An Interview with Spine Surgeon Michael A. Gleiber, MD, PA in Florida.
Dr. Gleiber's clinical expertise is in: minimally invasive spine deformity correction, spinal trauma, complex cervical, thoracic, and lumbar corrective and revision surgical procedures.
While today's healthcare environment has become more challenging for solo practitioners; there still remains a great opportunity for spine surgeons to establish a successful independent spine practice today.
"I believe in order to become a solo practitioner in neurological or orthopedic spine surgery, one must first have an idea of how difficult it can be to start a solo practice right out of the gates," says Michael Gleiber, M.D., F.A.A.O.S, a Board-Certified, Fellowship Trained, Spinal Surgeon and Founder of Michael A. Gleiber, MD, PA, in Jupiter and Boca Raton, Florida. "Therefore, most surgeons who go into solo practice and limit their practice to spine surgery do not start out that way. Those who seek the benefits of an autonomous private practice generally demonstrate an entrepreneurial spirit and enjoy learning the facets pertaining to the business of spine. There are day to day operations that can be cumbersome, but the overall benefits certainly outweigh the daily challenges in my opinion."
Here are Dr. Gleiber's top nine practice recommendations for independent spine surgeons today.
1. Establish yourself within the community. Form a strong professional relationship with other practitioners in the community early on. Primary care physicians, neurologists, emergency room physicians, physiatrists, chiropractors, and pain specialists are invaluable referral sources for the solo spine practitioner.
"One has to develop a strong and well-respected reputation in the community which generally takes years grow," says Dr. Gleiber. "It takes that long to develop a mature spine practice and the surgical confidence to take on challenging cases. Referring physicians like the simplicity of sending their patient to you, knowing you will take the reigns from that point on, no matter how complex the pathology may be. Not every spine surgeon, regardless of their practice model, wants to perform spine trauma, deformity, or revision surgery, but if they do, they should be comfortable handling any potential untoward event. Should a situation arise, adeptly handling these issues yourself benefits the patient rather than having to refer them elsewhere."
Community marketing is best performed when done in a professional fashion that is not solely geared toward self-promotion. Talks and lectures performed in concert with your affiliated medical center are generally geared towards community education. Meeting with practices and discussing techniques that you utilize in surgery can be valuable since most outside the field of spine are not familiar with what is new with technology and how far the spine field has come in terms of minimally invasive surgical options.
2. Earn the trust of medical and surgical colleagues. Help your patients consistently return to their normal quality of life as soon as possible on a consistent basis and keep lines of communication open with referring physicians.
"A valuable principle for the solo practitioner is constant and direct communication with referring physicians," says Dr. Gleiber. "That includes copying the referring physician on all operative notes, initial consults and even simple follow-ups to let them know how their patient is doing. Make sure the patient is referred back to them for preoperative clearance. I personally speak with the doctor whether they have referred 100 patients or 1 patient to me after the initial consult, as well as post-surgically."
"The phone call allows you to personally acknowledge the physician for entrusting their patient in your care as well as explaining why non-operative treatment or surgical care is the best option. This is always much appreciated," says Dr. Gleiber. "It benefits the referring physician so that when the patient calls, they already know what the treatment plan is."
3. Don't over-book your schedule. "Over-booking your schedule will leave patients in the waiting room too long. Studies have shown that patients become frustrated with lengthy wait times and have a lower perception of the practice. If I were in the patient's position, I would take exception with the fact of waiting for my scheduled appointment longer than 15 minutes because my time is valuable too. While their appointment with me is very important, I don't want my patients to feel as if they are beholden to my schedule."
As spine surgeons, our schedule is very fluid, we could be called in to see an emergency consult in the ER, we could be running late from our rounds or be delayed in surgery," says Dr. Gleiber. "If this is the case, I have my office call our patients and let them know my schedule so they can adjust theirs accordingly. Patients really appreciate this notification."
"Every new patient spends at least 90 minutes with me to go over all of their studies. In this specialty, we have a very difficult task of telling people that they may need spine surgery, which may be very scary to them. Rushing out of the room and not answering all of their questions in order to catch up with your schedule can be further disconcerting. Many times, if I indicate a patient for surgery, I ask them to consider my recommendations and schedule a follow up appointment with a spouse or family member, so we can sit down and answer all the questions they have. As soon as you recommend surgery, a lot of what you say to follow will not be recalled because the patient is overwhelmed. Therefore asking them to return to the office with a notepad full of questions is not only more efficient in running your practice but also allows time to discuss all the options you lay out for them. If you overbook your schedule and end up having a lot of patients seen by allied healthcare professionals, there is a sense that you are not immediately involved in their care, even if you are," says Dr. Gleiber.
Spine surgery is often an overwhelming prospect for patients and spending more time with the surgeon can help calm anxieties. "We also provide our contact email address, which is checked every day regularly and special phone numbers for patients. We encourage patients and families to contact us if they have any questions, both pre- and postoperatively."
4. Create a comfortable office environment. It's important to have a clean, well-furbished and comfortable office environment for patients.
"I wanted a relaxing environment for patients so I designed my office to be very modern yet still have a calming aura," says Dr. Gleiber.
"The waiting room and clinic exam rooms were designed with all modern furniture and artwork. The waiting room is also supplied with the most popular reading periodicals currently on newsstands," says Dr. Gleiber. "Also, coffee, cappuccino, other beverages are offered, as well as snacks to make waiting less stressful for the patient." Dr. Gleiber's waiting room also includes a wall mounted satellite television and multi-media access.
5. Assist with insurance. Patients are often confused with how their insurance will cover a procedure, especially if you are an out-of-network provider. If possible, hire someone at your office dedicated to helping patients figure out their coverage and ensure the right codes are used on outgoing claims.
"In my office, I have a billing manager responsible for speaking with the patient and acting as a liaison between the patient and the insurance company to obtain authorization for all studies and procedures. This is time-consuming, however by assisting patients in this regard and submitting their claims to make sure that they are filed appropriately, this is one less thing they need to be concerned about," says Dr. Gleiber.
6. Surround yourself with the best staff possible. Only hire the best candidates to fill positions within your office staff. Ideally, your receptionist is someone with a good telephone presence and can demonstrate empathy and kindness on the phone to patients. Other staff members should also have a positive attitude and be team players in the office environment. It only takes one personality conflict to upset the balance and this can have a domino effect on the job satisfaction of your employees in a negative fashion.
"Your receptionist is the face of your practice," says Dr. Gleiber. "They should have excellent multitasking and organizational skills. However, it's a common misconception that they should have spine surgical practice experience. Some of the best staff I have worked with previously were employed in other medical practices unrelated to my field. They are simply wonderful people willing to reach out to someone who calls the office in distress and demonstrate personal assistance and genuine kindness."
Staff that embody these traits are hard to find, but integral when making a very good first impression for your office.
7. Be available for referring physicians. To grow the practice, solo practitioners must be available at all hours to take calls from other physicians and see their patients. This is especially true on weekends and evening hours.
"Being available does come at a price and there is a fine balance to make sure you keep your personal life in focus and a priority," says Dr. Gleiber.
For example, one Friday night Dr. Gleiber cancelled plans with his wife when another physician called with an emergency. Dr. Gleiber went to the hospital and performed an emergency surgery after ensuring his wife understood the situation. "I subsequently got a letter from this physician thanking me for helping him out in a time of need that was very stressful for him," says Dr. Gleiber.
8. Develop a website to educate patients. The Internet and social media may be the first place for patients to learn about their practitioner or diagnosis. Becker's Spine Review has previously written excellent articles on this concept and a personalized website can be used as an educational tool to help patients learn more about their spinal conditions.
"Use social media outlets for educational purpose, and if done professionally, you will not only be performing a service to the community at large, but also patients will understand your style of treatment even before they step foot in your office," says Dr. Gleiber. "Our office has a Twitter account where we often post an interesting case showing preoperative and postoperative images along with clinical findings and outcomes. I did not know how this would be perceived when we integrated this into the practice. However, now I have received feedback from healthcare professionals around the country as well as patients looking forward to the next case that I show."
"Surgeons can also develop blogs or newsletters on their website. For my blog, I create the content in layman's terms," says Dr. Gleiber. "The blogs are written personally by me so potential patients can garner a sense of my personality by connecting with a more informal voice."
9. Take curbsides whenever possible. Give other physicians your cell phone number and let them know you'll make time for them any time they call. It's important to connect with these colleagues, even though you aren't reimbursed for your expertise.
"Giving advice to colleagues on how to manage a patient they are concerned about goes a long way in developing trust and confidence in the community," says Dr. Gleiber. "I give my cell phone to all physicians, nurses, OR staff, and therapists. This cuts through the red tape so they can reach me directly and not have to go through our on-call service should they need to contact me after hours."
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