Critical Factors in Healthcare Reform

What the Politicians aren’t telling you.
Written by Jean Covillo

Cost CalculatorThe US healthcare system spends more dollars than any other developed country yet ranks the worst in healthcare outcomes. According to a study conducted by the Commonwealth Fund, which regularly ranks healthcare systems across the world’s 11 most developed countries, the US is also the worst performer. Not only has the US spent significantly more than other developed countries at 16.6% of GDP compared to 10% GDP for every other nation, it has done so consistently for the past twenty years all while life expectancy is continually declining. David Blumenthal, president of the Commonwealth Fund states these findings are due mainly to a lack of insurance coverage, administrative inefficiency, and under-performing primary care. 1

Although these points are valid, they do not include any discussion related to the 800-pound-gorilla-in the room, PROFIT. Profit derived from the big private insurance and pharmaceutical industries is a critical underlying root cause of the healthcare crises we face today. The money generated from these companies is used to fund political campaigns effectively shaping and influencing critical health care policy making decisions.

No good can result from a dynamic where profit holds priority over our ethical responsibility to provide societal health care and yet that is what is happening with large “for-profit” insurance and pharmaceutical companies who through their large political contributions, set the price and conditions associated with health care with little regard for the needs of the patient or that of the provider. The truth is that the costs associated with the overall healthcare “pie” are being divided up in a highly inefficient, disproportionate and frankly unethical manner with profits and administrative costs gobbling up the Lion’s share.

Aside from these profits, studies show administrative costs currently account for 30% of the total healthcare dollars spent in America. 2

This is twice the amount being spent by Canada. It is interesting to note that only 15.9% of dollars spent is associated with the actual hands on care administered by the doctor to the patient.3 Yet ongoing efforts to reduce overall costs are primarily focused at lowering reimbursement to hospitals and physicians, all while administrative work continues to increase, i.e. billing, contract negotiation and increasing requirements associated with quality care outcome measure submission and documentation.

Although most would agree that universal healthcare is critically needed, any plan that is to be successful in achieving this goal must first focus on preserving the primary resources utilized in its provision (the physician) while eliminating unnecessary costs associated with profit and administrative costs. This paper will examine the real cost associated with physician salaries, why Medicare for All is not a viable economic solution for the country as a whole or for physicians, and offer ideas and methods already being utilized in successful, developed countries around the world with the goal of creating a universal healthcare plan that can economically and sustainably support everyone.

Real Cost Comparison- Physicians vs. Other Professionals

Although most physicians don’t enter the profession for the money, altruism is inconsistent with economic rationality. People typically behave altruistically because they get some benefit, or utility, from doing so.4 Very few would consider investing staggering amounts of money, energy, and time in order to become a physician who works for free or even a marginal return. In order for the supply of the resource (in this case the physician) to remain sufficient to meet the demands of the healthcare system, the basic rule of rational economic decision-making applies. The marginal utility received (revenue, satisfaction, lifestyle, etc.) from delivering these services must exceed the marginal cost of becoming and remaining a physician. 5

Physicians are considered one of the highest paid professions coming in closely behind investment bankers and entrepreneurs. But like investment bankers this appearance can be grossly misleading. When factoring in the “real cost” associated with becoming a physician; coupled with the utility (revenue and job satisfaction) returned, a very different picture emerges. Real costs include the exertions of all the different kinds of labor that are directly or indirectly involved in making it, together with the time required waiting for saving the capital used in making it.6 This includes the direct cost of education, the lost opportunity costs associated with the time spent in medical school and residency without offsetting revenue, non reimbursed labor costs associated with educational training coupled with reimbursed labor by the hour as a physician who typically expends quite a bit more than a 40 hour work week.

Breaking these costs down into an easy to understand wage per hour summary will give a better understanding of earnings of physicians as compared to other professionals. Multiple studies exist attempting to compare actual realized physician earned dollars/hour with other professions. One wildly liberal comparison showed physicians making about 0.03 cents more per hour then teachers when all factors were considered.7 Although this study was fundamentally flawed due to its vast overestimation of total number of hours worked over a lifetime, it does bring attention and focus to the simple fundamental truth that physicians invest large sums of money, and return considerably more labor than the standard 40 hour week while sacrificing vast opportunity costs before earning a cent. Physicians don’t typically work according to a time clock. Working weekends, and nights and holidays is a common occurrence and many of these hours are not reimbursable as they are spent performing administrative duties, traveling to multiple sites, or simply waiting on procedures or patients to be transferred to the operating room.

The following is a realistic comparison of two professionals’ salaries and average wage/hour estimates projected over a lifetime with retirement set at 65 years of age. Tom and Mary are the same age. Tom decides to become a physician anesthesiologist and Mary chooses to become a nurse. They both begin school at the same time and each will have 43 years to work toward their lifetime-realized income.

They both attend undergraduate school together and each receives Bachelor of Science degrees in chemistry and nursing respectively. Since they both have equitable college loans from undergraduate studies, the comparison will begin as their paths diverge. For ease of comparison, no adjustments have been made to these numbers for cost of living or taxes withheld for either party.

Critical Factors: Graphic 1Following graduation, Mary works as a registered nurse and averages 40 hours a week. The Bureau of Labor Statistics states she will be paid a yearly mean salary of $75,510.00 for 2,080 hours of work /year.8 Upon Mary’s 65 birthday she will have accumulated a lifetime total of 89,440 hours worked and a gross lifetime wage earnings of $3,246,930.00 which equates to an average hourly wage of $36.30.

To continue reading, please download the PDF.

Message in a Minute

Victor Quintero, CRNA- Honored with “Humanitarian Award”

The Year of the Babies!

Excel Anesthesia is Hiring! Join Our “ALL CRNA” Practice!

Excel Anesthesia Corporate Office Headquarters

Excel is hiring qualified CRNAs to join our expanding practice in Kansas and Missouri! CRNAs applying must have at least 2 years experience and be comfortable working in non-medically directed settings and have at minimum a valid Missouri license (preferably both Kansas and Missouri). Currently, we are seeking both FT and Part-Time positions in Kansas and Missouri for our “all CRNA” company. Excel is a well-balanced service provider, providing service at over 16 facilities, and hospitals in the Kansas City and surrounding areas (within a 90-mile radius). Excel Anesthesia has more than 17 years’ experience in the industry. Types of facilities/services range from ophthalmology with the provision of ophthalmic blocks, GI endoscopy centers, several urology centers and multi-specialty centers, three major hospitals as interim locum providers, and ENT, while servicing both pediatric and Adult populations.

CRNAs working for Excel are not required to be proficient in all skill-sets as we are able to closely match CRNAs to the type of patient population and skill-set most comfortably suited.

Full-Time Position- Compensation varies and is depending upon skill level and CRNA flexibility. For more information regarding compensation see post# 169513 on Additional sums may also be negotiated in order to offset provider Malpractice expense. Compensation package is for slightly less than 45 weeks of service, taking into account 6 weeks of scheduled time away and 6 Holidays in which CRNA won’t be providing service. Call is taken from home for one small rural hospital and is negotiable. Complete the following embedded application and submit. Once completed our staff will be notified of your interest and will contact you. You can also E-mail

Part-Time positions are also available.  For more information regarding compensation see Gaswork post by clicking here:
Complete our application online here. Once completed our staff will be notified of your interest and will contact you.  You can also contact us at


“BLING-UP!” While Helping Advance Missouri CRNA Practice!

CRNA Custom Crystal Rhinestone Pin


“Get your bling-on” in the operating room with this beautiful custom-made crystal, rhinestone pin!  This sparkling, “eye- catching, attention- getter” will surely raise the opportunity to  educate your patients as to what CRNAs are and the valuable service we provide. All pins have clear  dazzling stones and are silver plated.  Priced at $79 each plus postage, the proceeds will all be applied to the Missouri Association of Nurse Anesthetist, MoANA PAC fund.  There is a limited quantity available so be sure to get yours while supplies last.  The purchase price is an effort to raise PAC funds and as such are not tax deductible.  Support Missouri CRNAs by purchasing one of these lovely pins today.  We guarantee your satisfaction for 30 days after receipt of your items. We will either correct a problem or refund your money if you are not satisfied within 30 days.

Support Missouri CRNAs by clicking here or you can follow the link at the bottom of the post which will take you directly to the MoANA purchase site.  Both links will function to complete your transaction which will equally fund our MoANA PAC.  Even if you don’t have a Paypal account you can safely purchase with a credit card and order one of these beautiful pins today!  You will be glad you did!

The Missouri Association of Nurse Anesthetists Political Action Committee (MoANA PAC) is a political action committee representing the interests of CRNAs in Missouri. It is a voluntary, nonprofit committee established to elect candidates that will advance MoANA’s legislative program. MoANA PAC is important because it allows CRNAs to speak with one strong voice, reinforcing our “presence” in the state capitol. MoANA PAC is not affiliated with any one political party but supports individual candidates who believe in advancing the CRNA practice and persuade other candidates to hear the voice of the CRNAs.



Missouri Nurses Association Statement on Ebola and Nurse Preparedness Information, Resources, and How You Can Help

Missouri EBOLA PreparednessMissouri Nurses Association Statement on Ebola and Nurse Preparedness

The Missouri Nurses Association (MONA) continues to monitor the global health crisis of Ebola Virus Disease (EVD). We take an active role in addressing the safety needs of our nurses and their patients. As Ebola has spread to the United States, MONA has reached out to the Centers for Disease Control and Prevention (CDC) and the Missouri Department of Health and Senior Services for guidance. MONA will continue to communicate with these agencies, as well as other nursing associations, the Missouri Hospital Association, and the Missouri State Medical Association as the situation progresses.

Ebola Preparedness Survey
“Nurses serve on the front lines of health care, and it is imperative that they and all health care workers be guaranteed safe working environments, including proper personal protective equipment (PPE), current training in safety protocols, and Ebola preparedness,” said MONA CEO Jill Kliethermes, MSN, RN, FNP-BC. “Nurses must feel safe and prepared when dealing with any potential Ebola cases.” To that end, MONA is asking nurses in Missouri to participate in our five-minute Ebola Preparedness Survey to gauge facilities’ levels of training, preparedness and availability of PPE. Your responses will help keep nurses, patients and the public safer by identifying any possible gaps in training and preparedness.

Nurse Safety
Recently, the first case of Ebola in the United States was diagnosed in a man who traveled from West Africa to Dallas, Texas. Sadly, this patient passed away on October 8, 2014. Subsequently, two nurses who were caring for this patient at Texas Health Presbyterian Hospital in Dallas have been diagnosed with Ebola. Officials at the hospital have since acknowledged that a lack of clarity, protocols, and guidance contributed to a critical lapse in safety for these nurses and health care workers.

MONA joins with the American Nurses Association (ANA) in urging the CDC to provide clear standards and guidelines that nurses and health care workers can follow to ensure their safety and the highest quality of care for patients. MONA and ANA urge the CDC to adopt PPE standards that have been demonstrated to provide effective protection for nurses and health care workers in the clinical setting when caring for Ebola patients, such as those used by Doctors Without Borders and Emory University. CDC officials plan to release revised PPE guidelines soon. MONA and the ANA will review these guidelines and provide additional feedback, if necessary.

While we unequivocally believe that nurses are obligated to care for patients in a nondiscriminatory manner, with respect for all individuals, we also recognize that there are limits to the risk of personal harm nurses can be expected to accept as an ethical duty. MONA urges nurses to take our Ebola Preparedness Survey and speak up if they feel their facilities are underprepared to treat any patient. Nurses should have the right to refuse an assignment if they do not feel adequately prepared or do not have the necessary equipment to care for Ebola patients.

MONA joins with the American Nurses Association in urging nurses to review infectious disease guidelines and checklists to ensure they understand Ebola, how it is transmitted, and what precautions are necessary to protect themselves, their patients, and the public.

A multitude of resources are available from the Centers for Disease Control and Prevention and other health care organizations:
CDC: Ebola – Information for Healthcare Workers and Settings
CDC Webinar: Preparing for Ebola: What US Hospitals Can Learn from Emory Healthcare and Nebraska Medical Center
ANA: Ebola Information
ANA: News Release on Ebola
Public Health Emergency (PHE) Webinar: Ebola Preparedness for the US Healthcare System
National Institute for Occupational Safety and Health (NIOSH): Ebola Information
World Health Organization: Ebola: Protective Measures for Medical Staff

This current health crisis is of grave concern to MONA and a top priority for all of us, but we must remain calm. Through education, training, and preparedness we can manage EVD. MONA urges all nurses to avail themselves of informational resources and take our Ebola Preparedness Survey to help our state meet this challenge effectively and safely.


Stuber Post

Missouri Nurses demonstrated how personal party affiliation can be set aside in this year’s mid-term election.  Both Republican and Democrat nurses came together last night in support of Dr. Robert (Bob) Stuber.  They, better than anyone, know that it is not about the party this year; instead it is about the critical issues affecting the healthcare and safety of our citizens.

Last night many volunteers participated in a phone bank in support for Dr. Robert (Bob) Stuber as the candidate to elect for Missouri Senate district 34.  This district includes both Buchanan and Platte counties of which Parkville, Platte City, and St. Joseph Missouri are located.  There was an amazingly strong turn-out of nurses holding advanced degrees, volunteering their time in making calls to constituents of the 34th district; and it’s no wonder considering Dr. Bob is a strong advocate of the nursing profession.  He understands the need for Missouri to offer qualified heath care providers to our citizens.  He knows first-hand how poorly Missouri ranks (47th compared to other states in the nation) in its ability to get access to care to its rural population and is willing to do something about it. Read more

ROB SCHAAF- Holding Missouri Hostage

Missouri Needs Access To Care

Posted by Jean Covillo

October 10, 2014


Nearly 300,000 working MISSOURI adults will spend another year locked out of access to affordable health care because their income level places them in a coverage gap. WHY?
Because two men are obstructing the path to Medicaid Expansion and holding Missouri Hostage!

Missouri had a path to Medicaid expansion this year. The governor and the state’s leading business groups wanted it. All of the legislature’s Democrats and a growing number of Republicans supported it. Read more

Excel Anesthesia Proudly Announces The Wedding of Jenny West


Mr. and Mrs. Chris Frazier


Jean Covillo, Managing Member, Jenny Frazier, Scheduling Coordinator, Karen Parker, Senior Partner


Mr. and Mrs. Chris Frazier

Excel Anesthesia is proud to announce a name change within the organizational staff.  Jenny West, scheduling coordinator was recently wed October 4, 2014 in a beautiful fall, outdoor wedding held at Gallagher Barn in Bonner Springs, Kansas.  The weather could not have been more perfect.  The venue was amazing, with beautifully allocated seating outdoors for the ceremony followed by a reception held indoors in a warm, festively decorated barn complete with twinkling lights festooning its antique wood beams and tables heavily laden with savory cuisine.  Both Jenny and Chris will be honeymooning over the next week in Mexico.  Warmest Wishes and Congratulations to the couple from Excel Anesthesia.