The most important changes in the independent spine practice arena


Four spine surgeons discussed how the independent spine practice landscape has changed in the last 10 years.

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: How have health IT tools, such as EHRs, affected your workflow?

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

Question: What is the biggest way in which independent spine practice has changed in the last decade?

Richard Kube, MD. Founder and CEO of Prairie Spine & Pain Institute (Peoria, Ill.): When I look at our practice, the biggest change is the way in which we obtain patients. Years ago, there were relationships with the primary physicians in the community, and those doctors would refer their patients. Over the years, as those practices have been bought out by large hospitals, those referrals have disappeared.

Anticipating that trend, we began promoting our own brand internally as well as externally years ago so that the patients seek us directly. The vast majority of our patients are self-referred or are from recommendations made by previous patients. We control our own referral base, and hence, have a better ability to remain independent. This changes the way we behave and how we interact with the patients.

Frankly, I believe our care has never been better because our strongest loyalty is to the patient/customer coming through the door. We do not have to bow to outside forces telling us how to practice. We can provide what we believe the optimum treatment is. That further drives us to remain current and be knowledgeable about new technologies, as that is what patients frequently desire. Those market forces have driven us to be a center of excellence more rapidly than how our original plan was mapped. In the end, it has been a win for our patients as well as our practice.

Rob D. Dickerman, DO, PhD. Director of Neurosurgery at Presbyterian Hospital of Plano (Texas) and Director of Spine Surgery at Medical Center Frisco (Texas): Competition with hospital markets to remain independent versus [becoming] employed.

Brian R. Gantwerker, MD. Founder of the Craniospinal Center of Los Angeles: Besides cuts in reimbursements, I think independent practice surgeons have learned to run leaner in the last 10 years. I know in my practice we are making sea changes in terms of where we devote time and energy. We are busy reinforcing existing doctor-doctor relationships rather than running around to different areas that may or may not be fruitful. Instead, by doubling down where we are, we can demonstrate dedication to the community and hospitals and increase volume by persistence rather than spreading thin and taking me away from family time.

Payam Farjoodi, MD. Orthopedic Spine Surgeon at Spine Health Center at MemorialCare Orange Coast Medical Center (Fountain Valley, Calif.): In my geographic area, there has been a push for consolidation of spine practices. It is becoming rarer to have a single, independent spine surgeon practicing alone. Instead, groups are combining forces for improved negotiating power with insurers and the foundation model is hiring spine surgeons as employees.

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