Saturday, February 25, 2012

A Cautionary Tale

Anesthesiology may be the best job in medicine. The money is good. The hours are, usually, not as punishing as surgeons' or internists'. And we get to handle all these mind altering drugs with little supervision from others (just kidding). But the field can also have surprisingly little job security. As anesthesiologists, we bring little revenue to a hospital's balance sheet. We are more often considered on the expense side of a hospital's budget as mere leeches sucking up its money. Therefore it is not shocking to find that in an era of ever decreasing reimbursements, hospitals will find any way to cut costs as much as possible. And this includes hacking away at their anesthesiology department.

Last year, all the anesthesiologists from the Visalia Anesthesia Medical Associates (VAMA) were summarily terminated from their contract with Kaweah Delta Medical Center. This despite working diligently for the hospital for sixteen years. The hospital board decided to open up the anesthesia contract to competitive bidding even though the group had fulfilled and exceeded all contractual obligations. Says Chief Operating Officer Tom Rayner, "I think it's common business practice" for hospitals to seek other proposals for anesthesia services. VAMA was allowed to give an oral presentation to the hospital board to defend their contract. Unfortunately, it was widely considered to be a formality as the hospital had already made up its mind to go with a lower cost anesthesia provider. Kaweah eventually gave the anesthesia contract to Somnia Anesthesia Services, a nationwide group that uses predominantly CRNA's to allow it to undercut bids from anesthesiologist-only groups.

What does this say about the state of anesthesiology? First of all, your golfing and fishing buddies from the surgery department are unlikely to help you out. Despite protests from surgeons over their lack of input, Kaweah decided to fire all their anesthesiologists anyway.  Second, if the hospital board is determined to find another anesthesia group to provide services, there is little the group can do no matter the volume of dire warnings about patient safety compromises. Third, unless an anesthesia group is involved intimately in the hospital's political structure, there is no job security no matter how many years its been working at the facility. Just something to keep in mind next time an anesthesiologist in the group complains about the work load in the OR's. It can quickly become lighter before you know it.

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