Facing an increasingly uncertain healthcare climate, spine surgeons have to make a tough choice — whether to remain independent or take up hospital employment. Two spine surgeons weigh in on the issue.
Question: What is the expectation as to spine surgeons staying independent or becoming employed by hospitals? What are the key considerations?
Richard A. Kube II, MD, CEO, Founder, Prairie Spine & Pain Institute, Peoria, Ill.: In general, there are more physicians joining hospital settings, and I believe this holds true for spine surgeons as well. With the uncertainties that exist in medicine, many are searching for what is perceived as a safety net.
However, inherent to employment is the surrender of control. That lack of control certainly creates a degree of uncertainty as well. I believe that the culture of new trainees, especially after the initiation of the 80-hour work week as residents, does not have the same sense that medicine is a profession and being a doctor is a 24/7 job. There is a greater clock punching mentality, which does not tend to correspond to an entrepreneurial attitude required to remain independent.
I believe if you have an entrepreneurial spirit that is based upon hard work and delivery of a product that contains value for the consumer, independent practice is still an option. It really boils down to an individual's tolerance for risk and hours on the job.
Don Johnson II, MD, Founder, Southeastern Spine Institute and Ambulatory Surgery Center, Mt. Pleasant, S.C.: The single biggest consideration with regard to spine surgeons staying independent is the continued ability to own, operate and self-refer to ancillary services. The Stark exemptions for in-office referrals are under increasing pressure and attacked from multiple outside sources.
Most independent spine surgeons feel that control of ancillaries provide for a better patient experience and higher quality services. These also provide a source for income, which has become more important with ever decreasing reimbursement for professional services. For independent physicians this revenue can help offset the numerous regulatory and governmental requirements such as electronic medical records and compliance programs. Without this ability I am very concerned that most independent physicians will necessarily become hospital employees.
More Articles on Spine:
Hospital for Special Surgery Names Dr. Todd Albert Surgeon-in-Chief
Costs for SI Joint Disruption, Sacroiliitis About $270M Over 5 Years
The Robotic Difference: How New Technology Could Impact Spine