Chris Cheaney, M3 University of Oklahoma College of Medicine
Many of us have experienced the anesthesiologist’s role in the operating room, but what does an anesthesiologist’s overall practice actually look like? The two main categories of practices in anesthesiology are academic medicine and private practice. Due to the nature of our training w e have primarily been exposed to academic anesthesiology . Yet even in academic medicine, w e only see the clinical aspect of our attendings’ work without seeing the time they invest in research and teaching. Also, data from the Anesthesia Quality Institute shows that 57 percent of anesthesiologists were employed in a private practice as opposed to an academic setting. The majority of us will practice outside of teaching hospitals but if your training has been similar to mine, there has been little exposure to this subject. The differences can best be explained by contrasting the work environment and compensation between the two types of practice.
Traditionally, academic medicine was differentiated by a professorship appointment and large amounts of administrative time for the clinician’s scholarly pursuits. These pursuits are referred to as the three-legged stool: an equal balance of teaching, research and patient care. More recently, a wide variety of practice types have emerged in academic medicine. Many teaching programs offer various tracts for their clinical faculty. These can include clinician-educator, clinician-research, or pure research tracts and vary significantly with each university. These tracts allow faculty at teaching/research hospitals to pursue the areas of academic medicine that interest them the most while still providing opportunities for promotion and professional growth. Oftentimes, a balance of research, teaching and patient care is still encouraged regardless of tract, but the clinician can heavily favor their time towards their preference. Clinical time is primarily spent supervising residents and/or CRNAs with less than 10 percent of time spent directly performing cases or procedures.
Anesthesiologists in the private sector primarily operate in a physician group. There is a wide amount of variation between different physician groups. Some are large national companies that operate similar to any other corporation with a CEO, CMO and board of directors that make decisions for the group. For example, there are over 15 anesthesia companies in the U.S. that employ 500+ physicians. In contrast to this, many anesthesia groups are local companies that employ less than 20 physicians. These smaller groups often have either a small ownership group or more commonly each physician shares as partner after an initial “buy-in” or after spending 2–3 years in the practice. Time is spent primarily attending to clinical duties either at one hospital or rotating between various hospitals with which the group has a contract. Clinical practice can vary widely depending on the particular group. All-physician groups independently perform all of their own cases. Other groups utilize care teams where the physician both performs his or her own cases and supervises CRNAs or AAs.
The majority of academic facilities compensate their physicians with an annual salary based on the number of years spent with the institution and title (professor, assistant professor, etc.). Many academic hospitals have a system that pays a base salary to their clinical faculty and supplemental income based upon the number of cases worked. Physicians in academic medicine make an average of 10–25 percent below those in the private sector.
Compensation is much more likely to be fee for service than salary-based in private practice. There are two main models for this reimbursement system. First is the traditional fee-for-service model in which one receive the payment for each case he or she performs with a percentage deducted by the group to cover overhead such as malpractice, billing, office space, etc. The other model commonly used is similar in that one receives payment for each case or procedure performed, but this method takes the total Relative Value Units (R VU) earned and multiplies it by the group’s average reimbursement rate across all insurance types. This allows for a fee-for-service payment model that does not fluctuate based upon the insurance provider for each case performed.
While these are the major differences between academic anesthesiology and private practice anesthesiology, these are generalizations that do not take into account the large amount of variation from practice to practice. Both private practice and academic medicine have pros and cons that each physician must consider in order to find the type of practice that provides the best fit. As you continue your training in medical school, ask if your school has any community rotations in anesthesia. If they do not, most private anesthesiologists are more than happy to talk through how their group operates and let you spend time working with them. Experiencing the day-to-day life of private practice is the best way to learn the differences in practice and see what setting appeals to you.