When health systems and organizations push for new ways to grow revenue — through opening new locations, launching additional service lines or scheduling more visits — surgeons can push back.
Management can earn surgeon buy-in through a number of different ways. Presenting new services with the same process as a new equipment purchase or educating physicians with the financials behind the introduction of a new implant can ease resistance, according to these leaders.
Three executives and surgeons recently connected with Becker’s to share how they create buy-in from their physicians when trying to expand revenue and productivity.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: What is the revenue lever leadership pushes for that spine and/or orthopedic surgeons resist the most? How do you get buy-in from surgeons?
Thomas Fondren. CEO of Advanced Orthopedics of Oklahoma (Tulsa): In our specific situation, the resistance from our group falls into two main categories: resistance to new clinic locations and service line expansion. Most of our surgeons want patients to come to the main clinic, which means our satellite locations struggle to build volume. We see the same dynamic with service line expansion — rheumatology is a good example. The group is wary of the upfront cost of an infusion suite, even though the downstream revenue and referral upside is significant. As an independent group, we need to create our own access and generate organic referrals to succeed.
To address this, we’re not asking the entire group to participate in the expansion — we’re identifying the specific surgeons for whom a satellite clinic is a better fit and creating a clinic structure around them individually rather than as a systemwide mandate. For the satellite locations, we’re showing that home-clinic time and referral volume aren’t eroded to prop up a new site, so they don’t feel they’re subsidizing growth at their own expense.
For the infusion suite, we’re presenting the referral math the same way we’d present to the group considering a new piece of equipment: what the buildout costs, what the referral volume from rheumatology realistically returns within 12 to 18 months and what the financial upside is for the group. The goal is for both initiatives to look more like an opportunity rather than an obligation.
Robert Tatsumi, MD. President and Spine Surgeon of Oregon Spine Care (Tualatin): Spine and orthopedic surgeons resist cost containment when they feel their workflow or implant choice is restricted due to price. The key is to empower the surgeons so they can make financial decisions that align with their operational flow. For example, we recently performed a cost savings analysis for arthroscopic, knee, meniscal repairs to demonstrate how profitability changes with insurance payer and implant choice. Management hesitated to provide the financial data to the surgeons, fearing it might incite anger or frustration. In fact, the opposite reaction occurred and the surgeons felt educated about the insurance reimbursements and aware of the cost of the implants. As a result, surgeon behavior changed to promote profitable cases.
Alex Vaccaro, MD, PhD. President and Spine Surgeon of Rothman Orthopaedics (Philadelphia): The revenue strategy that tends to generate the most resistance is increasing clinic access and patient throughput. Leadership often wants surgeons to add more clinic sessions, shorten appointment times or accommodate more same-day visits. From the health system’s perspective, this makes perfect sense. The clinic is the entry point for the entire episode of care, and each new patient creates opportunities for imaging, physical therapy, injections, surgery and other downstream services.
Surgeons, however, often see this differently. Most spine and orthopedic surgeons are trained to solve complex problems in the operating room, and they generally derive the greatest professional satisfaction, and often the greatest financial reward, from surgery. When they’re asked to spend more time seeing routine clinic patients, it can feel less like an effort to improve patient access and more like a request to sacrifice surgical time in order to support the health system’s financial goals. The resistance is usually not about working harder; it’s about whether the additional clinic work creates value for both the surgeon and the organization.
The best way to gain buy-in is to change the structure of the initiative rather than simply asking surgeons to “be more productive.” One effective approach is to build strong advanced practice provider teams around each surgeon. That allows the practice to expand access while reserving the surgeon’s time for complex evaluations, operative decision-making and surgery. It also helps to be transparent about how improved access benefits the entire practice. When surgeons understand that better access strengthens OR utilization, supports ancillary services, improves market share and ultimately contributes to the financial health of the group, the conversation shifts from being a productivity mandate to being a shared investment in the practice’s success.
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