For more than 15 years, Gary Lawson, MD, has run a small anesthesia practice in Southwest Florida. In that time, he says he has been able to retain the same staff despite the rapidly changing field.
As ASCs face anesthesiologist shortages, rising salaries and falling reimbursement, many have come to rely on costly subsidies to keep anesthesia coverage in place. Dr. Lawson said his practice has stayed competitive by rethinking how anesthesia teams are staffed, putting both anesthesiologists and CRNAs directly in operating rooms. It has also built a culture that keeps clinicians from leaving for higher pay elsewhere.
Dr. Lawson, an anesthesiologist and a former naval officer, serves as chief medical officer of Quantum Anesthesia, which provides anesthesia coverage for surgery centers from Tampa to Key West.
His wife, also an anesthesiologist, serves as vice president. The practice employs anesthesiologists and CRNAs, handles its own billing and relies on a business manager for contract negotiations, credentialing and scheduling across sites.
“It’s literally a veteran-owned mom-and-pop business,” Dr. Lawson told Becker’s.
Rethinking the floor model
Dr. Lawson’s approach to staffing comes from his military background, where anesthesiologists and CRNAs work as a team rather than in a strict hierarchy.
“A CRNA and anesthesiologist work hand in hand,” he said. “We do not bring the egos to the table.”
That philosophy shapes how his practice staffs operating rooms. Under the traditional floor model, CRNAs staff the rooms while an anesthesiologist supervises from outside. In a facility with two operating rooms, that means paying for two CRNAs and one anesthesiologist, with only two of the three working directly on cases.
Dr. Lawson’s contracts instead place a CRNA in one room and an anesthesiologist in the other. The physician can still respond to emergencies, but the facility pays for two clinicians instead of three.
“You just cut out a big chunk of change in the overhead, and therefore any subsidies if needed,” he said. “That’s the paradigm shift that has to take place.”
Cutting costs matters more than ever, he said. His practice bids for contracts with surgery centers, and until recently it could do so without asking facilities for subsidies.
“In the good old days, we could do that with no requests for subsidies,” he said. “But since the advent of COVID, that has changed completely.”
Keeping staff through loyalty
Dr. Lawson said his staff has stayed with the practice for over a decade, even though they could likely earn more elsewhere.
Much of his approach comes from his years stationed in Japan, where he trained Japanese physicians and learned that “the bosses do not get paid unless the staff is paid.” When COVID-19 canceled surgeries and other practices were losing staff to higher offers, he rotated shifts so everyone could keep working.
“Everyone got paid except the bosses, and we accepted that,” he said. “Staff have seen that sense of loyalty.”
The practice also covers continuing medical education, trains CRNAs in regional anesthesia and sends staff to outside training labs. CRNAs help train incoming physicians so new hires learn the practice’s culture, and staff members spend time together outside of work.
“My staff aren’t getting paid more than anybody else, but in terms of family and camaraderie, that is what we do,” Dr. Lawson said. “It is a culture that we create.”
Competing with national groups
Dr. Lawson said his practice has won contracts over large national anesthesia groups by focusing on local relationships.
When a new surgery center in Naples, Fla., faced about a year of delays, his practice did not charge its subsidy during that time. At a Fort Myers, Fla., center where case volumes fell short, the practice worked with the facility to adjust its contract and staffing, opening two days a week instead of five until volume grew.
“The company in Seattle, Washington, doesn’t understand what’s going on in Naples, Florida,” he said.
Dr. Lawson travels between practice sites to stay on top of issues.
“I want to know what issues are going on, not remotely,” he said.
What ASCs and practices can do now
For ASCs and practices dealing with anesthesiologist shortages and rising costs, Dr. Lawson offered several recommendations.
First, anesthesiologists and CRNAs should work side by side instead of in a supervisory model.
“What works, and where the future is going, is we have to work in synergy,” he said.
Second, anesthesia groups should focus on efficiency across the whole facility, not just in the OR. His practice trains preoperative and postoperative staff and looks at patient flow from the front office through recovery. Dr. Lawson said improving patient selection and cutting recovery time has also helped his practice safely bring higher-acuity cases into ASCs.
“That’s what my practice specializes in: bringing greater acuity and getting those patients out with the lowest morbidity,” he said.
He also teaches new physicians that their role goes beyond clinical work. “Your job is not just clinical,” he said. “They must be administrative. They must also educate.”
Third, contracts should be flexible enough to handle delays and changes in volume. Instead of enforcing rigid terms, his practice adjusts staffing and schedules with its partner facilities so both sides stay financially stable.
Looking ahead, Dr. Lawson said the anesthesia field would be stronger if anesthesiologists and CRNAs worked together more, including on reimbursement. He said the American Society of Anesthesiologists and the American Association of Nurse Anesthesiology should band together to petition Congress.
“If they band together, then we can actually get increased reimbursements,” he said. “Divided, it only works in favor of the payers.”
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
