Transcript The Business Psychology of Anesthesia Practice

Private practice–
your next adventure
Tom Archer, MD, MBA
UCSD Anesthesia
What Do All of These Jobs
Have in Common?
We are all workers in service
industries!
Does This Fact Make You
Uncomfortable?
Competition Implies That the Customer is Free to
Choose Between Competing Alternatives
Competition
• Aren’t we doctors above that?
• Doesn’t competition lead to haste and errors?
• Isn’t competition grubby?
• Shouldn’t the public just trust us to do the right
thing?
Competition
•
A fact of life in private medicine.
•
You are competing with other
anesthesia groups and with other
anesthesiologists in your own
group.
•
The challenge is to maintain a
high level of service without
compromising safety.
•
Whether you like it or not,
personal relations are every bit as
important as technical or “medical”
skill.
•
The 3 “ables” of the
anesthesiologist: Available,
Affable, Able.
Arrogance or Apathy– Not an
Option
• You will be expected
to be a “team player.”
• If you are apathetic or
unresponsive…
• Your customers will
take their business
elsewhere.
The Patient as Customer
• Patients are more demanding than 30
years ago.
• Scrutiny of medical practice (by everyone)
has intensified.
• Physician is still a respected authority
figure, but…
• Physician must realize that she has to
please customers and is part of a team.
• The days of prima donnas are over.
The business of medicine
• Efficiency, quality and customer service
never go out of style.
The Business of Medicine
• In a competitive health care environment, providers
will give the best care they can at the lowest price.
• Competition fosters improvement and innovation.
• State health care monopolies foster slow, inefficient
and bureaucratic care.
• Academic medicine frequently lacks incentives for
production (monopolistic mind-set).
Good doctors and
good business people:
• Give the best customer service they can
(technical care, bedside manner,
punctuality, courtesy).
• Don’t waste time or resources.
• Know their customer’s needs and wants.
• Know how to work in teams.
Service and safety issues
• Safety Issues are sacrosanct and must not be
compromised.
• Service issues (start times, cases on Saturday
and Sunday, after midnight, etc.) are negotiable.
• You need to clearly understand the difference.
• Monopolies (us?) often camouflage a desire to
avoid service as a safety issue.
Customers and the Golden Rule
•
Modern business philosophy:
patients, family, surgeons, nurses,
administration, technicians– these
people are all our CUSTOMERS.
•
This is really a restatement of the
GOLDEN RULE:
•
Treat your customers– your fellow
human beings-- with respect and
with consideration for their
aspirations, needs and fears .
Anesthesia groups are not all the
same!
Anesthesia Groups
• Look at more than just:
– Types of cases and how much money you will
earn.
– Work hours, call schedule, vacations and
CRNAs supervised.
Your Job is to Get Behind the
Window- Dressing and Find Out
What the Group is Really Like.
Anesthesia Group Culture
• Some groups are
healthy and promote
the happiness and
prosperity of their
members.
• Other groups are
dysfunctional and full
of psychopathology.
What Does Your Gut Say?
• Do people seem happy?
• Do group members seem
to like one another? Or
do they gossip with a
newcomer like you?
• Do members appear
over-worked, unhappy,
and yet greedy for more
cases?
Are New Group Members Treated
Barbarically?
• They get poorly
paying cases.
• More nights and
weekends.
• Buy-ins are
excessive.
• Many new hires don’t
make partner. They
get booted out before
they become eligible
for partnership.
How are the MDs compensated?
• What is the incentive
structure?
• What behaviors are
rewarded?
• What behaviors are
penalized?
Straight Salary
• You get paid the same whether
you do a lot of cases or not.
• More common in academic
settings.
• Does NOT reward production
or efficiency.
• Disadvantage: slackers can
slack off.
• Big advantage: allows time for
teaching, research, innovation
and careful, methodical care.
“Eat What You Kill” (Type 1)
• “Fee for Service” from
individual patient.
• You receive specific
collections from patients whom
you anesthetize.
• If you have indigent patients,
you earn ZERO!
• If you have all insured patients,
you earn a lot.
• FTC: Price-fixing via sham
corporation?
• Fraught with abuse potential–
schedule manipulation, etc.
“Eat What You Kill” (Type 2)
• “Fee for Service” but
based on “Corporate
Unit”.
• Money is pooled for
entire group. Your
month’s income =
Group’s Total
Collections X your %
of total units for the
month.
“Eat What You Kill” (Type 2)
• In my opinion, EWYK
Type 2 is the best system
for private practice.
• This system rewards
work and efficiency and
ignores payer mix.
• Schedule manipulation
and lies just stop.
Do You Hear About Conflicts Over
Anesthesia Service?
• Do surgeons want more night
and weekend coverage than
group wants to provide?
• Do the anesthesiologists have
a “can-do” service orientation?
• Does the group work with
nursing and administration to
provide service as a team?
• Or does the group blame
nursing or other hospital
employees for inadequate
service?
Who runs the group?
• A group of old
cronies, in a murky
and capricious
manner? Or…
• An elected Board of
Directors?
How does the medical community
view the anesthesia group?
• As money-grubbing
technicians? Or…
• As team players?
Is the “group” really a group, with a
clear business purpose?
• Yes, the group takes care of
all the patients in an
efficient and compassionate
manner.
• No, the so-called group is a
loveless marriage of
convenience between
competing individuals.
A Good Anesthesia Group
• Healthy, happy individuals, who enjoy
caring for their patients.
• Internally, the group functions as an
anesthesia team, with a clear business
purpose.
• Minimal to no schedule manipulation,
cheating and lying.
A Good Anesthesia Group
• Externally, the group works constructively
with nursing and hospital administration to
provide care as a hospital-based team.
A Good Anesthesia Group
• The compensation structure aligns
individual incentives with business goals.
• Best system is income pooling with
individual compensation proportional to
services provided.
• Individuals who participate on Medical
Staff and hospital committees are
respected and rewarded.
The New Member (You)
• Well trained.
• Knowledgeable.
• Eager.
Advice for the new member:
• Be humble– there’s more than one way to
skin a cat.
• Ask lots of questions, listen– and learn!
• Try to understand why they do what they
do– it MAY make sense! (Or it may not!)
• Ask the established and respected
practitioners how they would do things.
Good Luck!