'Something will have to change': How orthopedic surgeons can thrive amid economic challenges


Five orthopedic surgeons connected with Becker's to discuss what orthopedic surgeons will have to change to remain successful if current economic trends continue.

Ask Orthopedic Surgeons is a weekly series of questions posed to surgeons around the country about clinical, business and policy issues affecting orthopedic care. We invite all orthopedic surgeon and specialist responses.

Next question: How do you predict knee and hip replacements will evolve over the next five years?

Please send responses to Riz Hatton at rhatton@beckershealthcare.com by 5 p.m. CDT Thursday, April 27.

Note: Responses have been lightly edited for length and clarity.

Ramy Elias, MD. Medical Director for the Center for Advanced Orthopedics & Sports Medicine at Cerritos (Calif.) Surgery Center: The current healthcare model is not sustainable.  Decreasing reimbursements and rapidly escalating costs of doing business will accelerate the decline of private practices. This will force many practices to shut down or sell to private equity or insurance companies. Companies such as Optum are rapidly taking over with the guise that they can provide better care. The only path to success is for physicians to band together and stand up to the insurance companies. The divide-and-conquer model has worked well for insurance companies, and we must put an end to this. We need to realize that we are not in competition with our colleagues and we are much stronger together.

Nicholas Grosso, MD. President of MedVanta: Orthopedic surgeons must think big picture and look ahead at future trends — not what's right in front of them — to remain successful. Surgeons are doing well with the fee-for-service model, but value-based care is the way of the future. Orthopedic surgeons should prepare now to implement evolving payment models of the future to remain successful when this time comes. 

Frank Kanovsky, MD. Orthopedic Surgeon (Glendale, Calif.): Current economic trends seem to favor orthopedics as incomes keep rising with bonuses — change nothing.

Laura Reese, DO. Orthopedic Surgeon at Ashland (Ky.) Orthopedic Associates: If current economic trends continue, orthopedic surgeons will need to diversify in order to stay successful. My fear is that so many orthopedic surgeons have gone to subspecialties and super subspecialties, that the well-trained general orthopedic surgeon has become almost a lost art. It is time for the dinosaurs to speak.

Physicians in general have lost autonomy over the years. It has happened in exponential proportions in recent years. Surgeons in general are at more of a disadvantage. After all, you can't operate without a room, a staff, including anesthesia, nurses and techs, equipment (promised by hospital systems to lure doctors in, and often not delivered after the marketing campaign).

Current orthopedic surgeons in training are not seeing the big picture. They do not realize that they are narrowing their job playing field to the point that it will soon be a pinhole. Private equity firms and hospital administrators who have no idea what the front line of patient care entails are dictating the future of medicine. That is an understatement — they are controlling it. The next line to conquer is an entourage of suits, those that have either never practiced medicine, or our former teammates that have given up the purpose of patient care for promises that end up truly empty. Unless orthopedic surgeons, as well as all physicians, understand that we are doctors first, we are doomed. We took an oath to do no harm. We pursued a career that would have a one-on-one relationship with a patient's care. We pursue our passions learned through attending medical school and our rotations in person. Our careers have been driven by our ability to mentor colleagues, patients that tell us their stories, and peers to share the learning process. Unless we get back to the reason we do what we do, none of us will be successful.

Arjun Saxena, MD. Adult Hip and Knee Reconstruction Surgeon at Rothman Orthopaedic Institute (Philadelphia): Inflation, rising costs (rent, staff, supplies), and declining reimbursements will continue to create difficulties for practice management for all private practice physicians. Unfortunately, I do not see any of these trends reversing. In order to maintain their small businesses and their autonomy, something will have to change. Orthopedic surgeons will need to expand ancillary capabilities and seek partnerships they may not have discussed in the past. Opportunities such as ambulatory surgery centers, co-management agreements, private equity firms and practice consolidation will become more omnipresent in the future. Survival for small one- to four-physician groups will be challenging.

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