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0:00 [AUDIO LOGO]
0:12 Hello, and welcome to Scrub In. Today, we are talking about anesthesiology and surgical
0:19 care. It’s a hot topic today amongst anesthesiologists, obviously hospital executives, and obviously for any patient
0:27 who is seeking surgical care. So my name is Leslie Basham. I am the President and CEO of Surgical Directions.
0:35 And today, I am joined by three of our national experts, Dr.
0:40 Jason Klopotowski, Renaye Jenkins, and Supriya Patel. So let’s dive right in because this is an important topic.
0:50 And I want to get your thoughts. And I encourage us just to make this conversation, all right?
0:57 Have a discussion. But I pulled up a stat. So a lot of stipends, the cost for anesthesia are increasing.
1:05 So they’re up more than 40% just since 2020, a huge increase.
1:10 And hospitals are asking, why? What’s the– why is this going up so much?
1:17 What’s the return on investment? So let’s just get right to it. Why is this happening?
1:23 Why, all of a sudden, is anesthesia cost up so much and hospitals are paying so much more for the same or maybe sometimes less
1:30 anesthesia coverage? Number one, the labor. We’ve lost a lot of people in the industry.
1:36 The programs are requiring more, so it’s taking more time to replenish the people that
1:41 have left the industry. And the big thing is reimbursement. Reimbursement has really changed,
1:46 and now we’re seeing facilities like ASCs that have never had subsidies that now have to ask.
1:54 Yeah, it’s a supply and demand economics math question for me.
1:59 Reimbursement’s down. Costs of labor is up. It’s simple math in the end.
2:06 But I want to really focus more on the perceived– the perception in the market from hospital administrators
2:13 that– about the rise in these costs. Anesthesia groups, at one time, a lot of them were profitable.
2:22 For a long time, a lot of them were cutting even. And now, what we’re seeing is upwards
2:27 of 80%, 85% of groups requiring stipends. And really, what’s catching the attention of hospital leadership
2:35 and the people in the C-suite is not necessarily that there’s a stipend. I think everybody knows– or people in health care
2:43 know that this math equation isn’t working out anymore, but it’s the sheer increase and the multiples
2:48 of the stipend that are being asked for that, I think, are rising. This issue from the mid-levels of management
2:55 to the top of the C-suite now. It’s 100%, 200%, 300% increases in stipend,
3:03 along with room closures or the threat of room closures, it’s really pushing this to the top of any kind of concerns
3:10 amongst the C-suite. And I think a lot of it has to do with education of those administrators to understand exactly what’s going
3:18 on in the world of anesthesia, understanding how their ORs work. I think that there’s an issue with the groups,
3:27 being proud groups or being risk-averse to what stipends mean for them. Holding out, stretching their labor to the point of burnout
3:36 in some places that we see to try and keep that stipend low, and then all of a sudden, reaching a crisis mode and coming back
3:43 to the hospitals with multiples of the stipends that they asked the year before. That catches anyone’s attention and becomes a red flag.
3:51 The hospitals also, I think, need to be educated and understand how their operations affect
3:57 the cost of anesthesia. When you have rooms that are running at 40%, 50% utilization,
4:04 that equates to time that the groups have to spend paying their anesthesia providers,
4:10 but not being compensated for those anesthesia providers. And those deltas in that white space,
4:15 or that unreimbursed time, very much impacts the cost that’s being seen with regards to anesthesia.
4:24 And I think, Jason, just to add to that, we’re seeing a lot of groups not able to recruit
4:34 as many providers as maybe they’re used to. And now we’re starting to see that influx of locums.
4:40 And that increase in cost because of locums. And I think a lot of hospitals are
4:47 seeing that not just from a private group standpoint, but also from an employment standpoint. I think both sides of–
4:53 there is now, because of this demand and supply issue, a need to source, outsource, whether it’s locums
5:01 or whether it’s through a 1099, and that’s, I think, more prevalent than it was before.
5:07 I’ll piggyback on that a little bit. It’s not just locums. Mm-hmm. It’s stretching and burnout of your current workforce.
5:15 We see all kinds of permutations in variable pay and premium pay.
5:20 In order to cover these rooms that the hospitals are asking for, they’re asking these providers to work 45, 50,
5:27 55 hours a week, and the physicians in this market, knowing that locums can be paid so well, knowing that there’s
5:33 all these job opportunities elsewhere, are going back to their group or the hospital if they’re employed
5:39 and saying, I want to be compensated appropriately for this extra work I’m doing. And that’s been a change that we’ve seen over the last five,
5:46 10 years of anesthesiologists and anesthetists saying, my time is of value.
5:52 It’s not the old school where I’m going to come in and do what’s ever needed. I want to be paid for that time.
5:58 And the multiple permutations of that variable pay are really driving a lot of costs up in addition
6:03 to the locums. A little bit more about that burnout, and the whole reason
6:08 why this is such an important topic is because it’s about surgery and patient care.
6:14 So what should these groups be doing? Or what is anesthesiology’s role in providing great patient care,
6:25 safe patient care? And what can groups do to make sure that that’s sustained or hospitals do to make sure
6:31 that that’s sustained? One of the most important things is making sure that our anesthesia providers are OK.
6:39 Because– and I think that goes back to, with a lot of the private groups,
6:45 even with the organizations, making sure that mentally– because the ones that are still practicing,
6:52 they dealt with a lot during COVID. And so making sure that they’re so that they can take care of the patients.
6:57 And like Jason mentioned before, is transitioning out of that old-school model where we expected that everyone could
7:05 just work as many hours as there were to work and really making it OK with people having
7:13 balanced schedules, allowing people to have flexible schedules. I think that’s something that’s new,
7:20 that everyone needs to get on board with, that it is a deviation from what we did in the past,
7:28 but I think that will help to make sure that patients can be taken care of because their providers are
7:33 going to be OK mentally as well. Leslie, I grew up in an age of anesthesia where your anesthesia group was very good
7:41 if you were never heard from. We took great care of patients, there were minimal patient care
7:48 issues, and we didn’t ask for a lot of stipend, if any.
7:53 That dynamic has changed. And it’s almost to a detriment of anesthesiologists
7:58 and anesthesia groups, but anesthesia’s a different beast. You’re doing a good job, you’re never heard from.
8:05 And unfortunately, our group in 2018, somewhat related to that mantra, lost our contract
8:11 to another group. Long story there, don’t need to get into it, but I truly
8:16 believe that part of that was– although we were having great care of patients
8:22 and great outcomes, just taking care of a patient, induction,
8:27 emergence, safe exits, recovery, that is the most important thing
8:32 we do. But if we don’t show our value outside of that great patient care with blood bank, ERAS, pharmaceutical management,
8:43 those are all things that we can make ourselves more visible from the hospital and administration standpoint,
8:50 add value and also improve the care of those patients. So, there’s been a dynamic shift, I believe,
8:59 related to the increasing stipends that hospitals, administration leadership, they aren’t just
9:04 looking for great patient care, they’re asking, what other value can bring to our patients,
9:10 first and foremost, but also to the vision, goals, and strategy of the hospital in procedural care.
9:17 I think a part of burnout– and this alludes to, also, Jason,
9:23 what you were talking about in terms of the other things outside of just providing that direct patient care.
9:29 And I think a big part of burnout is also your culture. And when a hospital– and I think
9:35 this speaks to the hospital side of maybe things that they can do to help improve burnout and mitigate that,
9:43 is helping to establish a better culture with your anesthesia group. And that means including them in the decision-making that
9:52 directly impacts them or maybe sometimes indirectly impacts them. And that can be some of the examples
9:58 that Jason mentioned, that they’re going to be monitoring and improving.
10:03 But also, anesthesia is a big part of how efficient
10:09 your OR runs. And how not only safe your patients are, but how they get through the system.
10:15 And they need to be a big part of that decision-making because they’re directly impacted by it.
10:22 And I think a good example of that is setting up a collaborative governance structure that anesthesia is a part of where they feel
10:30 like their voice is heard, and if they’re facing struggles or if they think the market is shifting
10:36 and something needs to be evaluated or maybe something within patient care needs to be evaluated, they have an avenue to do that.
10:44 I completely agree, and I want to expand on that a little bit. Getting back to your original question,
10:50 based on what I had just said and what Supriya and Renaye had said, one big thing we hear in anesthesia right
10:56 now is availability, and the cost related to availability.
11:01 I want to open up OR 10 till 7 o’clock at night. I may not utilize that all the time.
11:08 Well, the education of the administrators and the people that pay those stipends is, that availability
11:15 needs to be paid for. We can’t stretch our anesthesiologists, our CRNAs,
11:20 our AAs, our staff to fit that need. Even if you don’t think you’re going
11:25 to utilize that block till 7 o’clock at a high percentage, that would increase reimbursement
11:31 to those providers. And I want to say availability not only pertains to the patient care, but getting back to the things
11:37 that I just mentioned, there has to be an acknowledgment and education about the cost of availability
11:43 to add to the value of your institution outside of direct patient care, and that gets missed a lot in anesthesia.
11:49 We’re asking all these providers to take care of patients, take care of patients, take care of patients. We’re also asking them to help us with utilization.
11:57 Help us with ERAS protocol. Help us with our regional bloc program. But they need time for that.
12:03 They need compensated time for that to help align with the value, strategy, and goals of the hospital, and that connection is broken.
12:11 And one of the things I really hope to do and what we strive to do at Surgical Directions
12:16 is to help groups communicate that and translate that to administration, and vice versa,
12:21 for alignment of those goals outside of the great care that anesthesia providers participate in.
12:28 And that is one of the biggest disconnects I’m seeing in the market.
12:34 That’s super interesting, and I liked the point, too, Renaye, you’ve got to make sure that anesthesiologists are OK.
12:40 And we’ve talked a lot about anesthesiologists and anesthesia generally, but what is the role of CRNAs or AAs?
12:49 How are those impacting the landscape right now?
12:54 Yeah, I would say that they are assisting with helping with that burnout.
13:00 Allowing CRNAs to practice at the top of their skill set allows for physicians to give more oversight,
13:09 and then also to lend a helping hand. Having CAAs and programs also, too,
13:17 allow for being able to stretch the work around. To allow for people to assist in areas
13:23 and to help hospitals with being able to provide more when we know that there’s a limitation on resources.
13:30 There’s a conundrum between how far do we go utilizing our CRNAs, and what’s safe.
13:39 And I think a lot of provider– or a lot of groups, hospitals,
13:44 are also facing the situation where, yes, you have a care team model, or maybe you want to implement that,
13:51 and you are trying to expand that, and a lot of, I think, hospitals sometimes also think that they’re going to maybe save
13:58 some costs there, but it could go in the other direction. And I also think that it depends on what
14:04 areas you’re implementing a care team model and expanding that CRNA, MD, or AA coverage
14:13 because that value of let’s make sure that our quality
14:18 and patient safety is still there, I think, is something that all everybody has to come together and agree
14:24 upon. The calculus sometimes becomes complex with private groups who have anesthesiologists and employed
14:32 anesthetists, CRNAs, AAs. There’s a lot of different versions of that.
14:37 And what we see sometimes are financial reasons drive scope of practice.
14:44 And that’s OK. We understand that. However, that being said, there are
14:50 a lot of different models of safe and effective anesthesia care. We see everything from solo practice
14:56 to CRNA-independent practice and everything in between between direction and supervision. We get it.
15:01 A lot of places do it, they do it safely. One thing that keeps popping up to us in the market,
15:08 or to me in particular, is there’s work out there for everybody right now.
15:13 There’s too much work out there for anybody. And if we don’t approach this in a aligned way
15:23 as anesthesia providers– forget the MD, the nursing, what
15:28 makes sense for your group has to be something we talk about, and it can’t just be, this is the way we’ve always done it.
15:35 There’s too much work, there’s too many expectations, the cost is too high, and the burnouts are a real thing.
15:41 People are getting out of anesthesia left and right because it’s just a tough place to be right now. But if we don’t have these conversations about scope
15:48 of practice, what are our optimal ratios in this facility? What is the acuity of these patients? What kind of cases are we doing?
15:55 Have those conversations. And most importantly, aligning with the hospitals
16:00 that we cover, the systems we cover on a case-by-case basis,
16:05 it’s going to continue to cause rift, continue to cause burnout, and, in a lot of instances, continue
16:12 to increase the financial demands of the department. I love that. I can see that–
16:17 I would agree, Jason. We need to talk about anesthesia, right? We need to talk about it.
16:23 It’s a problem in some instances on how– I think– we brought up the point about burnout.
16:30 60% of anesthesiologists under the age of 45 are considering reducing their hours
16:36 or leaving the profession because of burnout. And so then it creates this cost dynamic,
16:42 because how do you keep them? And then we’ve created something– just since last year, since 2024,
16:48 hospitals spent $2.5 billion on anesthesia subsidies, 2.5 billion on anesthesia.
16:55 And so we’re in this conundrum. So how do we create an environment
17:03 where great care can be delivered and well-being can be maintained for our anesthesia providers?
17:12 That’s where we come in. I mean, from the– like, every facility is not the same.
17:17 Every group is not the same. So, I think that’s where we have an advantage because we’ve all
17:23 played several roles, and we can go in and say, yes, a care team model may be appropriate here.
17:29 No, an all-physician or an all-CRNA model may be appropriate here, or no, you
17:34 should utilize all AA, CRNAs, and physicians. But I think it’s looking at it on a site-by-site basis
17:42 and creating that bridge between the group and the hospital to understand why it can work or maybe why it cannot work.
17:50 But I think that’s one of the advantages that we do here every day.
17:55 And I was going to say, it’s interesting, Leslie, you say that because we’ve seen, with many of the hospitals
18:02 we’ve been at, that maybe– and Jason, you probably can speak to this better than I can,
18:09 but there was a point where anesthesia, a weekly average for anesthesiology– or anesthesia work hours
18:15 was 50 for an MD anesthesiologist. And now you’re seeing that shift to 45, somewhere
18:26 around that area. For APPs or CRNAs, it’s 40. So the number of hours that you’re working in a week
18:34 are decreasing from what it was before, and that means that your number of FTEs that are needed
18:40 are going to naturally increase because the number of work hours are going to decrease. And that, I think, is also something
18:47 that’s a conversation with hospital leadership and the providers because it’s moving towards that,
18:54 let’s keep work-life balance, let’s reduce the burnout, and let’s see how we can mitigate some of these things
19:02 with the number of hours that are worked as well. I couldn’t agree more with that.
19:07 We’re undergoing– we’re with a client who’s doing a large transition to employment right now, and I just want to echo what Supriya said.
19:15 And part of that decreasing work hours that are expected as a means to recruit appropriately
19:22 have direct impacts on how we schedule. And it may be night shifts.
19:29 It could be totally shift work like we did for a large group in California.
19:35 And some of these things are necessary from a pure recruitment and let’s get our ORs covered standpoint, and it’s
19:42 been a shift in that market. Now, unfortunately, a lot of times it’s too late that a hospital has already
19:48 decided to go to employment that some of these things change. I see some stagnation within private groups,
19:55 large, national, regional, local, that it’s kind of, this is the way we’ve always done it.
20:02 And it’s very hard for those groups to somehow change the dynamics of how we schedule,
20:09 how we do the work. This is the way we’ve always done it, this is the only way we know how. One of the things that we get really excited about
20:15 is how can we help work with groups to help them educate– help educate them on what are alternatives that we’re seeing in the market?
20:22 What can make you more sustainable from burnout? But most importantly to me is, how can we
20:28 help you educate your administrators in the hospital that you provide services for of what that cost actually is?
20:36 We get a lot of calls that, I want to switch to employment because that’ll be my silver bullet for the costs that I’m seeing.
20:44 It’s not. It’s costs. The costs are there. Hospitals get worried about covering
20:51 their ORs, and sustainability and stability. How can groups deal with the burnout
20:58 that we’re talking about in this call, schedule appropriately, recruit appropriately, mitigate their locums costs, and help
21:05 the hospital understand what that means, not only for patient care, but we talked about adding value in alignment with goals,
21:12 but being transparent, being strategic, and having a plan of how we interact with the hospital
21:19 so that both sides have walked out of the room after a sometimes tense negotiation
21:25 feeling like their needs have been met and they had a fair discussion? Great point.
21:30 What you’re really getting at is like what creates a relationship between the anesthesia
21:35 group and the hospital or the ASC that really thrives?
21:40 We’ve seen unionization in anesthesia. We’ve seen the opposite side, which is not as positive.
21:47 So, one thing– we’ve worked in over 100 hospitals–
21:54 over 500 hospitals, 100 hospitals on anesthesia. What are those important morsels or tips that we can provide of,
22:06 this is a common thread of a highly functioning relationship
22:13 versus a dysfunctional relationship? Jason, I’ll start with you. There’s a lot of answers to that question.
22:20 I think there’s a lot of minutia in the weeds we can get into. I think the number one thing–
22:26 and if I could do one thing, it would be covering the ORs.
22:32 In this time of upheaval financially, in this world right now, the revenue from procedural care in the OR, outside the OR
22:43 is vitally important. A lot of groups reach these breaking state stages,
22:49 and we’re going to not cover your ORs. We’re going to decrease our capacity. We’re going to close your ORs.
22:57 That is the number one thing that gets raised to the highest levels in the administration.
23:03 And I’m not saying that there’s–
23:08 Not in a good way. Right. I’m not saying that that doesn’t come about
23:14 after many different factors, but the one biggest value groups
23:21 have, one of them, is just being able to cover the ORs in an agreed-upon fashion
23:29 with the administration to keep access to procedural care stable.
23:34 And that is a complex thing I just said. And there’s lots of layers to that,
23:40 and good and bad on both sides. But what we’ve seen is when restrictions, procedural care
23:48 starts happening, the perceived value of a group drops exponentially.
23:54 And I love how you said, like, that one thing. Like, what is the one thing? So I’m going to go to Renaye and Supriya to have you guys think about your one thing
24:01 while I ask one follow-up question for Jason. Jason, you said that closing down an OR
24:06 is the thing that gets hospitals saying, we’ve got to switch groups. We can’t have control over this–
24:12 or we can’t lose control over this. What can a hospital do to help in that situation with the OR?
24:20 You mentioned something about it before, but what’s the hospital’s obligation on that side, too?
24:27 I sometimes think that hospitals don’t do their due diligence in vetting the requests from proceduralists, both in the OR
24:37 and outside of the OR, for additional space. Everybody wants anesthesia.
24:43 Everybody wants access to anesthesia. What they don’t often have is the cases
24:49 to sustain anesthesia providers. I’m going to pick on cardiology, just because it comes up a lot,
24:56 and this is no offense to any of the cardiologists that may listen to this. Cardiologists are classic in the anesthesia space
25:04 for wanting an anesthesia provider available all day for their cardioversion or echocardiogram
25:11 around lunchtime. That’s extreme, but I’m using an extreme example here. And what they do is they go to their director,
25:19 they go to their COO, Sometimes they go to their CEO and say, I’m going to bring you X amount of volume
25:26 because I need an anesthesiologist– and if I have an anesthesiologist, I can bring you that volume.
25:31 I’m not saying it always works out like this, but oftentimes, they are very rarely fulfilling what they’ve
25:40 promised because they know if they can tell a COO that I’m going to bring you more volume, that gets clicked,
25:45 and we are going to the group and saying, we need an extra anesthesiologist, we don’t really care how you get it, we need it.
25:54 And I think vetting that request– and I use an extreme example, and I picked on one group,
26:01 but that happens in every department within procedural care, surgery or non-surgery.
26:07 And what ends up happening is you get a lot of unproductive time from very costly resources that
26:15 end up squeezing the group, causing retention issues, causing financial issues, causing burnout, and increasing
26:22 that stipend to the one to two to three times that we’ve talked about earlier that are now becoming burning
26:30 platforms for hospitals and creating this chaos that we’re seeing right now. So, you don’t always need an anesthesiologist
26:39 when a proceduralist says, I need an anesthesiologist for the day. You may need part of that, but making those demands
26:45 on a group for unproductive time is, frankly, unfair to the group, and you’ll end up
26:51 eating that cost in one way or another over the long-run. Thanks, Jason.
26:56 All right, let’s go back to our magic wand, one thing that helps relationship
27:02 thrive between a health care facility and their anesthesia group. Supriya, I’ll go to you if you want to go–
27:09 Sure. So I would say communication. And I cannot stress enough how important that is to have
27:16 a thriving environment between anesthesia and hospital leadership.
27:21 And there’s many avenues to that, I think. There’s communication when it comes to–
27:27 within a governance structure format. There is communication when it comes to talking about compensation, talking about recruitment.
27:35 But I think at the bottom line, anesthesia providers want to know what’s going on.
27:41 And they want to know, OK, we have a plan of action in place
27:46 to fix some of the things that are going on. And when that is broken, you start to then break trust.
27:54 And that’s when things start going downhill. And hospitals then come to a situation
28:00 where they have to think of other avenues. The anesthesia group has to think of what they’re going to do next.
28:05 So that’s most– what’s actually what we spend most of our time on as well with hospitals and anesthesia groups,
28:13 is just finding that communication bridge between the two, and going back and forth with,
28:20 hey, you both are saying the same thing. You both want the same thing.
28:25 Let’s just come to an agreement on what that plan is and how to get there. So I think that’s the most important
28:32 to a thriving environment. Yeah. And Renaye, so we’ve heard coverage of the ORs,
28:38 communication. What’s your tip? I would say be a partner versus a vendor.
28:45 I think that’s very important because with that, I think that rounds up what everyone said.
28:50 When you are a partner, it’s that transparent communication for good and bad. Don’t just show up when it’s bad,
28:57 don’t just show up when things are rosy. Have that constant communication as far as being a partner,
29:03 being vested. Because you’re going to hear about all of the things from corporate, from administration, to your leaders
29:10 onsite. I think that’s really one of the things that I’ve seen groups that thrive with hospitals,
29:16 they have that partnership mentality. I love that, partnership versus vendor.
29:23 What is the cost of not doing these things
29:29 for either the group or the hospital? What is the cost of not doing these?
29:36 I would say the biggest thing that we don’t think about is that– I know we look at the money, but it’s really your community.
29:44 The patients. I think people not being able to get the procedures that they need because we can’t agree?
29:51 I mean, the obvious thing is that you may have to switch over to another group, but I really think the biggest thing in all
29:58 of this, when we can’t provide the number of staff or when the hospital can’t provide the support,
30:06 it’s the community that suffers. I was going to take– Renaye took mine.
30:14 One negative consequence that we’re seeing is the inability for groups to survive.
30:19 And I think private practice and third-party anesthesia groups,
30:26 I think they have a place in this world of anesthesia
30:31 within our country. We’ve seen that when there’s not great communication,
30:38 there’s not great partnership, some of those groups don’t survive. And I think the way that it was approached
30:48 with their relationship with the hospital, there’s mistakes. I don’t want to be a Monday morning quarterback, but a plan, a strategy to how your group’s going
30:56 to survive, provide value, and be a good partner to a hospital, I think being proactive with that can lessen the risk of that
31:06 happening to groups. I don’t want to not mention Renaye’s point,
31:12 I want to piggyback on that. Ultimately, it’s about patient care in the community and access to procedural care that people need in every part of the United
31:19 States, and I think that really does suffer when we have two silos that are mad at each other, who
31:26 are working on propaganda campaigns or whatever message they’re sending in the community
31:33 amongst themselves, to their physicians, the hospital won’t work with us, the hospital’s being stubborn, the group’s being stubborn.
31:41 Sometimes I just want to lock these people in a room together, the administration and the anesthesiologists, and say,
31:49 let’s hash this out. Everybody means very well. We work a lot with hospitals, and very few of them
31:55 have any nefarious things to say about anesthesia. They actually know they have to pay for anesthesia.
32:01 They know they have to get along with anesthesia. They don’t know how always how to get there.
32:06 And we see groups the same way that have become so entrenched and angry at the hospital, because frankly, sometimes they just
32:12 don’t understand or have the education to understand what’s really pushing them to where they need to be.
32:19 That just– communication breaks down, alignment breaks down, and there’s just distrust on both sides.
32:27 And I think Renaye, also– so what I was going to say, too, I think serving the community is the most important,
32:34 and that’s the cost that comes into play here. Along with that, I do think that many places we go to,
32:41 the anesthesia providers have a good relationship with their surgeons that work with, the staff they work with.
32:48 And a cost is other people being impacted by this.
32:53 And surgeons then feeling that limited access, that pressure,
33:00 their relationships getting strained. Staff being worried about their jobs because anesthesia
33:07 is the crucial key to everything running, and that has a ripple effect to everything else
33:15 and everybody around it as well. So I think that’s another cost. I think that’s a great point.
33:20 How often do we see, Supriya and Renaye, recruitment and retention of surgeons and their ability
33:28 to operate in small or large communities, and how much anesthesia plays a risk
33:33 in losing some of those providers that people spend a lot of time recruiting to that organization?
33:41 Yeah. Supriya, you brought up a good point because it’s the employees of these groups, too.
33:46 It’s the physicians, CRNAs, AAs that are impacted,
33:51 that they want to work there, but they’re caught in the middle like children in a divorce that we sometimes forget about.
33:58 Right. Very important point. Well, thank you all so much, three of our national experts
34:06 on anesthesiology. I’ll do a lightning round. So based on everything we’ve talked about,
34:11 is there anything that we haven’t touched on or that you want to double-click into before we wrap up?
34:20 Don’t be afraid of change. Yes. And don’t be afraid of being proactive
34:26 about the cost of your anesthesia services. Everybody knows anesthesia costs money.
34:31 Everybody wants a sustainable practice. Hospitals and administrators know they need to spend money.
34:37 They want to do it in a way that’s transparent, fair, and aligned with their goals. I couldn’t say that enough or with enough emphasis.
34:47 That is really the key. And if you don’t know how to do it, find someone that can help you in that road to make yourself
34:54 as valuable as possible, and education on that value,
35:00 along the journey. And I would also say, evaluate your options.
35:05 An option that you may think is the right thing may not be. And I think everything is on the table,
35:12 whether it’s employment, whether it’s a contract negotiation. I think there is never a truly right answer,
35:20 you have to weigh everything on the table.
35:26 Well, thank you all, this was very enlightening. I always learn a lot. And hopefully through this conversation,
35:32 our listeners can as well. and I loved the point about it really comes down to our communities and our clinician
35:40 well-being, and how do we make sure that we provide safe and accessible surgical care
35:46 for anyone who needs it? So I appreciate everyone’s time, and that’s a wrap.
35:54 [AUDIO LOGO]
