Provide framework for younger surgeons to build their own legacies, successes
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The delivery of health care today is inundated with buzzwords. Terms, such as value-based care, precision medicine, population health management and risk-based contracting, now reflect something more than their original meanings.
These terms have become slogans used in high-level administrative meetings to inspire change and to promote innovation and market leadership. However, the terms are often ill-defined, and when carefully inspected, fail to live up to their original concepts.
Words drive purpose, such as aspirational budgets beyond reasonable expectations being referred to as “inspirational.” The driving force behind change and proposed innovation is frequently referred to with patient-based buzzwords, such as “value-based care,” yet the key factors that impact many decisions are truly based on creating margins or profits to ensure sustainability and growth of the organization.
Patient care vs. profit
At the intersection of patient care vs. profit, decisions may be made not on what is ideal for the greater good of a patient population, but rather on perceived need of the organization. Two intelligent, competent and thoughtful leaders can have different viewpoints based on personal priorities. Our patients expect us to selflessly act on their behalf – tempering and adjusting the business drive for maximum revenue and profit, which may be the primary definition of success for many organizations.
The call for more physician leadership has resulted in an increase in physicians being involved in these critical decisions. Unfortunately, the ethics, morality and bias related to access to care and caring for patients are not uncommonly challenged and overruled by the principles of developing and growing a successful business. People are replaced with terms, such as “encounter,” “consumer,” “subscriber” or “member,” and then converted to a number. Once patients are reflected as numbers, the entire environment shifts to a financial game. The plan has removed any sense that there is a person represented by the number.
The leadership guiding orthopedic surgery is not immune to the challenges of growing a successful business, as well as the temptation to pursue opportunities that can substantially increase profits, shareholder value and overall personal wealth. New models, strategic partnerships and owners with unique financial expertise have led to an ever-increasing variety of practice models that have resulted in a decrease in independent practices with a concomitant increase in corporate enterprises and employed orthopedic surgeons.
Independent practices
Independent practices continue to evolve. Variable relationships include strategic alignment with partial ownership from private equity or other sources, other types of investors, aggregation of practices, as well as increasing the number of employed orthopedic surgeons who are challenged to reach an equity or partnership position. A proposed advantage of being an employed surgeon in a health care system is business issues are frequently addressed by non-physician administrators. However, when overall resources are restricted or contribution value is reallocated away from the contributing physician or department, business decisions impact the physician’s ability to achieve their full potential with compromises in support staff for clinical and surgical practices, low-efficiency models in the office and OR, and less incentives, including compensation and professional growth opportunities.
An area of great concern for mid-career and younger surgeons who choose to work for independent or corporate practice is not just the direction many practices are pursuing, but also what will remain once senior-level partners and new business partners have extracted what they believe is their rightful compensation and equity value. The most significant margins and equity value are found with ancillary services, including facility fees at an ASC, radiological procedures, rehabilitation services, durable medical goods, pharma or biological injections, and practice-owned real estate. If the contribution to these services from midlevel and younger surgeons is diluted or not included in their value to the organization, then they will be severely limited in demonstrating the same value as their senior partners have been able to demonstrate during the past 20 years. It would not be unusual for ancillaries to be considered an enterprise-wide service, tilting the value toward senior partners and outside investors, artificially reducing the true contributions from junior partners and employed physicians in the practice. The value cannot be overcome by working harder, seeing more patients or focusing on high-value procedures. The entire matrix becomes more confusing and often less valuable to younger surgeons when nonphysician partners are part of a regional or national business model.
The drive for an orthopedic practice to be financially successful and create a business that adapts to the current challenges in health care while growing is critical for the leadership of independent and corporate practices, as well as health care system administrators. Currently, it appears that many practices are struggling with the threshold between what is a healthy and sustainable financial model and what is greed. In the movie Wall Street, fictional character Gordon Gekko, states, “... that greed, for lack of a better word, is good. Greed is right. Greed works. Greed clarifies, cuts through, and captures the essence of the evolutional spirit.” Some transactions appear to have this mantra as a guiding principle. However, this belief is in direct contrast to the successful servant model and most other leadership models.
Pay it forward
Orthopedic surgeons have seen multiple examples of senior-level surgeons providing time, education and resources without expectation of repayment or financial renumeration. These senior-level surgeons expected nothing in return other than dedicated effort to orthopedics and to pay it forward. We have benefitted from those before us in our accomplishments.
When the intense desire for an outcome becomes self-centered and selfish, not considering those who will follow, the essence is no longer ambition but rather greed. We should not support greed through the celebration of high-value transactions that benefit only a few surgeons in the practice. Senior leaders and business advisors should be held accountable for developing sustainable models that allow for growth, continued innovation and provide the framework for younger surgeons to build their own legacies and successes.
- For more information:
- Anthony A. Romeo, MD, is the Chief Medical Editor of Orthopedics Today. He can be reached at Orthopedics Today, 6900 Grove Road, Thorofare, NJ 08086; email: orthopedics@healio.com.
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