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Explore the intersection of business and medicine in private anesthesia practice. Learn how competition drives improvement, the importance of customer service in healthcare, and how to succeed in a competitive market.
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Private practice– your next adventure Tom Archer, MD, MBA UCSD Anesthesia
Competition Implies That the Customer is Free to Choose Between Competing Alternatives
Competition • Aren’t we doctors above that? • Doesn’t competition lead to haste and errors? • Isn’t competition grubby? • Shouldn’t the public just trust us to do the right thing?
Competition • A fact of life in private medicine. • You are competing with other anesthesia groups and with other anesthesiologists in your own group. • The challenge is to maintain a high level of service without compromising safety. • Whether you like it or not, personal relations are every bit as important as technical or “medical” skill. • The 3 “ables” of the anesthesiologist: Available, Affable, Able.
Arrogance or Apathy– Not an Option • You will be expected to be a “team player.” • If you are apathetic or unresponsive… • Your customers will take their business elsewhere.
The Patient as Customer • Patients are more demanding than 30 years ago. • Scrutiny of medical practice (by everyone) has intensified. • Physician is still a respected authority figure, but… • Physician must realize that she has to please customers and is part of a team. • The days of prima donnas are over.
Are We In Business?Or Are We Practicing Medicine? • Isn’t business all about money? • Doesn’t business subordinate quality, ethics and patient care to the Almighty Dollar?
Are we in business?Or practicing medicine? • Is there a conflict between business and medicine? • NO! • Good medicine implies good business, and vice versa.
The business of medicine • Efficiency, quality and customer service never go out of style.
The Business of Medicine • In a competitive health care environment, providers will give the best care they can at the lowest price. • Competition fosters improvement and innovation. • State health care monopolies foster slow, inefficient and bureaucratic care. • Academic medicine frequently lacks incentives for production (monopolistic mind-set).
Good doctors and good business people: • Give the best customer service they can (technical care, bedside manner, punctuality, courtesy). • Don’t waste time or resources. • Know their customer’s needs and wants. • Know how to work in teams.
Service and safety issues • Safety Issues are sacrosanct and must not be compromised. • Service issues (start times, cases on Saturday and Sunday, after midnight, etc.) are negotiable. • You need to clearly understand the difference. • Monopolies (us?) often camouflage a desire to avoid service as a safety issue.
Customers and the Golden Rule • Modern business philosophy: patients, family, surgeons, nurses, administration, technicians– these people are all our CUSTOMERS. • This is really a restatement of the GOLDEN RULE: • Treat your customers– your fellow human beings-- with respect and with consideration for their aspirations, needs and fears .
Private practice– what will it be like? • Possible contrasts with academic medical centers: • Faster pace (no one is in training). • Great emphasis on good interpersonal relations (being nice) and consistent, good results. No rewards for originality or extra frills. • Emphasis on collegiality rather than conflict (everyone’s earnings depend on everyone’s actions). • Pay is based on cases performed– not on salary.
Anesthesia Groups • Look at more than just: • Types of cases and how much money you will earn. • Work hours, call schedule, vacations and CRNAs supervised.
Your Job is to Get Behind the Window- Dressing and Find Out What the Group is Really Like.
Anesthesia Group Culture • Some groups are healthy and promote the happiness and prosperity of their members. • Other groups are dysfunctional and full of psychopathology.
What Does Your Gut Say? • Do people seem happy? • Do group members seem to like one another? Or do they gossip with a newcomer like you? • Do members appear over-worked, unhappy, and yet greedy for more cases?
Are New Group Members Treated Barbarically? • They get poorly paying cases. • More nights and weekends. • Buy-ins are excessive. • Many new hires don’t make partner. They get booted out before they become eligible for partnership.
How are the MDs compensated? • What is the incentive structure? • What behaviors are rewarded? • What behaviors are penalized?
Straight Salary • You get paid the same whether you do a lot of cases or not. • More common in academic settings. • Does NOT reward production or efficiency. • Disadvantage: slackers can slack off. • Big advantage: allows time for teaching, research, innovation and careful, methodical care.
“Eat What You Kill” (Type 1) • “Fee for Service” from individual patient. • You receive specific collections from patients whom you anesthetize. • If you have indigent patients, you earn ZERO! • If you have all insured patients, you earn mega-bucks. • FTC: Price-fixing via sham corporation? • Fraught with abuse potential– schedule manipulation, etc.
“Eat What You Kill” (Type 2) • “Fee for Service” (Based on Group Average Unit). • Money is pooled for entire group. Your month’s income = Group’s Total Collections X (Your Units / Total Group’s Units)
“Eat What You Kill” (Type 2) • In my opinion, EWYK Type 2 is the best system for private practice. • This system rewards work and efficiency and ignores payer mix. • Schedule manipulation and lies just stop.
Do You Hear About Conflicts Over Anesthesia Service? • Do surgeons want more night and weekend coverage than group wants to provide? • Do the anesthesiologists have a “can-do” service orientation? • Does the group work with nursing and administration to provide service as a team? • Or does the group blame nursing or other hospital employees for inadequate service?
Who runs the group? • A group of old cronies, in a murky and capricious manner? Or… • An elected Board of Directors?
How does the medical community view the anesthesia group? • As money-grubbing technicians? Or… • As team players?
Is the “group” really a group, with a clear business purpose? • Yes, the group takes care of all the patients in an efficient and compassionate manner. • No, the so-called group is a loveless marriage of convenience between competing individuals.
A Good Anesthesia Group • Healthy, happy individuals, who enjoy caring for their patients. • Internally, the group functions as an anesthesia team, with a clear business purpose. • Minimal to no schedule manipulation, cheating and lying.
A Good Anesthesia Group • Externally, the group works constructively with nursing and hospital administration to provide care as a hospital-based team.
A Good Anesthesia Group • The compensation structure aligns individual incentives with business goals. • Best system is income pooling with individual compensation proportional to services provided. • Individuals who participate on Medical Staff and hospital committees are respected and rewarded.
The New Member (You) • Well trained. • Knowledgeable. • Eager.
Advice for the new member: • Be humble– there’s more than one way to skin a cat. • Ask lots of questions– and learn! • Try to understand why they do what they do– it MAY make sense! (Or it may not!) • Ask the established and respected practitioners how they would do things.
One Final Note • Try really hard to be respectful, pleasant and courteous to EVERYONE. • I am VERY serious about this and this is VERY important. • Arrogance and being a jerk is our most common mistake. • This point has nothing to do with your “technical” care, but it has everything to do with your success in your new work environment.
