Hospital employment vs. independent practice: 5 spine surgeons weigh in


Here five spine surgeons discuss the value of remaining in independent practice and the reasons behind the decision.

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 some of the most innovative patient engagement initiatives you have incorporated in your practice?


Please send responses to Anuja Vaidya at by Wednesday, August 12, at 5 p.m. CST.


Question: What is your advice for physicians who would like to switch to hospital employment from independent practice?


Kern Singh, MD, Minimally Invasive Spine Institute, Chicago: Medicine is all about being your own boss. The days of the physician cottage industry may be over; however, the ability to run a successful independent practice is not. No one knows what we do, so why should we be told how to do it? Rather we should become efficient and cost-effective so that we can still maintain our autonomy.


Kenneth Pettine, MD, Founder, The Spine Institute, Johnstown, Colo.: In general, hospital administrators are your worst nightmare. For some reason, physicians that work at a hospital typically have an extremely tenuous relationship with the hospital administrators. I have no idea why this seems to be ubiquitous. Thus, if you decide to be an employee of a hospital, expect to be treated poorly and cast off whenever it would appear to be in the best interest of the hospital. Always remember that any decision that is made will be made in the best interest of the hospital and not you. My understanding is that historically most hospital contracts last about three years and then either the hospital or the surgeon elects to change their employment situation.


Brian R. Gantwerker, MD, The Craniospinal Center of Los Angeles: Carefully consider how you like to practice. Do you enjoy your independence? Do you like to compete in an open field? How do you feel about your employees? I would advise [surgeons] to think twice, because it probably is a one-way street. You will probably bid farewell to a lot of the patients you have come to know. You will need to be able to exist within an ecosystem of compliance, paperwork and lots of oversight. This is not necessarily a bad thing, but never make a decision like this based on fear of the future and what people are telling you.


Richard Kube, MD, Founder, CEO, Prairie Spine & Pain Institute, Peoria, Ill.: My practice name is Prairie Spine & Pain Institute and I can be reached at 309-691-7774.  Keep that information handy for the next two or three years and feel free to reach out to me for an opportunity to return to private practice when the deal doesn't work out like everyone had hoped. In all seriousness, be very careful about how the deal is structured because the hospital is not hiring you to lose money. Rest assured that once you are locked in, they will use whatever ability they have to impose pressure on  your performance and your income.


Neel Anand, MD, Clinical Professor of Surgery, Director, Spine Trauma, Cedars-Sinai Spine Center (Los Angeles): At the end of the day you have to do what you need to do. Make the decision that is right for you.


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