However, today physicians tend to choose hospital employment over private practice for a variety of reasons: the uncertain healthcare environment, long hours required to run a business and declining reimbursement. Nationally, 25 percent of physicians report hospital employment while another 24 percent say they're in single- or multispecialty groups owned by the hospital, according to Medscape's "Employed Doctors Report: Are They Better Off?" Around 70 percent of physicians under the age of 40 are choosing employment over private practice and 64 percent of employed physicians are likely to recommend employment to others. Only 11 percent of employed physicians would recommend private practice, and even 32 percent of private practice physicians said they would recommend employment.
Although spine surgeons are becoming employed at a much slower rate than other physicians and specialists, many see more hospitals in their market purchasing physician practices or employing spine specialists. According to the Medscape report, employed physicians today like not having to deal with the business of running a practice, worry about billing and having a guaranteed income. Fifty-six percent said their work/life balance improved after leaving private practice for employment and 49 percent are satisfied with their level of autonomy.
So, is there still a place for entrepreneurial-minded spine surgeons today, even if they aren't in private practice? And for those who are, can they exercise their leadership within larger group structures?
The answer, says Fred Davis, MD, Founder of Michigan Pain Consultants, is yes. Younger entrepreneurial-minded surgeons are carving out ways for themselves to provide value and creative leadership through various — and sometimes unique — opportunities outside of private practice, including:
• Spine device development and innovation
• Spine and medical mobile app development
• Healthcare analytics and software development
• Political activism
• Non-profit research and charity care organizations
For many young physicians, innovation has changed from independence to focusing on analytics and applications that can strengthen clinical processes.
"Young physicians are now getting degrees in clinical analytics, MBAs or IT areas and using cross disciplinary brilliance to advance care," says Dr. Davis. "Their business is inventing a new algorithm, app or software that can provide better care instead of the past generations creativity going from a hospital-based treatment environment into the private ASC to capture facility fees."
On the other end of the spectrum, spine surgeons wishing to remain independent are carving out niche areas for specialization. Some are opening concierge spinal practices offering unlimited access to the providers, personal services and travel arrangements for patients. The uptick in self-funded employers, people with Health Savings Accounts and other self-pay arrangements are driving this level of back pain care.
Both employed and private practice physicians are also taking on leadership roles in accountable care organizations and bundled payment initiatives. These new healthcare trends provide opportunities for surgeons to negotiate episodes of care and oversee the patient's whole spectrum of care. Paul Slosar, MD, president of San Francisco-based SpineCare Medical Group and medical director of Spine Care Institute of San Francisco, has spent several months researching cost-savings and bundled payment strategies and is preparing to move forward with such initiatives.
"Over the past 20 plus years surgeon ingenuity has brought countless medical device advances to the market resulting in remarkable improvements for patient outcomes," he says. "That same surgeon IP will soon be needed to reduce the cost of spinal surgery while preserving good outcomes. We are the only ones who can really bend the cost curve and with optimally structured bundled payment strategies, with the right business partner, we can participate in our fair share of the savings only we surgeons can produce."
Finally, device development and innovation has long been a creative outlet for spine surgeons; however, scrutiny on surgeon-industry relationships tightened with the Sunshine Act in 2013. Additionally, Office of the Inspector General also released an opinion last year advising against physician-owned distributorships. However, there is still ample opportunity for surgeons to partner in the research and development of new products advancing the field
"I think spine surgeons working with device companies is going to continue," says Hyun Bae, MD, co-director of the spine fellowship program at Cedars-Sinai Spine Center in Los Angeles. "It has been a rewarding and fruitful experience for spine surgeons to deliver better patient care. I still think we'll have a lot of surgeons involved in trials or testing, invention or consulting for device companies."
More Articles on Spine Surgeons:
Scoliosis Procedures for the Growing Spine: Advances in Anterior Vertebral Body Tethering
Minimally Invasive vs. Open Spine Surgery: Where the Field is Headed
Iliac Bone Crest vs. Synthetics for Spinal Fusion & Beyond: The Biggest Opportunities in Spinal Biologics