hospital vs. private practice?

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prominence

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What are the pros and cons of working as an anesthesiologist in a hospital vs. in private practice?

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Originally posted by prominence
What are the pros and cons of working as an anesthesiologist in a hospital vs. in private practice?

Anesthesiologists, and most doctors don't work in or for hospitals, for the the most part. Anesthesiologists form groups, that vary in size from 5 to 20 in my experience. The group then contracts with hospitals to provide services to that hospital. The hospital does not pay the group, they charge insurance separately for their services.

A given group will usually contract with more than one facility if they are large enough, for example one group ma contract with one community hospital, and 2 surgi centers, and a pain clinic. When you choose to join a group you need to look at what hospitals they provide services to and decide if that is the kind of work you want to do. For example, if you go to work for a group that only works at out patient surgi centers you will probably not have to work weekends, but will not get as challenging cases, and little variety. This will vary from group to group and area to area.
 
At one of our hospitals, the anesthesiologists are hired by the hospital - they agree that for them this is a good set up. They don't have to worry about maintaining a practice, negotiating OR space, dealing with the more mundane aspects of running a practice. Having said that, they also have little say with the running of the department, as one in their own practice does.

As far as remuneration, they get $28 per billable unit (I hear this is on the low end) - Say for example, they do a 45 minute hernia repair, that has a 4 unit reimbursement for induction and 1 unit for each 15 minutes, giving a total of 7 units or ~$200 for the operation. They can easily do 6 in the OR in a day and many times it is far more than this (I'm trying to keep it simple) - thus around ~1200 per day, or 6K per week and 300k per year. Clearly not a bad set up for working for the anesthesiologist or hospital.

Airborne
 
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Originally posted by Airborne
At one of our hospitals, the anesthesiologists are hired by the hospital - they agree that for them this is a good set up. They don't have to worry about maintaining a practice, negotiating OR space, dealing with the more mundane aspects of running a practice. Having said that, they also have little say with the running of the department, as one in their own practice does.

As far as remuneration, they get $28 per billable unit (I hear this is on the low end) - Say for example, they do a 45 minute hernia repair, that has a 4 unit reimbursement for induction and 1 unit for each 15 minutes, giving a total of 7 units or ~$200 for the operation. They can easily do 6 in the OR in a day and many times it is far more than this (I'm trying to keep it simple) - thus around ~1200 per day, or 6K per week and 300k per year. Clearly not a bad set up for working for the anesthesiologist or hospital.

Airborne


Is this an acedemic hospital airborne? Most of the anesthesiologists that are salaried workers, that i have heard of are at acedemic hospitals. Some times they are an acedmic department themselves and sometimes there is just an acedemic surgery department.
 
i have a question regarding an anesthesiologist who works in a hospital.

there are several deaprtments that require anesthesia for treatment (i.e. OB-GYN, surgery, etc.) is there a separate anesthesiologist for each of these departments, or does a single anesthesiolgist rotate in each of these departments?
 
Again, that varies from group to group. Some will have you rotating through them all, and at others you stick to one area. Sometimes groups will look for people with expertise in an area, like ob, or cardiac, and have them do mostly that.

If you are an acedemic, well they usually have fellowship training and stick to their field.
 
There is a huge advantage of going with a hospital (hired by the hospital). First of all, many private practice groups are crooked!! The contracts and offers are made with the group's best interest and not yours. Groups have a buy-in either as a considerable lower salary for several years before partnership, or an actual purchase of shares. Lastly, some groups can lose their contract with the hospital, fall apart, or drop you several weeks before you make partner. You know, just because a partner is making X amount of money now does not mean you will make X amount when you become a partner. Groups change and reimbursements change even faster. Many established groups have collapsed or have had drastic changes in their incomes.

With a hospital (non-academic), you are usually dealing with an establish employee contract (used by all of the employees of the hospital), there are no buy-ins, and they are usually trustworthy. The other advantage is that you do not have to worry about your patient's insurance. The hospital will do the billing and pay you a guaranteed salary regardless.
 
Originally posted by residentphysici
With a hospital (non-academic), you are usually dealing with an establish employee contract (used by all of the employees of the hospital), there are no buy-ins, and they are usually trustworthy. The other advantage is that you do not have to worry about your patient's insurance. The hospital will do the billing and pay you a guaranteed salary regardless.

Its true that there are crooked groups out there, but their are also crooked hospitals. If a group makes a deal that is best for the group, you can be sure the hospital is trying to do the same. Hospitals can fall apart and have huge finacial problems as well.

Typically if a hospital had salaried employes, the only sectors making a net profit for the hospital are certain surgical divisions, radiology, and anesthesiology. Medicine and peds departments in some hospitals (private and acedemic) have been in the red for 20 years. Thus anesthesiology, surgury and other money making departments support the rest. For this reason many surgical and radiology departments are pulling away from hospitals, so they don't have to support the dead weight off these other departments.

You seem to have heard differently, but most doctors I have spoken to think it asking to be screwed to work for hospital. Anesthesiologists have told me to do my best to find a large stable group out there, and that will be best kind of working environment. Some even own or part own surgi-centers these days, and those groups are gold mines. In this job market, it will be harder for a group to screw anyone because they need people desparately. Maybe the people you have talked to are remembering the days when there was an oversupply of Anesthesiologists, and new graduates were being screwed left and right, being forced to work for CRNA salaries and not being offered partnerships. Alot of those groups are paying for their behavior now, they got a bad rep, and now have to pay through the nose to hire people.
 
Actually everything I've discussed is from personal experience from close to a year in interviewing for anesthesiology practice opportunities. I took a hospital practice after speaking to about 20 private practice offers from around the country including 2 groups with over 70 anesthesiologists and talking to several recruiting firms. Plus, I spent the past 2 years speaking to the past 50 graduates of my program. All of the information I provided are based on the discussions I've had and my personal experiences. In terms of large groups that have collapsed or have done crooked things, just look in Little Rock, Tulsa, DC, Las Vegas, NY, Richmond, and several other places. Even with the shortage, there are still crooked groups. You are right, hospitals can do the same thing, but I have found it too common that the groups could not be trusted. Email me personally and I can give you the proof.
 
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