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April 1997
Volume 61 |
Number 4
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| Practice Options:
The Anesthesiologist as a Consultant |
Jessie A. Leak, M.D.
In this and following issues, the ASA NEWSLETTER
will be publishing articles about some of the various practice
options available to anesthesiologists today - inside the operating
room and in other venues.
So, you have decided to try something new and you have established
that you want to be a consultant. Before you make this leap, you
may want to consider many angles and determine whether or not
you should logically pursue consultative practice.
What exactly is a consultant and why should you as an anesthesiologist
consider pursuing this broad field?
Consulting could variously be defined as the ability to
synthesize a problem, design a solution, confer with a client
regarding these issues and effectively communicate advisory summations
or conclusions to the client within a predefined framework.
Consulting, as defined here within, is a logical outgrowth of
the skills that we should develop as a consultant within our institutions:
mediator, diplomat, humanitarian, secretary, businessperson, psychologist,
employer, employee, medical specialty expert technician and administrator.
Clearly, financial remuneration must be considered a positive
byproduct of our efforts.
The adage that we heard repeatedly during our training, "See
one, do one, teach one," must be expanded, however, to "see
many, do many, teach many." To venture forth as an unqualified
or unprepared consultant can cause irreparable damage to your
reputation as a physician consultant as well as potentially undermine
efforts by your client to remedy the very situation that you have
been hired to address.
How Do You Get Started?
Starting a consultant practice requires preparation and thought.
It is necessary to define your strengths, weaknesses, skills and
background as a prerequisite to targeting your niche. One should
consider such attributes as how you define yourself: "hands-on,"
technical, a "people person," innovator, mediator, negotiator
or implementor. Other skills that can be helpful include writing,
public speaking, computers, management, marketing, public relations
and managed care negotiation. Interests in politics, current affairs
and general business are valuable. Previous undergraduate education
in such areas as engineering, business and psychology can be an
asset.
One should be aware that weaknesses will define the scope and
effectiveness you may bring as a consultant. Capitalize on your
skill level and your interests and emphasize the positives.
Networking is essential in order to establish not only a client
base but also to provide a gauge to the marketplace. Potential
contacts include other physicians and physician groups, insurance
or managed care entities, medical product or pharmaceutical companies,
computer software enterprises, entertainment industry representatives
or politicians. The list of potential contacts is limited only
by your imagination. Remember that almost anyone you know in business,
either large or small, is a potential client, including your own
hospital.
Education in your chosen area can come from many sources: your
own group or academic department business manager, formal physician
executive training such as through the American College of Physician
Executives, on-the-job training with another consultant or through
formal graduate degrees in business, public health or hospital
administration. The most persuasive educational prerequisite is
your own on-the-job training or experience. Also invaluable is
experience serving as a training program director, quality assurance
and improvement (QAI) representative, budget negotiator, managed
care liaison, group or department leader, medical practice chief
executive officer or chief financial officer, leader of a physician
hospital organization or individual practice association (IPA),
organized medicine leader or any other position through which
you have obtained marketable expertise.
What Are Your Opportunities?
The most logical leads and opportunities for resources are in
your back yard. Converting hospital administration requests previously
regarded as onerous and distasteful into positive developments
may be a win-win situation. An example might be refining a paid
medical director position within your hospital to oversee perioperative
blood administration and salvage. Many hospital pathology departments
have been reticent to extend their continuum of oversight into
operating room suites, particularly when there is no "hands-on"
control of quality with regards to salvage and administration.
Other consulting opportunities may exist in your hospital or
other outside hospitals to set up, on a one-time basis, policies,
procedures and protocols for such different specialty areas as
obstetrical anesthesia, QAI practice parameters or pain management.
These opportunities may provide additional networking options
outside your institution.
Managed care negotiation ranging from deeply discounted fee schedules
to complex bundling arrangements, including full capitation, requires
considerable expertise. Aside from the obvious need to have negotiating
skills, most physicians/managers do not realize the depth of information
that they need at their fingertips in order to assemble the most
competitive fee arrangement bids.
For instance, it is not unusual for a physician group to go to
the table and simply ask for what they think is a fair unit value
fee schedule and then face summary rejection. When the provider
group cannot define specific reasons for each fee request, the
managed care organization has no compelling reason to reconsider
other numbers. Savvy anesthesia consultants have developed algorithms
for database analysis to answer the most basic questions of cost
of each service to the group so that there is a rational and consistent
basis for the fee requests.
The skill to negotiate aggressively with managed care organizations
as an anesthesia group becomes invaluable to other provider groups
such as surgeons, primary care (e.g., CPT codes for office visits,
etc., may be shared by primary care and pain management), and
even pulmonology/critical care.
If you have the depth of experience to organize client databases
and facilitate managed care negotiation, these may be one of the
most marketable options for consultation.
As varying degrees of both vertical and horizontal integration
continue to mature on many fronts, the skill and expertise to
negotiate also may be sought by your own IPA, outside IPAs or
other complex provider groups. Anesthesiology, almost more than
any specialty, is in the ideal position to interface clinically
with almost every other specialty in a hospital-based or office
setting. Thereby, it uniquely lends itself to a wealthy database
with limitless opportunities to advise other specialists on many,
if not all, aspects of billing and fee negotiation.
It may be worthwhile to consider "spinning out" a management
consulting group from your practice for many pragmatic reasons.
If you are contemplating operating complex billing arrangements
for other groups, the perception of client confidentiality is
essential. Also, liability issues that may arise in your practice
or the management group may expose either entity to needless risk.
The other positive outgrowth of separate groups may be that certain
contract negotiations may be facilitated by the management group
and simply be subcontracted to your practice.
If your goal is to do consulting full time and you require a
guaranteed salary or income, it may be worthwhile to investigate
a position with a managed care organization as a medical director.
Additionally, with the right prerequisites, an appointment as
a hospital medical director might be another option.
Other Consulting Options
Current efforts by anesthesia pain management centers to address
cancer pain early, in aggressive partnership with oncologists
and other related providers, provide anesthesiologists with opportunities
to be medical directors of hospices and home health services.
Additionally, technical expertise out in the field continues
to be viewed as a valuable commodity by medical product manufacturers
as well as some pharmaceutical companies. More than ever, significant
value is placed in test marketing and developing products out
in private practice because of the issues of cost-cutting, lengthened
amortization schedules and capitation; all of these factor into
the development and release of new products. Product safety and
liability issues may ultimately provide more consulting opportunities
as cost-reduction efforts are key issues.
While it is unusual for an anesthesiologist to work in any capacity
other than a volunteer lobbyist consultant, there are opportunities
in both legislative and regulatory arenas to have input. If full-time
work in either of these areas is your ultimate goal, an avenue
for entry may be fellowships such as the Robert Wood Johnson Health
Policy Fellowship conducted by the Institute of Medicine of the
National Academy of Sciences. This is a 12-month program designed
for six deserving health care professionals every year to work
on Capitol Hill or in administration.
A variety of media markets offer options for consulting. From
proffering technical advice on movie and television scripts to
editing, producing, directing or performing radio or television
spots, any market, local or national, is a potential client. Somewhat
more limited in availability is print media consultation for newspapers
or magazines. Limited opportunities with public relations firms
are also a consideration.
The communication/software sector provides a totally different
arena for the consultant anesthesiologist. Physicians have already
been blueprinting and marketing software programs for years. Software
can be designed for medical practice time and office management,
managed care fee negotiation algorithms, dynamic medical information
database analysis, Web site design, billing and on-line billing
design, as well as multiple other offerings. Your imagination
is the only limiting factor.
Mediation, facilitation and arbitration are other areas to investigate.
These are not traditional activities in which physicians invest
energy. Nonetheless, as many doctors decide for a variety of reasons
to become employees of business (e.g., Kaiser Permanente or others),
participation in these exercises may become more commonplace.
Even today, many private practices and academic departments proactively
plan retreats on a timely basis to deal with interpersonal issues,
workplace issues and short- and long-range planning. As a result
of these retreats, studies report an increase in the bottom line
as well as increased employee well-being. Physicians trained in
facilitation techniques who have "been there" will find
increasing demand for their expertise.
A Few Pearls
As you probably realize, physician consulting embraces all sectors
of the economy and is not a clear-cut "specialty." Whether
you choose to embark in a specific area or whether you are merely
reviewing your options, there are few absolutes; you will most
likely customize your style and client base as you go along.
Nonetheless, there are a few pearls to take with you:
- Remember that your value as a consultant is only as great
as the sum of your experiences, your knowledge and your timelines.
If you decide to pursue consulting full-time, realize that the
critical selling factor that you have may be the fact that you
are "in the trenches," so to speak. You may lose part
of a potential client base if you are not practicing and in
touch with the most up-to-date situations that you are hired
to examine.
- If money is your sole objective, find something else to do.
This will be evident to prospective clients.
- Do not expect that earning an advanced degree such as an M.B.A.,
M.P.H. or M.H.A. will necessarily or automatically qualify you
as an anesthesiologist consultant. Personal experience is often
the best teacher.
- Do not try to consult on a job or project for which you are
not qualified or which is out of your area of expertise. Remember
that time is money for your client and that one suboptimal or
late proposal will jeopardize your chances of obtaining work
for which you may be more suited. Positive perception in this
marketplace is paramount and difficult to restore if eroded.
- Lastly, enjoy what you do ... it shows!
Jessie A. Leak, M.D., is Clinical Assistant
Professor at the University of North Carolina, Chapel Hill, North
Carolina. She is also Senior Partner at Cumberland Anesthesia
Associates, P.A., and staff anesthesiologist at Cape Fear Valley
Pain Management Center, Fayetteville, North Carolina.
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