Free
Reviews of Educational Material  |   November 2015
Gasonomics: Understanding Anesthesia Economics and Employment
Author Affiliations & Notes
  • Richard W. Rosenquist, M.D.
    Cleveland Clinic, Cleveland, Ohio. rosenqr@ccf.org
  • (Accepted for publication July 8, 2015.)
    (Accepted for publication July 8, 2015.)×
Article Information
Reviews of Educational Material / Practice Management
Reviews of Educational Material   |   November 2015
Gasonomics: Understanding Anesthesia Economics and Employment
Anesthesiology 11 2015, Vol.123, 1217-1218. doi:10.1097/ALN.0000000000000840
Anesthesiology 11 2015, Vol.123, 1217-1218. doi:10.1097/ALN.0000000000000840
Every resident and junior staff member has had someone offer them friendly advice regarding lessons learned and things to watch out for as they transition from training to their first career job. Gasonomics is the first textbook to provide practical advice regarding economic factors that need to be considered as the anesthesiologist moves from residency into their first position as a staff physician.
The text is a brief Kindle book written in a practical, folksy manner that resembles the kind of advice passed on and picked up piecemeal during a residency and is often missing from the formal curriculum. It is an easy read with a lot of practical information assembled in one place. The book is divided into five chapters:
  1. The economics and business of anesthesia.

  2. I’m twenty something and indestructible.

  3. Getting an anesthesia position after residency.

  4. The interview—Do you have any questions?

  5. You got your dream job. Now what?

Each chapter addresses an important aspect of preparing to leave residency, getting a job in the “real world,” and understanding financial realities and planning.
The first chapter briefly addresses the importance of understanding the business fundamentals of anesthesiology practice. These fundamentals seem fairly unimportant during the long phases of training in medical school and residency as young physicians’ labor to acquire the medical knowledge requisite to pass examinations and provide safe and effective patient care. Although business education is part of the recommended curriculum, few training programs provide residents with a strong foundation for understanding the economics of an anesthesia practice and the market forces that will come into play as they enter the workplace arena. The author underscores the importance of understanding the fundamentals and the role they will play in the short and long term.
The second chapter emphasizes the importance of recognizing your own mortality. It addresses the role and need for job-specific disability insurance. It also underscores the importance of saving for retirement at the beginning of your career instead of playing catch up later. The author also provides a brief overview of various investment vehicles, the importance of managing expenses, and, most importantly, the need to take time to become educated about the financial world.
The third chapter focuses on the process of getting a job at the end of residency. The author addresses the competitive nature of job hunting and the importance of starting the job search process early to find a desirable position. The importance of separating yourself from the herd through old-fashioned networking is emphasized. Also underscored is the fact that many high-quality anesthesia positions are never advertised and must be discovered through the networking process. The author discusses the utility of the in-person call for targeted locations as a means of differentiating yourself from the other applicants whose resumes may be piling up on the desk of the department chairman. Also identified are a variety of ways to look for job opportunities and the value of getting engaged in various state and national organizations as a means of meeting the “movers and shakers” within the anesthesia community who may know of good jobs or be in a position to make hiring decisions. It is recommended that the new graduate look for a position within a full-service hospital that will allow them to do bigger cases and fully develop their clinical skillset as independent practitioners before moving to an ambulatory practice.
The fourth chapter describes the purpose of the interview process and the best means of preparing for the interview. This includes the importance of presenting yourself as a team player, learning about the local community, and, finally, being prepared to ask good questions. The author recommends that the applicant learn as much about the group as possible before interviewing so that questions can be informed and focused. Outlined are a number of important questions with a detailed rationale for asking each one along with the type of information that may be included in the responses. The questions include the following:
  1. How much will I be working?

  2. What is the associate or probationary period like?

  3. How many of the last five associates became partners?

  4. What is the termination provision?

  5. How is vacation handled?

  6. How is the group governed?

  7. How is everyone paid?

  8. How is the billing handled?

  9. Will I receive a 1099 or a W-2 form?

  10. Do I need to be board certified?

  11. How long does it take to get privileges at each facility?

  12. Do you utilize CRNAs [certified registered nurse anesthetists] or supervise residents?

  13. What is the political situation?

  14. You survived the interview….. Now what?

The fifth chapter outlines what to do after the applicant receives an offer. This includes the need to carefully review the contract to be certain that what has been conveyed verbally is written into the agreement. The author urges the new physician anesthesiologist to approach their new financial position modestly and to live below their means so that they can address existing debts, plan for retirement, and create a buffer for potential “rainy days.” There is an additional recommendation that the new anesthesiologists get a good accountant and gain an understanding of their new tax status. The author emphasizes the importance of making a good impression on your colleagues and those around you and displaying team perspective by both asking for and providing help when needed. The chapter underscores the importance of being organized so that the recurrent demands for credentials and ongoing certifications can be met for all facilities in which privileges are granted. The importance of staying current with the medical literature and acquiring new skills throughout the anesthesia career is emphasized. The author also warns about falling into the “grass is greener” trap and the need to evaluate any new practice opportunities in detail before considering a job change. The final chapter closes with advice regarding how to keep an anesthesiology practice position and the importance of being engaged and indispensable to the practice and the hospital.
This brief text provides a quick guide for the uninitiated as they begin to navigate the sometimes stormy waters of searching for a job and learning about the economics of medicine. Its folksy style makes it easy to read, but future editions would benefit from additional editing to correct style and grammatical errors that occasionally create confusion in the text. Nonetheless, it is a useful handbook that provides valuable information in a concise fashion and is a worthwhile read for the resident or fellow in training. The author is working on Gasonomics 2, which will address the fundamentals of maintaining financial well-being and should be available in 2015. If the second text is like the first, it should serve as a good primer on aspects of financial planning important to the physician anesthesiologist.
Richard W. Rosenquist, M.D., Cleveland Clinic, Cleveland, Ohio. rosenqr@ccf.org