How orthopedic & spine practices can thrive over the next 5 years — Drs. Richard Wohns, Daniel Murrey, David Rothbart

Practice Management

The healthcare landscape is tough, but there are orthopedic practices thriving today.


At the Becker's 13th Annual Spine, Orthopedic & Pain Management-Driven ASC Conference + The Future of Spine event, three spine surgeons discussed what it takes to be a thriving orthopedic and spine practice over the next five years.


"I don't think you have to be a mega group to survive, but I think you have to make a choice," said Daniel Murrey, MD, CEO of OrthoCarolina. "If you are going to be a comprehensive provider for the community and if you're going to stay independent, I think you need a certain level of infrastructure. You need to recreate the hospital infrastructure to meet the regulatory and market mandates."


That infrastructure should support data gathering and reporting, business office functions and managing risk in the coming years. OrthoCarolina currently includes more than 150 orthopedic surgeons, and more providers are scheduled to join next year. Dr. Murrey finds managing the larger group of surgeons easier than managing a smaller group, especially one with 17 to 22 physicians.


"I usually call that range the valley of death for growing practices," says Dr. Murrey. "If you are 20 physicians, one physician can hold up the show and that's challenging. You are big enough that it's hard to get everyone around the table for meetings, but small enough that if someone threatens to leave, others will cave and they'll get their way. If you become 30 people or more, the practice is more about the brand than individual surgeons."


Many markets are seeing hospitals employ primary care physicians and encouraging them to refer within the hospital network. "The challenge there is who you align yourself with and how do you make sure you have a seat at the table with access to patients," said David Rothbart, MD, a neurosurgeon with Spine Team Texas.


But there are still opportunities for independent physicians, especially in markets that can support boutique-style practices. Patients are becoming more educated and savvy about their healthcare, as well as how to spend their healthcare dollars.


"We are getting the sector of the population that likes the boutique, one-stop-shop approach," says Richard Wohns, MD, founder of NeoSpine in Puyallup, Wash. "I'm not worried about losing patients in the future because of forces that are pulling them into other networks. The people have spoken and this is what they want."


The panelists were also less concerned with specialists becoming hospital employees, seeing most orthopedic and spine surgeons desiring independence, if possible. Dr. Murrey has even spent time traveling the country and educating surgeons-in-training about their options to join independent groups and alternatives to hospital employment and academic medicine.


"I don't find many surgeons who voluntarily joint a hospital after they've been in private practice," said Dr. Murrey. "Some do it because they don't have any hope. We have to get the message out there about private practice. If you are willing to invest in your physicians leadership and willing to be transparent about your results — financial, operational and clinical within your partnership — and willing to hold yourself accountable, you can stay independent forever."


Outpatient surgery center investment has also been a smart choice for several orthopedic groups across the country. Physicians in Dr. Rothbart's group have investments in ASCs as well as physician-owned hospitals in Texas, and Dr. Wohns credits the ASC setting for his flexibility in growing other professional endeavors.


"The outpatient center frees up your time because you become extremely efficient," he said. "You can work 40 hours per week clinically and do a huge amount of cases because you don't have to do rounds. Outpatient surgery becomes your passion, but it's also an enabling factor for you to do so many other things."


All three surgeons were optimistic about the future for their practice.


"I don't see many threats to my practice," said Dr. Wohns. "We are busy as can be; we have more cases than we can handle. We joined two ACOs. We are part of the network in that sense, but we didn't feel like we needed to join the hospital employment ranks."


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