Private Practice...Fee for service model
- Thread starter ecf1975do
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A common model like this happens, for instance, in San Antonio, TX.
In this case, you often follow one (or small group of) surgeon(s) around and become his/her(their) "personal" anesthesiologist. You take vacation when he/she takes vacation, you go to different hospitals/surgery centers, you gotta keep him/her happy.
Upside is that you get pretty good and knowing what one (or a couple) of surgeon(s) prefers and you can develop a good rapport. Downside... well, limited case exposuire, and obviously you're always going to be someone's b*tch.
I'm sure there are other models out there, but this is the main one I've heard of with pure "fee-for-service" independent practice.
-copro
In this case, you often follow one (or small group of) surgeon(s) around and become his/her(their) "personal" anesthesiologist. You take vacation when he/she takes vacation, you go to different hospitals/surgery centers, you gotta keep him/her happy.
Upside is that you get pretty good and knowing what one (or a couple) of surgeon(s) prefers and you can develop a good rapport. Downside... well, limited case exposuire, and obviously you're always going to be someone's b*tch.
I'm sure there are other models out there, but this is the main one I've heard of with pure "fee-for-service" independent practice.
-copro
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In addition to the aforementioned, another model of fee for service would be what is known as "eat what you kill". You get a percentage of whatever the collections are on a case. So if you do a room of 10 tonsils with private insurance then you made out pretty well. If the same room is filled with Medicaid you do less well. Same thing for a slow surgeon or room turnover.
Groups differ as to how cases are assigned, but it should have some mechanism for fairness if pure fee for service. Another way of this model is to assign an average value for a billed unit and then reimburse based on the points accumulated.
Nothing wrong with fee for service, just make sure everything is relatively fair before you sign on the dotted line. If you have doubts, ask around. When I say relatively fair I mean that as a new guy you are going to get screwed somehow. Just make sure that whatever that may be is acceptable to you. Usually some combination of money or time, but nearly everyone goes through a few years of dues paying to get in the door. You have less to offer and more risk as a new grad as well from an employer point of view.
Groups differ as to how cases are assigned, but it should have some mechanism for fairness if pure fee for service. Another way of this model is to assign an average value for a billed unit and then reimburse based on the points accumulated.
Nothing wrong with fee for service, just make sure everything is relatively fair before you sign on the dotted line. If you have doubts, ask around. When I say relatively fair I mean that as a new guy you are going to get screwed somehow. Just make sure that whatever that may be is acceptable to you. Usually some combination of money or time, but nearly everyone goes through a few years of dues paying to get in the door. You have less to offer and more risk as a new grad as well from an employer point of view.
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This is an extreme take on anesthesia in San Antonio. There are a number of groups here that are based on a pooled-points system (I will be joining one of them) and not fee-for-service. Even in the fee-for-service groups, you can plan ahead for when your usual surgeons would be on vacation, and if you don't like how a surgeon treats you, then you don't have to work with him/her.
The lack of exclusive anesthesia contracts at hospitals in San Antonio (except for OB) makes for a unique practice enviornment. The downside, as Copro mentioned, is that travel to more than one hospital or surgical center per day is the norm. However, it's a good environment for anesthesiologists wishing to do their own cases, since trying to arrange for 3 or 4 CRNAs to have all their cases start and stop at the same time at multiple locations would be impractical. It is predicted that eventually hospital-based contracts and CRNAs will take over, but for now the anesthesiologists are holding down the Alamo City.
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Thanks for the additional info. As stated, I'm not personally or directly familiar with the arrangements, and am not going to be working there. I know a few former residents who've gone there, and this is how they described it to me. Likewise, all seem to be pretty happy with their practice arrangement and are doing well financially.
-copro
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Most likely right when I finish my residency here in 2013.
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Private Practice...Fee for service model is great if you have good payer mix, lots of cases, and fair scheduling. If any of those piece is missing you could signing up for a bad situation. I worked in a surgery center where it was fee for service; unfortunately the place was over staffed. So there were not enough cases to make good money and the scheduling was grossly unfair. As the new person I got the worst payer mix of cases, the slowest surgeons, the lightest rooms. The Anesthesiologist who made the schedule employed CRNAs so I got to work around the CRNAs schedule. The CRNAS worked 7 to 3 so I got the early starts and the late cases but got to watch TV in the doctors lounge the rest of the time. The surgery center denied that this ever happened and keep lying to me that things would change, but of course nothing ever changed and I had to quit.
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