Practices consume a lot of time, choose carefully

Practice size and type, malpractice type and location all impact how satisfied orthopedists are when they start their first practice.

At least half of all orthopedists will make a mistake when selecting their first practice and later have to deal with the consequences, according to Andrew G. Urquhart, MD, of Ann Arbor, Mich.

Urquhart recommends studying a practice of interest extensively, perhaps as much as one would a surgical procedure scheduled for the next morning. But, he also admitted making his share of mistakes when starting out. “You probably shouldn't pick a practice or decide where you want to practice without looking at the data,” Urquhart said.

He cited some key practice-related factors, identified in census data from the American Academy of Orthopaedic Surgeons, as follows:

large practice groups are popular;
up to 63% of orthopedists are involved in large practices;
multispecialty groups constitute 13% of orthopedic practices;
25% of orthopedists are in solo practice; and
more than one-third of new medical school graduates choose to practice in large groups.

Under the microscope

Urquhart held an instructional course lecture at the American Academy of Orthopaedic Surgeons (AAOS) 72nd Annual Meeting during which several orthopedists and an attorney spoke about practice selection.

Urquhart noted the physician-practice relationship requires a serious commitment. “You’re also a business. You’re a lender. You’re a bank. You’re a liability and, most importantly, you’re really kind of a marriage,” he said.

He suggested looking at a practice closely to get to know its partners, determine its socioeconomic climate and whether performing services without making a profit — or even doing them at a loss — will be required. He also suggested learning what motivated the management to hire a new physician, such as needed coverage in a certain specialty or to be able to better compete against other practices.

A practice’s location — rural vs. city — may dictate how much specialization is permitted and the amount of on-call hours expected. “In a big urban setting, however, there's more competition and reimbursement may be tighter. It’s easier to become a subspecialist and being a subspecialist may actually be needed or mandated,” he said.

Ease of work

The size of a practice matters as it is easier to work in smaller groups. In such groups, “you have good control of your overhead, but it is much more of a marriage,” Urquhart said. Because some practice members are considered employees and need to sign contracts, fully understand the contents of the contract before committing, he noted.

He also urged the younger, aspiring orthopedists at the instructional course to look beyond the practice to the managed care environment in its locale and the kinds of payer mix trends that exist.

Urquhart encouraged attendees to be completely satisfied with all aspects of the practice before making a final decision. “Whether you're in solo practice or in a big group, your orthopedic practice will occupy a huge chunk of your time,” he said.

For more information:
Urquhart AG. Your first orthopaedic job: Understanding the numbers. ICL#108. Presented at the American Academy of Orthopaedic Surgeons 72nd Annual Meeting. Feb. 23-28, 2005. Washington.