How big is too big for orthopedic supergroups? 3 surgeons on the consolidation trend


Consolidation has risen among orthopedic practices during the pandemic, with four supergroups of 100-plus physicians recently formed in Texas, Florida, Tennessee and New Jersey. More independent practices are considering such partnerships with like-minded groups to provide a launch pad for growth and guard against increasing administrative and economic hurdles.

Three surgeons reflect on this emerging trend and discuss whether bigger is better when it comes to independent orthopedic practices.

Nicholas Grosso, MD. The Centers for Advanced Orthopaedics (Bethesda, Md.): There is no limit for how big an independent orthopedic group should be, so long as it is structured in a way that maintains efficiencies amidst growth. With 160 physicians and 60 office locations, my practice, The Centers for Advanced Orthopaedics, is considered a supergroup. When structured appropriately, the benefits of a supergroup of our size empowers physicians with the resources needed to navigate the rapidly changing healthcare landscape while retaining the independence to practice medicine the way they see fit.

Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: The size of any private practice group, whether it be two or 200, is immaterial. It is more about the leadership and culture fostered. Many times I have seen groups that should work on paper implode and scatter. When I have seen groups work, it is with a fair-minded and logical leader or leaders at the top. They encourage input from everyone, settle disputes openly and discourage backstabbing behavior. 

They emanate fairness because they operate on their own example. Inevitably, if it's "OK for me, but not for thee," the group is headed for dissolution. It is possible to maintain an "eat-what-you-kill" arrangement if the participating surgeons all see their goal is the same as everyone else’s in the room: survival and independence. Strong leaders should be strong not in being the loudest voice in the room but by their consistent confidence, fairness and clarity.

Vladimir Sinkov, MD. Sinkov Spine Center (Las Vegas): The answer depends on "too big" for what? For better insurance contracts, the bigger the better. The larger and the more dominant a group is in a certain market, the better the rates they can negotiate with private payers.

For physician independence, they would probably "top out" at eight to 10 partners. Beyond that, the governance of an organization becomes too complex for every partner to participate equally.  Executive boards with only a few of the partners get formed. The rest of the physicians start losing some control over how the practice is structured and run.

For better quality patient care, it's a little harder to say. Probably also around 10 partners. The larger the group, the more corporate they become. Most "corporate" groups depend on high patient volume to keep up with ever-increasing overhead and ever-decreasing reimbursement. The less time a physician has to spend with a patient, the lower the quality of care typically becomes.

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