Rothman Institute has grown 15-20% annually for 45 years — Dr. Richard Rothman's 11 key principles for success

Practice Management

Richard Rothman, MD, PhD, opened his practice in 1970 as an independent physician with one partner, a secretary and nurse; since then he's grown his business into one of the largest orthopedic physician groups in the country. And he has no intention of slowing down.

"Most people are retired in Florida worried about their health when they're 80. I'm still going full tilt, starting new projects with 10 to 15 year horizons," says Dr. Rothman.


Philadelphia-based Rothman Institute is legendary; its physicians serve as the orthopedics department for Thomas Jefferson University Hospital and the team physicians for the Philadelphia Phillies, Eagles, Flyers, 76ers and Villanova University. The practice's spine team performs more than 3,000 cases per year while the sports medicine team tackles 10,000 surgeries annually.


But the practice's reach extends far beyond their patient base. Rothman Institute physicians are focused on academics as well, and published more than 225 articles in academic journals last year. The practice also focuses on education at the Sidney Kimmel Medical School at Thomas Jefferson University and sponsors residencies and fellowships in adult reconstruction, spine surgery, sports medicine and pain management. The surgeons are highly regarded, having served as presidents of national organizations including the current president of the American Academy of Orthopaedic Surgeons.


The practice now includes 145 physicians, 25 office locations, two surgical hospitals and several ASCs. It was one of the original members of the National Orthopaedic & Spine Alliance and holds several business investments in data gathering, reporting and healthcare companies designed to help manage risk and provide better quality care. Earlier this year, Rothman Institute announced a strategic affiliation with New Hyde Park, N.Y.-based Northwell Health to expand its reach beyond Pennsylvania and New Jersey.


Now, at 80 years old, Dr. Rothman has his sights set on the rest of the country as well.


"My vision of the future is to develop a national footprint over the next five years," he says. "A national franchise by merging with other practices and partnering with health systems we respect."


Could Dr. Rothman have imagined all this when he first hung his shingle? Perhaps, but as the son of a Polish immigrant with meager savings when he arrived in the U.S., it was far from a sure thing. Dr. Rothman's father traveled to the U.S. around 1920 with little education or resources. He couldn't speak English and didn't have any relatives in the U.S., but he still managed to build a successful clothing company and pass along his resilient spirit and drive for success.


Dr. Rothman attended the University of Pennsylvania and studied history as an under graduate before attending medical school there, and he attributes his liberal arts education in part for his success. "I think it's made me a better citizen and a more interesting person," he says. His hobbies outside of medicine also reflect the liberal arts interest; he collects art — particularly Andrew and Jamie Wyeth paintings — and serves as a senior advisor with a private equity company on their healthcare holdings.


He is also embarking on new projects, launching an implant company in China and expanding the Rothman Institute brand. The practice has grown nearly 15 percent to 20 percent annually over the past 45 years. So what's Dr. Rothman's secret sauce?


"The key concepts are pretty simple," he says. He always believed a private corporate structure was the most productive for physician practices. Physician ownership has been a core aspect of the practice's culture. "The No. 1 way to retain employees and make them happy is allowing them to control their destiny; that's the strongest single motivator of any business person or employee. By being physician-owned, physicians feel they are in control of their destiny."


Here are 11 key principles Dr. Rothman abides by:


1. Focus on quality. "If it were a choice between profit and quality, we always came down on the side of quality care for our patients," he says. Physicians are encouraged to stay on the cutting-edge of quality care by exploring new technology and techniques, as well as developing a relationship with their patients.


2. Keep care affordable. The practice strives to treat all patients regardless of their insurance status. As they move to risk-based contracting, the physicians remain accessible. "We don't soak the rich or poor. By and large, we accept all insurances," he says. "We really are the orthopedist for the every man, and we want everyone to come to us for care."


3. Be convenient. As the practice grew, instead of bringing all the physicians under one roof Dr. Rothman expanded the practice to include satellite locations. "We go out to communities rather than expect them to come to a Mecca," says Dr. Rothman. "The old academic model is if you are really good, people will come to you. We always felt it was better for doctors to build their clinics where the people are."


4. Exude compassion. "The doctors, nurses and receptionists are always told to be compassionate in their dealings with people," says Dr. Rothman. "Patients can sense that. They can't sense the quality of care they are getting, but they can sense whether you care about them."


5. Choose partners well. "People always ask me about how I ensure quality growing from two physicians to 170. I think the key is selecting the very best surgeons and physicians," says Dr. Rothman. "I have a really good eye for people driven for quality intrinsically; it's in their DNA."


Around two-thirds of the Rothman Institute faculty were trained at the practice, including current president Alexander Vaccaro, MD, PhD, MBA. "You don't pick people who are dysfunctional. We know our partners, associates and faculty extremely well before we recruit them," says Dr. Rothman. "We know they'll get along in our group matrix and practice quality medicine."


6. Build teams. "Team building is essential. I'm not the smartest guy in the world or the hardest worker, but I'm a very good judge of people," says Dr. Rothman. "My role and the role of leadership is to identify the best surgeons and administrators, recruit them and retain them. I always joke that coming to work for us is a life sentence because nobody leaves."


7. Treat partners equally. "We are very egalitarian and transparent. All partners get the same contract. That doesn't mean everyone earns the same, but they have the same opportunities and our business functions are transparent," says Dr. Rothman. "Everyone knows what is going on every month and there isn't any in-fighting about income."


8. Subspecialize. "We focused on subspecialization early on," says Dr. Rothman. "What this does is allow surgeons to develop their skills to the maximum, and that's also satisfying for employees. They get very good at their jobs. We also provide good facilities and compensate people well."


9. Treat the business team as partners. "We have a very sophisticated business team and we treat our business support as partners," says Dr. Rothman. "Their success is related to the success of our business. They are motivated by the same factors that motivate our surgical partners."


10. Create a vision for the future. In addition to developing a national brand, 'Rothman Institute is also working toward more risk-based contracts and providing episodes of care. Gradually, Dr. Rothman hopes the practice will function as an insurance company to provide population health in the musculoskeletal space. "Accepting risk contracts with major insurance companies is a contest to see who has better control of the data, us or them," says Dr. Rothman. "Hopefully it's us."


11. Provide the best value. Providing value in healthcare is all about delivering great results in the most cost-efficient way possible. Rothman found physical therapy was an expensive aspect of the episode of care so the group helped develop a company that delivers physical therapy online for 5 percent of the cost of traditional PT. "We try to be disruptive with our care and provide the best value: quality divided by cost. Everything we do is to elevate quality and manage costs," says Dr. Rothman. "We are really innovative in terms of how we deliver care."


Dr. Rothman built his practice with an incredible amount of foresight into where medicine was heading and what makes providers successful. He encountered his share of challenges along the way, but adhered to his principles and, as is typical of second-generation immigrants, was able to get back up after being knocked down.


"I learn from adversity and come out a better person," he says. "I was born with a resilient personality. Being born in this country in this time in history contributed to my success, and I had a good deal of luck. But as Thomas Jefferson said, the harder you work the luckier you get."


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