Nurses' salaries top Docs'

Joyce Tsai

Some speciality nurses are being recruited at salaries that are $13,000 more than family-practice physicians — despite a nationwide shortage of family doctors, according to a new report by Irving-based Merritt Hawkins & Associates.

The study found that the average salary offered to family physicians is $172,000, compared to the average salaries for certified registered nurse anesthetists, or CRNAs, which is $185,000, according to the company’s annual review of physician and CRNA recruiting incentives.

About five or six years ago, it was unusual to see CRNAs make more than family practice physicians, said Kurt Mosley, vice president of business development for Merritt Hawkins. But in past few years, CRNA salaries have equaled or slightly surpassed that of family practice physicians. And this year, the gap is significantly greater than recent years.

Still, Merritt Hawkins, which is the nation’s largest physican-recruiting firm, fielded more requests for family physicians than for any other doctor, Mosley said. And there is currently a shortage of 55,000 to 65,000 family-practice physicians in the country, he said.

And in Texas, the need is even greater: There are an average of 152 primary care physicians for every 100,000 people, compared to 220 for every 100,000 people nationwide, according to a study by the Primary Care Coalition.

“There’s a shortage throughout the Texas area — and throughout the Dallas area. There are shortages everywhere — in all 50 states,” Mosley said.

The shortage has driven up their salaries to some extent, Mosley said.

Since 2004, his company has seen demand for family practice physicians more than double, while salaries increased almost 15%, he said. And compared to last year’s study, demand increased 60%, while salaries increased almost 7%.

That may seem like a strong increase compared to other medical specialties, but it’s still not enough, he said.

“It’s like saying there is an increased compensation to break concrete, but who wants to break concrete?” he said. “It’s not very positive, especially for someone with 12 years of education.”

Fewer American medical students are enticed by the opportunities in family-practice medicine, despite an abundance of studies that emphasize the crucial role of primary care, he said.

“Primary care is an endangered species, because fewer and fewer students are going into it,” Mosley said. “It’s a lot of hours and a high-hassle practice, and we are going to need to change the way we compensate them.”

Since 1997, the number of U.S. medical graduates choosing to enter family practice or general internal medicine has fallen by almost 50%, according the Primary Care Coalition study.

For example, since 2002, only about 40% of the slots for family medicine residency programs have been filled by U.S. medical graduates; the majority have been filled by foreign medical school graduates, according to National Resident Matching Program statistics. About a quarter of those foreign students go back to their home country, Mosley said.

And as older family-practice physicians start retiring, the demand will only continue to grow.

The need for family-practice physicians is most pronounced in Texas’s rural areas, but even in urban areas, such as the Metroplex, demand can be seen in high wait times for appointments, often for several weeks, Mosley said.

Texas’ distinction of having the highest percentage of uninsured residents in the nation doesn’t help matters, either. About 25% of the state’s population is uninsured, according to the Primary Care Coalition. It makes it especially difficult for family physicians, who aren’t always compensated for uninsured care, Mosley said.

Undervalued doctors

To many, the study is “one more sign that primary-care physicians are being undervalued,” said Dr. Guy Culpepper, president of Dallas-based Jefferson Physicians Group, a group that is working to preserve the private practice of primary care.

The health care system continues to favor procedures, and primary-care physicians often don’t have the bargaining power to command higher salaries, Culpepper said.

Linda Siy, president of the Texas Academy of Family Physicians, says comparing the two profession’s salaries is like “comparing apples to oranges” because “those salary lines have been different for a long time.”

Of less importance is whether “I get paid more than nurses of anesthesia,” she said. “The more serious issue is: Are you valuing primary care enough to insure there is a good pipeline of primary care in the future?”

Christopher Bettin, senior director of communications for the American Association of Nurse Anesthetists, said that CRNAs hold duties that are nearly identical to anesthesia physicians and “it’s a highly sought-after job in nursing.”

A shortage of CRNAs about seven years ago led to efforts to open more training programs and offer better salaries, so although “there is a shortage today, it is less dramatic,” he said.

“In 2000, there were about 900 new CRNAs a year, and now we are producing 2,000 a year,” he said. “The outlook has started to look a lot rosier.”

But Scott Kizer, manager of staffing services at Dallas-based Pinnacle Partners in Medicine, one of the largest anesthesia groups in the nation, said that the demand locally for CRNAs is still very high. His group handles about 200 of the roughly 500 to 600 CNRAs employed in the Metroplex, he said.

“You can hire about three CRNAs for one anesthesia doctor, so in smaller towns and communities, especially, they are definitely in high demand,” he said.

He estimates that about 90% of the health care facilities in the Metroplex have a need for CRNAs.

“Anywhere from Dallas to Fort Worth, at any given point, we could have anywhere about 15 to 20 openings for CRNAs,” he said of his medical group. “We are about 20% short in CRNAs, even though we stay pretty well staffed.” | 214-706-7121

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