Traditionally, a doctor’s role has been as a patient’s advocate, with a focus on medical care and clinical decision-making. To be an effective clinician, some believe that a physician should be separated from conflicting financial interests, and administrative management should be outsourced to nonclinical administrators. As health care consolidation accelerated, the divide continued to grow between physicians and hospital executives, resulting in physicians being siloed as “providers” and administrators becoming divorced from the needs and challenges of their staff. This has created multiple challenges, including suboptimal communication, operational inefficiencies, and financial loss. By re-engaging physicians in health care administration, we can begin to address some of these entrenched challenges.
Physician engagement is the investment of a physician’s time outside of direct patient care. Engagement has been shown to increase physician retention, improve cost savings, and increase hospital quality metrics. For instance, Stanford Health has found that engaging physicians in the review of resource utilization measures decreased the length of stay in intermediate intensive care units, resulting in approximately $5.7 million in cost savings (Am J Med Qual 2021;36:387-94). Physician engagement has also been shown to decrease burnout, which can cost a hospital $0.5-$1 million per physician (Clin Med Res 2020;18:3-10; asamonitor.pub/42nWAKU). Hospitals experience reciprocal benefits when there are high levels of physician engagement.
A key barrier to anesthesiologists becoming involved in nonclinical administrative work is the discrepancy in financial reimbursement for the work performed. Clinical work is highly reimbursed, while administrative work at the entry level is often not. If compensation is being received, it is typically from a facility or department and is considered a cost center. As such, with the lower initial reimbursement for administrative work, many physicians take on nonclinical duties simply because they believe in the mission. Although these dedicated physicians should be lauded, this sets up a challenging precedent and perpetuates an unsustainable cycle of working more hours for less reimbursement. As such, it is important to support physicians engaged in administrative activities.
Mechanisms of compensation for nonclinical time
Increasingly, health care systems have begun to recognize the clinical divide and have tasked physicians with more nonclinical duties. How these administrative tasks are compensated varies depending on the type of clinical practice.
In an academic medical center, nonclinical time is often funded through an academic mission, allowing the clinician to position their work toward that defined goal. Often, this work is compensated by providing a carve out of clinical duties for that physician, effectively allowing them to maintain their base salary if they are not overscheduled beyond their clinical commitment. Unfortunately, given the current national shortage of clinical resources, this is often not the case. Anesthesiologists are frequently losing nonclinical days to cover staffing shortfalls, causing disruption in research and administrative work. It’s essential for the department to advocate for a fair compensation structure to address these scenarios to mitigate frustration and burnout.
In the private practice model, nonclinical compensation can be derived through two main sources: the practice itself or the health care facility in which the work is being done. In the case of the latter arrangement, funds can flow either directly to a practice for an individual’s work or can be sent directly to an individual physician. In both scenarios, there is underlying pressure to undervalue nonclinical time. For a practice, those performing clinical work may balk at paying someone to perform administrative duties. Also, with budgetary constraints, few administrators believe that an anesthesiologist, with little to no administrative experience, should be compensated at their baseline clinical rate. However, physicians involved in these administrative tasks are frequently working more for less compensation than their regular duties, placing additional stress on an already strained workforce.
Due to diminished reimbursement and lack of protected time, many physicians view administrative tasks as a burden. The current perception of nonclinical time needs to be reframed. To be sustainable, physicians tasked with administrative duties should be encouraged to negotiate for parity in compensation for their endeavors.
To make a case for proper reimbursement, prepare to show what you have to offer as a strategic plan and provide evidence for your value. It may be challenging for a hospital system or a group to allot funding to an anesthesiologist they perceive as having minimal administrative background for nonclinical tasks. However, doing your research to show what you want to achieve and how to achieve it lends legitimacy to your experience. Focus the discussions not on what you have achieved, but rather what you intend to achieve. This also helps you think more strategically about the organization as a whole and helps ensure you are aligned with the organization’s growth model.
Second, understand the perspective of management. Negotiations for compensation may feel like a zero sum game, but that perspective may harm discussions. Understand the financial constraints of an organization and try to work within those limitations. If your proposal reduces costs, consider contingency pricing to defer the initial cost of your project. This decreases risk to the institution and aligns both parties’ incentives.
Third, consider timing and propose solutions when they can be implemented. You will want to make suggestions prior to the budget being set. It’s much easier to approve funding prior to funds being allocated. Also, consider if your proposal matches the strategic mission, vision, and objectives of the organization.
The value of an anesthesiologist’s work extends beyond the clinical space, and the challenge is to be compensated for the time invested for administrative work. However, with the increasing push by payers toward value-based care, growing demand by hospitals for physician engagement, and increasing pressure on systems for efficiency and cost savings, it is critically important for anesthesiologists to have a seat at the table. For the investment of nonclinical time to be sustainable, physicians should have support for the time invested in these endeavors.