The future of orthopedic private practice: Q&A with Dr. Subir Jossan of The Centers for Advanced Orthopaedics

Practice Management

Orthopedic surgeon and Treasurer Subir S. Jossan, MD, of Bethesda, Md.-based The Centers for Advanced Orthopaedics discussed how a large private practice like CAO continues to grow, recruit and succeed.

Q: What are some tried-and-true physician recruitment strategies? Do you actively involve your center’s surgeons to attract others?


Dr. Subir Jossan: We founded The Centers for Advanced Orthopaedics in 2013 with 128 physicians and have grown to 175 physicians in 65 locations. We are a major regional provider, and as such, word of mouth marketing has been especially successful for physician recruitment. Many of our new hires have come to us as a result of our members networking with contacts from medical school or residency programs. We also receive a significant number of CVs to our corporate office, as our continued growth organically attracts physicians in the region.


Equally important, we rely on traditional channels for physician recruitment, such as through the American Academy of Orthopaedic Surgeons online and at their Annual Meeting. Some of our care centers place advertisements in subspecialty publications when they are looking for a specific specialist. We have also worked with recruiting firms that specialize in orthopedic and musculoskeletal care providers.


Q: What would you say is the most challenging part of recruiting new physicians and groups? How have you overcome these obstacles?


SJ: The biggest challenge we see associated with recruitment is financial. Health systems and hospitals are recruiting heavily, and in this incredibly competitive market for orthopedic physicians, larger systems are often able to initially offer higher salaries than private practice groups like ours. Higher salaries are a huge selling point for hospital and health system employment, especially as student loans are higher than ever before. However, many physicians who become employees for large health systems have found that their contract terms decrease once the initial employment term expires. They're left without control of their schedules and burdened.


However, we saw the writing on the wall when we launched four years ago — physician autonomy is extremely valuable, and that is simply not something you can find as a hospital employee. Employment trends are shifting and physicians want more control over their career paths. They can find that flexibility through a business model like The Centers for Advanced Orthopaedics, and we are receiving significant interest because of that.


Q: What is the onboarding process like for new groups joining CAO?


SJ: We developed an 'onboarding binder' which lays out all of the requirements for groups to join The Centers for Advanced Orthopaedics, such as operating under one Tax ID number, HR processes and a recommended EMR system. There are financial and legal requirements that have to be completed prior to a new group's 'go live' date as well, but it is a relatively simple process to join The Centers.


One of the perceived challenges — mentally — for new groups is the branding transition. We require that all care centers introduce their patients to The Centers for Advanced Orthopaedics and take on CAO branding through collateral, signage, logos, etc. This can be very difficult for physicians who may have founded their practice decades ago and are proud of the business they've grown — and rightfully so. When new practices adopt the new branding, they find that they're able to accomplish a lot more through strength in numbers as a member of the largest orthopedic group in the country.


Q: Do you believe independent practices will be able to survive on their own with so much consolidation occurring in the industry, or would you suggest they join groups like CAO?


SJ: I think there will always be a place for private practice groups, especially for niche practitioners who offer unique services, and for physicians who have a well established reputation in their community. In general, however, I do believe that physicians will ultimately have to choose between being employed by a large health system, where they lose autonomy, or in a larger private practice mega-group.
Our group is quite large — 175 orthopedic physicians spanning five states. Groups with 20 to 30 physicians can have an impact on the market, but they'll still struggle with having the quantity of patient health data and resources to invest in data analytics that are essential to staying ahead of the shift to value-based payment models.


Q: How does CAO ensure personalized patient care remains at the core of your work as you continue expanding?


SJ: The mission and vision of our group is to offer excellent and compassionate orthopedic care where every decision is made by the physician with our patients' best interest as the sole objective. We are owned and operated by physicians; our board is made up of physicians with that one common goal, so it's actually quite easy to remain focused on personalized patient care. We aren't working for anyone else, as we are completely physician-owned.


This is particularly evident as we move towards value-based care, which is all about cost savings and making the best clinical decisions for the patient. As we work with insurers to negotiate rates, they recognize that we are standardizing patient care, improving quality outcomes, driving efficiencies and operating ahead of the curve. We are well poised to operate under value-based care as we make each and every decision based on what is best for the patient.


More articles on practice management:
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US physician shortage may hit 100k+ by 2030 — 5 key points

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