Andrew Wade began his orthopedic career as a medical assistant at one of the practices that would eventually become Myrtle Beach, S.C.-based OrthoSC.
Nearly eight years after rising to lead the independent orthopedic group as CEO, he is leaving South Carolina for a larger test.
Mr. Wade is joining Princeton (N.J.) Orthopaedic Associates, a division of Somerset-based OrthoNJ, as CEO, moving from an organization he helped build to a platform with a broader footprint, decades of local history and significant growth ahead.
The decision, he said, was difficult precisely because he was not looking to escape what he had built. “I love what we’ve created, and I love the community that we’ve created it for, deeply,” Mr. Wade told Becker’s. “But I’m excited for a challenge.”
That challenge reflects one of the central questions facing independent orthopedics today: Can practices gain the advantages of scale without losing the physician involvement, local trust and responsiveness that made independence valuable in the first place?
Mr. Wade believes they can. But scale, in his view, has to do more than make the organization bigger. It has to make care easier to receive and easier to deliver.
The workforce problem is becoming an infrastructure problem
One of the opportunities drawing Mr. Wade to New Jersey is the ability to optimize surgery centers and the broader patient journey across a larger orthopedic platform.
He sees that work becoming more urgent. Demand for musculoskeletal care is rising as the Medicare population grows. At the same time, Mr. Wade sees an opposing workforce trend: surgeons retiring while the pipeline of new physicians struggles to keep pace. Eventually, he said, healthcare organizations risk asking the clinicians who remain to simply absorb the difference.
“There’s kind of a tough place coming somewhere down the road where we’re going to really be looking at our clinicians and saying, ‘Hey, I need you to do two people’s worth of work,’” he said.
Mr. Wade does not believe that is sustainable. The alternative is to build better systems around physicians. That can mean more efficient ASCs, better scheduling, shared data, purchasing efficiencies and infrastructure that reduces the amount of nonclinical friction surrounding patient care.
The goal is not simply throughput. It is giving clinicians more capacity to do the work for which they are uniquely needed. “How do we create an environment that is a great place to give and receive care, and not just one side or the other?” Mr. Wade said.
He sees private practice as particularly well positioned to solve that equation because clinicians and organizational leaders can remain close to one another. Patient experience matters. So does clinician experience. The next generation of orthopedic platforms may have to optimize both.
Patients experience healthcare differently than executives measure it
Mr. Wade learned at OrthoSC that some of the measures healthcare organizations care about most are not necessarily the ones patients can see.
A practice can track excellent clinical outcomes. It can demonstrate efficiency. It can know internally that its care is high quality. But a patient deciding where to go for orthopedic care may have limited ability to compare those things.
Most patients cannot distinguish a technically exceptional knee replacement from an average one before the procedure. Even price can remain difficult to compare despite years of transparency efforts.
What patients understand immediately is access and experience. How quickly could they get an appointment? Did someone listen? Was the process confusing? Did the practice make an already unwanted healthcare experience harder or easier?
“We’re not manufacturing widgets in a shop somewhere,” Mr. Wade said. “We’re taking care of people’s family members.”
That became one of OrthoSC’s operating principles. Orthopedic patients rarely arrive because they want to. Something hurts. Something broke. Something has taken away a piece of normal life.
“How do we come alongside people on a day that often they really didn’t plan for and they don’t really want to be having and make that better?” Mr. Wade said.
For an independent group competing against hospital-employed practices, that experience can become part of the business model. Good outcomes still matter. So does making patients feel they chose the right place to receive them.
Keep the exam room connected to the boardroom
The second lesson Mr. Wade is carrying with him is about who gets to make decisions. At OrthoSC, physicians were not detached from strategy.
“The folks that are working it out in the boardroom are also the folks that are working in the exam room,” he said.
That connection gives independent practices an advantage Mr. Wade believes should be protected as they grow. Physicians see operational problems differently because they live inside them. They know when scheduling is frustrating patients. They understand when a workflow designed for efficiency creates additional work in practice. They can identify when a financial decision conflicts with how care actually needs to be delivered.
As organizations grow larger, preserving that proximity becomes harder. Mr. Wade sees OrthoNJ’s growth as an opportunity to build scale without allowing that distance to widen.
Princeton Orthopaedic Associates brings roughly 50 years of history in its community. The wider platform creates opportunities for shared purchasing, data and infrastructure, while giving patients more ways to receive orthopedic care closer to home.
The challenge is ensuring the infrastructure supports physicians instead of gradually separating them from the decisions that shape their work.
Independent does not mean isolated
The third lesson from OrthoSC is that independence depends heavily on relationships outside the practice. Mr. Wade points to banks, payers, referring physicians, and local and state governments as partners that helped support the organization’s growth.
“We’re not just hired guns,” he said. “We’re here for the long haul.”
That distinction shapes his definition of independent practice. Independence is not simply the absence of hospital ownership. It is the ability to remain invested in a community over time and build partnerships around the needs of that market.
Those relationships also become more important as orthopedic groups move beyond traditional physician-office care and into ASCs, value-based reimbursement, payer strategy and other forms of healthcare delivery.
Scale can improve a practice’s negotiating position and create efficiencies. But Mr. Wade’s experience at OrthoSC taught him that durable growth still depends on trust, with physicians, patients and the organizations around them.
What built yesterday’s practice will not build tomorrow’s
Mr. Wade is leaving South Carolina with one final lesson that may matter most in his new role. Do not confuse past success with a future strategy. Healthcare is changing too quickly. Patient expectations are different and payment models are shifting. Technology is moving faster. Workforce shortages are becoming more visible.
The assumptions that built a thriving orthopedic practice a decade ago cannot simply be extended indefinitely.
“We cannot assume that what got us here will get us there,” Mr. Wade said. Instead, he views leadership as a continuous process of examining what has changed and adjusting accordingly.
“Every good day, tough day, everything in between is all data,” he said. “It’s all an opportunity to learn and to evolve and to grow.”
That philosophy helped take him from medical assistant to CEO. Now it follows him into a different organization, at a different scale, during a period when independent orthopedic practices are under pressure to become larger, more sophisticated and more efficient.
Mr. Wade does not see growth as a threat. Losing sight of what growth is supposed to accomplish is.
Independent orthopedics has spent years proving it can compete on access, cost and patient experience. Its next test may be proving it can scale those advantages without scaling away the relationships that created them.
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.
