Always Avoid the Bad Jobs—Review the Practice’s Special Funding Sources, Obligations, and Benefit Packages
Norman A. Cohen MD
Many anesthesia practices receive payments from facilities to provide specific clinical services or complete administrative tasks. In a 2004 American Society of Anesthesiologists (ASA) survey, 57% of practices received stipends of one sort or another, and 91% of academic practices received institutional support. Almost 10% of the stipends exceeded $3 million/year!
Clinical service stipends frequently address provision of obstetric or trauma anesthesia coverage, because the income potential compared to the cost of providing these services is not favorable. Cardiac anesthesia is another area that may receive support, because such a large percentage of patients are covered by the poor-paying Medicare program.
One of the most frequent types of stipends, although one of the lowestpaying, is for medical director services. Medical director responsibilities may include departmental scheduling, addressing operating room operational issues, and quality and cost improvement initiatives. Paying an anesthesiologist to fulfill these responsibilities is often seen as money well spent by facilities.
A substantial number of hospitals and other surgical facilities have entered into exclusive relationships with anesthesia groups to provide specified anesthesia services.
Advantages and Disadvantages.
For the hospital, an exclusive agreement usually provides guaranteed anesthesia coverage for the operating rooms, obstetric suite, and sometimes the intensive care unit (ICU). The hospital often has the ability to bypass medical staff due-process rules to quickly address perceived issues of quality. If the group does not meet its contractual obligations, the hospital frequently has the option to terminate the agreement, with automatic relinquishment of medical staff privileges. When this option is present, the hospital has significant power and influence over the group.