A group’s mission statement, if it has one, gives you an inkling of what is important to the organization. Although many mission statements are boiler plate—“We strive to provide quality, cost-effective care and serve our customers at the highest level… yada, yada, yada”—well-managed groups do use their mission statements as the foundation for all decision making. An example may be deciding not to enter into a business relationship with a facility that has a poor track record for quality or a history of confrontational relationships with providers. Although all groups should be able to address why they are in business, be particularly suspicious of intermediate-size or large groups that have not formally developed a group philosophy or mission. It might be a sign that the group places pecuniary interests above all else, a potential recipe for future problems.

Note that multispecialty groups will have a mission and focus that is much broader in scope than that of a single-specialty anesthesia group. For multispecialty groups, assuring a commitment to fair treatment of all physicians, regardless of specialty, is an important consideration. For academic practices, the mission will extend beyond delivery of anesthesia care and will address the research and teaching obligations of the organization.

Well-run groups are proactive in determining their needs and addressing challenges, have a well-defined plan to recruit new members as the practice grows or members retire, and have little turnover in established members. If you are looking at a group that demonstrates few or none of these characteristics, be very wary. You might be able to negotiate a better agreement initially because of the group’s desperation to meet a significant shortfall in staffing; however, just as a leopard doesn’t change its spots, a poorly run, unstable group rarely miraculously improves the quality of its decision making. Be sure to ask the group’s representatives about turnover among the anesthesia
staff and assess the longevity and quality of its relations with the facilities where the group practices.

As a new anesthesiologist in a group, you will likely be given a time-limited employment contract. Some groups promise new hires the moon—short time to partnership, astronomical income, and great benefits. But if you dig a little deeper, you might learn that the group has a long-standing history of bringing in “fresh meat,” taking advantage of their lower pay and vacation allotment, and then letting them go before their probationary period is up.

Ask about the status of previous hires and follow up with nurses and surgeons at the hospital or facility. Also ask for contact information for those who have recently left the group. If there is a disconnect between the group’s story and the other information gathered, the red lights should flash and the sirens should sound. Do remember to take the statements of those who have left with a grain (or more) of salt, as these individuals may have a personal axe to grind. The goal is to make an informed decision. If you know of problems but take the plunge anyway, that’s your choice, but you will have no one else to blame if/when past history repeats.

As discussed in other chapters, groups have many ways to calculate compensation. When you join a group as a new member, the group may handle your pay differently than that of senior members or shareholders. In discussing these mechanisms, I will focus primarily on some of the implications, particularly for new graduates. I will also look at the cost of buying an ownership position in a practice.