OrthoCarolina's new CEO on how his passion for sailing has prepared him to lead

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In October, Charlotte, N.C.-based OrthoCarolina announced that beginning Jan. 1, orthopedic spine surgeon Leo Spector, MD, will succeed Bruce Cohen, MD, as the practice network's CEO. 

Dr. Spector has spent 17 years in various leadership roles at OrthoCarolina, including chief quality officer, chair of the quality/value committee and co-fellowship director at the organization's spine center.

Dr. Spector spoke with Becker's about his vision for the practice, the system's laser focus on ASC migration and value-based care, and his continuing clinical role as a spine surgeon. 

Editor's note: Responses have been edited for length and clarity. 

Question: What are your top priorities for your first 12 months as OrthoCarolina's CEO? 

Dr. Leo Spector: As incoming CEO, there are one or two priorities I plan to focus on. From a culture standpoint, we really do have a great culture at OrthoCarolina. Fortunately, we've had two wonderful CEOs that precede me that have done a tremendous job creating a great culture here. I plan on doubling down on that. I think a part of it is, as we move forward as an organization in general, I want to start focusing not on just what we do, because I think the what is great; we already have a fantastic why, which is to care for our patients; but I really want to focus on how we do it and working as a team and uplifting each other and creating that kind of culture.

The second part is strategy, and for me it's a three-legged stool. The three pillars are going to be our access, community and value. Underneath all of those, we'll set some specific initiatives for access. Things like orthopedic urgent care, after hours clinics, utilizing our extenders, most of which are PAs. We have over 100 musculoskeletal PAs. And also leveraging technology. We're working with a company called the Hurt app to ensure patients are getting high quality expert care the moment they need it by leveraging technology. Those are ways we can help to expand access to patients, which ties in nicely to the community, caring for the community. Our big two focuses there are going to be on health equity; we've done a good job at creating a diversity, equity and inclusion committee, but health equity is a big problem and it's something we want to recognize and identify and make sure we're caring for the whole community and everybody is getting the care that they need. The other part of community is education. At OrthoCarolina we've done long-standing work educating residents and fellows and in research, and that's something we always want to continue doing. And part of that is taking that education to our patients so they can be better consumers of healthcare.

Third, we want to work on the development of our ASCs. North Carolina is a certificate of need state. CON reform has been enacted, and in two years that will go away in the state, so it's a wonderful opportunity for us to increase our ASC footprint so we can move patients from high- to low-cost settings and help them to have a better experience and lower costs, so it's a win-win for everyone. As a part of that, under value, we've entered into a value-based care enterprise, which is a clinically integrated network with ourselves and EmergeOrtho, the other independent group in North Carolina, to form a value-based enterprise partnering with a third-party vendor to help us deliver on value. Together, our two independent groups comprise just over 50% of the orthopedic surgeons in the entire state of North Carolina. We take care of approximately 50% of musculoskeletal spend, so we have a tremendous opportunity to be able to deliver value to the entire state of North Carolina. 

Q: How do you expect this role to differ from other leadership roles you've held at OrthoCarolina? 

LS: I've had two separate leadership roles at OrthoCarolina. We're an independent, physician-owned practice, so as a result, we have a very robust physician structure with committees that help to run the group. Throughout my tenure, I've spent time on various committees. I've been on our executive committee, which is essentially our physician-led board, and so that has given me a tremendous amount of experience on the physician side of running things. I've also served on the administrative side as chief quality officer, where I oversaw our value-based care offerings. That was obviously a relatively minor percentage of my time, but it gave me a sense of both the physician leadership role and the administrative role.

Obviously this new role is far more encompassing. I joke with my partners that hired me that it's supposed to be 70% administrative and 30% clinical, and I said it's actually going to be 100% clinical and 110% administrative, because obviously I have to do all of those things. But the plan is for me to spend part of the time as a surgeon, spending one day still seeing patients and doing what matters most, which is the patient care, but I can also see the struggles of delivering that care on a daily basis as a shareholder. But then I will be running the practice, which encompasses 1,600 employees. Fortunately, we have a great team that I will be working with from our C-suite all the way down to our front-line folks. This is going to be a much more encompassing role than I've ever had. 

Q: Why was it important for you to continue in your clinical role, at least part time? 

LS: On a personal level, I went into medicine to care for patients. Continuing to practice medicine allows me to care for patients on the most micro levels. In this new role, I'll be at the macro level. I really think being able to do both is going to make me a better CEO. I want to be in the office, seeing patients, helping out with issues both operative and non-operative. 

Q: What does OrthoCarolina's development and expansion plan look like for the next five years? 

LS: OrthoCarolina formed about 15 to 20 years ago. It was originally a merger of two practices that have been in the community for over 100 years. Much of our expansion over that time was to merge with other groups in the metro Charlotte areas and up into other areas. We went from the original 50 or so physicians to over 115 shareholders. Now, our growth is much more in line with high-value enterprise that we're doing with EmergeOrtho. To me, I look at that as a way to expand our footprint, allow for us to care for the entire geography of North Carolina, working with like-minded physicians like we have at Emerge, but not having to go through the pain and challenges of a merger, which often slows down our ability to deliver top-line care. You spend so much time focusing on merging entities as opposed to providing care for patients. This will allow us to get the best of both worlds. We will get to increase that footprint and knowledge from two groups. We'll get to care for more patients and push more into value, but not go through the challenges of merging groups. We're excited about that and we think it could be a nice model to continue to potentially expand our footprint. We're already in parts of South Carolina, but there are other areas where there are other like-minded groups, and I could very much see us partnering with them to continue to expand. 

Q: How closely are you monitoring the migration of procedures from the inpatient to the outpatient setting? 

LS: We're watching it very closely. You're seeing, on two levels, the payers and the federal government are taking more things off of the inpatient only list, and they are starting to appreciate the value ASCs provide in lowering costs of care. COVID-19 also played a large role in this, as we've started to see much more patient acceptance. Prior to COVID, patients were aware of ASCs but thought that the hospital was the better place to get care. Obviously in many circumstances when you're talking about tumors and trauma and bigger things, hospitals are a good place to get care, but during COVID patients saw that hospitals were overrun caring for sick people, being shutdown to elective surgeries, but ASCs allowed for lower acuity, elective care to be performed. I think patients are realizing that this is not a cheap alternative to a hospital, but is a more appropriate place for them to get the level of care they need  for those appropriate surgeries. We think those two things, in conjunction with CON reform, are going to continue to have an increased migration. There is going to be more and more demand, and now with the CON reform we're going to be able to have the supply to meet that demand for outpatient cases being done at ASCs when appropriate. 

Q: Do you have any hobbies outside of work that make you a better leader?

LS: First, I like to run for exercise. The biggest thing I like about running is both the mental and physical health benefits. As a leader, you have to be taking good care of yourself. You can't take good care of your patients or your people if you're not taking care of yourself. The other one is reading. I was a history major in college, I wasn't a bio or chem major or something like that, so I really enjoy reading. Some of my favorite books are "Team of Rivals," which looks at Abe Lincoln and how he formed his cabinet and brought diverging opinions and views in. One of my other favorite books is "4,000 Weeks," which looks at longevity. It says we have, in essence, 4,000 weeks to live, which is a very different way to think about longevity when we typically think about years. It looks at how you spend your time, how you choose to do that, and as a leader it's important to use time in an effective manner. The third thing, which has been a passion of mine since I was a child, is sailing.

I grew up as a daysailer with my parents. I really like analogies of how sailing fits into leadership. When you think about leading an organization, it is very much like preparing to go for a sail. You have a destination, which is the mission of the organization. You have a route that you'll take to get there, which is your organization's strategy, how you'll accomplish it. The boat itself is the organization, and then you have the crew. Those are your teammates, the people helping to get the boat safely there. I love the thought about the unexpected things that pop up when you're sailing. That analogy really struck home as a sailor to say that really does make sense and I can see how that really does fit in with being a leader. 

Q: What new orthopedic technologies are you keeping an eye on right now? 

LS: I'm a spine surgeon by background. For me, I knew about the spine world more than anything. The technologies I am looking at are robotics, which has played a large part in the hip and knee world. It is starting to make its way into the spine world, and I think that is only going to increase with time as far as ability to reduce intraoperative radiation. Going hand in hand with that is what people have been terming enabling technologies, which is more like navigation, guidance systems that allow us to place hardware in a safer way for our patients, more efficiently, but also allow us to do more parts of the procedure, not just place hardware, but help us to do our decompressions more efficiently and safely. We are still in the early stages of this with spine, and I think we'll see it continue to explode over the next five to 10 years as industry hones this technology. 

Q: Is there anything else you would like to elaborate on? 

LS: The biggest thing, not just with COVID, but you hear a lot about physician burnout and the challenges in healthcare and I think those things are very real, but I personally think it's an exciting time in healthcare. Not just from all the technology that's coming on, but there are a lot of changes occurring around healthcare delivery models, things that are disrupting the ways we typically deliver care, and for some folks, that can be scary or disturbing or unsettling, but I look at those as opportunities for those willing to seize upon it. I think independent practitioners like ourselves at OrthoCarolina are well positioned because we're able to be nimble and focused on simply delivering great care to our patients, and there are a lot of market forces that push on us to do so. It enables us to take advantage of what's happening in healthcare. I am very excited about healthcare, and I think this is a great time.

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