Perhaps not surprisingly, I received several responses to this week’s PAADs “Profits, Providers, and Private Companies: What Happens When Wall Street Owns Your Neonatal Care or Anesthesia Practice? Parts one and two.” Several readers pointed me to the article by Peter Whoriskey in the Washington Post: “Financiers bought up anesthesia practices, then raised prices: Private-equity firms are merging doctor groups to create firms that critics say are big enough to wield excessive power over prices.” Created 10 years ago by a private-equity firm, USAP is now one of the largest in the U.S., with more than 1,000 doctors and spanning nine states. Read the entire article at: https://wapo.st/3D74e1U (Please note that many of the “facts” in this article are in dispute.)
A similar article was published by the New York Times on Tuesday by Reed Abelson and Margot Sanger-Katz entitled: “Who employs your Doctor? Increasingly a private equity firm.
https://www.nytimes.com/2023/07/10/upshot/private-equity-doctors-offices.html#:~:text=Nearly%2070%20percent%20of%20all,from%20the%20Physicians%20Advocacy%20Institute.
From Anonymous
I wonder if you can add a third part to this topic and discuss non competes when you try to leave a private or academic practice. It’s an unnecessary stressful nightmare and is much akin to being an indentured servant. Is it even legal?
From Amr Abouleish, MD, MBA, Professor, Vice Chair, Faculty Development, Department of Anesthesiology, The University of Texas Medical Branch, Galveston, TX commenting on OR efficiency of fellowship trained anesthesiologists
You are very correct that a small number of minutes will not change OR throughput except if the reduction in minutes is a significant portion of the operative time.(1) In other words, saving even 10 minutes a case will not allow you to do another case in an OR if the surgical duration is 2 hours long and you are only doing a max of 3 cases a day. Further complicating the evaluation is that just saving time will not necessarily save money unless you reduce staffing costs, finishing earlier will not really save you money. There two possibilities to consider. First, if the anesthetizing site always starts on time and finishes at 2 pm but staff is paid till 3 pm, then finishing earlier will not reduce staffing costs. Second, if the anesthetizing site finishes after 3 pm and staff is paid overtime after 3 pm, then in this case, even small reductions might save money through staffing costs reduction even if one cannot do another case.
Finally, I am confident I am the most efficient anesthesiologist at my institution. I have adopted the “move on one” policy for all my patients. As Brodsky (2) noted (in one of my favorite publications), changing to this policy saves 4 seconds for every patient. If I take care of 1000 patients a year, then I save 4000 seconds in a year which is a savings of over an hour of OR time. Just think of all that money I saved and we can do another couple of BMTs!
References
Dexter F, Marcario A. Decrease in case duration required to complete an additional case during regularly scheduled hours in an operating room suite: a computer simulation study. Anesth Analg 199;88:72-76. https://doi.org/10.1213/00000539-199901000-00014
Brodsky JB. Cost savings in the operating room. Anesthesiology 1998;88:834. https://doi.org/10.1097/00000542-199803000-00041
From Dr. Chris Sutton on single use medical items and waste
Thank you for Dr. Chen’s review on reprocessing medical devices. I have expressed my views on this in the past but I wanted to reaffirm the Pediatric Surgery Centers of Tampa Bay’s practice.
We reuse fiber optic laryngoscope blades and handles after every patient use. This entails removing the batteries before autoclaving, but we believe that this man(woman)power is well used. We use one circuit for the day changing out the mask and disposable Pall filter at the patient site with each case.
Our surgical volume is over a 1000 children per month so we believe our practice is environmentally friendly. Yes, I will join SPAs Sustainability group. For kids!