1. Follow the industry. Dr. McCormack says most of the intellectual advances and innovations in spine surgery were emanating from the private sector. “So to me, it didn’t make as much sense to remain in a university-based practice at University of California at San Francisco,” where he used to serve on the faculty and practice before leaving just over a decade ago. “I decided to leave and was thinking of returning to New York to private practice. But I decided to stay in San Francisco. I’d heard people saying single practice is over, but I didn’t believe that. If you work hard you can make it happen. Going on your own will help you to learn your practice from ground up and if you decide you don’t like it, you can always join a group.”
2. Practice where you want to live. “I’d enjoyed living in San Francisco, but many people warned me there were too many doctors here to support another spine surgeon,” Dr. McCormack says. “That wasn’t true. I just needed to market throughout the Bay Area to a broader audience,” he says.
3. Be creative in marketing yourself. Since Dr. McCormack was the new guy on the market and relatively unknown, he needed to market himself in different ways to attract physicians who would refer patients to him.
“I began sending out flyers and giving continuing medical education talks at hospitals around the Bay Area — I’ve been to every hospital in Northern California,” he says. “Sometimes nothing comes of them, but if you get just one referring doctor out of the audience, that’s great. I actively marketed my practice outside of the city, but as time went by I received more referrals from within the city.”
He says the first three or four years after he left the university there weren’t many referrals. But as his name recognition and reputation have grown, those efforts produced referral streams. “That was key to building a successful practice,” he says.
4. Recognize that not every back surgery outcome will be favorable and respond appropriately to poor outcomes. Dr. McCormack advises investigating any negative outcomes to learn the root causes to avoid recurrences. “A few disgruntled patients can ruin a practice by word of mouth alone,” he says.
He recalls some years ago when spine surgeons in the Bay Area were using discography as the sole basis for determining whether certain spine surgeries were necessary. “I wasn’t seeing good results from that and quickly dropped that practice. Payors were impressed, but that’s not why I did it,” he says. “It’s not worth it and you can’t build a successful practice on something like that. Rejecting it gave me credibility. At the end of the day you want to have a happy patient.”
5. Diversify your practice. “Make sure your practice is diversified and not totally dependent on income derived from surgery,” he recommends.
Dr. McCormack says he hedged his bets years ago and broadened his practice by performing medical legal evaluations for workers’ compensation and other cases.
“Every time you operate there is a risk of a bad result or a medical malpractice lawsuit,” he says. “If you write a report analyzing a treatment, there is no downside risk and it is very lucrative. So, as opposed to trying to do more and more surgery, which some doctors do try to keep numbers up, I found another way to support my practice. It was a conscious business decision. I might be better off financially if I perform more surgeries, but performing utilization reviews and analyzing the nature of injuries in auto accidents has helped me avoid the kinds of reduced volume a lot of physicians are seeing. Even as elective surgeries are down considerably, my medical legal work is going through the roof. I’ll make as much this year as I did last year.”
