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Bill$****!!!!! The argument I'm making here is NOT that the MD's provide better care (I suspect that in most cases, the MD is over-trained to handle most intraoperative anesthesia anyway). My point is ONLY that the MD's are the ones responsible for training and educating all of the mid-level providers, and therefore when push comes to shove the MD's are ABSOLUTELY NOT forced into these market-driven relationships. MD's have a weapon that they are loathe to recognize. Why they keep it quivered is quite beyond me.
That's fine. But what you are intimating is that MD anesthesia has become lazy and entitled. To the extent that is true, they deserve to be replaced by people (whoever they are) that are willing to do the work they are unwilling to do. Is that the explanation for why these management companies are able to make headway into the marketplace? I can't see why a private MD group can't police itself just as well as effectivley as a corporate MD group can. That they are not is one issue. That they are incapable is quite another.
Well, this gets back the question I originally asked you - if the corporations are unable to provide an equal for better service for the same or less amount of money, they have no shot in the marketplace. I wondered then how they could possibly compete if they have (essentially) introduced another level of revenue skim between the hospital and the anesthesiologist. You can crystalize this whole issue by writing here whether or not your contracts with the hospitals have been more favorable or less favorable since the management companies have started to bid. If they are less favorable (which I gather they have been otherwise this whole issue would not warrant an entire thread), the question is "why". One answer is that the management companies could, despite the extra layer of profit-takers, provide a better or same service for less money (presumably by paying their staff much less money). If that is the case, then I am back to my original question - who are these MD's willing to earn so much less money? They are either stupid or bottom or the barrel? They don't do it out of the goodness of their heart.
I'll say something else as well about this as well - my understanding of the management company model suggests to me that they hire more transient, locum, temp . . . whatever, sort of people to staff the OR's and ICU's. You might describe them as anything you like, but "top teir" is not one of them. Top teir people are not willing to work for less money.
The last bit about the hospital MBA agreeing to pay the management company more simply because it has greater top-down expenses is ridiculous. MBA's don't make these sorts of allowances. You pay for service and results.
Judd
JUdd, I answered your questions but you do not like what you read. Thus, you respond in a defensive and speculative manner.
The fact is many hospital administrators prefer to deal with MBA's over Physicians. Simply charging the hospital the same price as the management company is not enough. You must show you are a better value than they are in every way: better care, more services and a lower price. This is the way to show the administration you are doing everything possible to work with them. But, you need to realize the management companies "inflate" the actual costs so they can make a 20% profit on each contract. So, any decent Group should be able to provide more services and beat the overall price.
As far as lazy Anesthesiologists out there I hate to inform you there are many. This is why the management companies can move in and get the contract. Once employed by the company these lazy individuals are forced to work or must find a new job. My understanding is that up to 50% or more of the "old guard" will leave within the first 24 months of being employed by the company.
The hospital gets to clean house with the management company without being bogged down in medical staff and legal issues. When a Physician has been of Staff at a hospital for many years it can be quite difficult to get rid of them (almost impossible). An easy way to get rid of these lazy guys is to have the management company do it. The company reduces their salary and provides clauses in their contracts making a ceratin amount of work mandatory.
Like it or not, there are many 50+ year old Anesthesiologists out there "coasting" on past service and previous work. These guys look to not do cases, avoid call and cancel cases. They have made a great deal of money and will "deal with the consequences" if it happens. In short, they are not "hungry" and concerned about winning the game. Also, it is not easy for the "Group" to get rid of these guys either (legal issues). Thus, the hospital takes the easiest route and starts over with a new company. So, one bad apple really can spoil the whole lot for everyone.
If the hospital grows unhappy with the management company or the Anesthesia Providers all they need to do is replace the company. They have no medical staff or legal issues with the providers because they work for the company. If the company goes so do the providers. This makes cleaning house fast and easy.
However, if the Group providing services is First Tier and proves their worth daily (both with the staff and with the $$bottom line) then the hospital will want to retain them. This is another reason why you want to examine the credentials and work ethic of any Group you join.