Outcomes, access, experience: How one orthopedic group measures success

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Growing an orthopedic group for the sake of size isn't a guarantee for effectiveness, according to orthopedic surgeon Thomas Graham, MD.

Dr. Graham, physician in chief at Allentown, Pa.-based Lehigh Valley Orthopedic Institute, stepped into leadership on the cusp of a transformative era. As physician in chief he's thinking about how to use the group's scale to the advantage of the patient and how to further grow the staff.

He spoke with Becker's about his goals for 2024 and how he approaches one of healthcare's toughest hurdles.

Note: This conversation was edited for clarity.

Question: You're coming up on a year of being physician in chief at Lehigh Valley Orthopedic Institute. What's been your top accomplishment so far, and what are your top goals for this year?

Dr. Thomas Graham: I was the beneficiary of a lot of great work that went on before I got here. I came here at a high inflection point of coalescence of a couple of very large groups. Now we are essentially a megagroup with a couple hundred providers doing over 28,000 orthopedic procedures a year. Our key goal is to first integrate. We must act as a unit. It's really to the ultimate interest of our patients and providers that we derive that benefit from the scale we've achieved. Being big for the sake of being big doesn't help, but we want to translate that into a larger geographic area to service more highly integrated care. 

Our scorecard is pretty simple. It's access, it's patient outcomes, and it's patient experience. We also are cognizant of fiscal responsibility, and we strive to provide the best professional work environment for our colleagues for their recruitment and retention. We think a lot about the elements of where and how we deliver care and try to optimize and facilitate those. It's another page we're taking out of the book of taking care of the professional athlete. We try to grease the gears for everybody. We want to make it easy. We've expanded access considerably. 

You don't want to wait if you or your loved one has an orthopedic injury, and that goes across our whole institution. I credit a lot of folks in cardiology and cancer and other departments. We think that having a chassis as large as ours shouldn't be something that slows you down and becomes cumbersome. It should be an enabler to give faster, better care. We think a lot about that model, and talk a lot about surgical technique and technology. What's around the corner in orthobiologics, augmented reality, virtual reality and artificial intelligence? Those are all super important. It still comes down to the center of the medical universe, and that's where the patient, the doctor get together. How can you look at the things that bring them together, the things that happen while they're together and the critical things that happen once significant clinical decisions are made? So it's that level of structure and discipline that we've been trying to work on for a year. 

Q: Could you elaborate on your physician recruitment strategy? What has worked, especially as a lot of other health systems are having trouble with that?

TG: Manpower is of critical importance everywhere. We need to develop a multifaceted professional environment that is appealing for people to come and people to stay. The variables in that equation include, but certainly are not limited to, the ability to practice in the way they want and be compensated fairly for that. It's not all about compensation, but it's a component of that. Are we able to allow them the flexibility to achieve a work life balance? That goes into our integration. Usually an organization like ours is one of the biggest employers in the whole community. We're a community asset and an identity. We need to be part of the community, and that's critical not only for the service we give to our patients, but for an attraction for those who want to practice with us as partners. 

We want to also give them a place where they can express all the parts of the identity they want. Some people want to come in and do a great job taking care of their patients. Others want to have an opportunity to share their knowledge with learners. Others want to do research. Others want to participate in executive spheres. We want this to be a place where you can be hired and then retire because you didn't have to go somewhere else to say, "Hey I really wanted to be on specific committees to have influence over how we deliver care or how we buy things in supply chain or how the operating room runs." We want to make sure that our leaders aren't artificially limited. 

It's no secret that we are striving to bring accredited training programs to our institute. To date we just haven't had a residency program. We hadn't been structured for it, etc. In Pennsylvania, and I regret to say some other places in the country are having what can be seen as a reverse birth rate. 

We are not training enough orthopedic surgeons for our state. We've lost multiple slots to residencies or closing down. The average age of an orthopedist in Pennsylvania is 62 years old. We're not turning out enough to repopulate. Statistics across our specialty would tell you that about 75% to 80% of trainees stay in the local region from where they hail or from where they train. We need to be a great option for that. I'm continuously looking at the attractiveness of our program, but it just doesn't stop on how much you're getting paid or how much vacation time you get. I think we are looking at a multifactorial equation, and we have to consider how each one of those plays into professional accomplishment, personal well-being and that sense of community not only within our institute, within our organization, but the greater region in which we inhabit.

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