Episode 40: Building An Anesthesia Practice That Hospitals And Employees Love w. Tom Ellis

In this episode, I sit down with Tom Ellis. Tom is the founder and a healthcare consultant with Ellis & Associates based in Texas. He is also the founder of FirstMEDpractice.com which is a website designed to help residents understand the business dynamics of medical practice before they end up taking jobs. Make sure to listen to the end of this episode for a chance to win a free E-book from Tom!

Justin (00:56)
Today by Tom Ellis. Tom is a healthcare consultant with a, a a a consultancy which he founded Ellison associates based in Texas. And he is also the founder of first med practice.com which is a website designed to help residents and fellows understand the business dynamics of medical practice before they end up taking jobs that are going to be very much impacted by the practices which they join. So Tom, thank you very much for joining us today. You’re welcome. Thank you. To get us started, why don’t you just give us a little bit of background about the current scope of the work that you’re doing. Obviously there’s a lot of alignment in the message that I’m trying to bring to the anesthesia and pain communities and a lot of the work that you’ve already done in helping physicians understand the business of medicine.

Tom Ellis (01:38)
Yeah, I, I started my consulting business over 25 years ago and at the outset of my consulting business we were putting doctors into practice pretty much straight out of med school and we were providing them with a, with a range of services that was almost at 100% of everything they needed. The only thing we did not do was hire their clinical people because we weren’t obviously qualified to do that, not being physicians. And I continued to do that for a couple of years and then broke out into more of a general practice management consulting business where I was running practices and putting practices together dissolving them, bringing partners on, working out hospital contracts with a number of my clients which led me into kind of an expanded look at the business of medicine. And I helped to actually create a pathology company with one of my clients was a gynecological pathology company that’s been tremendously successful and found myself about 14 years ago, suddenly engaged in an anesthesia company and I, I ran an anesthesia company that had a captive contract or an exclusive contract at a hospital here in Dallas. I ran that company for about 12 years and we similar to what I had done at the beginning of my career, we pretty much built that company up from the ground. And I can explain more about that as we go farther into the interview.

Justin (02:58)
Excellent. There’s a lot of things that are, I’m really interested to zoom in on here. So talk about, you know, you said you were responsible for running medical practices, so there’s obviously a lot that goes into that and it probably depends on the specialty, exactly what that means, but give us a little bit of background about, you know, what are the different areas of consideration that you’re addressing in your practice?

Tom Ellis (03:16)
Well, you know, I’m, I’m putting a couple of doctors into practice right now and the service that I’m providing really these are physicians who are, who are coming out of corporate medicine who want to go out and practice on their own. So we are looking at at everything from a real estate location to generate good demographics or good payer relationships, higher paying payer relationships to the way we’re scheduling our patients to the range of services that we’re offering.

Tom Ellis (03:44)
It didn’t get engaged in credentialing right now in four for both of these clients. The marketing has become an extremely important piece these days is social media has, you know, become, become so such, such a bellwether for the way many people make decisions. The staff hiring, the revenue cycle management, the billing piece, that’s obviously one of the most important pieces as well. So it’s, I don’t want to say it’s completely soup to nuts, but in these two situations it truly is almost soup to nuts. Again, I’m not hiring the clinical people, but I’m working with them on the, on the operational staffing of the back office.

Justin (04:20)
Got it. And so in terms of maintaining the operations, are you and your company doing that or are you bringing in other experts to sort of pick up the Baton there?

Tom Ellis (04:29)
Well, the ladder, what I’ve always done is try to surround myself with, you know, the best healthcare minds for legal purposes, for accounting purposes, for billing purposes, from whatever. What I like to do with my clients is, is structure the practice and do the strategic planning on the practice for the first 18 months. And then once the practice is open, I may be in the practice regularly for four to eight weeks. But my goal is for the, for the physician to understand enough about the business of medicine that working with the other experts that I bring in, they are able to to let the practice move forward from a business standpoint in a way that doesn’t compromise their clinical time, gives them a feeling of comfort gives them some metrics that they can, that they can watch as the practice grows and can be watched and monitored and create a very smooth working environment literally from the first day.

Justin (05:31)
Excellent. Okay, so you, you said the physicians you’re working with right now are coming out of corporate medicine. I’m very interested in this. I, it seems like not a week goes by when I get some person kind of dropped me a line on LinkedIn or Twitter or elsewhere telling me a story of, well there was another buyout and my practice is like falling apart. It’s not the place that it used to be and I in some cases I want to leave medicine or I want to leave this practice or you know, it’s not that that happens all the time obviously, but it’s a consistent theme that keeps on coming up in the anesthesiology world that acquisitions, mergers don’t always go as hoped and then physicians are finding themselves trying to escape corporate medicine. I’m curious your perspective on that.

Tom Ellis (06:11)
Well, I think my experience is very much like yours. I have synced for the last couple of years a dissatisfaction among many of my clients and former clients about the corporatization of medicine and I, and I think you’re, you mentioned buy outs. I think that’s one of the key issues that seems to continue to come up. But that’s the, you know, the investment firms in New York or in large markets come in and buy up medical groups. They obviously are buying up those medical groups to get a good return on their investment. And many of them are more looking at two to five year plan to hold the property and then turn it over and sell it. And usually the buyer is also looking for a good return on their investment. And at some point there’s a compression in, in either revenue, excuse me, salaries or in the way the operation is run.

Tom Ellis (07:02)
And it creates an environment where physicians don’t feel that they have the business autonomy to really control their practices. I have seen some examples where corporate medicine was very good, but I’m beginning to sense that there is more and more dissatisfaction. And I think for a long time there was, you know, there was this cliche about the danger of private practice and it was almost, in my experience, it, it almost seemed like a PR campaign to make doctors feel uncomfortable about the idea of private practice when in fact private practice run properly can be not only rewarding personally and rewarding from a professional standpoint. They can also be, you know, rewarding from a financial standpoint, but it has to be done properly and the pieces to do it properly are much more in place now than they were say a decade ago.

Justin (07:55)
Interesting. I’m interested to hear you say that because you know, it, depending on who you ask, some people say, well, the forces of consolidation in anesthesia are, it’s like a, you know, a snowball rolling downhill and there’s no way that we can even stop it, let alone go back. So I’m curious your perspective based on the things that you’re seeing, the market dynamics that you’re observing there in Texas and elsewhere and the physicians you’re talking to, what’s your take on the consolidation trend in anesthesia right now?

Tom Ellis (08:20)
I think my take is at least here in the Dallas market, I think the consolidation has for all practical purposes run its course. We had some very large anesthesia companies here that were purchased by venture capital firms who then turned around and sold them another time. But there are still here some large there’s one or two large independent still privately held or private practice oriented anesthesia company. There are a number of small anesthesiologist groups that are still independent. The, the leverage seems to be that the larger groups are able to go in and secure a exclusive contracts with, you know, with hospitals, but also because of their leverage in their coverage in a market, they’re able to negotiate a little more successfully with payers. I think that the, as, as we begin to change the way medicine is looked at an anesthesia in particular and the quality measures become more and more important into, into the evaluation of the work that’s being performed in the work that’s being done and the money that’s being paid. I think there’s an opportunity for private practices to, you know, to get on that, on that train and provide good quality and, and still go to the payers even though they don’t have, you know, 500 anesthesiologists or anesthesiologists CRNs go to the payers and make a good argument that their rates should be what the, the larger groups rights are.

Justin (09:51)
Interesting. I want to dive more into that in a minute. First, let’s talk about this. You know, your experience at this anesthesia group that you mentioned just a few minutes ago that you you became involved with and help to build and scale over a period of years. Talk a little bit about that experience and how that unfolded. Why did you come in to do the work that you did and how did that play out?

Tom Ellis (10:11)
Well the way I entered into that anesthesia environment was a little unusual. Been working with some oncologists who I put into practice at one or two hospitals here in town. And as part of that effort, I became friends with the hospital president who called me after she had been transferred to a facility South of Dallas and wanted me to come in and try and deal with an anesthesia problem that she had. The hospital facility had been running for many, many years. I mean we’re talking decades, had been running under a physician [inaudible] supervision model. So there was no anesthesiologist in D or O who was engaged in the, in the continuum of care there. Mmm. Recently they had brought a physician on onto, into that anesthesia group. He had never run a group before, but he was a very, very good anesthesiologist. Brilliant. In fact, when I entered it, I entered because the a hospital president liked the anesthesia group and she liked the direction it was going, but she was unhappy with the current owners and the way they handle some of their billing practices.

Tom Ellis (11:19)
So I came in and we set up an arrangement where the practice was purchased from, it’s been owner for $1. We held and had negotiated an exclusive contract at the facility. We started out with with one physician and five CRNs. All the CRNs had been I’ve been present for sometime all of them had preceded or their tenure had preceded the arrival of the MP. I found myself kind of in a situation where we were going to have to completely build an anesthesia company from the ground up and I was the only one that had any business experience to do. So we, we expanded that company and grew it to include a more CRM [inaudible] that was our model. It was a CRA model. Towards the latter half of my time there, we ended up adding some physicians. We added more CRNs and a few years before before I left, the hospital facility was closed as they opened a brand new state of the art hospital no more than two miles away.

Tom Ellis (12:23)
So we were there for the transition to a new hospital, which became extremely successful very, very quickly. They brought back L and D, for example, which they closed up for years. The emergency room was seeing an incredible volume of patients for the size of the hospital. They started to grow bringing on more surgeons and, and more complex procedures. So we grew with it and we, it was a pretty organic approach to growth and we, we did a lot of things that I think no one was doing at the time because we felt like we could do a better job in reporting and controlling the country, kind of controlling the business than some of the larger groups were doing by by a different strategy. For example one of the things that we did write off was we started doing not just patient satisfaction surveys because hospitals do that and if you’ve ever seen them, generally it’s a four question questionnaire and if you answer one question you know, not in the affirmative or in the negative, then the whole thing is skewed and makes you look bad.

Tom Ellis (13:31)
We did more comprehensive patient questionnaires. We also did a lot of surgical questionnaires because we were very concerned that we were doing things right surgically. We got very entrenched with the politics of the hospital and with the chief nursing officer. And at one point the MD, then the senior MD in the group was the chief of staff of the hospital. So we really try to [inaudible] get as close as possible and we tried to control the flow of information so that it was, it was a more reflective of what we were really doing and a little more complete and complex than what we were really doing on the physician surveys. If we got, you know, if the physician said, I like this CRN a or I don’t like this doctor, you know, we went to them directly and talk to them and said, okay, what are the problems? What can we do to create a better situation there? We were very, very concerned with with our turnover rate. We actually had the best turnover rate in the entire hospital system. So we showed the hospital right away that we could create the kind of efficiencies that were important to them financially. And it was, it was a tremendous relationship. Very good relationship.

Justin (14:37)
Awesome. I’m, I’m very impressed with the sort of the data and analytics that you seem to have introduced w with a lot of depth and a lot of providing visibility to the operations. Even as a smaller group. You know, the, I I think that a bigger anesthesia would say part of their value prop is we can come in and we have the systems and infrastructure and the people and the software to be able to provide that kind of data. And that’s part of the benefit of, you know, maybe working with a bigger group. So to see how you have been able to do that with, you know, in the context of the few physicians and a few more than that. Crns sounds very intriguing.

Tom Ellis (15:15)
Well, let me, yeah, and you know, let me have one thing, and this kind of goes back to what I said earlier about, you know, practice management, revenue cycle management systems in place now that can, can help generate private practice activities. One of the things that we were concerned with was, and I’m sure you’ve heard this before, if you’ve talked to anesthesiologist, is that the, the problem you have with with what I call dr arrival creep where they’re supposed to be there and you know, start cutting at seven 30 and they don’t show up until eight o’clock and then they turn around and they say, well, it was anesthesia’s fault. Well, to correct that problem, we, we aligned ourselves with a proprietary billing operation and we were, we were able to show, you know, when we, when we were in the room, when we were out of the room, and then we were able to go back to the administration and say, no, no, no, no.

Tom Ellis (16:02)
We were all there and we were all there ready to cut. This was the, you need to talk to the surgeon about this because he’s the one that’s costing you a half hour surgical time. It’s not us. You know? And when we did that, it, it, it changed the dynamic in the relationship between the CR and a PR or the, excuse me, the anesthesia providers and the surgeons. It suddenly gave us, I don’t wanna use the word leverage, but it put us in a position of respect where the facts are the facts. So you know, you’re able to do those kinds of things. Now there are many, many software systems out there that provide that kind of data to you that you can get without having to sell your practice and join a larger group.

Justin (16:41)
Yeah. So I’m curious, you know, at the very beginning, take us to that moment when you know, you’re talking to your friend, the hospital CEO, and they say, we’ve got this doctor that we like the CRNs are doing a great job, but there’s something about the operations or the ownership that just isn’t clicking. As you’re stepping into that situation at the outset and you’re starting to roll up your sleeves and ask some questions, what questions are you asking? What things are you looking at? And as you’re starting to try to move the needle, because you know, you talked about you made great progress over a period of years when you’re trying to go from like zero to five miles an hour, what did that part of the process look like for you?

Tom Ellis (17:15)
Well, the first thing that we, that we took a look at right away was scheduling. What we found right from the outset was that the scheduling was all over the map and there was no concerted effort on the part of the administration to effect a really efficient scheduling for the, for the providers. So we had cases that would, we had cases that would start at, you know, seven 30 and would, and you’d have a room that was full until 10 30 and then that room would come back online at two and everything was being scheduled. Oh, say everything. A lot of the scheduling was being done around the, around the, the surgeons and what they wanted and it wasn’t effective for the hospital. So one of the first things we went in and said was, look, we know that it [inaudible] if we can schedule more efficiently, it’s not going to cost you as much money because you don’t have people standing around all day.

Tom Ellis (18:14)
You’re going to get a lot more utilization out of your, out of every one of your ORs and you’re going to get a lot more utilization out of your, out of your anesthesia group. Because right now the surgeons, the way, the way it’s so haphazard that it’s very difficult for you to bring in new surgeons. You can conform to the, to the, the vacancies in the schedule. It just, you know, it’s tough for a doctor to come down and do two procedures from one to three in the afternoon and kind of blow his whole afternoon apart when you could be seeing patients, you know, in the, in the in the office. So that was, that was the very first thing we did. Along with that, we also put in the kind of of planning and structure that the business would need.

Tom Ellis (18:55)
You know, I did some two year projections. We began to work with the hospital very closely on the, on the kind of physicians, our surgeons that they wanted to bring in if we needed to upgrade a certain PR, certain CRM, a knowledge, the knowledge base of certain CRNs. We did that initially this hospital was, was doing deliveries. We had some, some employees who were not as well schooled in deliveries as we wanted them to be. So we sent them back to CME classes. There was quite a bit of mentoring that went on between the physician and CRNs. So it was, it was a kind of a take no prisoners approach. I mean, we kind of hit everything we needed to hit, but the most important thing was the, was this strategic planning on how we were going to interface with the hospital and how we were going to be able to grow our business by being a lot more efficient with the way we ran things, making sure the hospital was so we really had an opportunity to grow.

Justin (19:51)
Yeah, it’s interesting. You came in and had a lot of you know, important you could say revolutionary ideas and a lot of them were kind of outside of your immediate what I would call sphere of influence. In other words like looking at how the surgeons are functioning or even the scheduling, how that’s managed, like that’s related to anesthesia, but it’s not strictly an anesthesia illogical responsibility. I’m curious, how did you get buy in from the CEO and from the board and whoever else was, were the key decision makers at the hospital to be able to make these changes?

Tom Ellis (20:20)
Yeah. Well let, let me say, let me answer that question. Let me add one thing. I had worked for, you know, 15 years with a lot of surgeons. So I understood the kind of the, the, the surgeon frustration with the, with, with the operating theater and had, had to deal with that. You know, when we were recruiting physicians for example, for some of the practices, the surgical practices, you know, we had to look at, you know, what’s the surgical schedule, where, where are we going to get our new employee placed in? How are we going to do that? How are we gonna make them efficient? How are we going to integrate them into their office? What we did was, to answer your question, we went to the hospital with the data and we went to the surgeons with the data and we said at a hospital you have nurses standing around doing nothing, waiting for cases to start, which is costing you money.

Tom Ellis (21:08)
We said to the surgeons, if you guys would be more efficient in the way you did your work, you’d have more, more truly open block time in your office. So you’d be able to see more patients, which would drive more surgeries to VOR. So a lot of what we faced, it was kind of the sleepy little hospital mentality. And what we did was we tried to pattern ourselves on, on a larger operation. We had some friends who were with large, well hospital groups who we talked to. We became very close friends with the chief of anesthesiology for the entire hospital system. And we were very aware of many of the problems that had been existing because he was feeling calls from the hospital all the time from the hospital administration. You know, there’s this problem with anesthesia and there’s that problem. Anesthesia. We wanted to completely eliminate that, which we did within a year. It was, it was a, it was a multifaceted approach, but with the hospital it was based on efficiency and based on the analytics we can provide to them.

Justin (22:10)
Yeah. So I’m sure there’s some people out there listening who are thinking our ORs sure do seem to be running inefficiently. And it’s great to hear Tom say, yeah, you just take the data to the administrators and they can’t deny the data. And obviously that has an underlying assumption that we can access data, that the data has enough integrity to it to be able to actually tell a story. So talk a little bit about, was the data there and you just sort of gathered it or did you have to put some things in place to be able to start collecting?

Tom Ellis (22:35)
Well, it was, you know, it was pretty obvious to get, get surgical reports out of the hospital to see how, how the ORs will be utilized and how much, how much of the us time available was actually being used every single day. One of the problems that they had with, with this particular facility was the surgeons were just scheduling elective procedures all over the map. I mean, they do a Mitt four o’clock, five o’clock, you know, very, very very, very much very comfortable for them, but very costly for the hospital to have people standing around. So that was the first thing we did. Then we began to look at what I referenced earlier through this proprietary billing system. We began to look at starting in times and we began to compare start and end times or cases with some of the national averages.

Tom Ellis (23:24)
So we would know, for example, we had a give you a good example. We had a physician that came in surgeon that came in and she was very interested in, in doing one particular type of surgery, but because she was kind of the new kid on the block in her group, she got a lot of different types of surgery, some of some surgeries that she hadn’t done in a long time. Just as you know, anyone that goes to fellowship, you don’t do every surgery every day. And she had okay, extremely long time for gallbladders. So, you know, we went to the administration and we said, look, this physician, good surgeon, but she needs to be mentor. She is costing you money because we are tying up, you know, it should take 30 to 40 minutes and she’s taking two to three hours because she’s just not familiar with it. That’s costing everybody money, including us. I mean, we can only bill up to a certain amount of time and not, and not end up being audited on a regular basis. And so, you know, we worked with, with that surgeon and the administration and her employment group to improve that environment and bring that, you know, bring her case times down.

Justin (24:28)
And I also noticed that you talked about, you know, questionnaires that were sent to the surgeons. So talk a little bit about, you know, there’s, I would say like a stereotypically potentially challenging dynamic relationally between anesthesia and surgery. So talk about how you built bridges and collaborated with surgeons in order to get buy in from them to Institute some of these changes.

Tom Ellis (24:48)
Well, you know, from the very outset, stepping into an environment where the surgeons had been providing physician supervision over CRNs, we were kind of behind the eight ball because obviously a surgeon knows a whole lot more than a CRM. And some of the surgeons at this particular facility had been there for years and years and years. They had, you know, extreme seniority and tenure and all those kinds of things. And you know, many of them had, you know, kind of the surgeon’s attitude that it’s my way, my way is the right way, regardless of how I do it. What we did, one of the, one of the first year goals for us was to take the anesthesiologist, the MD that was sitting at, at the top of the, of our company and have him interface with the surgeons in a way that they would begin to really understand the medical role that he had and the risk and responsibilities he had to to provide a service that was also risk-free for them.

Tom Ellis (25:52)
And that he really was qualified and talented. And this, this guy was really smart that he really could evaluate patients and could say from a really strong position of analytics. This patient is not ready to go to surgery. It’s just not ready to go. You can’t take them. In the old days, that person would have gone to surgery because the surgeon would have said, we’re going to do it. So we had to, to identify the kind of the knowledge level of the MD and make the surgeons understand and respect that. And we had to do that with the administration too. So that was the first thing. We subsequently followed up with [inaudible] these, you know, surgeon questionnaires where we, we usually, there was a 25 question questionnaire where we tried to really dig down into the services that were being provided, not only in the operating room but you know, the postop stuff that was done, all the qualifications, the H and P’s and you know, all that pre-surgical stuff and how the patients were being handled, you know, I’m sorry, pre-op, all the preop stuff.

Tom Ellis (26:57)
And then also all the post op stuff, you know, the followup we had and was there feedback coming to the, to the hub, to the surgeons offices that, you know, patients weren’t being followed after their surgeries. You know, what their pain levels were, you know, those kinds of postop questions that typically come up. So by being much, much more sophisticated in the, in the questionnaires we presented ourselves as really understanding and knowing what the, you know, the key buttons were for surgeons that they wanted to make improvements in so that their patients were happier across them.

Justin (27:34)
W and so you’re instituting these changes over time, the hospitals buying and the surgeons are buying in Oh, ours are getting more efficient. And this contributed to you probably needing more anesthesia staff to be able to start doing more surgeries. Is that kind of how the growth started?

Tom Ellis (27:51)
Yeah, it did. And you know, when, when they brought they, they terminated labor and delivery about three years into my time there. And then they brought labor and delivery back in a very big way when they opened the new hospital. That complicated are mission considerably because with no, with no labor and delivery, you know, you’re pretty much working nine to five. And then you have emergencies of course. But with labor and delivery, you’re working 24, seven. So we did have to bring more people on. We had to work out a better scheduling system. The hospital at that time really wanted us to have physician coverage forL and D, which didn’t mean in the hospital, but we needed to have somebody close by. That was a, you know, another complexity. We had to work out. We were as the, as the new hospital facility grew, the surgery schedule was growing as well.

Tom Ellis (28:46)
You know, they were starting first thing in the morning like they always do. And we had typically ended cases around, you know, maybe two o’clock in the afternoon. Now. We were doing non-elective cases oftentimes up until, you know, five, five 30. So it was much more complex. We did have to add a lot of people. But you know, we figured it out. We just figured it out. We worked with the hospital, we work with the surgeons. We made the hospital understand that we were not in a position to just provide everything for free. They couldn’t just have people sitting around, a physician sitting around doing nothing. It was very costly to do that and they were great. And working with the staff in that way because it was financially efficient, more efficient for them to,

Justin (29:23)
Right. So talk about the transition. What was the facility like? You know, you said it was like a little bit of a sleepy hospital environment and then you said it was a state of the art facility, it was the newer hospital that was open that you sort of moved the staffing to. So how was, how are the facilities different? How was the, the or like, or a number different and, and the types of cases, you said the L and D was coming online with the new facility. Like how did that impact your operations and the moving parts for you to make sure that there was no you know, quality issues or staffing issues during that transition?

Tom Ellis (29:54)
Well to call this place a sleepy little hospital is probably is probably not a true description. It was probably a little worse than that. They had, as I recall, they had four ORs. They, the facility itself had not been significantly upgraded probably in 10 years. I mean they were keeping up with things, but they weren’t, you know, buying new equipment and, and making a big move because I think the owners of that hospital were a little unsure as to, you know, how valid that market was going to turn out to be for them. And we’re reluctant to, to really invest. When they brought the new hospital on, you know, there were six O R’s that were finished out. I think there were two or three ORs that were not complete. I mean, they were finished out, but they weren’t, they weren’t completed from an equipment standpoint.

Tom Ellis (30:41)
So there was the opportunity for growth there. There were threeL and D [inaudible]. So suddenly we had, you know, the potential to have three women pregnant women there, you know, waiting to deliver. Uas I said, the emergency room grew tremendously. So the, the, the funneling of patients from the emergency room through to surgery,uthat became much, much more complex. It was a much larger emergency room, probably twice the size of the old one. So yes, it, it, it did add a very different level of, of, of complexity and the coverage requirements were significantly expanded.

Justin (31:21)
And so were you able to staff up and find good people who are a good fit at the time of the need? I know that’s, I mean that’s a huge challenge in any business. Healthcare is no different like finding good people to get in the right people on the bus so to speak, who are going to be part of your [inaudible].

Tom Ellis (31:35)
Yeah, that’s a great question. You know, one of the things that we wanted to do early on when we first started was a lot ourselves with, with the, with the hospital in a way that gave us plenty of advance notice about new surgeons new physicians that they were bringing on. And so we would have the opportunity to do what you just said. We’d be, have that timeframe to staff up. We were real lucky because we had a chief C RNA who was a, he had been a CRNI instructor in the air force and we had a couple of other military people CRNs as well as our, you know, very, very good, brilliant MD. And so we, we had the time Mmm. In advanced with a new hospital. Of course, of course they had to build it and that took a year and a half. We had the time to really go out and recruit very, very well.

Tom Ellis (32:29)
Our probably our biggest challenge was not hiring CRNs and qualifying them because there were a lot of very good candidates around and a lot of people who, who, you know, back to the corporate medicine conversation who had fallen into situations in corporate medicine, they didn’t like, they want to work for a smaller group, more of a family type environment or people are in more of a, of a rural type environment of hospital environment where like this hospital was the MDs were more difficult because the MDs, we didn’t really need them there all the time. It wasn’t like we had three MDs on staff every time we had to have one MD there all the time. And then if we had more than a certain number of rooms open, they wanted to have a second MD who was on call. That was a little more complex and it took us a little, a little bit of time to figure out. But we ended up again finding, finding MDs who, who were very happy to work that schedule and not be working in a corporate medicine type of, you know, schedule where they were, you know, working every single day and moved around from facility to facility.

Justin (33:28)
Yeah. In terms of and I don’t know how comfortable, I’d be glad to hear whatever you’re willing to share about this in terms of compensation for your group versus what you would perceive in the corporate medicine world. And in terms of autonomy, which is one of the big draws to private practice medicine, how did your group stack up against other, you know, local or, you know, maybe statewide call it competition in anesthesia?

Tom Ellis (33:53)
Well. I think we, I think we stacked up extremely well. One of the things we did not do, we did not hire mid-levels right out of training. They had to have at least five to six years of experience. So you know, in terms of compensation, I mean at that time I think, you know, starting salaries for folks coming right out of their program. Yeah. They were 125, maybe 130, $140,000. Our pay Ray, our pay range was more in the starting salary of about 180. And we actually had a number of people who were being paid 200. There was a very, very significant benefits piece to the, to the compensation. One of the best I’ve ever seen that really was comparable to any large corporate employer, anesthesia, employer. But we demanded a lot out of our employees.

Tom Ellis (34:53)
You know what I mean? It wasn’t like they just showed up for work. I mean there was a lot that we, we, we wanted them to do the knowledge level that they w we require to them was high. So I think from the standpoint of the mid levels, we were paying almost the same amount of money as was being paid here in the big Dallas, Fort worth market. And we were paying it in a rural market 30 miles away in terms of the physicians. You know, we looked at MGMA and Sullivan Cotter and you know, all of those, those groups that provide physician salary information. So we had a good idea of what was being offered everywhere we had to have that to compete. And you know, in the marketplace when we went out to recruit and we were paying a salaries there, again, that very similar to what physicians were making here in the Dallas market who were working similar schedules. So we realized that to bring on the level of people we wanted to bring on, we were going to have to pay we were gonna have to pay big city money to get that, that high quality and it paid off.

Justin (35:56)
So as far as other groups listening in who are thinking, I love the, the data driven approach, I love the emphasis on high quality staffing. You know, what types of you know, lessons or words of encouragement might you give to somebody who’s trying to either revamp or improve an existing practice in some of these ways?

Tom Ellis (36:17)
I think a lot of that depends on what the makeup of the practices. If it’s an all MD model, it’s very different from an all MD model and the model that we had using all of them, the CRA is the mid levels that we used. One of the things that was important to me, and this was based on my experience, you know, in running and working with other private practices, not anesthesia practices, was that we have some, some real respect. We showed real respect for the CRNs and the work that they did. At the time, you know, I got involved with this anesthesia company. Crns were not looked on very favorably on the CRN. A model was just being introduced to Dallas. CRNI only hospitals were prevalent, you know, all around the state. Which was a huge risk that was being taken by those facilities without, without an MD involved. And, you know, we, we tried to treat it, I mean, I hate to sound like a cliche, but we tried to treat this more like a family environment where everybody really respected everybody. And if there were deficiencies in abilities, no one was looked down on. Everybody wanted that one of that person to, you know, increase their knowledge base and, and get better. We paid well, we, we didn’t nickel and dime everybody. We tried to provide a benefits package that we thought was ethically and morally right.

Tom Ellis (37:43)
You know, we had great insurance, we had a 401k, we had short and longterm disability. You know, we, we created an environment where, where these people felt like they were respected, they were being paid properly and they wanted to stay there for a long period of time. The turnover was the one thing that we wanted to avoid at all costs. I think it a lot of anesthesia companies, you know, that are, especially some of the larger groups. I don’t, I don’t think there’s that level of attention to detail in the way they handle their employees.

Justin (38:14)
Yeah. Yeah, it makes sense. Well as we wind down here, I want to pivot a little bit and talk about first med practice.com and the work that you’ve done there. So obviously you’re drawing on your years and years of practice consulting experience and seeing all these different, different types of specialties, practices and you’re trying to equip residents and fellows to be able to make informed career in that context.

Tom Ellis (38:36)
So talk a little bit about the work that you’re doing there. Well, the Genesis of, of, of first med practice really started probably 20 years ago. And you know, what I was finding was I was meeting more and more physicians who were very unhappy with the positions that they were in. They had either taking a position right out of their residency or their fellowship and you know, they hadn’t really vetted the employer. They looked at a, at a contract offer, they said, wow, look at that salary and look at those benefits and look at that signing fee and a sign on the dotted line. And then they got into a working environment. I really didn’t work for them and you know, they weren’t happy and they didn’t feel productive and they, you know, there was a lot of dissatisfaction. I S I, we have continued to see that over the last 20 years with a number of physicians who have come to me, including some of the ones that I’m working with now and said, you know, I, I really, I’m really not happy here.

Tom Ellis (39:30)
I want to, I want to do something different. So, as I, as I took some time to kind of ponder all the experience I’d had two years ago, Mmm, I had a little time off and I started thinking about, you know, what are the biggest problems that I’ve seen? And, and this, the idea of vetting and analyzing employment offers and employers was one thing that I didn’t find anyone in the marketplace doing. And I still don’t, I went to see some of the recruiting firms, recruiting firms, you know, their attitude was, we’re working for a commission. Basically we want to play somebody and we get a fee after they leave us, you know, that’s it. They’re gone. So first med was concept around 12 modules and each module contains a specific topic that I have found to be very important when considering a new position, be it you’re living in an existing job or you’re coming right out of your, out of your training.

Tom Ellis (40:27)
The, the, the platform itself, the 12 modules, it really applies not only to residents and fellows, but also to nurse practitioners. Crns I mean, same people to me, nurse practitioners and CRNs, they’re not physicians, but they have the same issues as physicians when it comes to employment. Mmm. And so the platform was launched back last year around Thanksgiving and you know, had very, very good response to it. So far, I think I’m filling a, a market niche that has not been filled before and I’m using all of my decades of experience and bringing that to the, to the content of first med practice. Awesome. Yeah, and so for our listeners, if you go to anesthesia success.com/forty, we’re going to link to first med practice.com as well as some other resources that we’ve referenced here. And I spoke with Tom before the show and he has generously offered to to give two free licenses of his ebook and his course to the first two people that want to leave an honest review of this podcast on iTunes. So go ahead and go to iTunes, go to anesthesia, tell

Justin (41:34)
Us what you think, hopefully you like us and then email me@justinthatanesthesiasuccess.com and say, Hey, this was me, this is what I left. And and I will connect you with Tom. Tom will then connect you with his resources over there at first med practice. And he and I are very much aligned in our desire to equip physicians to be able to make informed career choices, to be informed about those decisions before they have to make them, rather than learning from the school of hard knocks. Hopefully learning from the school of first med practice.com and being more well-equipped. So, Tom, thank you very much for for that kind of offer. You’re welcome. And in wrapping up are there any parting words, resources, things that you would point us to Tom, that either attached to some of the discussion today or that you would encourage physicians to check out as they’re trying to build successful careers in anesthesiology?

Tom Ellis (42:23)
Well, I think, you know, mid-levels, physicians, dos, you know, everyone, the training program for, for all of those providers is extremely rigorous and it doesn’t provide a lot of time to, you know, just spend it, the fishing, surfing the internet to read, you know, medical economics and health care monthly and you know, all of these different publications. But I, I think that [inaudible] physicians need to understand that unfortunately when they enter the world of business of the medical business, they are looked at as a revenue generating source. The old days where physicians and everybody, everybody was with the respect and the levels of respect were a little more closely drawn. They’ve kind of gone away. And if you’re working for a big company, you know, they want to see some return on the investment and you need to understand what that means when you’re getting ready to walk into a job.

Tom Ellis (43:23)
If a, for CRNs for example, you know, I’ve known of CRNs who have you know, basically been running all over town, they start working and they spend tremendous amounts of time going here and there to do a few cases here, a few cases there. Yeah, may be great. That may not be what they want. Same thing with that, with anesthesia, MDs, dos, you know so you need to, you need to make a better, a better assessment of the, the working environment you’re going into. Obviously salary and benefits are extremely important. And you know, with medical school debt, they, you know, they’re high on the priority list with someone coming out of their training. But the thing you don’t want to do is make a mistake right now about 30% of the physicians who take jobs out of residency, fellowship leave those jobs within three years.

Tom Ellis (44:13)
And the disruption factor that that causes is just enormous, not only to the physician who typically has to pick up and move, you know, 20 miles away because he has a noncompete, but also to the hospital who may lose a, a, a surgeon or may lose a very valuable provider as well as the patients come to develop a relationship with that provider. That’s one of the things first med tries to address to eliminate that so that when you enter into the, into a new job, there’s an understanding and there’s the, the real ability to create both a job satisfaction and some job longevity as well.

Justin (44:51)
Excellent. Couldn’t agree more a while. Tom Ellis, thank you very much for joining us today on the anesthesia success podcast. Well. Thank you for having me. I appreciate your time. If you liked what you heard this week, head on over to anesthesia, success.com where you can find more content and free resources to help you build a successful career in anesthesiology and pain management. If you want to leave a review in iTunes, I would also really appreciate it. Thanks for using some of your valuable time to join me today on the anesthesia success podcast.