Demand for anesthesiologists has dropped, Karam says, because demand for elective procedures has dropped. "That obviously was a great deal of the profit margin that a lot of surgeons were seeing when they opened their own surgery centers. With that market dipping, it took away a lot of the profit margin and a lot of the demand," he says.
"In addition you have hospitals being far more aggressive in communities than they have been before. The consolidation of medicine has really pushed hospitals to go out in their communities, buy up these surgery centers, or at least partner with these organizations and be a stronger player in their own backyard, so that they aren't losing those profitable procedures when they are there," he says.
Of course, many of the same economic forces that are hurting anesthesiologists are also hurting CRNAs, but Karam says CRNAs are having a "far easier" time finding work, and it all boils down to labor costs.
"They are still even higher in the locums demand market than anesthesiologists. They are in a much more comfortable position simply because what they can do, what the law allows them to do, and what they are commanding for pay," Karam says.
Perhaps the best hope for anesthesiologists is if CRNAs get too greedy.
"Paying CRNAs will change once they start to lobby and demand higher salaries," Karam says. "Once it gets up there to $250,000 or what an anesthesiologist can make, then obviously hospitals or medical groups will be more comfortable paying that money to a physician rather than an allied professional."