Leading a top-ranked neurosurgery program requires fielding pitches for new technology, new trials and new hires. It also means staring down a hospital balance sheet. In interviews with Becker’s, chairs at three of the nation’s top-ranked programs described the same underlying tension: Leading an academic neurosurgery department increasingly means managing the pull between a research and innovation mission and the economics of running a complex health system.
Edward Chang, MD, of UC San Francisco, described what he sees as a dynamic common to top programs.
“One of the biggest challenges we’re seeing is the competing demands between the academic mission of doing research and innovation versus the economic demands of being part of a complex healthcare system,” he said. “When you talk to people in the top programs, they may have some similarities in the fact that the hospitals are growing, that they want to generate revenues. Maybe they don’t want the surgeons innovating. They just want them doing cases and seeing a lot of patients.”
Achieving the right balance between the two, Dr. Chang said, has become the core of his job.
“That’s probably the most important thing in my role — just making sure that we can meet our goals of innovation, improving care, at the same time as succeeding in a really complex economic environment,” he said.
Dr. Chang framed the relationship as manageable rather than adversarial, but only with deliberate leadership.
“That takes very skilled leadership to be able to make that true,” he said. “Innovation should bring down costs. It should have shorter hospital stays. People should be doing better, and in the end, that should improve the economy.”
At Chicago-based Rush University Medical Center, John O’Toole, MD, described the same tension from the capital-spending side. Emerging treatments in gene therapy and stem cell research for brain disorders will require significant investment in equipment such as intraoperative MRI and focused ultrasound, he said — spending that has to be weighed against tightening margins.
“Some of these other technologies are going to be required to perform what will ultimately be, probably, standard surgeries,” Dr. O’Toole said. “That’s going to be a heavy lift for institutions where margins keep getting tighter and tighter. So we have to be judicious in what we ask our institution to invest in, because obviously they want to see an ROI, and we want to be sure that we’re selecting technologies that are going to be here for the long haul.”
Dr. Chang said it is important to know when an idea is not worth pursuing.
“It’s not all innovation, right? You have to have a taste for what is good and what is not good — what are the things you actually want to invest in,” he said. “I think that’s the most important thing.”
At Columbia University in New York City, E. Sander Connolly Jr., MD, said the measure of whether an investment is valuable is patient impact, arguing that unnecessary innovation is itself a cost problem.
“All the innovation that we’re engaged with starts with the patient,” he said. “If there’s not a significant problem or it’s not solving a real need, then it’s probably adding expense, which ends up degrading access and affordability.”
Dr. Connolly said the pressure is only growing as more of the healthcare dollar shifts to government payers.
“As more and more of the healthcare dollar is controlled through government insurance, either through an aging population or through just shifts in the economy, I think the elite institutions are going to have to find a way to deal with that from an affordability standpoint,” he said.
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.
