As physician employment accelerates, anesthesia leaders say the biggest pressure points are structural rather than clinical.
Anesthesiologist Jason Hennes, MD, founder of anesthesia data and scheduling platform Anesthesia Data Services, joined Becker’s to discuss the workforce trends shaping how groups staff, pay and measure productivity.
Editor’s note: This interview was edited lightly for clarity and length.
Question: What changes are hitting anesthesia groups the hardest, and how did that influence what you built into Anesthesia Data Services?
Dr. Jason Hennes: The shortage of providers and the need for stipends to meet the salaries demanded by the marketplace are two major challenges groups face. The move towards employed work and more locums work isn’t going away, and philosophically, as more physicians across all specialties become employed, they will think and act more like labor.
So when I built Anesthesia Data Services, it was built to help groups navigate this shift in employment models. In the past, we paid ourselves based on units generated, and we handled billing and collecting everywhere we worked, so we had clear internal data on unit production. Now, we have more variety in our contract types exclusive at some facilities, hourly at, some stipend supported work, and so on. The pay and reimbursement structures are far more varied than before, and the platform allows us to manage that complexity.
Question: Outside the platform, what are your biggest concerns amid this shift to employment?
JH: I think one unanticipated consequence of physician employment is that it allows for a more transient provider workforce. I believe this is being seen across all specialties. When physicians are not tied to an area through a practice they have established themselves, it becomes much easier for them to leave for a new position on short notice. Geographical patient care patterns can be quickly disrupted when providers suddenly leave, and it takes a significant amount of time and money to hire providers to replace them, and that’s assuming replacements can even be found at all. Hospital leaders can no longer simply look at the age of their medical staff as an estimate of how long they can expect the physicians to be around. Significant upheavals in patient care can occur with only a 90- or 120-day notice.
Another “canary in the coal mine” of these changes is the dramatic uptick in physicians scaling back the amount they are working or even leaving clinical practice altogether. In employed scenarios, oftentimes the individuals establishing the operational structures and funding levels for physician departments/groups/providers are not the providers themselves. The decision-makers do not have to live and work with the consequences of their decisions. With private/solo/independent groups, group leaders and group providers are the same individuals, so they have “skin in the game” when making operational decisions.
A good example of this are recruitment ads that promise physicians jobs that allow them to “practice at the top of their license.” On an economic level this makes sense: Match the acuity of the work to the level of one’s training. But a daily onslaught of the most difficult and challenging aspects of one’s field can quickly lead to burnout and fatigue … and this applies to not only physician work but any line of work. So one has to question if there is a connection to be made between the significant number of physicians reducing their work levels or leaving the practice of medicine altogether.
Older practice models offered providers more control over the ebb and flow of the intensity of their work across the full spectrum of their careers. It offered more control over the practice model and physician-patient interaction. This resulted in longer physician careers. Remember, CMS uses taxpayer money to fund residency spots across the country. The longer a physician stays active and working clinically, the greater the return for the taxpayers on this investment. It really behooves our industry to figure out what is causing the scaling back and attrition of the physician workforce and see what can be done to stem the tide.
As physicians, we are trained to practice evidence-based medicine, which implies that high-quality scientific studies and experience should guide the decisions we make when treating our patients. Sometimes, what is initially thought to be a promising therapy turns out to create problems and side effects that ultimately result in the therapy being abandoned. So as these new paradigms of organizing the physician workforce are being put in place, they must be evaluated. Outcomes must be examined to see if they are yielding the intended results. And if negative consequences begin to arise that affect the healthcare industry’s ability to care for patients and carry out its work, then paradigms have to be reexamined and changed. In the meantime, physicians and healthcare workers will do what we always do: overcome staffing shortages, supply chain disruptions, facility closures, coverage denials, documentation overload … and stand at the bedside and find a way to deliver care to the patients in front of us.