While each geographic market has its own unique needs, there are some key considerations spine surgeons should be mindful of when thinking about expanding their footprint.
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Editor's note: Responses were lightly edited for clarity and length.
Question: What are your key considerations when deciding whether to expand your practice into new markets or add new service lines?
Tan Chen, MD. Geisinger Musculoskeletal Institute (Danville, Pa.): Considerations for expansion into new markets is of course multifactorial, and at a large health system it involves careful scrutiny of clinical need, adequate staffing, long term goals, and financials.
Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: Markets are fairly distinct in terms of access to practices. In other words, many markets are dictated by not just payer mix, but also existing relationships between hospitals and the doctors. I think that's true even if you are private and do mostly ASC work. I would consider how doable it is to move into a new geographical area and see who the big players are. Some of them will be extremely hostile, while others might welcome someone competent to share call burdens. I would advise anyone moving to a new area to visit the medical staff office at the local hospital and familiarize yourself with the folks that work there. They might also give you insights into who and where doctors are located and potential collaborators might be found. I myself found some very good colleagues that way, and we cross cover each other’s patients making it possible for all of us to have a life and coexist.
Anthony Giuffrida, MD. Interventional pain management physician. Paley Orthopedic & Spine Institute (Fort Lauderdale, Fla.): When deciding to expand into a new market, accessibility and patient demand are key considerations. With five locations across South Florida — Fort Lauderdale, West Palm Beach, Jupiter, and now Boca Raton — we've strategically grown to ensure convenient access to care without long travel times. This approach allows us to serve more communities while maintaining the high-quality care we're known for.
Our expansion also supports collaboration with our spine surgeons, Jeff Cantor, MD, and Scott Raffa, MD. By having multiple locations, we can work closely with them to ensure seamless transitions when our patients require surgical care, further enhancing the continuity and quality of our services.
Jason Liauw, MD. Hoag Orthopedic Institute (Laguna Hills, Calif.): Key considerations in expanding our practice hinge largely on wait times and access to subspecialty care in any given geography. As surgeons get busier, their geographic catchment tends to narrow as they travel less to make their practices more efficient. When this happens, we have to expand our practice to continue to grow our footprint. When it comes to adding new service lines, we often will take a look at the therapeutic offerings that each member of our group excels in and add new service lines or providers depending on what's missing in the group.
Kirk Owens, MD Norton Leatherman Spine (Louisville, Ky.): When considering expansion into new markets or service lines for a spine practice, it’s essential to evaluate both market demand and strategic fit. We evaluate the need for specialized care in the target region, patient demographics, referral patterns, and gaps in existing care. Equally important are operational readiness and financial alignment with your practice's strategic priorities. Ensure you have the resources, staff, and technology to maintain high-quality care and outcomes in the new market with strong projected patient volumes. Having reliable analytics and data to support these evaluations is crucial.
David Skaggs, MD. Cedars-Sinai (Los Angeles): Expanding a successful academic spine practice to satellite offices is appealing, but risky. Key considerations are quality of care and culture. In general, hiring a surgeon fresh out of fellowship as the first practitioner in a new office is often a set-up for failure. The first-year post-fellowship is a crucial period of continued learning, and young surgeons thrive when they are consistently exposed to seasoned mentors who are invested in their development. At a minimum, practices should establish weekly conferences where pre- and post-operative cases can be reviewed with trusted colleagues in an environment of psychological safety.
One strategy is for new surgeons to split their time between satellite locations and the main medical center, allowing them to remain connected to the broader team. However, I would caution against excessive travel—such as working in two locations in a single day or three locations in one week. The stress of commuting can take a significant toll, contributing to burnout far more than we often acknowledge.
Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): Large healthcare centers with employed multiple specialists have captured patient populations, when functioning at an optimum, allows for a constant referral and delivery system. Longevity within a complex spinal practice, highly depends on both affable and accommodating advanced practitioners to facilitate strong and lasting relationships in this effort. One of the best referral patterns is via reputation and interlocution within the OR staff as many discerning and scrutinizing coworkers witness one's abilities and service to patients. Interactions and complications are continually noted and discussed. In regard to adding new service lines, technological adjuvants are by far the most prevalent and expanding in use and patient awareness. Being adept in this expansive world is advantageous for any practice, market dependency and cost. Healthcare delivery will take front and center as a refocusing on its true value and meaning to our citizens is realized again.