Three orthopedic surgeons leading supergroups of 100 physicians or more in Florida, North Carolina and Maryland discuss the advantages of larger physician practices and how they see consolidation evolving in the specialty.
Note: Responses were lightly edited for length and clarity.
Michael Doyle. CEO of Florida Orthopaedic Institute (Tampa): There is definitely a sweet spot between leveraging scale and remaining nimble in your decision-making process. Ultimately this is dependent upon having the right people, processes and procedures in place. Even in a consolidated world, healthcare remains local. Certain models work in certain markets. Our model was designed to promote local independence to ensure specific needs and market drivers are met. I do not think there is such a thing as too big. Most groups experience difficulties when they fail to build the base infrastructure that provides the solid foundation for growth or diverge from the business where they experienced their initial success.
While orthopedics is still largely fragmented, I do believe you will see practices continuing to consolidate in the years to come. Ultimately, physicians still control their own destiny. Yes, there are several outside pressures making it extremely difficult for the sole practitioner to survive in today's world, but those that are willing to roll up their sleeves are still able to be successful. That said, I don't believe you will see many physicians going out and starting their own practices in the current environment. Orthopedic surgeons coming out of fellowship today seek stability. Stability in the form of a pipeline of patients as well as clinical and administrative support. Staying independent can be the right plan, but having a plan is the most important initiative that a lot of practices lack.
Bruce Cohen, MD. CEO of OrthoCarolina (Charlotte, N.C.): Scale is very important. Whether it is through affiliated networks, [management services organization] structures or group aggregation, it will be critical for independent orthopedists to align. We must be the leaders in musculoskeletal value-based care and population health. The only way to do this is through large groups or networks. So, at present, I do not believe "too big" is a barrier.
It will become more challenging to compete and survive as a smaller entity. The future for medicine to be successful during these challenging healthcare times is to embrace value-based care and evidence-based approaches to care. This transition is going to be difficult and consume resources, which will be very challenging for smaller groups. One additional challenge for smaller organizations will be access to proper IT platforms and cybersecurity over time.
Nicholas Grosso, MD. President of The Centers for Advanced Orthopaedics (Bethesda, Md.): There is no limit for how big an independent orthopedic group should be, so long as it is structured in a way that maintains efficiencies amidst growth. With 160 physicians and 60 office locations, my practice is considered a supergroup. When structured appropriately, the benefits of a supergroup of our size empowers physicians with the resources needed to navigate the rapidly changing healthcare landscape while retaining the independence to practice medicine the way they see fit.