'I anticipate our field will be a lot in flux': Dr. Cynthia Emory on difficult decisions, big trends in store for spine

Laura Dyrda -   Print  |

Cynthia Emory, MD, is the associate chief medical officer of surgery and vice chair of the department of orthopedic surgery at Wake Forest School of Medicine in Winston-Salem, N.C.

Dr. Emory participated in a fireside chat during the Becker's Spine, Orthopedic and Pain Management-Driven ASC + the Future of Spine Virtual Event on June 19, discussing her outlook for spine and the practice of medicine amid the pandemic and beyond.

Click here to view the full interview on-demand as well as access several other fireside chats, panels and workshops during the event.

In this excerpt, Dr. Emory talks about consolidation, independent practice and opportunities for growth in orthopedics and spine. Note: responses are edited slightly for clarity.

Question: What will the orthopedic field look like a year from now? Five years from now?

Dr. Cynthia Emory: I anticipate our field will be a lot in flux. Many hospitals are facing months of limited capacity due to staffing and bed constraints, which will in turn limits the ability of the orthopedic surgeon to serve their patient populations. We've already been hearing stories from trainees who are finishing their fellowships in two months and have recently found out that their jobs no longer exist.

Imagine thinking six months ago, you've got this great job lined up and you're finally ready to start your practice. You're done with training. I want you to have all of that stripped from you in a matter of weeks. These trainees are desperate for jobs, many turning to locum work or choosing a position that's good enough for now.

I think the attrition rate will increase over the next few years, not only in our new hires, but also in our senior surgeons who aren't able to successfully adapt to a new environment. Our patients are timid about coming to the doctor and many are not enthusiastic yet about having an operation, whether it's concerned about COVID-19, financial constraints or just too much stress along with everything else. I think it's going to take some time, likely months, if not years, before patients feel comfortable seeking out elective orthopedic care with the same rigor as which they did before COVID.

We're also going to be making some difficult financial decisions over the next several months and years. Large health systems are suddenly losing millions of dollars a day. So capital expenditures for new things won't be happening andtime away and expense coverage for presentations at meetings, those are going to be limited, and recruitment efforts will likely be tempered for the next few years. As we build back our volumes, I think five years from now, we'll be in a much more favorable financial picture, allowing more investment and growth into practices as well as new hires and advances in technology. But I think for the next year or two at least will be very limited.

Q: Do you think there will be a shift to hospital employment or other consolidation?

CE: I think in general, this shift or trend will be more towards an employed model. Larger health systems have been able to weather the financial burden with the millions or billions of dollars in cash reserves and that it is much harder for a smaller practice to recover from the substantial financial losses that they sustained for the COVID-19 pandemic. So I'd be surprised if small or moderate size groups are even hiring at this point.

Q: Where is the best opportunity for practice growth? How will you grow professionally?

CE: I think the best opportunity for practice growth is being accessible to patients, whether it's in person or virtually, many patients aren't going to want to come to a busy clinic and be surrounded by strangers, regardless of mask requirements and screening protocols. Meeting them virtually through a video visit can be a way to establish trust and build a relationship and builds your practice. Your word of mouth, ensuring your practice has an active online presence is critical to leveraging search engine optimizations, providing short videos featuring all of your providers, let them see who you are behind the mask is important to ensure that your patients have time to discuss their concerns that may be with you, your nurse, your PA, but those things are going to take more time now than they did in the past.

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