What will it take for independent practice to survive & thrive today?


Six spine surgeons weigh in on the future of independent practice in America.

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 personal habits you employ to take care of your health?

Please send responses to Anuja Vaidya at avaidya@beckershealthcare.com by Wednesday, April 26, at 5 p.m. CST.


Question: Can independent physicians survive in today's rather volatile healthcare landscape?


Alden Milam, MD. Spine Surgeon at OrthoCarolina (Charlotte, N.C.): It's hard to imagine independent solo practice existing in the future because of constant change in healthcare financing and regulation. However, large independent practice will have several distinct advantages that will help that employment model thrive.  


Plas T. James, MD. Spine Surgeon at Atlanta Spine Institute: I'm an individual physician and I'm surviving well. However, I think it really depends on when you start out. If I had to start out today from scratch, I think it would be very difficult but still viable. I think I have advantages in that I've been around long enough in the same market, in the same part of the town and city. There's always room for individual healthcare, provided you can offer great service.


No matter what it is, people want service. They don't want a robo-phone. They want to speak with a real person. If you give them individual attention, I think they'll come see you. It's important to make sure you answer their questions, and not get so busy trying to input data as opposed to listening to the patient. Independent physicians can survive if they remember to take care of their patients' needs and address them individually.


Richard Kube, MD. Founder and CEO of Prairie Spine & Pain Institute (Peoria, Ill.): I think it is challenging, but doable. Independent physicians have to regularly educate themselves regarding trends in their specialty. They have to have the ability to learn and apply new ideas to their practices in an efficient manner. In individual practice, there is also the opportunity to implement new ideas more rapidly than a larger bureaucratic model can do. Our practice has been diving ever deeper into the bundled payment model with some early success. Having the degree of control we do in creating an "all in, all one" price model gives the independent surgeons, especially those with a facility, an advantage when competing on value.


Brian R. Gantwerker, MD. Founder of the Craniospinal Center of Los Angeles: I am trying to figure that out myself. Ask me again in a year. It is probably just getting better at what you do, being compulsive about patient care and follow-through with referring doctors. The larger institutions will always loom large but most patients do not want to be in a "system" when they can spend good time with a surgeon and ask questions that are answered.  


Vladimir Sinkov, MD. Spine Surgeon at New Hampshire Orthopaedic Center (Nashua): With ever-increasing difficulty (thanks to the ever-increasing burden of new regulations and declining reimbursements), but yes! An independent physician must be willing to adapt to the changing environment and stay on the cutting edge of new science and technologies in his/her field to stay competitive.


Kern Singh, MD. Co-Director of Minimally Invasive Spine Institute at Midwest Orthopaedics at Rush (Chicago): We are seeing independent physicians on the decline in today's healthcare landscape. Dealing with regulatory pressures, growing insurance companies, EHRs and other hurdles is troublesome to say the least. Still, there are a few ways physicians can maintain their independence. One way is to consolidate practices. Physicians can band together and create much larger private practices. This allows for more negotiating power with insurance companies and less financial strain on individuals.


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