The national trend for physicians leans toward hospital employment, but many orthopedic and spine specialty groups have remained fiercely independent. While being a single surgeon or small group practice continues to be difficult, larger physician specialty groups are thriving. Stephen Hochschuler, MD, co-founder of Texas Back Institute in Plano, discusses what it takes for strong spine groups to remain independent today and successfully grow in the future.1. Recruit motivated, independent surgeons. It's more difficult to go into private practice today with decreasing reimbursement and increasing regulations, but the spine surgeons who have the most independent and entrepreneurial mindset still want that opportunity. Texas Back Institute has capitalized on these desires by bringing on physician partners who are clinically and academically inclined.
"Our rationale was to bring on surgeons who could have practiced at a large medical university but wanted independence," says Dr. Hochschuler. "These surgeons are committed to teaching, lecturing and writing, and are able to give up some present-day income so they can participate in new research and development."
Surgeons at Texas Back Institute have been involved in developing new imaging technology, pedicle screws and artificial discs. Continued research and development into biologics and robotic technology is currently taking place within the practice.
"You want to be on the leading edge when there are new techniques evolving," says Dr. Hochschuler. "You need to prove the efficacy of these developments."
2. Make time for the community. Leading groups and surgeons also make room in their schedule for community enhancement, whether related to the medical field or overall wellness. Find opportunities to become involved in local organizations and business groups and give lectures to potential patients and colleagues about your work.
"Make a mark in the community like any other leader," says Dr. Hochschuler. "It's not just being in a leadership role in the practice, but really becoming involved outside of the clinic. To make a stamp like Mayo Clinic, Cleveland Clinic or Texas Back Institute, it takes a concerted effort. You can't just be interested in cash generation."
Another method of community outreach involves connecting with the youth population. Speak with high school students who are interested in medicine and if you are able, hire a few interns for the summer to help with clinical research. You can also participate in other initiatives to make the community better.
"About 20 years ago, Plano had a lot of teenage suicides, and that had nothing to do with my practice but I became involved," says Dr. Hochschuler. "I met with others to discuss the situation and we worked to improve it. You need to get involved with community affairs — it's very important."
3. Get to know patients on a personal level. Surgeons are pressured to see a high volume of patients each day and must spend more time documenting and filling out paperwork than ever before, but it's important for patients to feel comfortable with their surgeons before undergoing procedure. Make sure you spend enough time with each patient individually, and recruit knowledgeable staff members who can fill in the gaps.
"You need to spend time with your patients because they are where you will leave your best mark," says Dr. Hochschuler. "You must spend time with them and get to know them on a personal level. This is difficult in a day and age when you are paid less, but the patients are the ones who will leave and recommend you to others."
Happy patients will likely bring in a few new referrals, but unhappy patients could turn away many more. Be respectful of the patient's time and experience so they are satisfied with care provided.
"If you aren't on time, post that in the waiting room so patients know how far behind you are," says Dr. Hochschuler. They can decide to leave and come back or reschedule their appointment. You can also make the waiting experience more pleasant with a DVD or computers in the waiting room."
When you are able to see patients after a delay, apologize for your tardiness and don't make excuses for running behind. "Just apologize because that's all they want to hear," says Dr. Hochschuler. "Communication is key and it gives patients a sense of your humanity."
4. Treat employees respectfully. Your receptionist might be the lowest-paid employee at the practice, but arguably one of the most important. The receptionist is the first person who greets patients, meaning their impression of the practice begins there.
"That person has to be polite and friendly to the patients," says Dr. Hochschuler. "You have to treat your employees professionally and respectfully so they are happy doing their job, and doing their job well."
Employees should feel comfortable referring their friends and family to the practice, which will happen if they trust and respect their surgeon employers. Make sure they see you can handle problems well and promote from within.
"If the CEO of your practice is less than good, there is a response from the whole practice," says Dr. Hochschuler. "Our CEO is wonderful and we have a climate where people are respectful. The doctor should set the tone at the office, but having a good CEO is key."
5. Find opportunities in the changing healthcare environment. As healthcare evolves, some opportunities for physicians are drying up, but others are just emerging. Find the next great opportunity for spine surgeons to lead the charge for better, more cost-effective care.
"Right now there is a sea change, and whenever there is change there is opportunity," says Dr. Hochschuler. "A lot of people are nervous about becoming employed or aligning with hospitals because they are afraid of being left out. There could be local, regional, national or international opportunities available for surgeons in the future. Telemedicine is going to be the fastest extender of care going forward to reach a larger patient base."
Other opportunities lie in lowering the cost of care and making a more efficient supply chain process. Texas Back Institute is involved in efforts to lower the cost of implants at their practice and investment in ancillary revenue. Ambulatory surgery center investment is one of the fastest-growing opportunities for spine surgeons.
"They should be proactively seeing joint venture ASCs with hospitals or on their own," says Dr. Hoschschuler.
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