, Washington, DC.Google Scholar
Poirier, N. B. (2004), ‘Opting out: liability and policy implications of eliminating the medicare CRNA supervision requirement’, Journal of Legal Medicine, 25: 229248.Google Scholar
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.Google Scholar
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.Google Scholar
Rosenbach, M.Cromwell, J. (1989), ‘When do anesthesiologists delegate?’, Medical Care, 27(5): 453465.Google Scholar
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.Google Scholar
Smith, D. M. (2002), ‘Pay and productivity differences between male and female veterinarians’, Industrial and Labor Relations Review, 55(3): 493511.Google Scholar
Stigler, G. J. (1971), ‘The theory of economic regulation’, Bell Journal of Economics, 2(1): 321.Google Scholar
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.Google Scholar
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).Google Scholar
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.Google Scholar
Wooldridge, J. M. (2003), Introductory Econometrics: A Modern Approach, 2e, Mason, OH: Southwestern/Thomson Learning.Google Scholar