How minimally invasive spine surgeons can stay independent: Key opportunities from Dr. Brian Gantwerker


Brian Gantwerker, MD, founder of The Craniospinal Center of Los Angeles, discusses key opportunities for private practice spine surgeons in the future.

Dr. Gantwerker is speaking on a panel titled "State of Spine Surgery and Independent Practice" at the Becker’s 15th Annual Spine, Orthopedic and Pain Management-Driven ASC Conference + The Future of Spine on June 22 to 24, 2017 in Chicago. Click here to learn more and register.


Question: How do you see independent practice evolving among spine surgeons?


Dr. Brian Gantwerker: I really see synergies between private practices and concierge medical groups. I think it's a natural fit and there will be an independent network of high quality, low volume physicians available for patients. The quality private practice can give patients attention to detail and follow through in a way that other physicians can't. Also, because they don't want to lose patients to the systems that have high volumes but low patient satisfaction, patients will have a better experience.


Going forward, I think there will be fewer private practice physicians out there as a whole; there are a lot of physicians joining large groups or selling to a hospital. For those of us who are brave enough, there is a nice opportunity out there for concierge physicians to provide good quality services.


If you have your own set of patients, it can be hard to be on call and provide direct-to-patient marketing. Insurance pressures may drive some patients out of your practice because patients will get plans from large companies that don't do direct-to-physician contracting. The physicians will then stop taking insurance and do direct fee-for-service models the old-fashioned way. There is the added benefit of having their stream of patients who have access to the physician any time instead of having to go through the system. You can distinguish yourself in the market because most surgical specialists will be forced to join larger practices or relocate.


Q: What are the biggest challenges and opportunities for independent practice spine surgeons?


BG: There is a pressure for surgeons to do things outside of practice medicine. Some physicians are working on internet startups or medical device startups, designing devices, consulting or providing medicolegal work. There is a pressure to do things outside of medicine. If things become as big as they are expected, it could be a nice adjunct to their practice and become a second career if the physician decides to cut back on their practice and do more paramedical activities. I'm involved in a surgery simulation company, VR projects, that's another opportunity on the back end.


Q: Where do you see the spine field headed over the next decade?


BG: I think you'll see about 50 percent or more of spine surgeries in the ASC setting. You will see the pressure from insurance companies and patients to do more outpatient procedures. That being said, the complexity of the inpatient side will also increase. More patients will have deformity corrections or big multilevel procedures and academic medical centers will drive up costs further. There will be a crunch on bigger hospitals and academic hospitals.


It is an uncertain future with the acuity being lumped into academic centers along with high-risk patients. They will have artificially increased complication rates than others with fewer higher acuity cases. Surgeons will be performing endoscopic spine surgery, minimally invasive decompressions, artificial disc replacements and more. I foresee specialty physicians will be performing these procedures and releasing patients to 72-hour stay facilities to drive the cost down.


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