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    Government Reports on CRNA Shortage at VA Facilities

    By Debra Wood, RN, contributor.  

    About three-quarters of the medical facilities run by the U.S. Department of Veterans Affairs (VA) have difficulty recruiting and retaining certified registered nurse anesthetists (CRNAs) due to lower-than-average salaries, which has led many VA hospitals to close operating rooms and delay surgeries, according to a new report from the Government Accountability Office (GAO).

    “They have a lot of unfilled positions,” said Laurie E. Ekstrand, Ph.D., director of health care at the GAO, the investigative arm of the U.S. Congress. “We are concerned that the situation with unfilled positions might get worse, in fact.”     

    The VA employs about 500 CRNAs who in turn provide the majority of anesthesia services in VA medical facilities.       

    In fiscal 2006, the GAO found that 54 percent of VA hospitals with CRNA vacancies reported temporarily closing operating rooms, 72 percent delayed elective surgeries, and 68 percent increased the use of overtime due to the shortage.     

    U.S. Senator Daniel K. Akaka, chairman on the committee of Veterans’ Affairs, asked the GAO to review the VA’s recruitment and retention efforts after hearing complaints from both military veterans and nurse anesthetists.       

    For their review, the GAO surveyed Veterans Affairs’ CRNAs, chief anesthesiologists and human resources officers across the country, and analyzed vacancy data from 2005 (the latest year available), and salary data from 2005 through 2007.       

    The team also interviewed a representative from Kaiser Permanente¾the nation’s largest not-for-profit HMO which primarily uses CRNAs for anesthesia services¾about steps it takes to ensure it has enough CRNAs on staff. The GAO team also visited eight VA medical facilities in different parts of the country, where they interviewed anesthesiologists, CRNAs and human resources managers.         

    In 2005, the VA had a 13 percent CRNA vacancy rate system wide. Twenty-six VA medical facilities had CRNA vacancy rates of 25 percent or more, and 15 had vacancy rates of 40 percent or more. 

    The GAO projects that 26 percent of the current CRNAs will either retire from or leave VA within the next five years. More than half the CRNAs in VA facilities are older than 51 years of age, and the average VA CRNA is seven years closer to retirement eligibility than the national average.     

    From 53 facilities surveyed, 93 CRNAs reported that they plan to retire or leave the VA’s health system in the near future. In 27 VA medical facilities, GAO projects the attrition rate will likely be 50 percent or higher.

    When the potential retirees were asked what would make them postpone retirement, 91 percent said that higher salaries would delay their retirement from a VA medical facility. Eighty-two percent of those not eligible for retirement said a higher salary would keep them working at the VA.         

    “We spoke to quite a few nurse anesthetists who work for the VA and the data showed they are paid less than market rates,” Ekstrand said.   

    Forty-four percent of chief anesthesiologists reported filling CRNA vacancies with contract nurse anesthetists, and that percentage has increased over the last three years.   

    The VA paid contract CRNAs an average of $112 per hour in fiscal year 2005 and $114 in fiscal year 2006. That compares to an hourly maximum salary for a full-time VA CRNA of $82 in fiscal year 2005 and $84 in fiscal year 2006.        

    More than half of all CRNAs earned the maximum statutory salary cap for a VA CRNA in 2006, which was $133,900.  At 107 of the VA’s 120 medical facilities employing nurse anesthetists, this cap is at least $20,000 lower than the local market average. 

    In addition, nearly three-quarters of the chief anesthesiologists surveyed reported CRNA starting salaries were lower than the market rate in both 2005 and 2006, and about 40 percent of them reported that the average of all their facility’s CRNA salaries were $10,000 to $30,000 lower than local market averages . 

    Several VA officials reported that paying less than the local market rate for CRNAs contributes to their difficulties with recruitment and retention. Facilities responding to the survey said it takes them on average 15 months to fill a CRNA vacancy; 11 medical facilities reported it took them two or more years to hire a nurse anesthetist.   

    Overall, Frank J. Purcell, senior director of federal government affairs at the American Association of Nurse Anesthetists (AANA), said the demand for anesthesia services has increased in the U.S., with more health care facilities and nurse anesthetists needed in more locations. He added that the AANA and other professional groups have been working to build up educational programs to produce more nurse anesthetists and meet the high demand.      

    The veterans’ facilities use bonuses, education payment programs and a locality pay system as tools to recruit and retain CRNAs. In fiscal years 2005 and 2006, more than a third of the VA facilities paid recruitment bonuses and less than one-third paid retention bonuses. All of the eligible CRNAs who applied for funds to offset educational debt received the money.          

    More than half of VA facilities used the locality pay system to determine whether to adjust salaries. However, the GAO found the eight facilities it visited did not follow the policy correctly.

    The GAO report recommends additional training for staffing managers so they are better able to assess market-rate salaries. Even so, Ekstrand cautioned that may not mean the VA can pay more.

    “In some cases, they may decide they cannot afford it,” she said. “The bottom line is they have a certain amount to spend on medical care, and they have to make tough choices.”


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