Miami Orthopedics & Sports Medicine Institute's John Uribe, MD, spoke to Becker's Spine Review about the biggest challenges facing surgeons today and how they affect patients, as well as his hopes for the future of medicine.
Note: Responses were lightly edited for style and clarity.
Question: What healthcare news are you keeping an eye on to improve your practice?
Dr. John Uribe: We're a big multispecialty practice with fellows in all different areas, so there's a lot of cross-interest in the subspecialties. So, it's good to see what's going on in the overall field that is impacting orthopedics in general. It's good to keep informed of the other specialties, where they're headed and how they're resolving problems. Sometimes, there's a lot of translational information that we can use to improve our [own] areas.
Q: What are your top concerns when it comes to healthcare overall?
JU: The thing that interests me the most — and I see it here in South Florida — is access. The cost of medicine has gotten almost out of proportion to what people earn, and I see many cases canceled on the day of surgery because [patients] couldn't come up with their deductible. And then, I read about the number of administrators that are now part of the picture of medicine. The New York Times just had an article [about] a 3,200 percent increase in the number of administrators. So, it seems the more administrators you get, the more of a burden there is on [providers] from a paperwork [and] administrative standpoint. And EMRs haven't been the boon that they were [made] out to be. It's really slowed us down and caused us to increase our staffing just to keep up.
Q: With all these frustrations, do you or your peers think about leaving medicine?
JU: It does frustrate a lot of people, and I know many of my peers have left [or] retired early. But to be honest, this is just such a rewarding profession — especially, I think, orthopedics — because the satisfaction of what you do is so quick. You're fixing things, and it's not like a chronic illness that you're treating. So, in that sense, it's very rewarding. Also, I don't think there's a greater compliment that somebody can pay you than to say, "Go ahead and operate on me." I don't know that you can put a value on that, and I truly enjoy it. It is frustrating, and that's why, [going back to the topic of] access, it's just hard sometimes to tell a patient, "Listen, your insurance won't cover this, and you'll have to pay this," and they don't have it and there's no way for you to work through it. In the old days, you could've just asked the hospital to write it off or something, but it's not done that way anymore.
Q: In surveys, Medscape asks specialists if they'd choose the same path again if they could go back and do it all over again. It sounds like you would.
JU: Oh, absolutely — there's no question. I have the best job. If you go into it [because] you just like seeing people satisfied and happy, and [want to] be a significant contributor to that ... you can maybe tolerate these inconveniences more and more. But it is hard. Especially private practice — to go into private practice today is almost impossible. I teach at the medical school, and these kids are taking out these huge loans and they have to pay them off. They can't just go hang a shingle. It's so complicated today. They have their college loans, they have their medical school loans, and then to find a position and residencies [is] tough. Now, surgeons are basically almost forced to work for hospital systems.
Q: What else is a pressing topic for you, apart from all the bureaucracy?
JU: Because we're impacted so much by government, private insurers and hospital systems that just seem to be converging, the world of medicine is changing. Everything's consolidating, and you would think that would cut costs, but that doesn't seem to do anything but increase the costs. I'm just hoping that we can at some point come up with some solution where everybody gets at least a basic level of care.
Q: Do you think value-based care could be a promising direction for healthcare?
JU: I really do. That's one area where [Baptist Health South Florida] has paid attention. I said, "Look, if we're doing all these surgeries and we're seeing all these patients, and we don't know how well we're doing it and whether it makes that much of a difference long-term, then we're missing the boat. So, we need to invest in patient-reported outcomes and really follow these people longitudinally, and know what works and doesn't work." Because [with] a lot of these more expensive technologies — and a lot of it is in orthopedics — you find out that there's no difference [in quality].
We're at a time when I think things are going to explode sometime soon as far as healthcare in this country. It's got to.
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