6 Steps for Spine Surgeons to Build a Strong Practice Foundation

Laura Dyrda -  

Robert BrayRobert S. Bray, MD, founder of DISC Sports & Spine in Marina del Rey, Calif., talks about how spine surgeons can build a strong foundation for their practice and career.


1. Pick a passion. While spine surgery is already a very specialized focus, surgeons must dig even deeper to become truly great in their field. Whether its scoliosis correction, tumor removal or lateral access surgery, pick the topic most interesting to you and pursue it clinically and academically.


"For me, it's minimally invasive spine surgery and outpatient spinal procedures," says Dr. Bray. "Surgeons should pick something they're passionate about and concentrate their efforts. You could focus on trends in complications to avoid, designing instruments or writing publications, and you don't have to do the same topic forever."


This doesn't mean you can't see patients outside of your passion — Dr. Bray still does spinal reconstructions — but if you become a known expert in a narrow field other surgeons will refer to you. "Strive to become an expert at that topic and make your mark there," says Dr. Bray.


2. Focus on delivering quality care. The biggest impact spine surgeons will have throughout their career is providing quality care for their patients. This is especially important as reimbursements decline and patients take more control over their healthcare decisions. Negotiate how you'll provide the best care for patients while seeing an increased volume and dealing with a heavier administrative burden.


"There is a big emphasis on quality in healthcare today, emphasized by insurance companies and the federal government," says Dr. Bray. "We are trying to move more cases to the outpatient setting because it's more cost efficient and there are fewer complications. We need to focus on making sure our procedures deliver quality outcomes in this changing healthcare environment."


Surgeons are spending more time documenting and reporting their outcomes today, which takes time away from patient care but ultimately will benefit care delivery as more information is gathered and analyzed.


"Maintaining quality care is very difficult in a time with the structure of medicine changing," says Dr. Bray. "Information is king and managing the information will allow us to continue providing quality care."


3. Avoid questionable and risky business decisions. As surgeons see reimbursements go down, many are looking for new opportunities to enhance their revenue stream. This could come from bringing ancillary services into their offices, investing in a surgery center or leadership positions within the hospital setting. However, be careful these relationships are compliant and be weary of risky situations.


"There are some relationships that reflect negatively on the surgeons," says Dr. Bray. "When people are taking reimbursement out of the system, that will backfire on them. This could be an improper physician-owned distributorship or handouts from implant companies that are meant to influence your work and clinical decisions. I caution against going that route."


Dr. Bray also cautions against surgeons working with companies to develop legal reports before their retirement. Physician bias carries weight in the professional community and it could impact patient care in the future.

"You walk a thin line when you accept or seek out reimbursement for anything other than quality patient care," says Dr. Bray. "The better way to do it is to structure your business so it's cost efficient and provides quality care."


4. Provide healthcare for altruistic reasons. Surgeons must be able to keep their practices running smoothly and provide good quality care, but remember why you became a surgeon in the first place: to help patients. Surgeons who become too preoccupied with accumulating wealth may fall into unsavory relationships.


"You have to be a business person to run your practice, but focus on providing a high quality product for better reimbursement," says Dr. Bray. "Don't look to implant companies that will pay big bucks. I don't even take royalties on the implants I designed and use myself in surgery. Taking handouts from the implant companies could lead to a negative reputation because you are taking money out of the system."


Surgeons who are interested in research and development often receive funding for their projects from insurance companies, but they shouldn't let that impact their findings. Presenters at national meetings must disclose financial relationships, and some have pages-long disclosures.


"Do this research honestly and for the purpose of teaching and forwarding the field," says Dr. Bray. "Sometimes there are so many things surgeons are paid for that you wonder whether they can give a presentation without any bias. If you're going to teach and document, do it in an honest, non-bias, non-paid fashion. The most respected surgeons are the ones who do it for an altruistic reason."


5. Promote your practice honestly. Marketing and development is becoming the standard for spine surgeons in today's competitive healthcare market, but surgeons must approach self-promotion carefully and honestly. They may want to reach patients directly, but more often surgeons find themselves marketing their services and outcomes to referring physicians and developing relationships to last throughout their careers.


"Promotion of yourself is part of the business development," says Dr. Bray. "Show referring physicians their patients will be treated fairly and receive surgical treatment when necessary and conservative treatment otherwise. If you promote your good outcomes and treat patients fairly, you'll have a positive reputation."


If you present yourself in the public light, make sure your numbers and service back up this image.


6. Put in the extra hours. It takes time and energy to build a practice that really makes a difference in the community. Put in those extra hours and you'll come by a good reputation honestly.


"You have to spend extra time on the practice if you want to build it into something that really makes a mark, and that's not the easiest thing to do when you're seeing patients," says Dr. Bray. "You have to really love what you do and want to do it. Focus on the business and make sure you don't get trampled. You have to become a savvy, astute and still caring business person."


More Articles on Spine Surgeons:
102 Spine Surgery Practices to Know
5 Steps for Spine Surgeons to Take Patient Experience to the Next Level
8 Steps for Spine Practices Considering a New Partner

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