Dr. Alexander Vaccaro on the 'secret sauce' behind Rothman Orthopaedics' Florida expansion

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Becker's Spine Review spoke with Alexander Vaccaro, MD, PhD, president of Philadelphia-based Rothman Orthopaedic Institute, about the secret behind the group's Florida expansion and key markets for orthopedics today.

Note: Responses were lightly edited for style and length.

Question: In January, we saw [New York City-based] Hospital For Special Surgery expand into Florida. How long has this move been on the cards for Rothman Orthopaedics?

Dr. Alexander Vaccaro: It was on the cards six years ago when I became president of Rothman Orthopaedic Institute. Florida is a playground for the young and is a popular place to live as we age. It's also a recreational community, so there's a lot of sports-related injuries. I think that's why you're seeing some of the bigger orthopedic groups entering the area. We looked at Texas, California and Florida.

Q: How did the partnership with AdventHealth come about?

AV: The move is made easy because we have a partner. If you don't have a partner, it's a lot more difficult. If you look at our strategy over the years, we've always had healthcare partners — Thomas Jefferson University in Philadelphia, AtlantiCare in Atlantic City, Capital Health in Central Jersey, Northwell Health in New York and Main Line Health in Pennsylvania.

For Florida, AdventHealth is the perfect partner, but we didn't pursue them. We were looking in the area, and I got a phone call from Duane Davis, MD, the CMO. He said they were looking closely at Rothman because they wanted to develop an Orthopaedic Center of Excellence. I knew AdventHealth would have most of the patient exposure in that region. We had a meeting a year ago and did our due diligence to get to know each other.

We ultimately decided that we would be a perfect fit. We would come down and be the academic arm of AdventHealth, with the goal to start an orthopedic residency in the future, engage in research, develop an outpatient ambulatory extension of their orthopedic arm and grow organically as well as together. We graduate 28 fellows who are specialized in orthopedics each year, so we will have a constant chain of physicians who will want to live in that part of the country. 

Q: I understand you've already signed several surgeons to employment contracts in Florida. Can you expand on the recruitment strategy over the next few years?

AV: We're going to start seeing patients in January 2021. We plan to have 50 surgeons there by five years and about 85 surgeons by 10 years. That'll probably be the sweet spot, depending on growth in the region. It's a combination of bringing people together. We have about seven to 10 local orthopedic surgeons signed up already. 

Q: What are the keys to the Florida expansion strategy?

AV: Our strategy is to enter the market with our experience and culture. Several of the more experienced surgeons in our group, Paul Marchetto, MD, Robert Good, MD, Gerald Williams, MD — physicians who've been at our practice for years — I asked if they'd be willing to spend part of their year practicing in Orlando. Dr. Marchetto just agreed to a role where he will go there two weeks of the year to mentor and practice orthopedic surgery. The secret sauce is to get local, great physicians, combine them with younger surgeons coming into the market, and then infuse our culture by having tenured surgeons that we work with relocate to that community.

Q: Will we see an increasing number of orthopedic groups expanding into Florida?

AV: I think you're going to see more orthopedic groups entering Florida in the future. You're going to see communities that are growing and communities with aging populations. We take care of people with aging orthopedic problems, performing total joint replacement, spinal stenosis, etc. Areas with good weather have a lot of sports-related injuries. If you look across the country now, all orthopedic surgeons are suffering somewhat because sports injuries significantly decreased when sports were effectively cut off. I think you will find those areas to be battlegrounds. If you look at states like Texas, California and Florida, it makes sense, and that's where we're looking. We're looking at places that want to take on our platform; we have protocols, pathways and technologies that we believe will improve the value-based transfer of healthcare practice. That will be the future of healthcare.

Q: Will you find yourself spending much time down in Florida?

AV: As president, I spend most of my time in Philadelphia, but I kind of have to be everywhere. We'll probably have housing down there, like we do in New York City. We may have housing in Florida for people in the C-suite when we hold monthly meetings. I'm getting a Florida license, but I don't think I'll practice there. I'll stay at the university here in Philadelphia. 

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