2010 CRNA Job Market outlook

I recently contacted David Pierpont, President and CEO of  Stonebridge & Company and he agreed to share his perspective on the CRNA job market and offer suggestions on how best to approach employment transitions.

David,

In recent years anesthesia providers have been in relatively short supply, making jobs opportunities plentiful, sign on bonuses and attractive salaries "normal" and a person could choose to live in almost any part of the country. Although healthcare has been spared the massive downturn that other industries are experiencing, there has been a definite softening of the anesthesia market. Could you provide an overview of the current job market for CRNAs ?

CRNA’s are in an interesting place currently. Healthcare as a whole lags behind economic indicators and subsequent industry downturns/fluctuations. Conversely, it shows recovery more quickly. This being said, economic times definitely caught up with healthcare in 2009, and the “right-sizing” of hospital staffing models truly came to the forefront.

Examining the economic impact on the healthcare job market, a line was drawn in the sand by consumers between necessary and unnecessary care based on the cost of care and insurance coverage. To this end a significant downturn was realized in the elective surgery market, causing a downhill softening of the anesthesia and CRNA job markets. This trend is just one more complication in a job market for  CRNAs which is already stressed with bipolar machinations of employment / contracting models, as well as care delivery models.

While much of this is not new, the push and pull between MDA supervision models and independent CRNA delivery models persists. In the Northeast the former is the dominant model, moving West we find a greater independence for CRNAs. Beyond simply independent practice, CRNAs are challenged with the decisions to consider supervised models where they may not be permitted to perform regional procedures.This has been a decisive factor for many SRNA/CRNAs as they consider their respective career paths.

Looking ahead, another significant factor which will impact the near-term job market is compensation. CRNAs have enjoyed, as you mention, a job market of plenty. This has enabled, as some clients tell me, the CRNA to write their own ticket – but that was then – and we are starting to realize a stabilization in the negotiating process for CRNAs when if comes to compensation issues.

This is very evident with MDA groups who have an active supervision model. Interestingly, this trend is also reflecting in MDA groups who have historically not utilized CRNA supervision models, but have begun exploring these models as a manor of providing more cost effective care (or a better bottom line for the practice).  The latter of these two groups is by its nature identifying the price/compensation elasticity of the current market for CRNAs in traditional MDA practice models and at some level concurrently in hospital employment models.

The developing CRNA employment market, however is also realizing opportunity in aligning with ASCs and Endoscopy practices. The ongoing development of these market segments will continue to offer CRNAs independent earning opportunities, especially as management companies and non-MDA practices drive market segment growth.

Have all regions of the country been equally affected ?

The job market is soft nationally. Specifically for CRNAs we see a split between East and West – with the East displaying the highest volume of open positions for CRNAs. Currently, west of the Mississippi accounts for  27% of the open positions to the eastside’s  63% of the open position market. Overall the downturn is relatively consistent.

 For those exploring employment options, what do you consider the most important factors they should take into consideration when evaluating and comparing potential job opportunities?

It is important for each individual to be true to themselves. The person in the mirror needs to make an honest assessment of what is most important to them – is it money, clinical practice or location.

If money – what is the magic number and how hard are you willing to work to get there? If it is clinical practice, what type, what career path do you seek? Will you only take a position that will enable to you to perform regional procedures? Location is the simplest – if this is your #1 all you need is to find a position where you want it. The complication only arises if there is nothing available in your location of choice.

After almost 20 years in this business these are, when you drill it all down, the only three truly consistent motivating factors for taking a position. So at the end of the day, it is what position is right for you given your focus. If you happen across two “right” positions then start with which group you liked better from a personality standpoint – you will be spending a great amount of time with these colleagues – happiness first. One telling factor, may be to simply meeting and casually observe the group during your interview. Get out of the formal QA sessions and into the break room. See who is hanging out, what they have to say, if they are able to share any good stories. Then move to some of the more easily defined areas of compensation and benefits, call rotation, clinical load – all the work life balance stuff.

What would you recommend that candidates focus on when preparing CVs and for employment interviews ?

CVs need to be clear, concise and accurate. Name address and numbers; personal data (optional – but I like it for male candidates and not for female); schooling ; training; work experience; pubs/ research.  Often times discrepancies in dates or unexplained gaps in training or clinical positions are a major hold up for candidate review. Many times these oversights lead to a CV being put aside by a potential hiring organization.  This being noted, gaps in training or clinical practice should be explained in a cover letter not on the CV itself.

The cover letter should be designed to identify reasons the candidate wants to be in the local market and offer a brief snapshot of clinical skills then deal with any potential road blocks, finally closing with two action sentences which offer times that are convenient to speak on the phone and a best reach number.

Specific to employment interviews, It is important for candidates to consider these in simple stages – typically phone interview then in-person interview then offer. Each step of the process only has one goal – to get to the next stage. Too often candidates on a phone interview eliminate themselves from consideration based on how they respond to practice elements being presented to them. While candidates for a position need to make honest evaluation about what they are hearing, or seeing, these evaluations need to be “mental notes” only, reserved for self-consideration later.

Simply put the goal of the phone interview is to be invited for an in-person interview. The goal of the in-person interview is to be invited back for a second interview or to get an offer. At the point where an offer is made – this is when you re-review all the “mental notes” so that you can make a good and informed decision regarding the opportunity. If you never get yourself to the point of an offer, however, nothing else will matter. Please take these comments with a clear understanding that each candidate is, as mention in the previous response, approaching their search after making an honest self-assessment of what they are looking for.

Would you provide examples of some of the CRNA positions your company is currently recruiting ?

While we are working with several clients nationally who are seeking clinically oriented CRNAs for mixed practice settings – ranging from Hospital employment to Anesthesiology Practice employment both for inpatient and/or outpatient delivery, the most intriguing position we currently represent is for a Director Anesthesia Services. The Director position is truly a leadership position which will put the incumbent in a role which will oversee a staff of 50 CRNAs – all hospital employed – while at the same time working as the lead for the Anesthesiology Practice which has the exclusive contract with the hospital.

This organization is seeking someone who is a multifaceted leader, with a specific strength in people management and from my perspective change management. While the goal of positions like this are typically increased efficiencies and better outcomes, one particular element sought from this position will be to engage the currently employed CRNAs at a higher level organizationally.

Presently CRNAs in the facility are highly regarded for the clinical work they do and the value they bring to what is a high volume multi-delivery system, however they live “behind the OR doors” and come and go relatively un-engaged within the organizations operational structure. Leadership in this organizations wants the CRNAs to be more involved. So the questions are: why are they not? Do they want to be? And how can we get them there?  I view this as a terrific opportunity for the individual who accepts the challenge, not only as a leader within a department, but as a leader who integrates CRNAs system wide within the organization.

Any insights on future demand for anesthesia providers ?

We see a lot of continued need for CRNAs. As stated previously, much of what we are seeing is practices and facilities who are better trying to align CRNAs within there respective models to enhance performance qualitatively and financially. The question is will the CRNA marketplace accept the roles being offered. What makes the market so dynamic is the wide array of compensation plans available, some lower dollars better quality of life, some higher dollars and heavy call, some independent and some employed.

The CRNA market is also very interesting in the sense that there are a significant number of independent CRNAs who run their own contract business platforms either as an individual or as a group. With the economic slow down we have seen a number of solo-independents work to re-engage the employment market. This has created a small bubble of available CRNAs to answer standing demand, but has not truly impacted shortfalls in overall supply.

We feel that the independent market will continue to be strong over the next year or so, and are actually creating a platform which we will hopefully launch within the next 3-6 months that would serve as a resource for CRNAs to build independent virtual businesses with a national presence. Lastly, it is important to note some of the ongoing unique programs that employers are utilizing to ensure CRNA staffing – not the least of which is tuition assistance/ loan repayment/ scholarship option for CRNAs that commit to the practice prior to the completion of training.

How can we get additional information about the positions you described or contact your company for additional information ?

Thank you for the opportunity to provide my contact information. We consult with all our professionals confidentially. Personally, I can be best reached on or off hours on my cell 203-258-5075 or in the office 203-256-1185, xt 101. My email is davep@stonebridgcompany.org and the web site is www.stonebridgecompany.org. We also have a sister company specializing in contract placement www.prodigyhealthcare.com  As an organization we take great pride in consulting with the professional and facilities/practices with whom we work to deliver the best possible resources for each to achieve their goals.

Thank you David.

Dennis Gundersen
www.CRNAbiz.com