Anesthesiologists Only

[gasattack3]

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So, we often hear about AMC's coming in and low-balling PP groups, and offering some type of "value proposition".

What about an all MD/DO group, say of 15-20 anesthesiologists, coming in and taking over a flailing ACT model at some smaller to medium sized hospital system? Say an ACT model of lesser quality MD's "supervising" a bunch of malignant CRNA's whom basically have NEAR full autonomy in the day to day practice of anesthesia.

I KNOW these outfits exist. What about a group of younger (or not), hungry, and perhaps fed up, anesthesiologists coming in and offering a value proposition, which would likely include some level of compromise such as more call, longer hours, and less pay (the value proposition has to come from somewhere.......)?

This hospital system would benefit from an all physician group, and they could advertise as such. Billboards could read "at St. Joseph's, 100% of our anesthesia services are performed by physician anesthesiologists" or "Ask your surgeon if a nurse will be providing your anesthesia or a physician anesthesiologist" or "at St. Vincent's we feel you deserve the best anesthesia care available. Ask about our 100% physician run anesthesiology department".

Would YOU sign on to such an endeavor? Maybe the trade off would be greater autonomy in day to day practice, less CRNA headaches, more control of your destiny?

If you were debt free, would you work in such an environment for $300K??
How about 250K? 350K? I know it would depend on hours, call, and ultimate responsibility. Details would need to be worked out, but I'm sure that some of the trade offs would/could be coupled with some very real intrinsic rewards. This "system" would necessitate hard working, service oriented, people.

But, to how many of you does this CONCEPT reasonate?

 

[IlDestriero]

When the hospital/surgeons is/are unhappy with the AMC "quality" care and headaches, low morale, etc. and is open to change you don't have to sell yourself short. Demand premium compensation for premium service. They've just seen cut rate service, and they don't like it.
There is great opportunity right now to capitalize on this. The pendulum can swing back, you just need some intel on what groups are a bunch of fick ups.

 

[gasattack3]

When the hospital/surgeons is/are unhappy with the AMC "quality" care and headaches, low morale, etc. and is open to change you don't have to sell yourself short. Demand premium compensation for premium service. They've just seen cut rate service, and they don't like it.
There is great opportunity right now to capitalize on this. The pendulum can swing back, you just need some intel on what groups are a bunch of fick ups.

Yep, I agree. You present an alternative to administration and they may bite.

Unfortunately, there are too many clowns in our field and these are the people whom are a big part of the problem. The lazy as.es who let their CRNA's whom they supposedly "supervise" do the epidurals when it's 2 a.m. and they don't want to leave the call room.

Also, these losers have long since lost the respect of the surgeons, so they won't likely be able to claim any sort of real support from the surgical community.

I just had an attending tell me about some "intel" she had on a group in our state which fits this bill. Allowing near total autonomy of their CRNA's, while continuing (for now but this IS going to change) to claim that they are needed by the CRNA's to supervise, thus justifying a minimum of $100k in premium compensation. This will not last. And these greedy sell outs to our profession are a major reason the AANA is doing everything they can to eliminate supervision from impeding their "practice". After all, how could CRNA's under this level of MD involvement think any other way?

My attending, a very experienced, very hard working, and phenomenal cardiac and transplant anesthesiologist with both academic and PP experience actually described it this way "they make a lot of money but basically they practice "side by side"with the CRNA's and do the same things".

Once again, we've been our own worst enemies.

Back to the original topic, I can envision getting together with a group of like-minded colleagues (after a few years experience in PP) and seeing about going after some vulnerable, flaky group like that. They will deserve what's coming to them. And it would feel just as good telling the CRNA's to take a hike.

 

[RussianJoo]

I would jump at a chance to join a group like that. Not only would it make work fun again and serve to make a point but also, I would be coming in at the very beginning with lots of financial potential. I graduate in 2 years and will hopefully be doing a cardiothoracic fellowship.

 

[urge]

You would need a bunch of anestesiologists to quit their jobs to start this new venture. You could think of all your unemployed ca3 buddies but you will want experienced people to begin.

What is it that you offer that the AMC doesn't? There are physician only AMC groups.

 

[sevo85288]

Absolutely possible. Get some basic business education (ideally an MBA) and have a group of like minded individuals and you can go a long way. This is a good place to start.

 

[Mman]

So, we often hear about AMC's coming in and low-balling PP groups, and offering some type of "value proposition".

What about an all MD/DO group, say of 15-20 anesthesiologists, coming in and taking over a flailing ACT model at some smaller to medium sized hospital system? Say an ACT model of lesser quality MD's "supervising" a bunch of malignant CRNA's whom basically have NEAR full autonomy in the day to day practice of anesthesia.

I KNOW these outfits exist. What about a group of younger (or not), hungry, and perhaps fed up, anesthesiologists coming in and offering a value proposition, which would likely include some level of compromise such as more call, longer hours, and less pay (the value proposition has to come from somewhere.......)?

This hospital system would benefit from an all physician group, and they could advertise as such. Billboards could read "at St. Joseph's, 100% of our anesthesia services are performed by physician anesthesiologists" or "Ask your surgeon if a nurse will be providing your anesthesia or a physician anesthesiologist" or "at St. Vincent's we feel you deserve the best anesthesia care available. Ask about our 100% physician run anesthesiology department".

Would YOU sign on to such an endeavor? Maybe the trade off would be greater autonomy in day to day practice, less CRNA headaches, more control of your destiny?

If you were debt free, would you work in such an environment for $300K??
How about 250K? 350K? I know it would depend on hours, call, and ultimate responsibility. Details would need to be worked out, but I'm sure that some of the trade offs would/could be coupled with some very real intrinsic rewards. This "system" would necessitate hard working, service oriented, people.

But, to how many of you does this CONCEPT reasonate?

1) you'd need to have some kind of objective evidence it was a horrible group

2) you'd need to be able to offer some objective improvements you'd make that benefit the hospital

3) you'd need to know when their contract was due for renegotiation. It doesn't do you any good (regardless of how true the first two things are) if they just signed a new 5 year exclusive contract for anesthesia services

 

[gasattack3]

1) you'd need to have some kind of objective evidence it was a horrible group

2) you'd need to be able to offer some objective improvements you'd make that benefit the hospital

3) you'd need to know when their contract was due for renegotiation. It doesn't do you any good (regardless of how true the first two things are) if they just signed a new 5 year exclusive contract for anesthesia services

Yeah, intel would be very important.

Urge, I realize there are MD only AMC's (I'll take your word for it), my area is exclusively (as far as I know) ACT model, with CRNA's working borderline independently in areas that I would not go so far as to call truly rural.

I agree we'd need to offer some objective improvements. This would need to be worked out. Also, I emphasize that we'd need an all-star group of anesthesiologists, but they do exist.

 

[Mman]

Yeah, intel would be very important.

Urge, I realize there are MD only AMC's (I'll take your word for it), my area is exclusively (as far as I know) ACT model, with CRNA's working borderline independently in areas that I would not go so far as to call truly rural.

I agree we'd need to offer some objective improvements. This would need to be worked out. Also, I emphasize that we'd need an all-star group of anesthesiologists, but they do exist.

The problem is you need a large number of anesthesiologists who are all without jobs or who can all quit at exactly the same time and start somewhere new. Taking over a contract is a big deal and an enormous hassle.

Realistically you'd need a large sum of cash to start with and pay locums to start it off on a given day. Then gradually replace the locums with permanent hires over time. Because it's not like you can just round up 20 or 40 MDs to all quit their jobs and be able to start on January 1 at a new job in likely a new state (if not at least new city). Quitting a job and finding housing all takes time. Add in the hassle of finding malpractice insurance as a brand new entity, taking the hit of not getting paid for months, working out the kinks of how you are going to bill/collect,going through the credentialing process for each new physician, etc. It's not something that lends itself to starting from scratch.

That's why when takeovers happen, it's almost always a big corporation that is doing the taking over. They've already got the cash and they've already got a pipeline of locum MDs that they can stick in a hospital on short notice to have their ORs running.

I wouldn't even begin to know a good way to try to steal a contract from another group in another city. It would be expensive and painful and there is no way around that.

 

[pgg]

Realistically you'd need a large sum of cash to start with and pay locums to start it off on a given day.

Which is probably exactly what the AMC was doing in the first place. Paying a bunch of locums to fill holes. Hospital administrators who hire AMCs are *****s, but they're not so stupid that they won't notice your plan to swoop in with a bunch of different locums guys. Your AMC is better than their AMC ... how exactly?



About the only scenario I can imagine this working is if you have an existing group of anesthesiologists, and they get abruptly underbid by an AMC and lose their contract. Now you suddenly have a bunch of unemployed anesthesiologists who already have some structure in place, group malpractice, billing, etc. Even so, convincing everyone to pick up and relocate like a swarm of pissed off bees to go return the favor to another AMC in another location is a tall order.

 

[gasattack3]

Which is probably exactly what the AMC was doing in the first place. Paying a bunch of locums to fill holes. Hospital administrators who hire AMCs are *****s, but they're not so stupid that they won't notice your plan to swoop in with a bunch of different locums guys. Your AMC is better than their AMC ... how exactly?



About the only scenario I can imagine this working is if you have an existing group of anesthesiologists, and they get abruptly underbid by an AMC and lose their contract. Now you suddenly have a bunch of unemployed anesthesiologists who already have some structure in place, group malpractice, billing, etc. Even so, convincing everyone to pick up and relocate like a swarm of pissed off bees to go return the favor to another AMC in another location is a tall order.

I think this could only work at a smaller to medium sized hospital. I think the difference is that, ideally, you would have folks ready to go if you could pull the contract. People willing to work hard and smart, with a strong emphasis on service who want to be a part of something, and work to build a business. Not sayin Locums people don't work hard but having people lined up with a stake in the game would be best.

I know this would be hard to do, but it could be fun. Making a nice opportunity for some people willing to work for it and sending some chumps sailing with their CRNAs. This opportunity is contingent upon a group whom has indeed gotten fat and lazy while letting their CRNA's (with their nursing attitude) virtually run the show. Claiming superiority during the day, but through their actions, sending a different message while their CRNA's take all the first call in-house and covering nights and weekends. These groups DO exist and I'm certain that administration is just waiting for the right opportunity to do something about it. Again, these hypothetical's will have long since lost their support from the surgeons. Probably the surgeons even resent them, along with administration.