I think it is time that someone addresses the money--income issue as it relates to nurse anesthetists.

First, I will be open and tell you that one of the MANY reasons I went into anesthesia was the financial opportunities. I was career oriented and realized that this was something I was going to be doing for many years and that there appeared to be a limit on income in nursing, unless one went into administration. I always wanted to be involved with patients, so anesthesia seemed a good option. I do not apologize for financial motivation for this career choice.

Second, I have been fortunate to make a nice income, of which also, I do not offer any apologies.

Third and most important--why do you think CRNA's have good incomes? And what goes into that process?

Administration of anesthesia involves intelligence, difficult education, ability to work in adverse environment and being able to give medications and use techniques that are inherently very dangerous, that can lead to complications and even death, if not administered properly. The ability to think independently, on a second to second basis, to make your own decisions (no orders, no standing procedures or protocols) without supervision all have a monetary value. There is even a "Relative Value" guide published by the ASA that puts a value on all of the procedures performed in anesthesia.

There is also clearly an economic perspective to income for all professions. The first rule of economics is supply and demand and if you look at the demographics of CRNAs you will find a lot in the upper age group who will be retiring in the next few years. At the same time, there is an increased demand for anesthesia services. Those factors set the basis for high income potential.

Another factor that is foreign to most nurses, is the business perspective of anesthesia. It is a business, whether you are an employed or self-employed anesthetist and all businesses fail if there is not more income into the business than expenses--the old "bottom line". In other words, if insurance stops paying for certain procedures, there are very few medical professionals who are willing to work for nothing. Either the patient pays, as in cosmetic plastic surgery or the procedures are not performed. There are two parts of a financial statement for businesses--income and expenses. It seems that most of the perspective CRNA students just look at the income part of the equation and not the expense part. Since this is close to the end of the year, I am getting my financial paperwork together for my accountant and can tell you some of my professional expense categories. These are paid by my corporation, not anyone else. Professional dues and licenses, auto lease and expenses, health insurance, malpractice insurance, telephones, answering service, anesthesia equipment (I bought my own monitor this year), secretarial salary, billing service, accountant, computer, office supplies and of course, a salary to myself. I also put money into a pension plan in anticipation of retirement.

I think we get paid what we are worth, but I am realistic and know that there are going to be major political changes in the economics of health care delivery on the horizon. Which leads to the second rule of economics--self-interest. Everyone is going to want their piece of the smaller economic pie for healthcare in general. We are all going to have to be excellent practitioners and just as excellent negotiators. One thing we have going for us is a very strong and effective professional organization--AANA. Be sure to be involved.

I hope I didn't offend any of you, but it appears that the facts need to be presented and a little bit of reality therapy in order for some of you whose only motivation to enter this wornderful profession is financial.