October 15, 2012

We are in the middle of the ASA Annual Meeting, which draws thousands of anesthesiologists from across the country to spend several days at meetings and lectures, all without compensation.  We know the incentive for the rank-and-file:  the opportunity to attend an incomparable array of refresher courses, panel discussions and other continuing education offerings.  Hundreds of anesthesiologists come to educate others and participate in committee and board activities as specialty leaders.

The sight of so many physicians spending valuable time together away from the operating room, along with some questions heard lately, made us wonder how anesthesia groups secure attendance at their own internal meetings.  Board and other governance meetings, finance and employment committee meetings, and all-employee and departmental meetings are important—indeed, they are indispensable to effective group management.  While recognizing the need to conduct business by meeting, few individuals wish they could attend even more meetings, and many people will avoid them if possible.

What incentives, then, will motivate anesthesiologists to come to and participate in group meetings?  Here are the major options in use:

1. A sense of duty, professionalism and team spirit.  By no means do all practices reward their physicians for meeting attendance through cash or other tangible benefits.  Particularly in the case of clinical meetings (case review, patient safety, IT training, etc.), participation may simply be expected of physicians and nurses.  Attendance at practice-wide meetings may also be expected as a matter of course.
2. The prospect of advancement within the group or the specialty, explicit or unspoken.  As with option number 1 above, self-motivation, perhaps encouraged by a mentor, is powerful among anesthesiologists and other professionals.
3. A financial carrot.  Many groups pay their members to attend meetings, both within the group and at the hospital committee level.  Even more groups compensate their officers and board members for their work on behalf of the practice.  Time is a valuable and prized commodity, whether OR time or evenings and weekends, and money is an efficient way in which to influence individuals’ prioritization.  There are many ways to determine the amount to pay for committee work.  The most frequently encountered methods are listed below as examples only—the variations are limited only by a group’s resources, values and creativity.
   • Flat rate.  Group members will be a paid a predetermined amount, which may vary according to the length, frequency and timing (e.g., during OR hours or evening) of the meeting, and also according to whether the physician is a chair or an officer as opposed to an attendee with fewer responsibilities.  The amount may be set as a function of benchmark income levels or of medical director stipends received by the group, if any. External benchmarks can be found in various survey reports by the Medical Group Management Association (MGMA), notably the Management Compensation Survey and the Medical Directorship and On-Call Compensation Survey.   In large practices where leadership devotes significant time to meetings and related administrative responsibilities, the annualized flat rate can be $120,000 or more.
   • Hourly rate.  Another common method of establishing compensation for meeting attendance is by setting a time-based rate, typically by the hour.  Medical director or other hospital administrative service stipends may be divided by the average number of work hours in the relevant period (month, year).  Alternatively, some groups assign a point value to meeting attendance and other nonclinical activities such as scheduling and pay a fixed dollar amount per point.  Another variation is to calculate a dollar conversion factor and apply it to the number of “time units” spent in meetings.  In an equal-shares income distribution system, this is a good way to incentivize participation in meetings held during the hours when the anesthesiologist would otherwise be in the OR.  A modified time-unit equivalent method would take the average number of total units produced on, e.g., Wednesday afternoons, and multiply that number by a dollar conversion factor for a Wednesday afternoon meeting.  Another variation that attempts to normalize for base units and not just time units might allow five or six units per hour of meeting time.
   • Revenue-based rate.  Committee members receive 1.0 percent, or some other share, of the total dollars distributed to the physicians in the previous year for attending at least 75 percent (or more, or less) of the committee meetings throughout the year (quarter, month).  
4. And a financial stick.  We know of one group in which the physicians all vote on a prospective dollar amount (or a percentage of salary) representing “citizenship” or “practice leader” compensation—a withhold, in concept.   Only those group members who attend at least 75 percent of the corporate meetings are eligible to share in this administrative compensation for the year. If at any time during the year, they fall below 75 percent, that portion of their paycheck is deducted and they have no chance of recovering the lost salary. If they then improve and bring their attendance percentage back to 75 percent or more, their citizenship compensation is reinstated going forward. The forfeited amounts can be re-allocated to the doctors with high attendance rates at bonus time, or they can be added to the employee bonus pool.  

Any variation that offers the right balance of incentives and equities is possible.  Once again, a group may decide that meeting attendance is to be expected without additional remuneration, or it may create a scheme allocating varying values to different roles responsibilities and extent of committee service.  A practice that introduces a meetings-compensation system is likely to find that changes are appropriate after gaining experience.  There is no one-size-fits-all model here, although we can learn from each other. We hope that your own system is working well for your group -- or that we have sparked some felicitous changes.

With best wishes,

Tony Mira
President and CEO