Will Spine Surgeons Seek Hospital Employment? 4 Leaders Weigh In


Four spine surgeons discuss whether or not hospital employment will be the future for industry physicians. Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. We invite all spine surgeon and specialist responses. Next week's question: What are your thoughts on the medical device tax? How will it impact spine surgery?

Please send responses to Heather Linder at hlinder@beckershealthcare.com by Wednesday, April 3, at 5 p.m. CST.

Kern Singh, MD, Rush University Medical Center, Chicago: I will not seek hospital employment. Hospital employment offers short term job security and overhead protection from the newly enacted healthcare mandates. But it offers these benefits at a significant loss of autonomy and control over clinical practice. Hospitals will control salaries and arbitrarily assign value/renumeration for work. Several scares have occurred in healthcare previously (HMOs) yet the system has evolved allowing physicians to practice independently. No one is quite certain as to how bundled payments will affect physicians and how monies will be distributed. To make an instinctive reaction is both rash and short-sighted.

Jeffrey Wang, MD, UCLA Spine Center: I am already employed by the UCLA School of Medicine Health System, so I guess I am already considered employed rather than in private practice. However, with the changing landscape, we know that most physicians are moving out of private practice and into larger groups, hospital systems or consolidating with other groups. I think it makes sense to be able to attain a critical mass to be able to meet the increasing demands on our practices, demonstrating outcomes and being able to cope with the future requirements. I do think it is the way of the future and most surgeons, at least in major markets, are moving in this direction.

Richard Kube, MD, Spine Surgeon, CEO and founder of Prairie Spine & Pain Institute, Peoria, Ill.: I will not be seeking hospital employment. Reasons are many, but the main issue is that I do not wish to lose my autonomy as a physician. Taking a hospital position makes me an agent of the facility and places a large variety of business degree bureaucrats between me and the patient. Also, I have spent many years building a successful integrated spine care model that I don't wish to walk away from at this time. I value my ability to adapt my practice to engage patients in fresh new ways that would never be possible if those ideas were bogged down in a committee.

Walter Eckman, MD, owner of Aurora Spine Center, Tupelo, Miss.: I am 69 years old, and I have been in private practice for 37 years. I have always appreciated my independence from hospitals in spite of the fact that many hospitals try to be very controlling. In some ways the future is bleak for private practice with declining reimbursement, increased government regulations (demands for new software, needs for increased office personnel) and increasing reluctance of private insurance companies to approve fusion procedures while reducing payments.  

Hopefully, efforts will be made to coalescence groups of spine surgeons to control their own facilities and increase services with particular emphasis on ambulatory surgery. If these efforts succeed without abusing the opportunity for ancillary services, then private groups may benefit from their independence. These efforts will also offer an opportunity for private contracting for services with individuals or companies when reimbursements are no longer tolerable. One who remains a hospital employee becomes a serf, and in the future will have to accept what the hospital gives them.

More Articles on Spine:
5 Qualities of Effective Spine Surgeon Leaders in Profitable Practices
Discectomy for Disc Herniation Could Save $2.1 Billion Over Non-Surgical Treatment
5 Initiatives for a Better Patient & Physician Experience at Spine-Driven ASCs

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