In July, ASA Monitor conducted an email survey that polled readers on their top perceived challenges facing today's anesthesiology profession. You shared your greatest concerns regarding various topics and offered some innovative solutions to those challenges.

This final article in a four-part series dissecting the survey results focuses on readers' key career concerns. With a work environment that is often high-stress and extremely demanding, anesthesiologists face a number of career-related challenges on a daily basis. At the top of that list, according to a recent ASA Monitor survey, are non-physician scope of practice, burnout/work-life balance, and negotiating contracts.

Non-physician scope of practice

As the discussion regarding non-physician scope of practice continues, anesthesiologists must understand how to navigate this issue and its potential impact on their careers. This includes recognizing the implications for reimbursement, while also continuing to prioritize relationships with the entire care team, including non-physician providers.

“From my experience, we have an excellent relationship with our non-physician providers, who are integral to everything we do,” noted Madhav Swaminathan, MD, MBBS, Vice Chair of Faculty Development in the Department of Anesthesiology at Duke Health. “Mutual respect and trust enable us to take better care of our patients. While conflicts will arise, the beauty is that they are resolved in a manner that helps everyone.

“The national conversation can seem very fairly distant from the day-to-day working environment,” he continued. “Where the issue comes into play is at the leadership level and in discussions surrounding the future of reimbursement.”

So, what does this means for anesthesiologists? “We need to recognize that health care organizations are looking for the best value while still providing effective patient care,” Swaminathan said. “If anesthesiologists can provide this? Great. If not, it's time to step back, and consider how we can best provide high-quality, safe care.

“However, in my opinion, physicians do bring better value when it comes to caring for the sickest of our patients, who are growing exponentially,” he continued. “This is not to discount the work of our non-physician providers. The more expertise available to you the better and it takes a team to provide exceptional care.”

Burnout and work-life balance

Given the demands of their career, avoiding burnout and achieving work-life balance can be challenging for anesthesiologists.

“When it comes to burnout and resilience, there is an inherent conflict in how physicians, especially certain specialties, such as anesthesiology and critical care, are trained,” noted Swaminathan. “Failure is not an option and we are taught to be as productive as possible while working harder.

“However, this is unsustainable in the long term and what leads to burnout,” he continued. “We must find a balance and work smarter not harder.”

Swaminathan noted this is particularly true among faculty in their early career. “They tend to have a hard time saying ‘no,’” he explained. “Mentors can play a valuable role in helping these physicians build their career and hone their skills without taking on more than they can handle.”

“The key to successful contract negotiations begins with recognizing your worth as well as what you consider essential.”

Burnout must also be addressed at an institutional level. Leadership should respect their staff's personal time, Dr. Swaminathan noted. “Work-life balance is never going to be perfect,” he said. “It is going to be a matter of finding the imbalance that you are most comfortable with. The term has changed to work-life integration because at certain times work is going to be harder and sometimes life gets in the way.”

Colleague interactions is another area that can lead to burnout and undue stress. “A lot of conflicts arise because of difficult conversations that we have with our colleagues,” Dr. Swaminathan advised. “If we can develop ways to have more meaningful relationships, we can mitigate one of the causes of burnout.”

Small changes can make a difference, Dr. Swaminathan suggested. This can include greeting one another or introducing yourself in the operating room as well as checking in with your colleagues and offering your help when needed.

Leaders must prioritize civility and take visible action against unprofessionalism, Dr. Swaminathan emphasized. “When these ideas are a part of an institution's core values, the number of stressors will go down dramatically and so will the risk of burnout,” he explained. “As a result, people are more confident that their leadership values their word and they feel comfortable speaking up.”

Contract negotiations

The key to successful contract negotiations begins with recognizing your worth as well as what you consider essential. “In contract negotiations, the most important perspective is that you shouldn't be undervalued compared with your colleagues,” Dr. Swaminathan said. “And when you enter a negotiation be ready to articulate your priorities.”

When it comes to negotiation strategies, anesthesiologists should start with what they want most. “It's easy to get lost in the minor details,” said Michael L. Smith, JD, The Health Law Firm. “Definitely prioritize the terms that you want to modify rather than focusing on lesser concerns.”

Knowing who you are negotiating with is also helpful, according to Smith. “Some large health systems may be less likely to change certain provisions,” he advised. “Therefore, particular items may be moved down the priority list based upon the type of entity the physician is contracting with because some points just will not be modified.”

A simple, but crucial, step in the process is reading the entire contract ahead of time. “Don't sign anything until you read it, front to back,” Smith noted. “When I review a contract with a physician, I explain the different provisions, including automatic renewal and non-competes. I will focus on items that may not stand out, such as a liquidated damages provision or any money that must be paid back if they choose to leave the practice.”

Smith advises that physicians, especially those just beginning their career, should contact an attorney to have their contract reviewed. “Advocating for yourself includes seeking out expert advice when needed,” he said. “Finding an attorney who specializes in health law can be a valuable asset in the negotiation process.”

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