Ram Mudiyam, MD, MBA, is a board-certified orthopedic surgeon with Hoag Orthopedic Institute in Irvine, Calif. He specializes in reconstructive spine surgery. Q: What are the main factors spine surgeons consider when choosing a practice?Dr. Ram Mudiyam: Young, fellowship-trained spine surgeons, fresh out of training typically look at practice location, reputation and longevity of a senior associate or group, as well as the reputation of the primary hospital they will be associated with and its standing in the community. Social issues such as family and parental obligations may also be determining factors in choosing a particular location. The primary hospital that the practice affiliates with also plays a major role in a spine surgeon's decision-making process.
Q: What should surgeons be sure to factor into their choice of practice?
RM: The reputation of a senior associate or partner is of the utmost importance. Another defining factor is geographic location. The sunbelt areas of California, Florida and Texas have always been attractive due to better weather and opportunities for year-round activities. However, these pluses have to be weighed against minuses of increased competition and decreased reimbursement due to a heavy concentration of managed care organizations, especially in California.
Q: Are there any reasons a spine surgeon would decide not to join a particular practice?
RM: A young surgeon would do well to shy away from practices that have questionable moral or ethical values. Although things may appear rosy in the beginning, disappointment and disillusionment will soon set in resulting in the practice breaking up. One also runs the risk of being considered guilty by association, which could be very detrimental to a young surgeon's practice. Do your homework, ask a lot of questions and get sound legal advice.
Q: Are there any particular elements spine practices find to attract surgeons?
RM: Spine surgeons should also consider the local hospital options. It is extremely important that the hospital is not only reputable in the areas of nursing, critical care and outcomes but also that the administrative staff are friendly, approachable and amenable to new ideas. Having an established spine center of excellence provides a useful head start to a young surgeon in terms of availability of sophisticated equipment, established perioperative treatment protocols and supporting infrastructure such as trained nurses and OR techs to help make a smooth transition from training to practice.
In summary, the task of choosing a spine practice is complex and should be based on multiple factors including location, reputation of the would be associate/group and support from the practice's primary hospital. Other factors include family considerations, academic versus private practice, single versus multispecialty groups, density of spine surgeons in that area and patient demographics.
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