5 Tactics for Bringing Spine Surgeons to Small Hospitals


Hospitals in smaller communities and rural settings often have a difficult time attracting spine surgeons. However, once a community has established the need for a spine surgeon, there are a few things hospitals can do to attract good surgeons. Here are a few ways hospitals in smaller communities can entice and prepare for employing spine surgeons.

1. Offer competitive compensation. Surgeons coming out of medical school are most likely to practice in larger cities, which mean hospitals in smaller communities must offer a competitive salary, around the 75th percentile, in order to attract surgeons. "Generally, when you are looking at a specialty surgeon, there is a pretty substantial guarantee base in the hospital," says B.J. Millar, a director in Quorum Health Resources' physician services practice. However, he cautions that rural hospitals should not offer a large guarantee base in contracts extending out more than three years because the surgeon still needs incentives to increase his or her case volume.

Mr. Millar also suggests the hospital offer signing bonuses, citizenship bonuses tied to quality outcomes and the hospital's overall success and compensation based on leadership positions, such as directing a spine institute or participating in outreach clinics. "About 20-25 percent of the surgeon's potential income should be tied into the blended bonus structure," says Mr. Millar. "The surgeon has to be incentivized to work hard, build volume and be productive."

2. Show the potential for patient volume. Hospitals should research the potential number of cases for spine surgeons in the community to decide whether hiring a spine surgeon is cost-effective. If it is, use that data to entice spine surgeons to the area. "The surgeon needs to know how he or she is going to be busy and will have a stable salary, long-term," says Bob Bregant, executive vice president of Horton, Smith & Associates, based in Overland Park, Kan. If the case volume is likely not high enough at one smaller hospital, the hospital should consider partnering with other area hospitals to support a surgeon in the community, says Mr. Millar. The surgeon can contract to work certain days at each location, provided they are within 45-90 minutes of one another. This surgeon will most likely be one of the only spine surgeons in the area, which means there will be little competition for services and the potential for a high case volume.

3. Have technology and materials available. The hospital needs to have the surgical instruments, a spine surgery table, C-arm and other tools available for the spine surgeon to use during operations. The hospital also needs the appropriate ancillary services and diagnostic tools on hand. This can be problematic for hospitals in smaller cities because spine surgery equipment is often expensive, says Donald Corenman, MD, a spine surgeon with The Steadman Clinic in Vail, Colo. "If the hospital doesn't want to invest in the equipment, they will have a hard time attracting spine surgeons," he says. If an industrial representative is available in the area, he or she can bring the tools to the hospital when the spine surgeon needs them for cases.

4. Employ a team around the surgeon. In addition to supporting a spine surgeon, the hospital must employ a team of nurses and other professionals, such as interventionalists and anesthesiologists, to work alongside the surgeon. While these professionals are necessary, the hospital can bill the team as working around the spine surgeon. "You can entice spine surgeons to the hospital by making them a big fish in a small pond," says Mr. Millar. "Technology has gotten to the point where you can do orthopedic procedures in a rural setting just as well as in an urban hospital."

5. Provide call support.
Smaller hospitals and communities are likely to support only one full-time spine surgeon to work regular hours and be on-call. When negotiating the contract, the hospital must specify a specific amount of time the surgeon should be on-call, says Mr. Bregant. Beyond the surgeon's required call time, the hospital needs to provide another source of coverage, possibly a surgeon from a neighboring community or locum coverage to cover the hospital's needs. The contract should also specify the vacation time for the surgeon, which will need to be covered by an alternative source as well. "Agree with the surgeon on the front end that they will only have a certain amount of call coverage," says Mr. Bregant. The surgeon needs to know he or she will receive time off.

Read more about spine surgery in rural areas:

- Rural Spine Practices Meet Recruitment Challenges by Emphasizing Decreased Competition, Small-Town Life

- 5 Thoughts on the Physician Supervision of Anesthesia Rule From ASA President Dr. Mark Warner

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