Every year, Nicholas Grosso, MD, gives orthopedic residents a talk that keeps coming back to one question: Is there life in private practice?
He tells them there is, and he’s helped build one of the region’s largest independent orthopedic groups to prove it. But making that case is not getting any easier, said Dr. Grosso, vice president of Bethesda, Md.-based Centers for Advanced Orthopaedics.
Training has changed
Part of the problem starts in residency, Dr. Grosso told Becker’s. When he trained, residents rotated through civilian hospitals and private practices. Today’s residents don’t get that exposure.
“Now these kids are going through training, and they never leave a hospital system,” he said. “All their rotations, all they see is hospital system-based medicine, and it’s very comfortable.”
Why employment can be appealing
For many new surgeons, a hospital job offers what private practice can’t: a salary and predictable hours.
“It’s very attractive to a lot of these young kids coming out who are looking more for lifestyle than they are necessarily to see as many patients as they can and be as efficient as they can, be their own boss and have the autonomy,” Dr. Grosso said.
Even established surgeons feel the pull. Dr. Grosso said some are deciding it’s easier to give up their independence than keep fighting cuts, regulations and payers.
“It’s easier to say, ‘I’m just going to go. I’ll show up at 7:30 in the morning, see my patients, do my cases and go home, and let somebody else worry about all that stuff,'” he said. “You give up your own autonomy, the kind of thing that private practice has always been based on.”
And the financial rewards that once made up for private practice’s demands are shrinking as Medicare reimbursement falls, he said.
Making the case for independence
Dr. Grosso and his colleagues have bet on the opposite path. CAO was formed in the early 2010s, when Maryland hospitals were acquiring orthopedic practices, as a way for independent surgeons to stay independent.
At the time, Maryland’s orthopedic surgeons were among the lowest paid in the country, he said.
“We were the least reimbursed orthopedic surgeons in the entire country in one of the highest-cost areas as far as cost of doing business,” Dr. Grosso said. “We’ve been able to reverse a lot of that.”
CAO did it largely through scale, giving the group more leverage with payers. The group is now looking at new ways to work outside traditional payer arrangements.
What’s at stake
Dr. Grosso said fewer surgeons entering private practice ultimately means fewer independent practices and less choice for patients. He said there’s nothing wrong with care at large academic centers; he trained as a resident at Walter Reed himself. But patients shouldn’t be forced into those settings.
At his annual talk, he tries to convince residents that there is life in private practice.
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