Preventing the Hostile Take-over of Your Practice
YOU practice in a “lightly supervised” setting in a 250 bed hospital with 14 CRNAs and 5 MDAs. Wages are competitive, benefits reasonable and life is pretty good. CRNAs do most of the main OR work, MDAs roam around,cover most of the OB and all the 1st call. There is some turnover in staffing every year, but locums fill in and you are not directly affected, nor impacted by their cost.
The MDA that owns the group has had the contract for twenty years. You signed a non-compete like everyone else, without much thought. Go to work, cash your paycheck and have a life. You are not involved with the business side of the practice. You aren’t required to join hospital staff and are discouraged from providing inservice training to hospital staff, something the MDAs will do. Surgeons are friendly and appear satisfied with the status quo, obviously aware that you and the other CRNAs are doing the work, while MDAs come when called.
Then the CEO retires and a new CEO is hired from a neighboring state. He brings a different perspective, and sees the hospital assuming all the cost and risks in an increasingly difficult reimbursement environment. He questions the 1.5 million dollar annual anesthesia subsidy.
The Hospital board backs the new CEO and you find out the the surgeons 
were not especially friends of the MDA owner. A Request For Proposal (RFP) is sought and a Mega Group responds.
The CRNAs are caught in the middle. Their positions are posted the next day on Gasworks. The mega group and hospital offer CRNAs lowball offers and the owner intends to enforce the non-compete clause.
Move or take a pay cut, not attractive choices. In this situation the train has probably already left the station and this practice will never be the same for the current anesthesia providers. But what can we learn from this scenario?
An anesthesia practice is much more than simply showing up for work.
Relationships with decision makers is vital if one expects to sustain a practice. As health care reform unfolds and competition between anesthesia providers increases, excellent anesthesia skills are expected or you won’t even be under consideration. A business consultant nicely summarized it, “You must bring something to the table besides a fork”. We must nurture relationships with administration, medical staff, hospital boards and hospital staff. We must develop our “brand” and solve problems, not be the problem.
Quality must be embraced. It is not good enough to be good enough, we must strive to make our service the best it can be and you can only do that by tracking outcomes, addressing concerns promptly and welcome these concerns because they are absolutely necessary for us to improve.
Communication within the practice insures that everyone is aware of the state of the practice. Failure to share information, expectations, positive and negative feedback prevents the sense of practice ownership and the “job” mindset will set in.
Integrity ““Success without honor is an unseasoned dish; it will satisfy your hunger, but it won’t taste good.” Joe Paterno -
Respect is earned and must be mutual. A Practice that fails to recognize the value of each member has no foundation for success.
Business-”An economic system in which goods and services are exchanged for one another or money, on the basis of their perceived worth. Every business requires some form of investment and a sufficient number of customers to whom its output can be sold at profit on a consistent basis.”- Business Dictionary
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