Larry Parker, MD, is a spine surgeon in Huntsville, Ala., with The Orthopaedic Center, a comprehensive orthopedic and spine facility that offers the comprehensive orthopedic services, including trauma and pediatric orthopedics. Dr. Parker discusses the challenges and benefits of practicing at a large comprehensive orthopedic care facility.
Q: How has your orthopedic practice grown from a few subspecialty physicians into a comprehensive orthopedic care facility?
Dr. Larry Parker: Over time, there was a move toward mergers with other orthopedic physician groups in our area. One of the advantages many physicians felt they had with a multi-specialty center was that it could be a one-stop shop for families. We can treat patients with injuries and conditions associated with youth and geriatric populations. We also have trauma services, so if you come into our emergency room, you'll see a trauma surgeon who is trained to handle multi-fracture and long-bone fracture situations. I think that's pretty unique for an orthopedic group.
We also decided we wanted to cover comprehensive spine care in our community, so we have a call 24 hours per day, seven days per week that's just for spine surgeons. We're one of the very few groups where you will get a spine surgeon on call every day of the week. Treating patients when they needed spine care was a reoccurring issue in our community and we were able to acquire the right surgeons to cover our services through mergers.
Q: What specific challenges are associated with merging several practices and subspecialists?
LP: When the merger occurs, there has to be a similar philosophy between the different groups. As specialists, we all got together and wanted to share the business costs of managing our group. I think the most important asset is to have a strong administration that is focused on preserving the integrity of the physicians as a whole. Each of the subspecialty groups has their own pull and interest they focus on, and a strong administration allows us to make sure the needs of every individual physician are tended to. At the same time, the administrators make sure these needs are met with the overall goals of the group in mind.
From an administrative standpoint, we have an executive committee of five physicians who are elected from the group and then rotate out every two years. Any year there is a representative for each sub division so everyone has a voice at the table on the executive side. This group meets bimonthly to take care of the issues that arise.
Q: Why is contributing to the management of the practice so important for physicians?
LP: In groups, there are usually one or two strong personalities that make decisions for the whole, but that's not the case with the executive committee. We let everyone serve and change the president every two years. It's key to have a mutual administration so that personalities and political influxes that may occur on a day-to-day basis don't overcome the group as a whole. Our group is very strong politically and internally because of the administration. This also includes being transparent.
Q: Beyond merging with other specialty practices, how do you acquire the specific surgeons trained to fill the initial voids in comprehensive care?
LP: If there is a need for additional subspecialists in your area, you may need to recruit new physicians. For example, there are only a small number of pediatric orthopedic surgeons who come out of training every year. If you look in Alabama, you'll find these specialists at the universities, but not usually in other practice settings. We were able to recruit a pediatric orthopedic surgeon who has worked with us for 10 years and recently decided there was a need for a second one within our group.
Q: What are the benefits of having a comprehensive orthopedic care setting?
LP: The advantage for the physicians is the camaraderie of having a large number of physicians coming together to take care of patients. When physicians become older, they are able to slow down a little and be more selective of the hours they work. We also have three female physicians and if they have families and children, our group environment supports that. We have additional flexibility within our organization because of our size. In a smaller group, it makes a bigger impact when someone takes time off. There is an added bonus of also knowing that my patients will be able to see one of our qualified partners when I'm gone.
For the community, we are able to support patients with all types of problems. If a patient comes in to see a spine specialist but the real problem is with the hip or knee, I have a vast group of partners who I can refer these patients to so they receive good quality care. You can have the different subspecialists right there to take a good look at the patient and give a professional opinion on the appropriate type of care.
Q: Are there any disadvantages to practicing in a large, comprehensive group setting?
LP: There are a few disadvantages to practicing in the large group as opposed to a solo or small group practice. Large groups are sometimes a little slower to react and make changes because there is a process to moving a large ship. There are also additional expenses and fixed costs associated with a larger comprehensive orthopedic center. When you look at all the different types of revenues that the subspecialties generate, one might be more than another. There's a tier to what a specialist will bring in and the overhead structure must represent what is fair to the group as a whole.
Learn more about Dr. Larry Parker.
Related Articles on Orthopedic Practices:
7 Key Elements of Comprehensive Orthopedic Care Centers
6 Best Practices for Effectively Managing Large Orthopedic Practices
5 Factors for Long-Term Stability and Growth of Orthopedic Practices
Q: How has your orthopedic practice grown from a few subspecialty physicians into a comprehensive orthopedic care facility?
Dr. Larry Parker: Over time, there was a move toward mergers with other orthopedic physician groups in our area. One of the advantages many physicians felt they had with a multi-specialty center was that it could be a one-stop shop for families. We can treat patients with injuries and conditions associated with youth and geriatric populations. We also have trauma services, so if you come into our emergency room, you'll see a trauma surgeon who is trained to handle multi-fracture and long-bone fracture situations. I think that's pretty unique for an orthopedic group.
We also decided we wanted to cover comprehensive spine care in our community, so we have a call 24 hours per day, seven days per week that's just for spine surgeons. We're one of the very few groups where you will get a spine surgeon on call every day of the week. Treating patients when they needed spine care was a reoccurring issue in our community and we were able to acquire the right surgeons to cover our services through mergers.
Q: What specific challenges are associated with merging several practices and subspecialists?
LP: When the merger occurs, there has to be a similar philosophy between the different groups. As specialists, we all got together and wanted to share the business costs of managing our group. I think the most important asset is to have a strong administration that is focused on preserving the integrity of the physicians as a whole. Each of the subspecialty groups has their own pull and interest they focus on, and a strong administration allows us to make sure the needs of every individual physician are tended to. At the same time, the administrators make sure these needs are met with the overall goals of the group in mind.
From an administrative standpoint, we have an executive committee of five physicians who are elected from the group and then rotate out every two years. Any year there is a representative for each sub division so everyone has a voice at the table on the executive side. This group meets bimonthly to take care of the issues that arise.
Q: Why is contributing to the management of the practice so important for physicians?
LP: In groups, there are usually one or two strong personalities that make decisions for the whole, but that's not the case with the executive committee. We let everyone serve and change the president every two years. It's key to have a mutual administration so that personalities and political influxes that may occur on a day-to-day basis don't overcome the group as a whole. Our group is very strong politically and internally because of the administration. This also includes being transparent.
Q: Beyond merging with other specialty practices, how do you acquire the specific surgeons trained to fill the initial voids in comprehensive care?
LP: If there is a need for additional subspecialists in your area, you may need to recruit new physicians. For example, there are only a small number of pediatric orthopedic surgeons who come out of training every year. If you look in Alabama, you'll find these specialists at the universities, but not usually in other practice settings. We were able to recruit a pediatric orthopedic surgeon who has worked with us for 10 years and recently decided there was a need for a second one within our group.
Q: What are the benefits of having a comprehensive orthopedic care setting?
LP: The advantage for the physicians is the camaraderie of having a large number of physicians coming together to take care of patients. When physicians become older, they are able to slow down a little and be more selective of the hours they work. We also have three female physicians and if they have families and children, our group environment supports that. We have additional flexibility within our organization because of our size. In a smaller group, it makes a bigger impact when someone takes time off. There is an added bonus of also knowing that my patients will be able to see one of our qualified partners when I'm gone.
For the community, we are able to support patients with all types of problems. If a patient comes in to see a spine specialist but the real problem is with the hip or knee, I have a vast group of partners who I can refer these patients to so they receive good quality care. You can have the different subspecialists right there to take a good look at the patient and give a professional opinion on the appropriate type of care.
Q: Are there any disadvantages to practicing in a large, comprehensive group setting?
LP: There are a few disadvantages to practicing in the large group as opposed to a solo or small group practice. Large groups are sometimes a little slower to react and make changes because there is a process to moving a large ship. There are also additional expenses and fixed costs associated with a larger comprehensive orthopedic center. When you look at all the different types of revenues that the subspecialties generate, one might be more than another. There's a tier to what a specialist will bring in and the overhead structure must represent what is fair to the group as a whole.
Learn more about Dr. Larry Parker.
Related Articles on Orthopedic Practices:
7 Key Elements of Comprehensive Orthopedic Care Centers
6 Best Practices for Effectively Managing Large Orthopedic Practices
5 Factors for Long-Term Stability and Growth of Orthopedic Practices