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The American Society of Anesthesiologists is an educational, research and scientific association of physicians organized to raise and maintain the standards of the medical practice of anesthesiology and improve the care of the patient.


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January 1, 2013 Volume 77, Number 1
What Every Resident Needs to Know About Practice Management… and Where to Find It Aparna Ananth, M.D.

Lars E. Helgeson, M.D.

Transitioning from residency into practice can be daunting. Residents are eager, clinically skilled and very well trained. However, being a strong clinician is no longer sufficient. Today, anesthesia groups are recruiting anesthesiologists who not only bring strong clinical skills, but who may also have other strengths such as administrative experience or an interest in active participation in the hospital medical staff organization through compliance, quality improvement, patient safety and other committee initiatives. They are looking to hire not only future partners, but future leaders.

Most residents have, at best, a rudimentary understanding about the business side of anesthesiology, and their eyes glaze over whenever the phrase “Practice Management” is mentioned. After all, they are busy enough just learning how to do anesthesia! They have become experts in time management, including prioritizing what is important to learn and what is less important. Unfortunately, regulatory, administrative and documentation topics are usually prioritized into the latter category.

Residents are also generally not well prepared to evaluate a prospective practice, deal with practice issues such as hospital and employment contractual issues, billing compliance, third-party payer negotiations, Medicare regulations, Joint Commission considerations and hospital medical staff relations. Residency does end, and the moment you start your new job (academic or private practice, salary or fee-for-service), these “Practice Management” topics will suddenly become very important.

Gone are the days when a practitioner cared for patients, and “paperwork” was almost an afterthought. Even prior to passage of the Patient Protection and Affordable Care Act (PPACA), compliance, regulatory and administrative requirements were already intrusive and pervasive. PPACA and other factors are forcing us, more than ever, to become knowledgeable about the business side of anesthesiology.

Keeping in mind the changing landscape of medical practice and the regulatory requirements that the next generation of anesthesiologists will have to face, ASA has produced several publications dealing with assorted aspects of practice management. In the coming months, the ASA Committee on Practice Management will be consolidating relevant topics on the ASA website. Outlined here are several resources available for residents and practicing anesthesiologists that will help clarify some of the concepts of practice management.

The following are available on the ASA website for residents and medical students (under “Resident Practice Management Tools”):

  • “Starting Out: A Practice Management Guide for Anesthesia Residents”:
    This downloadable PDF, covering several important topics for the physician new to practice, is a useful source of regulatory and legal advice.
  • Practice Management Videos for Residents: A series of lectures recorded at the 2009 Conference on Practice Management Resident Track.
  • Resident Webinars: These online modules are each approximately one hour in duration and will be available in early 2013.
    • Evaluating a Practice: As residents transition into practice, this module aims to educate them on how to evaluate a prospective practice, be it academic or private. It also includes a brief introduction to regulatory concerns, credentialing and contract negotiation.
    • Basics of Billing and Coding: This module will provide graduating residents and fellows with a primer on the billing and coding process and how to avoid potential pitfalls.

  • In the coming year, we hope to include additional modules on “Contract Basics” and “Medical Direction of CRNAs and AAs.” However, these are subject to change.

    Coming up in 2013 under ASA practice management publications:
  • “Negotiating an Employment Agreement”: A detailed document that will help you critically evaluate your employment agreement, recognize “red flags” and ask the right questions of your prospective employer.
  • “Compliance Manual”: A comprehensive description of current legal and regulatory aspects that every anesthesiologist needs to be aware of in order to stay compliant.

  • The ASA Certificate in Business Administration (CBA) program is a combination of distance learning modules on DVD and live, in-person sessions held on four weekends during the year in Houston. This program is designed for physicians with no previous formal business education to provide them with the skills required to successfully manage a medical practice or run a department. It helps participants understand the language and perspective of administration and how to actively participate in the strategic success of their organization.

    More details about the CBA program can be found on the ASA website: Go to “For Members” then “Education and Events” and then “Courses and Workshops.”

    In addition to the above, there is also a large ASA conference dedicated exclusively to practice management, sponsored by the Committee on Practice Management. This annual conference is held on the last full weekend of every January. As a part of this meeting, there is a full day of basic practice management education specifically designed for residents. The resident track at PRACTICE MANAGEMENT 2013 is held on the Saturday during the meeting. This year, it will be held in Las Vegas, January 26-27. Detailed information can be found on the ASA website.

    This is an incredible opportunity to familiarize oneself with the issues to be faced after graduation. Residents will also be able to discuss these issues with national experts and ask questions that they might have never known they needed to ask. Additionally, they will have the opportunity of having their CVs evaluated and critiqued by anesthesiologists who are knowledgeable about physician recruitment. Do not miss out on this valuable opportunity!

    Many state component societies and residency programs have set up sponsorship opportunities for interested residents to attend PRACTICE MANAGEMENT 2013. Please contact your program director and state society to see if you qualify.

    We cannot overemphasize the relevance, currency and value in attending this conference. We hope to see you in Las Vegas!

    Aparna Ananth, M.D. is an anesthesiologist in private practice with Pacific Anesthesia, PC, St. Joseph Medical Center, Tacoma, Washington.

    Lars E. Helgeson, M.D. is an Assistant Professor, Compliance Officer with the Department of Anesthesiology, Yale University, New Haven, Connecticut.

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