Polce, Dean DO | ASA Monitor 90(5):p 16, May 2026. | DOI: 10.1097/01.ASM.0001193144.05890.2f
Practice model
Our local practice in Nevada is 100% physician-owned, and U.S. Anesthesia Partners (USAP) physicians are the largest single shareholder group in the management company. Local clinical governance manages each practice. The physician owners in Nevada and other USAP practices choose their clinical governance board. The boards are in full control of the clinical operations of their respective practices in each state.
Clinical environments
The majority of the clinical work is in community hospitals and ASCs.
Group size
USAP Nevada is medium-sized, with roughly 150 providers. Delivery varies from care team (mix of residents, CAAs, and CRNAs) to hands-on delivery.
Typical workday
It varies by practice, but the average workday starts between 7 a.m.-7:30 a.m. and ends before 5 p.m. These average numbers include everyone in the schedule, from post-call to those on call assignments.
Predictability of hours
Hours are predictable, but there are unexpected late days. On a per-provider average, unexpected late days occur less than 15% of the time. We utilize data analytics to assess average OR shift length, average billed units per shift, case counts/day, etc.
Call burden
Average call frequency is one call between Monday and Thursday and one weekend every four weeks. All OR calls are home calls, trauma is in house, and most of the OB calls are in house as well. OR call is not very intense, with less than 10% utilization between 11 p.m. and 7 a.m. Trauma is variable, and OB is typically the most intense call. We track call types and frequency to keep our on-call work transparent; our goal is to address call as a potential dissatisfier. Information technology resources continue to evolve to keep partners happy and distribute night work as fairly as possible.
Compensation
Physicians in USAP Nevada are compensated for four productivity metrics: availability, productivity, call, and administrative work.
Financial incentives
Incentive pay above clinical work is provided for administrative work and some select meetings.
Unique benefits
Our benefits are quite attractive. Retirement plan fees are very low. We have a small buy-in that varies between one to two years and offers student loan support up to a maximum amount.
Nonclinical responsibilities
Nonclinical work is broken into clinical governance board, HR, scheduling, finance, vacation, government affairs, quality, and residency training.
Most satisfying
To this day, the most satisfying part of the job is clinical work. Meeting patients and managing tough cases remain the most satisfying part of our job.
Challenging/stressful
Administrative aspects are the most challenging; an example is payer relationships. Whether it be commercial or government payers, this aspect is very demanding. Legislative affairs is another. Like most practices, though, the challenge of administrative work is shouldered by a minority of partners. Other challenges include covering contracted OR sites, with manpower being tight in our group, as it is for most others around the country.
Long-term
Long-term progression looks like hiring new graduates or career physicians and then allowing them to flourish under the flexibility we offer as far as clinical and administrative work. We emphasize leadership development and mentoring for all new hires. As careers progress, we offer no-call tracks as well as retirement tracks.
Quality/performance metrics
The daily headcount and case scheduled start, end, and length time are key metrics. These items impact practitioner satisfaction, which helps with group culture and further impacts retention.
Practice culture
There is a clear and consistent emphasis on quality. Nevada does not have an academic medical center, so the high-acuity cases are handled by private practices like ours. There is an academic component to our practice because we do staff a residency. Productivity and efficiency are big pieces as well. Our culture, like any other organization, reflects our values and behavior. As such, there is a consistent push to support our partners regardless of practice type. Examples include offering leadership opportunities to any partner or partnership track physician who shows interest.
Biggest advantages
The biggest advantage is being a physician owner of a large private practice. As such, the partners choose the practice they want and actively manage all aspects of clinical care. Partners also manage the business side of the practice via our finance committee. Our board negotiates facility agreements. Our HR and scheduling committees work together to manage both the long-term and daily schedules.
Biggest trade-off/limitations
With a large group comes different skill sets, work ethics, priorities, etc. Balancing these assets and interests may present leadership with challenges.
Misconceptions
The major misconception often includes the ownership of clinical and financial aspects of our practice. Further misconceptions are that private practices are not academic or progressive, but rather stagnant. A major upside to a busy practice is high case volumes; combining this with quality reporting on all cases allows for sharpening our clinical skills.
Important questions to ask
What does living in Las Vegas look like? Am I able to participate in governance? How much flexibility does the job offer? How stable is the practice? Clinical work options: mandatory skill sets across the board?
Would you do it again?
I would select the current practice model again. The model allows for self-governance with excellent administrative support, a wide range of clinical cases, the ability to work within or without a care team and participate in resident education, and group stability.
Summary
Our practice model allows for the best mix of work-life balance because we are physician owned and led, which allows for group-determined direction and management that makes us stronger together.