ASA April 2003 Newsletter

Fundamental changes have occurred in medicine during the last decade that require new business skills for physicians. A single focus on the science and art of medicine will no longer allow us to provide optimal patient care, which is our primary mission. Following macroeconomics in a daily or weekly business publication is no longer adequate, and this reality has led physicians to pursue formal and informal business education.

This need led ASA to develop educational resources for its membership such as the Certificate of Business Administration (CBA). Although there are various other external resources, ASA is a leader in the development of internal resources of varying complexities; one size does not fit all, and each anesthesiologist must determine which internal or external resource best fits his or her specific need.

Options outside ASA include a Master’s of Business Administration (M.B.A.) or a Master’s of Health Administration (M.H.A.), programs offered by management organizations such as the American College of Physician Executives (ACPE), seminars sponsored by university business schools, corporate business seminars and practice-specific business strategies. Formal M.B.A. or M.H.A. programs represent the most comprehensive option with the widest range of applications; they also are the most expensive and time-consuming. These programs are best suited for the individual who wants either a dominant administrative position with a limited clinical practice or a career change. Those for whom an M.B.A. might be a wise choice include departmental chairs, deans, facility and insurance executives and those who aspire to develop a private consulting practice. Executive M.B.A. or M.H.A. programs are best suited for physicians still involved in the practice of medicine These types of programs are offered in weekend and distance-learning formats as opposed to traditional full-time, weekday formats.

ACPE offers a variety of educational courses that range from introductory survey courses to graduate degree programs in medical management with formats such as conferences, distance learning and on-site programs at a sponsoring organization. ACPE publishes the Physician Executive, which covers topics such as career management, health law and managing change. Click is their online medical management magazine. ACPE’s orientation is general and not specific to anesthesiology.

Seminars offered by university business schools and educational symposia offered by various corporations are available with formats varying from one topic to general themes. The cost of a single weekend seminar may equal the cost of all 10 CBA modules.

Practice management activities in one’s own practice may offer a secondary educational benefit for those willing to scratch beneath the surface. A management services organization (MSO) may educate anesthesiologists during the application and administration of their services, and the format varies from formal, strategic discussions to more of an osmotic process. During an educational program in Chicago, one group discovered a great concept in activity-based accounting — their MSO saved them more on their professional liability insurance utilizing group purchasing power than they paid for their administrative services! Practice management companies may educate physicians in a similar manner, but they are more likely to have formal consulting divisions that go into greater detail. Learning from a practice administrator with formal business training will generally be more topical and issue-specific and may help physicians understand why they are making a business decision. A practice may generally benefit from the educational pursuits of individual members with formal business training; implementation is then carried out through the recruitment of such an individual or as part of a strategic infrastructure development plan that actively seeks to educate its members. Each year, a number of forward-thinking groups decide to send their members to the CBA program while paying their expenses.

The explosion of stipend negotiations and responses to requests for proposals has dramatically increased utilization of external consultants by anesthesia practices. Extensive use of consultants engaged by facilities has long been the norm, often resulting in an uneven playing field for physicians. Consultants can provide a significant educational resource if physicians take the time to understand the issues and the rationale for the consultant’s recommendations. Interaction with consultants will ultimately result in a better work product and provide a control loop that ensures a clinical applicability in addition to the standard financial metrics. Unless an anesthesia consultant has a clinical background, a financial analysis may not reflect the reality of the clinical demands. Ideally, consultants should have a nonpartisan focus on the needs of the community, not just on the hospital or the physician practice. A CBA can make an anesthesiologist a more knowledgeable and participatory consumer.

Because ASA is aware of the many practice management challenges of anesthesiologists, members and staff are united in developing educational resources for the membership. On the ASA Web site, members will find a wealth of constantly evolving resources. The Web site allows for material to be added, refreshed and accessed for real-time needs. The Committee on Practice Management is developing a virtual textbook on practice management educational resources. ASA offers an annual practice management conference the first weekend in February. The live format provides didactic learning and allows nation-wide interaction with colleagues in a natural process of cross-pollination. The ASA Anesthesia Consultation Program is primarily oriented to departmental organization but deals with some practice management issues that offer an opportunity for learning.

Since most anesthesiologists in clinical practice are reluctant to invest the time and resources in a degreed business program that exceeds their needs, ASA developed the distilled essence of an M.B.A. into a certificate program that is focused on the actual needs of practitioners. Such an approach allows basic needs to be met in a 100-hour format with four on-site weekends over a 10-month period, versus an approximately 800-hour format with alternating weekend classes for two years. The course is organized into 10 modules:

Module 1 — Successful Leadership and Management: Competencies of physician executives; management functions and systems; learning organizations and leadership; transactional and transformational approaches; leadership styles; assessing personal leadership style; leadership language; developing leadership skills.

Module 2 — Accounting and Financial Analysis of Health Care Organizations: Principles of accounting; forms of business organization; financial statement analysis; health care ratio analysis.
Module 3 — Management and Budgeting: Financial decision-making; flexible budgeting and variance analysis; cash budgeting; fiduciary responsibilities.

Module 4 — Legal Aspects of Health Care: Compliance guidelines; Stark guidelines; antitrust guidelines; health care legal issues.

Module 5 — Organizational Behavior: Decision-making/problem-solving; communications and interpersonal influence; conflict resolution and negotiations; team and intragroup relations.

Module 6 — Integrated Delivery Systems and Managed Care: Structure of integrated delivery systems; basic managed care concepts; negotiation strategies; contract analysis; governmental and legislative impact on health care delivery systems.

Module 7 — Management for Human Resources: Employment and labor law; effective selection techniques; compensation and reward systems; performance appraisal/coaching/counseling; handling employee problems and termination.

Module 8 — Health Care Services Marketing: Basic concepts and terminology of marketing; services marketing; development, implementation and evaluation of marketing strategies and marketing mix variables; American Medical Association marketing guidelines.

Module 9 — Business Communication — Integrated Marketing Communications in Health Care: Technical report writing; common forms of business communication; health services marketing; integrated marketing communications; promotion strategy.

Module 10 — Strategic Analysis and Business Plan Development: To conduct an internal and external analysis and SWOT (strengths, weaknesses, opportunities and threats) profile of your own practice or institutional component; to develop scenarios and strategies relative to environmental assessment niche, vision and mission; business plan development tied to SWOT analysis and needs assessment; the market and the competition; marketing plan; financial plan.

The interaction among participants provides an opportunity for them to learn from each others’ experiences. Previous participants credit this interaction with helping them to address many of their own challenges. In the course surveys, participants responded that they were receiving a wealth of information and networking opportunities and learning the business aspects of medicine. Some groups plan to send up to four members per year to the CBA program. There were 94 participants in the first class and 78 in the second class. Registration for 2003 is on a similar pace. Participants came from various practice situations, parts of the country, years in practice, age and clinical interests — the one thing they shared was an interest in gaining skills that would allow them a chance to regain control of their destiny. The CBA program has exceeded the expectations of the majority of its participants.

Do not be dependent on someone else’s executive summary. Seize control of your own destiny!

More information about the CBA program is available at: <www.ASAhq.org/conted/cba.htm>.

Asa C. Lockhart, M.D., M.B.A., is a Partner with East Texas Anesthesiology Associates and Principal with Golden Caduceus Consultants, East Texas Medical Center and Trinity Mother Francis, Tyler, Texas. He is Program Chair for the ASA Certificate in Business Administration Program of the Committee on Practice Management.

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