Anesthesia practices come in many flavors; however, just about all fall into one of six categories: solo practice, single-specialty group, multispecialty group, academic, government, and locum tenens. Each has unique strengths and weaknesses, and, as we will see, characteristics that may mesh better with the personality and goals of the job seeker.

In a solo practice, the anesthesiologist is the only provider and has no associates. The anesthesiologist makes all the business decisions, and only external forces, such as medical staff bylaws, insurance contracts, facility agreements, and state medical practice regulations constrain the practice.

The solo practitioner’s greater freedom compared to a member of a group practice is at least partially offset by the physician’s lesser power to negotiate favorable agreements from payers and facilities. It is much easier for an insurer, hospital, or ambulatory surgical center (ASC) to replace a single doctor in their provider panel or medical staff than it is to do the same to a large group. On the other hand, not having to overcome a larger group’s bureaucratic inertia affords the solo practitioner the flexibility to aggressively and quickly pursue new business opportunities.

A single-specialty anesthesia group can range in size from two physicians to hundreds. All the members practice anesthesiology or a recognized subspecialty. Larger groups have significant market clout and are often able to
negotiate more favorable agreements with insurers and hospitals. However, there are risks in being large. Some dominant groups take advantage of their size to illegitimately raise prices. Such behavior can lead to exceptionally costly antitrust investigations and possible litigation by the Federal Trade Commission. Disgruntled competing anesthesiologists, who have been displaced from their jobs or seen their incomes reduced as a result of the large group exercising its market clout, may seek legal remedies. In addition, patients who believe that they have been financially harmed by excessive fees also have the option of creating a class-action lawsuit to recover overpayments. All of the risks lead responsible large groups to act conservatively in pricing and contracting.

Like the solo practitioner, smaller groups tend to be more nimble and flexible in taking advantage of business opportunities, but they may lack the resources and skills to implement their strategies effectively. They also do not have the economies of scale with regard to recruitment, benefits, and contract negotiations that a larger group can bring to bear on these matters. As groups increase in size, professional management and full-time office staff become a necessity. In addition, the breadth and scope of experience and knowledge that the physicians possess increases dramatically. Effective use of this resource often differentiates exceptional groups from average ones.

In large single-specialty groups, physician employees, even if they are shareholders in the group, may believe that their individual contributions to the group are limited. These physicians may assume an “employee” mentality, such that the motivation to attend to important matters such as group productivity and profitability, attention to customer satisfaction, and pursuit of new lines of business is no longer seen as a responsibility of the individual physician. In addition, this disengagement can lead to inadequate oversight of practice managers, billing vendors, and office staff, resulting in a range of problems including lost income, missed business opportunities, and even theft of funds. Well-run large groups have systems in place to help prevent these problems from occurring, which include careful oversight of employed managers, periodic audits, and mechanisms to encourage an “ownership” perspective for each physician in the group.

Because anesthesia practice is most commonly limited to a hospital or surgery center, fixed assets owned by the group and overhead expenses tend to be relatively limited. Medium to larger groups may own or lease office space and own office equipment; however, these groups do not usually have to hire clinical staff or own expensive medical equipment. A group that also offers chronic pain services may be an exception to this general rule. Because of these factors, group overhead expenses tend to be much smaller than seen for other medical specialties.