SAUSALITO, CA (ASRN.ORG) -- Despite the growing shortage of family doctors in the United States, medical centers last year offered higher salaries and incentives to specialist nurses than to primary care doctors, according to an annual survey of physicians' salaries.

Primary care doctors were offered an average base salary of $173,000 in 2009 compared to an average base salary of $189,000 offered to certified nurse anesthetists, or CRNAs, according to the latest numbers from Merritt Hawkins & Associates, a physician recruiting and consulting firm.

And the firm's projections for 2010 indicate that the average base salary for family physicians will be about $178,000 compared to $186,000 for CRNAs.

CRNAs are advanced practice nurses who administer anesthesia to patients. An important distinction between CRNAs and anesthesiologists is that when anesthesia is administered by a nurse anesthetist, it is still recognized as the practice of nursing rather than a practice of medicine.

"It's the fourth year in a row that CRNAs were recruited at a higher pay than a family doctor," said Kurt Mosley, staffing expert with Merritt Hawkins & Associates.

CRNA salaries have trended higher as the number of surgical procedures picked up pace over the past few years, fueling demand for anesthesiologists and anesthetists. Anesthesiologists' average salary is $344,000, according to Merritt Hawkins.

Mosley said medical doctors and specialists, including anesthesiologists, typically have four to five years more of medical training than CRNAs. After spending a lot of time speaking with physicians around the country, he said many family doctors are starting to feel like "second-class citizens."

This type of income disparity "won't make them feel better," he said. Most primary care doctors say they're already struggling to make ends meet as their costs rise faster than what Medicare and private insurers are paying them .

Looking at these compensation trends, the biggest concern for the nation's health care system is how to encourage more medical students to pick primary care as their specialty at a time when the nation is already facing a shortage of about 60,000 primary care doctors.

"The demand for primary care doctors will increase twofold when health reform happens and millions of more Americans have access to health care," said Mosley. "Who is going to triage these patients? It's not the neurologist or pulmonologist. It has to be the primary care doctor."

The American Association of Nurse Anesthetists (AANA), in comments subsequent to the original publication of this story, disputed the Merritt Hawkins figures. The group says the average nurse anesthetist salary is closer to $158,000, based on its own data collected from 10,000 of its 40,000 members.

"The Merritt Hawkins estimate is inflated because often when hospitals reach the point where they're willing to hire a recruiting firm, they've exhausted all other means to fill a position," said Lisa Thiemann, senior director of professional practice for the AANA and a CRNA for 14 years.

The association also said comparing its members to family practice physicians is not appropriate, since they provide different services, and that a fairer comparison is to anesthesiologists, who make much more.

"We deliver anesthesia to our patients and keep them safe and comfortable during surgery, and working with or without anesthesiologists we enable hospitals to keep their ORs functioning smoothly," Thiemann said. "From our perspective, we are fairly compensated for the level of responsibility we shoulder."

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