Evaluating An Anesthesia Practice Checklist

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Caninehalitosis

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This checklist is old but still relevant. I am posting since residents don't get much guidance in what to look for in an anesthesia practice.


A CHECKLIST FOR PRIVATE PRACTICE OPPORTUNITIES IN ANESTHESIOLOGY
Frank E. Block, Jr., M.D. 2 November, 1992
I. ORGANIZATION
A. Structure of the group:
1. Solo private practice "fee for service"?
2. Loose association?
3. Partnership?
4. Professional corporation (P.C.)?
a) One large P.C.
b) One large P.C. with individual P.C.'s
c) HMO or clinic or joint surgery/anesthesiology group
5. employee of person or group under contract with hospital.
6. Hospital salaried?
7. Federal/state/county/city employment?
8. Academic?
a) Straight full-time - University employee
b) Geographic full-time - just located at University
c) Private practice within academic department
9. Combination arrangement?
B. The hospital(s) and clinic(s) etc.
1. How many hospitals in area?
2. Ownership and control?
3. Number of beds? Number of surgical beds?
4. Kinds of patients?
5. More beds or hospitals in the future?
C. The department and personnel:
1. Anesthesiologists:a.
a) How many anesthesiologists are there?· How many will the system support?
b) How many anesthesiology groups co-exist within the hospital and/or system? Are they in friendly or unfriendly
competition?
c) Is there open, semi-open or closed medical staff?
d) What are the credentials of the other anesthesiologists? Board certified? Board eligible? Would you let them
anesthetize you or your family?
2. Persons who administer anesthesia other than staff anesthesiologists:
a) Residents?
(1) How many?
(2) What are their credentials?
(3) How is the residency organized?
b) CRNA's:
(1) How many?
(2) For whom do they work? Hospital, Anes. group(s),CRNA corp.?
(3) Who hires them and fires them?
(4) What are their credentials? Are they good, bad, indifferent? Would you let them anesthetize you or
your family?
c) Non-certified nurse anesthetists? (same questions as for CRNA's)
d) CRNA students? (same questions as for CRNA's)
e) Physician's Assistants? (same questions as for CRNA's)
3. Ancillary personnel:
a) Technical personnel (IV and monitoring lines, etc.)? For whom do they work? Hours? Call?
b) Equipment personnel (getting supplies, clean-up)? For whom do they work? Hours? Call?
c) Repair personnel (monitors, gas machines)? For whom do they work? Hours? Call?
d) Office and secretarial personnel? For whom do they work? Hours?
II. THE DAY TO DAY WORK
A. Operating Room
1. How many OR's are there? Lithotripsy? MRI? ECT's? "Outside" OR's? Endoscopy rooms? Cardioversions?
Burn Unit
2. Official starting time, stopping time?
a) Is there a time after which elective cases arenot started?
b) How many rooms are going at 1200, 1500, 1800, etc.
c) Is there an elective schedule on Saturday or Sunday?
3. What kinds of surgery are done? (Note: Ask to see the OR schedule for the last few weeks! This will clarify
kinds of cases there are, how long the rooms run, who is doing what cases, etc.)
a) Cardiac, vascular, neuro, peds, neonatal?
b) MAC's (local/stand-bys)? What percent?
c) Abortions? Sex-change operations?
d) Harvesting ova for in-vitro fertilization? GIFTs? etc Can individuals refuse to provide anesthesia for
certain kinds of procedures? Are they subjected to hassles and ridicule for
doing so?
4. How competent are the surgeons? Would you let them operate on you or your family?
5. How easy are the surgeons to work with?
6. Is background music played or allowed in the OR?
a) Who controls it?
b) What kind of music is played?
B. POSTING/BOOKING
1. how are surgical cases posted? Who controls the booking?
2. How are cases assigned to anesthesiologists?
a) Who assigns them?
b) Do certain people or groups get all the hearts, pediatrics, etc.?
c) Is there equal rotation of choice of cases?
3. What OR areas/hospitals/surgeons are covered by
What anesthesiologists?
4. When are cases assigned (night before or in the AM)?
5. What is a typical day's schedule for each anesthesiologist?
a) Average arrival and departure time from hospital?
C. Administration of anesthesia:
1. Does the anesthesiologist do own cases all the time?
a) some of the time?
b) Difference between elective and emergency cases?
2. Supervision of how many rooms?
a) Typical number of rooms?
b) Maximum numbers of rooms in extreme circumstances?
3. Are private, Medicare, Medicaid, Workman's Comp, and non-pay patients treated differently?
4. Are non-pay patients divided evenly among the anesthesiologists?
5. How does coverage change if anesthesia personnel are sick or on vacation?
D. Preops and cross-coverage
1. Pre Ops
a) Are preops seen by call person? Are there"preop-seers"?
b) By CRNA's? By CRNA students? By residents?
c) By anesthesiologist who does the case?
d) What about Sunday preops? Who reviews charts for ambulatory surgery and same-day admit patients, and
when?
2. Do anesthesiologists cross-cover (coffee break/lunch, end of day)
E. Other areas
1. OB
a) How many deliveries per year?
b) What percentage of patients are high-risk?
c) What percentage of patients have C-sections? What percent of C-sections are general? Spinal? Epidural?
d) What is the policy on epidurals for labor? Permitted? Required? "Forbidden"?
(1) Who puts them in?
(2) Who follows and tops up or adjusts the pump?
(3) Can anesthesiologists refuse to provide epidurals for routine labor?
2. ICU
a) How much anesthesiology input is there?
b) Do all anesthesiologists participate?
3. Pain consults or pain clinic?
a) How much pain work is there?
b) Do all anesthesiologists participate?
4. Separate ambulatory surgery area?
a) How many rooms?
b) Do all anesthesiologists rotate there?
c) Early out times?
5. Private surgeons' offices?
a) How scheduled, etc.?
III. ANESTHESIA EQUIPMENT AND SUPPLIES
A. What make, model, age of:
1. Anesthesia machines?
2. Ventilators?
3. EKG monitors?
4. Invasive pressure monitors?
5. Non-invasive BP machines?
6. Temperature monitors?
7. Pulse oximeters?
8. 02 analyzers?
9. Capnographs?
10. Mass spec. / Agent monitors?
11. Nerve stimulators?
12. Fiberoptic scopes and other intubation aids?
B. Who owns the anesthesia equipment listed above?
1. Who purchases equipment?
2. Who repairs broken equipment?
C. Who restocks & cleans anesthesia equipment between cases? Who brings needed items to the room during a
case?
D. Who purchases anesthesia drugs? How are controlled drugs handled? How are controlled drugs obtained
during a case?
IV. CALL RESPONSIBILITIES
A. What people or groups cover what kinds of night cases?
1. How many people take call?
2. Do all anesthesiologists take call?
3. Do all anesthesiologists take equal call?
4. Do CRNA's or others take call?
B. How is the call schedule made?
1. When is the call schedule made?
2. Is there a regular cycle of call?
3. Who makes out the call schedule?
4. Are call/no call requests accepted?
5. Do certain anesthesiologists have priority for call requests?
C. Call days
1. How long is call? One day? Whole weekend? A week at a time?
2. Do you get the day off before call? After call?
3. Do you get out early after a night on call?
4. When does call start? Stop?
5. How are weekends covered? Who sees preops for Monday?
D. Is call from home or hospital? Are you required to live within a certain distance or driving time of the hospital?
E. What happens on a typical night on call?
F. Is there a second call?
1. What if a second case needs to be done?
2. How often does the second call person have to come in?
G. How does call coverage change when someone is on vacation?
H. How does call coverage change when someone is sick?
V. Benefits
A. Vacation
1. How much per year?
2. How soon may it be taken?
3. May it be taken before it is "earned"?
4. How much may be taken at once?
5. How much can you accumulate?
6. How many people can be gone at once?
7. How is vacation time scheduled?· Automatic? First come, first served? Priority?
8. Does anesthesia group maintain a vacation house or other vacation or exercise facilities for employees?
B. Continuing medical education and professional meetings
1. Are there local meetings or conferences on anesthesiology?
2. How many meeting days per year? Additional time or part of vacation?
3. How is it determined who attends specific meetings? (Will you ever get to go to the ASA?)
a) Priority?
b) Who makes the decisions?
4. Does group pay for meetings? Dollar limit?
C. Allowances and professional fringe benefits
1. Professional society dues?
a) County, state, national medical association dues?
b) Anesthesiology societies?
c) Others?
d) Medical staff fees, etc.
2. Allowance for professional journals?
3. Book allowance?
4. Is there a group anesthesia library? Does the hospital library contain an anesthesia section?
5. Anesthesia office space:
a) In hospital?
b) Outside?
c) Secretarial services available?
6. Automobile allowance or leasing?
D. Insurance
1. Malpractice?
a) Dollar limits?s
b) size of claims in area?
c) Claims made or occurrence? If claims made, who must buy the tail when someone leaves
d) Does hospital require malpractice insurance?
2. Life?
a) Is it required that you be insurable at standard rates?
b) How much?
c) Term or whole-life?
d) Group or individual plan?
e) Can you take it with your when you leave?
3. Sick leave and disability insurance?
a) How long does your salary continue if you are sick or become disabled?
b) Are sick days counted?
(1) How many per year?
(2) How many can you accumulate?
c) Who pays for disability insurance?
(1) Is it required that you be insurable at standard rates?
(2) What is the monthly amount (or %) of disability insurance?
(3) How long is the waiting period? (Should relate to "a." above.)
(4) How is "disability" defined? Practice your profession or perform any occupation?
(5) What is the maximum period to receive payments?
(6) Can you take it with you when you leave?
(7) Is disability insurance taxable to you or not? (Probably you want it to be Non TAXABLE)
d) What is the coverage for pregnancy? Paternity leave?
4. Health/hospital/major medical insurance?
a) Who pays for you?
b) Who pays for your dependents?
c) Does health insurance cover pregnancy and newborn care?
d) Does group pay first-dollar health insurance?
e) Does your group provide for an HMO or preferred-provider arrangement?
f) Is professional courtesy observed in that hospital? By physicians? By the hospital itself?
g) Can you take it with you when you leave?
E. Pension and/or Profit-sharing plan?
1. How soon are you eligible?
2. What is the vesting arrangement?
a) How long do you have to stay before you are fully vested?
b) If you leave before you are fully vested, will your pension amount be paid to you as taxable income?
c) Defined contribution or defined benefit?
3. Percentage of your salary to pension? Percentage of your salary to profit-sharing?
4. What is the nature of the pension fund?
5. Do you have any choices?
a) Can you manage your own pension fund?
b) How much will your pension be?
c) New regulations on maximum pension amounts.
VI. BILLING AND SALARY
A. Income
1. Income -- professional fees, hospital contract, hospital guarantee?
2. What is the proportion of non-pay patients?
3. Who does the billing?
a) Group itself?
b) A billing service?
c) One individual?
d) Insurance release forms?
e) Who handles third-party billing?
f) Billing forms? Who fills out? Who mails or delivers the billing forms to the office?
g) How are collection problems handled? Collection fees?
h) What is the collection rate? (Be careful how this is defined!)
i) Is there an annual audit?
j) Can you see the books?
4. Anesthesia relative value guide unit
a) How many units per hour?
b) Cost of a unit?
c) What is typical unit charge in area?
B. Salary
1. How much each year before you join the group? Is this a fair amount in relation to the income you will
produce?
2. How much will the salary be after you join the group? (Or is this a big secret?)
3. Does everyone in the group do equal work (ICU, pain, etc.)?
4. Does everyone in the group get equal pay? If not, how is salary determined? (vary with billing or with
collections?)
5. Does chief of group, or "business" person, get extra pay for that work?
6. How often paid?
7. Is there a bonus or profit-sharing? When? how much has this been in the past? Do all employees receive it?
8. Who calculates taxes
9. What is taken out of paycheck (federal, state, city taxes; pension; disability ins.; parking; etc.)
VII. VISITING THE PRACTICE
A. Who pays for your expenses?
B. For how many trips?
C. For your spouse's expenses?
VIII. JOINING THE GROUP... AND LEAVING IT Note: You will eventually leave every group you join!
A. Joining the practice
1. Will the group provide you with loans/advances of income for relocating, buying a house, etc.? Are local
banks willing to lend you money?
2. How long until you become a full and equal partner? Any reason why you should not become a partner at the
stated time?
3. Is there a buy-in? How much? How is it determined?
4. What does the contract say? Have a lawyer review it!
5. Are the constitution, by-laws, annual reports for the last 5 years, contracts between the group and all other
employees available and satisfactory?
6. Are there restrictions on outside work and income?Examples: reviewing malpractice cases; honoraria for
speakers; pain blocks if outside the practice; moonlighting during vacations
7. Does group claim patent rights to any devices you may invent or copyright on books you may write?
B. Termination:
1. How much notice?
a) Allowable causes?
b) Mechanism?
2. What happens when someone leaves?
a) What about accounts receivable?

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How do you go about asking so many of these. The question "how are narcotics handled", is probably insignificant(compared to location, salary, vacay, etc) but good to know. How many questions like that can you actually ask?
 
How do you go about asking so many of these. The question "how are narcotics handled", is probably insignificant(compared to location, salary, vacay, etc) but good to know. How many questions like that can you actually ask?

i dont think thats insignificant. it can be annoying as hell
 
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I understand but who the heck considers that when choosing a practice ?!
Agreed. Aint nobody wasting time asking insignificant questions.
Does it matter if I have to get the meds from pharmacy vs in-room pyxis when the salary at the former is 25k higher than the latter? noope.
 
Thank you @kismetsdad for sharing this. Do you have a resource for a checklist for academic anesthesiology jobs?
 
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