Three total joint replacement surgeons discuss the future of independent practice in the orthopedics arena.
Ask TJR surgeons is a weekly series of questions posed to orthopedic surgeons around the country about clinical, business and policy issues affecting orthopedic care. We invite all orthopedic surgeon and specialist responses.
Next week's question: What are some key qualities of a TJR physician leader?
Please send responses to Anuja Vaidya at avaidya@beckershealthcare.com by Thursday, July 13, at 5 p.m. CST.
Question: Is independent practice still a viable option for TJR surgeons or would you recommend young surgeons seek hospital employment?
Michael J. Chmell, MD. Orthopedic Surgeon at OrthoIllinois (Rockford): Yes, independent practice is a viable option for TJR surgeons in the future. As with any independent practitioner, however, a medical practice in isolation will not work. An independent practitioner needs to be an entrepreneur. Owning one's own real estate, an ASC, ancillary services (such as MRI, CT, therapy and DME) as well as urgent care within a multispecialty orthopedic group is a must. Also, employing other related musculoskeletal healthcare providers is necessary to establish a 'one stop shop' for a patient's complete musculoskeletal care.
G. Daxton Steele, MD. Total Joint Replacement Surgeon at Andrews Institute for Orthopaedics & Sports Medicine (Gulf Breeze, Fla.): I feel that it is becoming tougher to stay an independent surgeon but definitely not impossible. It's all dependent on what your needs and expectations are as a surgeon, but there's definitely a role for independent total joint surgeons in this market. Larger groups including hospitals hold more leverage when it comes to negotiating contracts but pockets exist for independent surgeons to both survive and flourish.
Jeffrey C. Davis, MD. Orthopedic Surgeon at Andrews Sports Medicine & Orthopaedic Center (Birmingham, Ala.): Independent practice is becoming more difficult for most surgeons and can be even more difficult for TJR surgeons. Their practices are tied to hospitals in ways that many outpatient-heavy orthopedic surgeons are not. They are also targeted for bundled payments associated with an episode of care which includes the implant and hospital costs. There is also a trend for many surgeons not to do revisions leaving TJR surgeons doing more difficult and prolonged cases for very little increase reimbursement. This makes financial viability outside of hospital employment more difficult. With the right group of surgeons, I think independent practice is still viable but continues to trend toward a less attractive option.