Opting for hospital employment over private practice has been a fast-growing trend.
Four spine surgeons discuss what makes hospital employment such an attractive option for surgeons in today's healthcare climate.
Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. We invite all spine surgeon and specialist responses. Next week's question: Where is the use of biologics in spine surgery headed?
Please send responses to Anuja Vaidya at avaidya@beckershealthcare.com by Wednesday, July 2, at 5 p.m. CST.
Question: What are some of the reasons driving spine surgeons toward hospital employment?
Neel Anand, MD, Clinical Professor of Surgery, Director, Spine Trauma, Cedars-Sinai Spine Center, Los Angeles: I think the biggest issue right now is the uncertainty of what is really going to happen, especially in terms of reimbursement. If reimbursement drops, the ability to making a living in private practice is more difficult. The costs for establishing your own practice is very high.
Hospital employment gives physicians more security and so more of them are going in that direction. This is in part due to the control the insurance companies have on the industry. Ultimately, they are the ones determining the contracts and determining who is getting paid. So they are driving everything.
Raj Rao, MD, Vice Chairman, Department of Orthopedic Surgery, Medical College of Wisconsin, Milwaukee: I believe the primary factor in the recent trend toward hospital employment is a resignation to the fact that multiple CMS mandates and measurement metrics are here to stay, and that the surgeon in private practice is increasingly unable to comply with these requirements.
Electronic medical records were the first CMS salvo. Several surgeons/surgeon offices complied with this requirement by buying their own outpatient EMR software. This was followed by physician reporting requirements, meaningful use 1 and 2 and now various "value-based" initiatives, including patient satisfaction measurement. Hospitals face their own requirements for "value" and since many of these measures are linked with physician activity, the physician needs to comply with these inpatient metrics as well.
The combination of the complexity of these requirements, the costs associated with developing and reporting these metrics and decreasing reimbursement, is driving surgeons towards employment by an institution that has the resources to help fulfill these requirements. Whether this trend lasts or how it evolves still remains to be seen.
Richard A. Kube II, MD, CEO, Founder, Prairie Spine & Pain Institute, Peoria, Ill.: There are likely several reasons many choose hospital employment rather than private practice. One simple reason is that with the ability to capture large amounts of ancillary income, the hospitals are offering new graduates significantly higher starting wages, which are appealing to anyone, much less someone coming from fellowship salaries and likely large student loans.
Additionally, there is a lot of uncertainty in the healthcare arena. There is a general perception that a hospital-based job will be more stable with less risk, thus making it more attractive. With the complexity of management increasing, many do not want to deal with the non-medical issues often faced by private practitioners.
I believe that for the new grads, the 80-hour work week also plays a role. There is a larger shift [in] work mentality and less entrepreneurial spirit. Lastly, the more senior surgeons who are facing large costs to implement EMR and ICD-10 updates do not have enough practice years remaining to recoup the expenditures prior to retirement and it makes more sense to sell a practice and work as an employee for the last few years of their practice.
Brian R. Gantwerker, MD, The Craniospinal Center of Los Angeles: Most of the reasons are increasing overhead. Malpractice premiums do not tend to decrease overtime. Employees' cost of living increases, rent increases, internet expenses, all tend to grow over time. Reimbursements are trending down as codes get bundled, and carriers are looking to maintain the bottom line. Hospitals offering to cover the largest portions of their overhead while they get to maintain their lifestyle is very tempting.
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