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The ASA PRACTICE MANAGEMENT Conference is one of the best sources of information and education on how to effectively and efficiently manage an anesthesia practice. The offerings provide opportunities that range from expanding existing knowledge to building a basic foundational understanding. For several years, we have offered an exclusive Residents & Fellows track. These sessions provide foundational concepts in practice management that are essential to meet and excel at the non-clinical demands unique to starting out in practice.
As an anesthesiology resident, your schedules are full, but this is an opportunity well worth considering. If you want to know what you will get from attending, please review the feedback from three residents who were awarded Emerging Leaders scholarships for 2018:
Patrick Egan, M.D.:
“When applying for this scholarship, I viewed the opportunity to attend this meeting as a way to further my engagement with issues regarding the future of this profession, quality improvement, and our ability as anesthesiologists to provide care that truly serves the best interests of our patients. As the last guardians of the patient’s safety in the OR and the physicians who spend the most time in the perioperative arena (which is at once the most costly, acutely dangerous, lucrative, and litigious part of the hospital), anesthesiologists are uniquely qualified to serve as managers of perioperative care teams. Concomitantly, we are ideally positioned to function as physician leaders in the broader, constantly evolving health care landscape. Now and in the future, it is imperative that physician anesthesiologists take the initiative on advocacy issues and serve as leaders in health systems in order to best shape health policy and move those systems forward.
The resident component of PM2018 delivered a high-yield, efficient education in a series of engaging lectures concerning subjects that, although scarcely touched upon in formal medical education and residency training, will be highly pertinent to our future careers. Some lectures covered subjects that are salient in a short-term, pragmatic sense for anesthesiology residents. These talks addressed different types of anesthesia practice models, as well as clinical and non-clinical expectations of first-year attending physicians. An attorney who specializes in employment contracts delivered a lecture that was particularly informative and timely for residents and fellows, many of whom will soon be applying for jobs. Another topical lecture addressed the financial challenges and potential pitfalls as residents transition into attending physicians.
With a focus on long-term career trajectories of anesthesiologists, one lecture focused on creating a solid foundation for professional development and encouraged residents to think outside the box to find their own niche as attendings and leaders. It also encouraged residents to take the time to reflect and articulate professional goals for one, three, and five years ahead, before highlighting Harvard Business Review’s tips for professional success. Another lecture devoted to marketing and managing anesthesiology practices encouraged physicians to directly engage the hospital management in pursuing its goals. This lecture reflected on ways for physicians to effectively articulate how we address those goals and how we communicate our value to the macroscopic health system. It also encouraged anesthesiologists to become leaders in cost control discussions and policy development.
Further speakers articulated some of the present and future challenges of running an anesthesiology practice. The Billing lecture explained how reimbursement is determined for anesthesia services and distinguished between medical supervision and medical direction. This lecture also pointed out the essential nature of thorough documentation with regards to informed consent, ASA status, and billing for certain perioperative procedures. The Risk Management lecture differentiated between complications, unexpected outcomes, adverse events, and medical errors, and also defined Rapid Analysis versus Root Cause Analysis (RCA). It emphasized the importance of clear communication with family members, disclosure and follow-up with patients and families, when and how to offer empathy, and the definition and legal application of medical malpractice. The OR Efficiency lecture discussed the impact of OR time to hospital revenue, the practice of block scheduling and calculating OR utilization, as well as avoidable errors that negatively impact a practice’s efficiency and financial bottom-line.
The highest impact lectures were those addressing the future of anesthesiology practice models. The Chair of the ASA’s Committee on Practice Management spoke to us about Alternative Payment Models, elucidating the differences between fee-for-service, pay-for-performance, bundled payments, and capitation models of reimbursement. He then described opportunities for anesthesiologists to demonstrate quality by developing the perioperative surgical home and by improving postoperative pain. Another demystifying lecture described the transition to Value Based Care payment systems, describing ACO’s and value-based quality metrics. Finally, the ASAPAC Board President expounded on the impact of political advocacy in protecting the highest standards of patient safety and advancing the field of anesthesiology in the modern health care landscape.
My experience at the resident component of Practice Management 2018 convinced me that physician anesthesiologists need to actively engage practice management and advocacy issues, and we must also foster greater support and involvement from our colleagues concerning such issues. This meeting was an invaluable learning experience, as well as an opportunity to connect with physician anesthesiologist leaders. I would wholeheartedly encourage every anesthesiology resident interested in these topics to apply for this scholarship.”
Sagar Navare, M.D.:
“In many ways, the life of a resident can be simple. The days may be long, and the work can be exhausting, but our current practice and (livelihood) are very well defined and secured. Many of my mentors in residency have made it a point to discuss that while our clinical acumen grows exponentially during our training years; most residents are lacking the practical knowledge of what it takes to succeed in practice. Realizing my own inadequacy in this regard, I decided to pursue attending the ASA Practice Management (ASA PM) conference in 2018 to help improve my exposure to this realm. My expectations were simple: gain greater insight into how Anesthesiology is and will be practiced in the coming years; develop an appreciation for the practical challenges facing the field; and network and learn from the innovators who are helping define how Anesthesiology will be practiced in the future. Thanks to the generosity of my residency program for granting me the time and having the good fortune to be awarded an ASA Emerging Leaders Scholarship; I was able to attend the ASA PM 2018 conference in New Orleans, Louisiana.
In planning for the conference, I was impressed (but not in the least surprised) by how well organized the ASA was in structuring the experience and proactive they were in communicating ways to maximize my time at the meetings. The specifically designed ‘Resident Track’ was perfect for accomplishing my personal goals for the conference while being with a cohort of my peers from around the country. For being a relatively brief meeting, the ASA PM conference was surprisingly robust in the diversity of offerings and I often found myself torn between 2-3 conflicting events due to the sheer volume of high-quality speakers. Within the ‘Resident Track’ a number of speakers early on discussed items relevant to the current practice of Anesthesiology including an insightful talk from Dr. Alex Choi and his experience managing a large Anesthesiology practice in Indiana. Equally, beneficial were talks from multiple Anesthesiologists regarding what employers were seeking in the current market climate and variations between Academic, Private, and Employed settings. Especially for residents, this is often a key detail difficult to ascertain from within the ‘bubble’ of residency in an academic medical center. From these early meetings, I felt as if I had a general grasp of both the current state and the near future of the practice of our great specialty.
Another block of talks was centered around future changes and challenges to the practice of Anesthesiology. Most of these centered around changes in the Centers for Medicare and Medicaid Services (CMS) policy and how this would affect practice. While I cannot pretend to be an expert in dissecting federal policy and translating it into practical terms; the ASA PM speakers did an excellent job not only distilling the issues to the most poignant details but also providing key strategies to adapt to the coming changes. From this experience, I left impressed by the host of downstream effects changes in public policy can have on healthcare in general. However, I was equally impressed by how the ASA develops strategies to not only meet these downstream changes head-on, but by also proactively engaging with policymakers are able to influence how future policy that affects Anesthesiology is created and implemented.
Of all the aspects of ASA PM 2018, my favorite by far was networking with fellow residents and learning from current leaders in the field. Mirroring my experience at other national conferences, I was impressed and inspired by the intelligence and drive of my colleagues across the country. Likewise, learning from their unique considerations and practice patterns geographically was enlightening. I found that one of the most insightful aspects of this conference was gaining an appreciation for the sheer diversity in how our specialty is practiced and how conferences such as the ASA PM are crucial for not only learning about these differences but also gaining an appreciation for trends in the field that are yet emerging. Equally impressive was being able to gain insight from current leaders in the field and of new innovations in the practice of Anesthesiology. An extremely engaging talk by Dr. David Lubarsky was based on the concept of incentivization within an academic department. Applying some of the latest concepts in behavioral economics, Dr. Lubarsky’s talk brought to light some of the challenges in leading a group of one’s peers and how to promote productivity without stifling creativity and academic inquiry.
Attending the ASA Practice Management conference was one of the most impactful 48 hours of my time in residency thus far. From appreciating the economic, structural, and public policy constraints of the current practice of Anesthesiology to gleaning insight from the leaders in our field - the conference exceeded all of my expectations for the weekend. I believe that the current climate in healthcare demands a higher level of engagement and responsibility on the part of Anesthesiologists to meet expectations from patients, institutions, and financial stakeholders. It is only through meetings like the ASA PM that we can confidently adapt to change and be proactive in defining our future practice environment. I hope that more ASA members and residents in particular take advantage of this incredible opportunity in 2019 and participate in creating a brighter future for our specialty and our patients.”
Lindsey Gouker, M.D.
In the winter of 2018, I had the opportunity to attend the ASA Practice Management Conference in New Orleans through the Emerging Leaders Scholarship Program. I sought this opportunity as a CA-2 as I felt this would be a great introduction and overview of practice management, a component of the practice of anesthesiology with which I had little familiarity but great interest. The Emerging Leaders Scholarship provided a generous stipend to cover my airfare, lodging, and registration fee, allowing me to attend this valuable conference as a resident while not requiring any out-of-pocket expense.
I started my anesthesiology residency in 2017 as a non-traditional applicant as I had already trained in and practiced pediatric oncology for four years prior to returning to residency. I had experienced a few versions of healthcare delivery up to that point through my pediatrics residency, fellowship, and attending practice in both an academic and non-academic setting. These experiences were rewarding and challenging in different ways, ultimately igniting my interest healthcare administration. But, as with so many full-time clinicians, I had neither protected time nor mentorship to broaden that interest.
When interviewing anesthesiology residency programs, the University of North Carolina quickly stood out as it offered a truly unique opportunity: protected time and financial support to complete a master’s degree in healthcare administration during the CA-3 year. This was the perfect combination of clinical and administrative training to serve my long-term career goals. I started my MHA in the fall of 2018 and, as I was preparing for the program, I looked for other opportunities to expand my knowledge of healthcare administration, especially those that pertained to anesthesiology. I quickly recognized the value in the ASA Practice Management Resident/Fellows Track and took advantage of another great opportunity.
The resident/fellow track is a one-day course solely dedicated to introducing basic concepts to trainees that have had a fair amount of clinical experience in an academic healthcare system but lack meaningful exposure to other practice models or the financial and administrative structures of healthcare in general, all of which contribute to and influence our clinical practice. I know I’ve asked myself and assume many of my co-residents and fellows have the same thoughts: why do I practice the way I do, what influences my institution’s processes and work-flow, and how can I be more efficient. The workload of a resident, however, leaves very little time or energy to take the next steps with those thoughts. This conference fills that gap by providing protected time with colleagues and mentors, all with similar goals and interests, to introduce some of those anesthesiology practice fundamentals—the various types of anesthesiology practice models, medical direction and supervision, billing and coding requirements, and payment models are just a few of the topics covered.
Additionally, there were lectures aimed at facilitating a smooth and successful transition from resident to attending, something about which all residents (even those doing it for a second time!) are nervous. Managing employer expectations, professional development, and fiscal responsibility were all covered by established mentors with much experience and wisdom to share. These topics covered both private practice and academic practice models and were applicable to residents at all levels of training, regardless of intended career path.
Overall, the ASA Practice Management Resident/Fellow track was a fantastic and efficient way to become introduced to some of these important concepts, both professional and personal, that will certainly be sources of great assistance in any resident or fellow’s future career. I personally left with new knowledge of our very nuanced and complicated healthcare system and some helpful tips on making my transition to attending in this whole new world less tumultuous and stressful. I would highly recommend it to any resident or fellow, regardless of your interest in healthcare administration, as it provides some great framework for a successful career as an anesthesiologist. I plan to continue building on my healthcare administration and management knowledge and look forward to attending the Practice Management Conference as an attending in just a few years.
PRACTICE MANAGEMENT 2019 will take place on January 18-20, 2019 in Las Vegas.
To learn more about the Residents & Fellows Track, please contact ASA Member Services at [email protected] or visit https://www.asahq.org/meetings/practice-management
