'Trading their legacy for a quick payout': What we heard in March

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Spine and orthopedic experts and leaders spoke with Becker's Spine Review on key topics in March from tough career decisions and the benefits of awake procedures.

1. "The most dangerous current trend in orthopedic surgery is the insinuation of private equity into our business. Over the past five years, we have seen a rapid increase in the number of groups coming under the control of private equity. These companies place a premium on profitability, seeking to maximize profit and flip the practice to the next-highest-paying suitor in a relatively short time frame. They are, in general, impervious to quality of care issues, instead focusing entirely on maximizing revenue while minimizing cost/overhead. The physician owners lose a substantial degree of control and autonomy once the acquisition occurs, often leading to problems with recruitment and retention of future hires. I've watched a number of groups, many of which have existed and thrived for over 20 years, sell out to private equity, trading their legacy for a quick payout. This trend, in my opinion, is the most pressing threat to orthopedic practices nationally." — John Corsetti, MD, of Springfield, Mass.-based New England Orthopedic Surgeons, on the most dangerous trend in orthopedics.

2. "The most difficult decision I have ever made was to not cover multiple hospitals. One of my mentors bragged to me he used to cover 17 different hospitals. At one point, I was covering three to four hospitals. It is simply not sustainable. Committing to one or two locations or hospitals is hard. It is hard financially and there is the panic of not spreading out enough. But if you are working hard, following through and doing your best, in this day and age it does not necessarily mean you have to be everything to everyone and everywhere for everyone as well." — Brian Gantwerker, MD, of The Craniospinal Center of Los Angeles, on his toughest career decision as a spine surgeon.

3. "The patient gets a more respectful, patient-centered experience, so the experience is totally different when you're awake. The music we listen to in the operating room is what the patient wants, not what I want. We talk during the operation, and the patient knows that I'm doing the surgery, not one of my assistants. They get that kind of continuity and respect that they deserve when they're awake. In other words, if the patient is awake, we're not talking about the next surgery we're going to do or the last surgery we did or what we're going to do on the weekend. We're focused on this case. I think you kind of forget that there's a person in the room when they're asleep, but when they're awake, it's a more respectful environment." — Ernest Braxton, MD, of Vail-Summit Orthopaedics & Neurosurgery in Frisco, Colo., on why awake spine surgery can be attractive to patients.

4. "I see two big problems with posting too soon: First, you don't know how the patient did clinically if they're only a couple of days out. Now you're telling people that this is a good way to do surgery without knowing the patient's outcome. Two, from a legal standpoint, what if that patient has a bad outcome and you've posted images on social media about their surgery? I've told a lot of colleagues my age range who are asking for tips on how to use social media. I tell them don't post anything until the patient is three to six months out because it's kind of a false advertisement to say how great your intraoperative fluoros are by posting those images one day after surgery. Again, anyone can have great intraoperative fluoros; it's all about the outcome." — Chester Donnally, MD, of Addison-based Texas Spine Consultants, about his social media practices and why surgeons should be patient when posting.

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