Physician autonomy remains more important than ever in the orthopedic landscape, but it has to look different compared to past decades, Michael Meneghini, MD, said.
Dr. Meneghini, CEO of Noblesville, Ind.-based Indiana Orthopedic Institute, spoke about what this shift looks like and where individual expertise still remains paramount in healthcare on an upcoming episode of the Becker’s Spine and Orthopedic Podcast.
Note: This is an edited excerpt.
Question: How are you balancing physician autonomy with standardized processes?
Dr. Michael Meneghini: I just had a physician meeting recently, and we were talking about the topic of implant costs. What we did is we all sat in a room together, and then we put up the data. Physician autonomy is going to have to be different than what it was 20 years ago when I graduated from my Mayo Clinic fellowship. [Back then] you went out, you thought about everything and made all your choices. Well, now we can’t make those choices as black and white as we did. We still have autonomy, but I would say it’s more of a collective autonomy. We get in a room together, put up everybody’s variable direct cost and the utilization of implants, and then we together make decisions. We have to make autonomy not in our own clinical vacuum, but rather as it relates to the business and making a viable orthopedic practice.
That can be challenging for some physicians who don’t want to feel forced to do X, Y and Z. But they’re not being forced. It’s macro economics that are forcing us to do it together. Even if a physician wants to go be employed, many times [as employed surgeon] decisions are made by a committee. I would say the new term would probably be collective autonomy versus individual autonomy for private practices and orthopedic enterprises to survive and thrive in 2026 and beyond.
Q: That’s a really interesting shift you’re describing here — this shift to collective autonomy. Do you think that will remain the trend?
MM: I think it’ll have to. In orthopedics and musculoskeletal care, many of the procedures can be relatively standardized. With cases like carpal tunnel, shoulder replacement, lumbar spinal fusions or hip and knee replacement, you shouldn’t have a wide variability. Sometimes surgeons don’t like that because they have their own nuance they want to impart on it, but you’re going to have to justify anything that is sort of outside of a standard value-based and evidence-based protocol. I think that will be hard for some surgeons who really like the “art of medicine.” But I think that’s the way forward, and that’s here to stay. It’s more of a team approach.
Q: What would you say needs to be done to balance a collective shift while still embracing the art of medicine? Is there a middle ground?
MM: Your individual autonomy is going to be how you interact with the patient. It’s going to be how you care for the patient … We all interact with patients differently. I have certain phrases that I use and certain things that I discuss with patients that are different from my colleagues, and that’s where you can get your autonomy. The same thing goes with your post-op visits and things that don’t dramatically impact the bottom line is probably where you can get some of that autonomy.
If it’s a good collective, [physicians] have mutual respect for all the individuals in there and their autonomy. We have 14 surgeons. We’re all in a room together. Everybody’s voice should be heard and good ideas received well and considered. I think what employee doctors are frustrated with right now is when their voice isn’t even heard when there’s a committee … I think people will be OK with a team-based approach as long as they understand they’re valued and respected.
