Theodore Koreckij, MD, has reached a familiar crossroads for successful spine surgeons: His practice has more room to grow, but his schedule does not.
“I’m sort of capped out,” Dr. Koreckij, an orthopedic spine surgeon at Leawood, Kan.-based Kansas City Orthopedic Alliance, told Becker’s. “I don’t know that I can do much more than I currently do.”
For KCOA, the solution was to recruit another spine surgeon. But amid tightening reimbursement and competition from hospital systems, adding a physician is hardly a straightforward investment for an independent practice.
The group in October welcomed Brant Ansley, MD, as its second orthopedic spine surgeon, a move that coincides with broader expansion across the Kansas City region. KCOA is also opening a clinic with MRI capabilities and a surgery center in the building, adding to its existing network of orthopedic services.
Behind that growth is a calculation increasingly confronting independent physician groups: How much must a practice invest today to remain competitive tomorrow?
The cost of getting ahead of demand
For Shawna Haggerty, KCOA’s chief operating officer, the decision to expand begins with patient access.
The organization evaluates appointment availability, geographic coverage and surgical wait times when determining where additional physicians are needed. Advanced practice providers help extend a surgeon’s clinical reach, but they cannot eliminate the competing demands of clinic and operating room schedules.
“Dr. Koreckij was still only one person who can do spine surgery,” Ms. Haggerty said.
That capacity constraint made expanding the spine team a priority. Yet identifying the need for another surgeon was only the beginning.
“It’s harder and harder to compete with hospital systems for that up-front salary,” Dr. Koreckij said.
Independent groups may have substantial patient demand and established referral networks, but a newly recruited surgeon still needs time to develop a practice. During that period, existing physician partners must be willing to absorb the financial commitment.
Dr. Koreckij said the investment may not pay for itself until three or four years down the road. That requires a different mindset from simply filling an immediate staffing vacancy.
Why independence requires more than professional fees
The challenge is compounded by reimbursement pressures. Ms. Haggerty pointed to payer contracts and declining professional fees as significant obstacles to maintaining an attractive independent practice. With many spine patients falling into Medicare-eligible age groups, changes in physician reimbursement can have an outsize effect on the specialty’s economics.
For KCOA, remaining competitive has meant building financial and operational infrastructure beyond the traditional physician office. The independently owned group has 36 physicians and 29 advanced practice providers across multiple locations, along with rehabilitation clinics, radiology and MRI services. Its physicians also hold ownership interests in surgery centers, and many are owners of Leawood, Kan.-based Kansas City Orthopaedic Institute, a specialty orthopedic surgical hospital.
Those services and ownership opportunities are an important part of attracting physicians to independent practice, Ms. Haggerty said, particularly when hospital employment may offer greater immediate financial security. But the appeal of independence extends beyond compensation.
“The thing that makes it most attractive is the autonomy that you get in being able to develop your practice the way you want to be able to do it,” Dr. Koreckij said. “And it does take a bit of an entrepreneurial spirit to be able to do that.”
In an independent setting, physicians can retain greater influence over decisions involving their clinical teams, supplies and care delivery. Within larger systems, those choices may be made at the organizational level. That freedom, however, comes with financial responsibility. Younger surgeons entering practice may face substantial student debt, making the prospect of a competitive hospital salary difficult to overlook.
For independent groups, the challenge is persuading recruits to look beyond their first few years of earnings toward the longer-term opportunities of building a practice.
The risk of waiting too long
Dr. Koreckij recalled periods when KCOA would go two or three years without encountering a potential spine surgeon recruit. The group’s reputation has since helped attract more interest, but he cautioned that the availability of candidates can change quickly.
“If you wait till you’re ready, you’re probably behind the eight ball,” Dr. Koreckij said.
That uncertainty makes advance planning essential. Ms. Haggerty said practices considering spine expansion should evaluate both internal referrals and demand from outside physicians. A strong existing patient base can support growth, but recruiting another surgeon without a strategy for generating and managing referrals risks leaving the investment underutilized.
“You want to be able to make good on what you’ve done,” she said. At KCOA, that planning extends beyond surgical volume. The practice also has interventional physiatrists who provide pain management and injections, allowing patients with spine conditions to access nonsurgical care.
Dr. Koreckij noted that many patients seeking treatment for back pain do not want surgery, while others may become surgical candidates only after pursuing conservative treatment. Having those services within the same organization helps support a broader spine program.
The addition of Dr. Ansley therefore addresses more than one surgeon’s full schedule. It gives KCOA additional capacity within a practice that is expanding its facilities and range of orthopedic services.
For independent groups considering similar investments, the larger lesson is that growth cannot begin and end with recruitment. It requires the infrastructure to support new physicians, the financial patience to develop their practices and a clear understanding of where patient demand is headed. And as Dr. Koreckij’s experience illustrates, the greatest risk may not be investing too early, but waiting until there is no capacity left to grow.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
