6 essential tips for spine surgeons entering practice

Practice Management

Establishing a practice can be daunting in the early days of a spine surgeon's career, where so many decisions are critical to ensure you're starting on the right foot, such as choosing the right orthopedic group or health system, signing a fair contract, developing your surgical technique or managing your finances.

Six spine leaders shared essential tips to ensure a fruitful start to a spine surgeon's practice:

1. Considerations for hospital or health system contracts.

Alen Nourian, MD. Solo practitioner spine surgeon in California: There are several key considerations when orthopedic surgeons are considering entering into a contract with a hospital system. One of the most important considerations is to make sure that the surgeon is allowed to buy into any outpatient surgical center associated with the hospital. As more spine surgeons are doing surgeries in outpatient surgery centers, it is very important that when joining with a hospital that there is a carve out to be able to buy into the hospital outpatient surgery centers or any affiliated outpatient centers. The other important factor for surgeons entering into possible agreement with a hospital is the ability to choose the type of spinal implant and technology. Some hospital systems are limited in which companies they are contracted with and limited on the latest technology including navigation. It is important that surgeons are allowed to help collaborate with the hospital.

2. How to handle your finances.

Alexander Vaccaro, MD, PhD. Rothman Orthopaedic Institute (Philadelphia): The worst decision or investment I've made in my life is listening to financial advisers when I first entered practice, believing they were truly fiduciaries of my hard-earned money and abandoning the simple strategy of index fund capital allocation as a method of building long-term financial security. When you're young and naive, you're often influenced by savvy, smooth-talking financial advisers and disability brokers on the importance of letting them manage your money. What I found over time is that simple dollar cost averaging, exploiting index funds and therefore minimizing unnecessary fees, and maximizing tax-deferred investment opportunities including 529 plans for educational purposes was the most efficient way to develop wealth over time.

3. What to look out for when joining an orthopedic group.

Lali Sekhon, MD, PhD. Nevada Neurosurgery (Reno): Having done this in 2019 and being 20 years in practice, this is what I looked for:

  • A need for my services. Need to have the volume/demand to support spine.
  • Good people. Good reputation. Had to have the same principles and work ethic.
  • Growing, not shrinking.
  • Put the patient first. Ethical. Principled. Provide appropriate care.
  • Well-established ancillaries, such as imaging, physical therapy, urgent care and surgery center.

4. Four key questions when considering new surgical technology.

Usman Zahir, MD. ScopeSpine-The Orthopaedic Group (Dulles, Va.): For me, the key considerations are:

  • Does the technology promote efficiencies in the OR? Does it shorten the steps for a procedure without compromising potential outcomes? How many trays are associated with the device?
  • Does the tech minimize use of radiation? This primarily applies to new spinal implants and procedures.
  • Is it cost-effective?
  • Does it allow for a less invasive approach than what the current standard offers?

5. Get on the telehealth bandwagon.

Richard Berger, MD. Midwest Orthopaedics at Rush (Chicago): It's a great way to help people, not just in your office, but at home. You have to remember that we're talking about patients who have hip and knee arthritis. It's hard for them to get around to begin with and really hard for them to get to your office, and lots of people aren't getting treated because they can't get to the office.

Number two is, you're going to have to figure out how to be more efficient in the operating room. But not doing the surgery faster; the surgery is the important part. All the stuff that goes around the surgery, what's done in between cases and how to make that go more smoothly. There are lots of techniques that busy centers like ours use, which makes the turnover of cases easy. We use case carts where everything you need for the case is in a cart, and that makes the entire procedure so much faster in between cases.

6. Select the right EMR.

Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: We started out with a server-based EMR that became increasingly laggy and unwieldy. Looking back, cloud-based software was not so great at the time, but data security is and remains paramount. I think picking the right EMR (until they unite and we are all using one system) is one of the most important choices you make in practice. Make sure the one you pick allows access to data, order input and a way for your practice manager to monitor your accounts receivable.

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