“It’s not personal; it’s business.”

– Michael Corleone, from “The Godfather”

The clinical aspect of anesthesia practice is personal and intimate. There is something undeniably special about meeting a patient and using your hands-on, personal, and professional skills to guide someone through one of the most difficult and stressful situations of their life. But the business aspect of health care is far from personal. It’s about making tough choices regarding control, risk and quality. It’s about welcoming a new business partner or maintaining autonomy. It’s about choosing a new financial path or staying the course of proven returns. It’s about positioning one’s anesthesia practice to survive and flourish in a changing environment.

Anesthesia practices are merging, joint venturing, and being bought and sold at a startling pace. According to the Anesthesia Quality Institute, large group practices of at least 70 physicians account for 15 percent of anesthesia practices, 45 percent...

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