Doug Yunker, MD, an anesthesiologist who is medical director of Upper Arlington Surgery Center in Columbus, Ohio, reviews some of the advantages and disadvantages of employing versus contracting anesthesiologists, both from the anesthesiologists' point of view and from the hospital or facility's point of view.
Employing anesthesiologists
Advantages. When anesthesiologists are employed, all the hassles are now in the hospital's or facility's lap. The anesthesiologist doesn't have to worry about billing or about getting paid because the hospital or facility takes care of that. In return, the hospital or facility gets slightly more control over the anesthesiologist's time.
Disadvantages. Employment means another party manages the billing. The hospital or facility's claims processing system might not be receiving full reimbursement for the anesthesiologist's services. And if surgeries are slow, the employed anesthesiologist won't have many cases, which means both the anesthesiologist and the hospital or facility are missing out on payments.
Contracting with an anesthesiology group
Advantages. By contracting with a group, the hospital or facility gives the anesthesiologist an incentive to work harder. Anesthesiologists who are paid strictly for work done have a reason to stay late and do more cases. From the anesthesiologists' point of view, contracting is a way to limit the facility's control. In the contract, the anesthesiology group can negotiate work on weekends and taking night call.
Dealing with CRNAs is another issue. In a contracted relationship, either the hospital or facility employs the CRNAs or the group does. Most groups employ their own CRNAs. This gives the anesthesiologist more control over them in terms of hiring, firing and wages.
Disadvantages. The hospital or facility may have less control over the anesthesiologists, but it would still not have control over clinical matters, such as the drugs and techniques the anesthesiologist uses. From anesthesiologists' point of view, they may have fewer hassles with billing if they are employed, but in most cases this can be easily handled by a large group.