Compiled and Submitted by Joshua Atkins, ASA-RC Secretary

The first speaker was Frank Rosinia, M.D. who is managing partner of a large multi-hospital anesthesiology group with over 180 physicians and nurse anesthetists working in sixteen facilities throughout Louisiana. He discussed things to consider working in private practice as he described how his group was organized and as well as alternate practice models.

The second speaker was Gary Walker, J.D. who presented a detailed overview on physician employment contract provisions and negotiating points.

He emphasized the following general points:

• Involve a contract attorney with healthcare expertise in your contract negotiations as early as possible
• Identify a skilled advisor to provide a strategy for asset protection early in your career
• Large practices with high turnover will generally be less flexible in contract provisions than smaller practices who hire less frequently
• There are lots of details in contracts that might not even cross your mind; don’t be bashful; fleshing out these details before signing a contract is crucial to professional satisfaction

Mr. Walker offered a great deal of detailed explanations and advice:

• As you begin contract negotiations you should determine the precise formula for buy-in as a shareholder and be especially cognizant of exclusion of “goodwill” in that buy-in formula
• Without cause termination is a common part of most contracts; consider a initiation period of 6-12 months in which the employer cannot terminate without cause
• Non-compete clauses must be taken seriously and depending on your local area of practice are VERY enforceable
• Every effort should be made to determine call coverage and vacation scheduling preferences
• Strong consideration should be made to purchasing short-term disability coverage
• Malpractice insurance is complex; premium usually paid by the group
  • Obtain insurance with a relevant trigger (i.e. deductible) and maximum
  • Important to consider coverage of past events when you switch practices
  • Common practice is expensive tail coverage or alternative nose coverage
  • For your own protection get in the habit of being a documentation hound
    

The third speaker was Shena Scott, MBA who is a senior administrator at Brevard Anesthesia Services in Melbourne, Florida and also President of the Anesthesia Administration Assembly (AAA) and the Medical Group Management Association (MGMA). She presented a comprehensive overview of behind-the-scenes operations in private practice with a talk titled “Understanding the Bottom Line of your New Practice.”

Six steps to a successful practice:

• Earning the money: doing your part
• Billing and collecting what you earn
• Dividing the pie: compensation alternatives
• Reaping today’s rewards: time off
• Enjoying the benefits: options and costs
• Protecting your investment for the long term

General points that everyone should know:

• Lack of clear documentation on the anesthetic record ROUTINELY results in under billing and lowered reimbursement
  • For example, include all details of the surgical procedure;
  • placement of hardware may be eligible for a higher anesthesia rate than without hardware
• Times on anesthetic record are CRITICAL
  • If the time record says you are in two places at once you will NOT be paid
  • If you are giving lunch while you are supposed to be immediately available for coverage in another room, you forfeit the ENTIRE reimbursement for that other room
• Two options for billing in a private practice – internal staff vs. external contractor
  • Size of practice often determines which is best
  • Internal more expensive, but more available and familiar with individual variations within the group practice
• Options for dividing compensation in a practice – equal vs. “eat what you kill”
  • most anesthesia practices based on equal compensation
  • different types of cases bring in substantially different reimbursement
  • “eat what you kill” – you get paid for exactly what you do; common in pain management
• Ask about pension eligibility, deferred compensation benefits, options to buy/sell calls to gain flexibility or earn additional money
• Very hard to assess a practice from outside; ask people, including CRNA’s how they like the culture, find out how many people hired in recent years are still there

Our final speaker was Carol Warfield, M.D., Professor of Anesthesia at the Harvard University Beth Israel Deaconess Hospital. She gave an insightful talk on academic medicine and how to think through what kind of practice environment is right for you. General advice on obtaining a position:

• Start looking at least 6-9 months before the end of training
  • Hospital and insurance company credentialing takes months
• networking with alumni from your program is an extremely valuable approach to identifying job opportunities
• Learn about the staff (especially academics) and their interests before the interview
• Dress in professional business attire for all interviews
• Visit your competition and ask them why they think they are better
• Get all offers in writing
• Spend at least a day in the OR’s where you plan to work
• The “culture” of your work environment is one of the most important aspects of your job
• Don’t ask about salaries and money too early in the interview process

Comparing academics and private practice:

• Don’t make the mistake of comparing apples and oranges
• Private practice usually offers hire salaries, BUT ….
• Consider non-clinical time, call schedule, meeting time, contract lengths, intellectual stimulation, research support, sabbaticals, computer support, malpractice insurance
• Academics typically offers lots of support and flexibility
• Try to identify people who have moved between private practice and academics to get their opinion on the pros and cons of each