Tuesday, March 23, 2021

The Anachronism Of An All Physician Anesthesiologist Practice


The all physician anesthesiologist group


Prior to becoming hospital employees, our anesthesia group had been fiercely proud of our all physician anesthesiologist makeup. Our group had served our hospital well in this fashion for three decades. Before that, the hospital also had never hired any CRNA's. But that was then. Medical economics has transformed tremendously in the past several decades. It was probably a long time coming but the covid pandemic pushed us into an anesthesia care team (ACT) model and there is no turning back.

First of all, let's set aside the question of equivalency between physician anesthesiologists and CRNA's. That is a contentious discussion that has been well covered in this blog and anesthesia posts all over the internet. Let's just talk about the nitty gritty, the dollars and cents aspect of using CRNA's. While our group was researching the pros and cons of the hospital takeover offer, we discovered that we were one of the last large all physician groups still in existence. Almost every other large anesthesia group had switched to an ACT years, or decades ago. We were an anachronism, a dinosaur. We were the equivalent of an Al Bundy, sitting around thinking about how good we had it years ago and wondering why we don't have it as good as the next door neighbor driving a Mercedes.

If one looks strictly at economic factors, then hands down the use of CRNA's makes perfect sense. You can hire two or three nurses for one anesthesiologist. If the medical facility is expanding rapidly like ours, then it quickly becomes cost prohibitive to hire more anesthesiologists every time new OR's come on line and need to be serviced. The current shortage of anesthesiologists makes this a buyer's market. With the lack of benefits in our old business model, we were having a terrible time trying to get new recruits to consider joining our group. This made our service agreement with the hospital difficult to fulfill as we were frequently short of enough people to cover all the OR's. We were in danger of losing our hospital contract if we couldn't live up to our obligations.

A second impetus for the hospital to switch to a care team model is the ever decreasing anesthesia reimbursements from insurance companies and the government. Every hospital would love to have an all physician anesthesiologist group staffing the operating rooms. Unfortunately the entities paying the bills don't see it that way. They are looking for the least expensive method to achieve the same quality results. While we were desperately holding onto our physician anesthesiologist model, others have figured out that having a physician led ACT was almost as good for a lot less money.

When we saw the overwhelming odds that our anesthesia group was not going to survive through the pandemic and beyond, it almost wasn't a choice anymore. We had a hospital that was willing to keep our group intact and offer us extremely generous benefits we never had before. The only thing in return that they asked for was that we incorporat CRNA's into our practice. We would have committed professional suicide if we turned down their terms due to misplaced pride. The first CRNA joined our group one month after we signed on the dotted line.

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