October 23, 2023

Effective management of any medical practice must include three distinct roles, which are often identified in classic business terms: the CEO, the CFO and the COO. Traditionally, the CEO is the one with the big vision, who sees the practice as a whole, who negotiates contracts with clients and payers. This is the person who should have the strongest relationship with administration. He or she should have a clear sense of what distinguishes the practice and what the practice’s value proposition is. In the current environment, CFOs play a critical role as they must have a sound understanding of their practices’ finances. It is their role to ensure that collections are being optimized and that expenses are being minimized. Ideally this person has a strong working relationship with the billing company or staff. Provider compensation can be a particularly challenging aspect of this role, especially given the national anesthesia manpower shortage. The term “chief operating officer” may not be the best description of this third role, as it is as much about customer service as manpower and staffing. Essentially, this is the person who deals with clinical issues, surgeon complaints and collaboration with the other members of the O.R. team.

The Management Matrix

Some practices consider themselves lucky because there is one experienced physician who plays all these roles effectively and who commands the respect of the members of the practice and administration. Sometimes such practices are even referred to as czar-model practices although such a term is hopefully hyperbolic. The point is that such practices usually enjoy a good relationship with administration and provide a very favorable work situation for physicians and CRNAs. The challenge may be that this head physician personally holds the contract with the hospital. These are not usually the most democratic of practices as management decisions come from the top. Clearly, longevity of such practices is limited to the tenure of the leader.

Such practices aside, many groups struggle with the identification of appropriate players for each of the roles defined above. Typically, individuals are nominated for management positions and voted in by the membership. While this is standard operating procedure for most groups, it can have interesting consequences. When there are strong candidates who understand the business of medicine and have the respect of their colleagues, good leaders can enjoy long tenures. The problem is that too often this is the exception rather than the rule. Sometimes, nothing is worse than an endless succession of short-term presidents or managing partners. A practice must present a continuous and consistent presence to its customers.

There are two critical dimensions to the management of any business, and anesthesia practices are no exception. Every team requires clear and decisive leadership. Think of the role the quarterback plays in football: he has a strategic vision that he effects in carefully selected plays. This is what effective chairmen do; they inspire and motivate the team members to provide a consistent and state-of-the-art service. The flip side of the leadership coin must be effective management. Someone needs to ensure that the visionary standards are consistently implemented. This is the yin and yang of good management. It is a critical counterpoise that exists in all successful organizations. No leader can be effective and successful without a strong support team. This is the responsibility of the executive committee.

Grooming for the Future

It has been said that the problem with most physicians exercising management roles is that they are doctors first and business people second. While there may be some truth to this, it does not have to be the case. This explains why the ASA started providing practice management seminars in 1994. The society recognized the reality that healthcare is a business. Since then, scores of providers have had their eyes opened to the economic challenges of medicine. It is an important theme that many practices continue to focus on and stress. The success or failure of a practice is much more a function of what happens outside the operating room than within its confines.

The perspective of anesthesia providers is often conditioned by the work they do. They are problem-solvers in the context of individual cases. It has even been said that they have the shortest decision-making sequence in medicine; there is no clinical issue they cannot address in a matter of seconds. The problem is that managing a practice requires strategic thinking and long-term planning. It is a different mind-set; and, just as providers had to be trained to provide anesthesia, now they must be trained to manage their practices. It is a new paradigm but one that can be learned and mastered.

Never has there been such turmoil and turnover in the specialty of anesthesia. Too many practices are successful today and gone tomorrow. This is the new challenge, and every practice must understand and appreciate the need to create enduring organizations that will continue to meet the challenges of tomorrow. Just as parents strive to groom their kids for life as an adult, so too, anesthesia practices must groom their young members to be managers of the future.

If you have any questions on this topic, please contact your account executive. 

With best wishes, 

Rita Astani
President—Anesthesia