Houston, Office Based Anesthesia

[tdiggs]

Our physician owned office based anesthesia practice is seeking an additional anesthesiologist in Houston, TX. Part time clinical work is available, but the ideal candidate would also be interested in development of the practice in cooperation with the current team. Office based anesthesia offers high hourly pay, no call, no weekends, and no evenings.

If you are practicing in a hospital setting and are interested in a new challenge in a completely different work environment, if you are tired of hospital administration roadblocks, if you have group dynamics that are unhealthy, if you have wanted to grow a business while having a stake in a business, I'd love to have a conversation with you.

I transitioned from a full time private practice cardiac position to an office based practice two years ago. I still work for my old private practice group a couple of times a month but have enjoyed the new challenges that an office based practice has presented. Office based anesthesia is not for everyone, but for the right person I'm confident it would be a breath of fresh air.

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[spike7585]

Any additional details you can share?

Are we talking about dental offices? Surgery offices?

All anesthesia equipment available there or are you carrying everything with you?

Hourly pay rate?

 

[tdiggs]

It’s dental and oral surgery offices so far. Almost entirely GA with nasal intubation. We bring our own equipment.

The pay ranges from $400-500 per hour. The lower amount is accompanied by an 8 hour guarantee. The majority would be at $500. If there’s interest in a leadership role the pay would be higher.

 

[GassYous]

Very interesting, there's a guy here with the exact same deal

 

[AKMD_1984]

Oba arrangements are best done with guarantee plus production not set hourly rates.

I hope most anesthesiologists are smart enough to understand this and get away from “hourly worker”.


The anesthesia group or mgt company that’s sending you is taking a much bigger cut and you’re providing the labor.

I understand that they’re bringing supplies but you can purchase those one time from a vendor and provide Anestgesia yourself.

All you need is a briefcase of meds.
Ambu bag
Oxygen and suction at site
Lma/ ett

Also a good preop evaluation mechanism so they’re not booking unsafe and crazy **** in office****again you’ll be a sitting duck when you show up to work and unaware of these cases

This midel compensates the anesthesiologists who’s actually doing the work and stuck without much help And support

OP - what do you mean by leadership? What exactly are you leading?

It’s an extremely high risk practice catered to ent and dentists to capture costs because the insurance reimbursements or cash pay for the office cases

Plenty of oba opportunities available

 

[tdiggs]

Oba arrangements are best done with guarantee plus production not set hourly rates.

I hope most anesthesiologists are smart enough to understand this and get away from “hourly worker”.


The anesthesia group or mgt company that’s sending you is taking a much bigger cut and you’re providing the labor.

I understand that they’re bringing supplies but you can purchase those one time from a vendor and provide Anestgesia yourself.

All you need is a briefcase of meds.
Ambu bag
Oxygen and suction at site
Lma/ ett

Also a good preop evaluation mechanism so they’re not booking unsafe and crazy **** in office****again you’ll be a sitting duck when you show up to work and unaware of these cases

This midel compensates the anesthesiologists who’s actually doing the work and stuck without much help And support

OP - what do you mean by leadership? What exactly are you leading?

It’s an extremely high risk practice catered to ent and dentists to capture costs because the insurance reimbursements or cash pay for the office cases

Plenty of oba opportunities available

I agree with the pitfalls that you describe and that's why an in depth understanding of who you are joining if you're interested in OBA is important. Many groups, especially management companies and groups not managed locally or by physicians do exactly what you caution in that they don't provide many working hours or tie hourly rate to other metrics such as finding new business.

If you're careful in selecting your business relationships, OBA is unique in anesthesia in that it's not reliant on insurance reimbursement and is associated with higher hourly/daily pay.

If a clinician wants to market, recruit, buy supplies and deal with shortages, develop a business and growth strategy, network with other providers, find anesthesia techs, has a willingness to take the light/empty work days, can be the main contact when the medical board inspects the practice, and more, then a provider should definitely consider starting their own PLLC and escape the pitfalls your describe.

If, on the other hand, the clinician doesn't want the administrative burdens of running a business but still wants to leverage the potential benefits of OBA, and has an honest, hard working team to join run by someone who wants to create a place that people like working at and aren't taken advantage of, it's a reasonable choice to join such a team. And they do exist.

All the guys who work with me make more per day with me than they do working a longer day at the hospital. That's the only way to recruit high quality clinicians.

I'm happy to elaborate more on your other points but fundamentally disagree that it's an "extremely high risk practice." Careful preop assessment, intraoperative preparedness, and conservative management make it no more risky than an ASC. Anesthesiologists are the solution to in office dental patient morbidity/mortality issue, not the source.

The leadership responsibilities described include some of the business administrative tasks I mentioned and more. Not all clinicians are interested in that and both options are available.

 

[AKMD_1984]

Hmmmm…


“I'm happy to elaborate more on your other points but fundamentally disagree that it's an "extremely high risk practice." Careful preop assessment, intraoperative preparedness, and conservative management make it no more risky than an ASC. Anesthesiologists are the solution to in office dental patient morbidity/mortality issue, not the source.”

?????
You’re honestly telling me that office based anesthesia is somehow safer than asc and hospitals?

So why are you paying the higher rate? We all know the rate is higher because it pays for labor and logistics.

You’re telling me you prefer to manage aspiration, nausea/vomiting, bronchospasm, need for breathing treatments post op and common issues like pain and hypertension etc all by yourself in an office while doing another case?

I don’t do OBA unless there is a production component on collections or have some sort of skin in the game.

Otherwise I’m not interested.

And this has been the stance of many of my colleagues as well.

 

[tdiggs]

Thanks for the reply.

I didn't assert it was safer but rather that it was not more risky. Nonetheless, I made an assertion without data and I'm happy to retract that.

I also didn't say that I'd prefer to manage complications in an office instead of a proper OR with other experienced providers available. The OR setting makes it easier in every way. Still, providers should be ready to deal with all the complications you mentioned in the office.

I have no issue with anyone who prefers not to do OBA. The alternative providers of sedation are CRNAs, dental "anesthesiologists," or the dentists themselves. As one who has had family members as patients, I would have appreciated the choice of sedation provider to include anesthesiologists.

 

[spike7585]

OBA is not for everyone. It definitely deserves a premium and the rate that dentists are willing to pay reflects that. $1,000/hr is not uncommon.

At the end of the day, you are the ONLY person in that room that can properly run a code or manage a medical emergency. Even the most sketchy of ASCs, there is at least a surgeon and multiple RNs that hopefully could be of more assistance than a dental assistant who has zero medical knowledge.

So even with proper screening, it can NEVER be as safe as an ASC simply from the fact that you are the lone medical professional in the whole building.