Do you want to be a Mazda or a Maserati? Dr. Robert Gray on the evolution of hand surgery & how value-based care will impact clinical outcomes

Written by Mary Rechtoris | August 31, 2016 | Print  |

Orthopedic surgeon Robert Gray, MD, of Chicago-based NorthShore University HealthSystem, highlights what the future holds for orthopedic surgeons.

Question:  How has hand surgery evolved over your career? What new techniques have taken hold?


Dr. Robert Gray: I haven't been doing it for all that long, but the biggest changes have been to how we do what we do. Wide-awake anesthesia is becoming increasingly popular, though it has been my go to since I started. This allows us to do more procedures out of the hospital, and even out of the surgery center. This adds a layer of complexity to our decision process about indicating cases and what can or should be safely done in an office setting.


I think that a lot of our questions parallel those of our partners doing outpatient lumbar fusion and joint replacement. I do think that as things continue to progress, our practice model will be more like that of dentists and anything that we do, we would do without anesthesia input and in our own freestanding centers.


From a technology standpoint, wound care has seen huge advances with the use of Integra and negative pressure therapy. The indications for flaps are diminishing and the need for long microvascular cases is narrowing. While this limits our skill set, I think it is overall a positive for patients.


Q: What challenges and opportunities do orthopedic surgeons face?


RG:  I think that our challenges and opportunities are one in the same. We are victims of our own success. Our procedures have increased quality of life for patients while minimizing risk and inconvenience. As these trends continue, our acceptance of less-than-perfect clinical outcomes and any inconvenience or disability continues to go down.

As we seek incremental improvements, we are also being faced with increasing cost pressures that limit our ability to drive improvements at the edges.

Q: How will value-based care impact the orthopedic field?


RG: I think that cost pressures are good for forcing us to ask ourselves what is really important to our patients and ourselves.  I think that patients and providers will both be forced to decide if we want a Mazda or a Maserati.  While we may agree that one is clearly better than another, we can each decide if the incremental benefit is worth the price difference.  I think that some people will always want a Maserati and some dealers will always want to sell to those people, but most of us probably don't need or want that.  And Mazdas are pretty nice cars.  But the main reason mass market cars are better is because the luxury cars got better first, perfected the technology and scale got it cheap enough to sell broadly.


Learn more from Dr. Gray at the 15th Annual Spine, Orthopedic & Pain Management-Driven ASC Conference + The Future of Spine in June 2017! Click here for more information. 


More articles on practice management:
Less Exposure Surgery Society hosts 1st business symposium: 5 notes
Experiences in Emergency Medince: Q&A with Dr. Michael Boyle of ECI Healthcare Partners
Association of Independent Doctors grows across the US: 5 notes

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