James H. Lubowitz, MD, an orthopedic surgeon with Taos Orthopaedic Institute in Santa Fe and Taos, New Mexico, and Assistant Editor-in-Chief of Arthroscopy Journal, practices in a rural area noted as a destination ski and mountain resort where most of the surgeons are no longer in private practice. His region is following the national trend toward hospital employment for specialists, including orthopedists. Some private practices around the country are having difficulty competing with hospital recruitment packages for young physicians, but many still believe there is a place for physician groups in the future. "We've had a very stable practice, so there's no reason to think that in the future we won't continue to be a stable private practice," says Dr. Lubowitz. "We've been in business for almost two decades, and I think sharing our track record is important for having a vision of private practice in the future."Here are four reasons why private practice is still attractive to young orthopedic surgeons.
1. You are your own boss. Running a practice means you are your own boss, which many surgeons are finding attractive when compared with employment at the hospital. Surgeons in private practice are able to make their own schedules, decide when they want to be busy and when they can slow down, choose their vacation time and selected which days of the week to work.
"There is also a greater degree of control over the people with whom you work because you can hire, fire, or reassign employees depending on your preference," says Dr. Lubowitz. "The number one advantage to private practice is the autonomy."
Private practice also allows more flexibility to make changes in the schedule and employees. If you bring on a surgeon who prefers a physician assistant and another who prefers a nurse practitioner, you can accommodate both.
2. Financial stability. One of the biggest concerns for young surgeons is being able to pay off their medical school debt. Many aren't trained in business principles, and a hospital salary seems tantalizing. However, orthopedic groups have been strengthening through the economic downturn and will become a better option in the long run.
"In 2013, orthopedic groups are in a stronger position to make the argument for private practice and demonstrate financial stability," says Dr. Lubowitz. "People whose groups are thriving have found a way to survive the recession and demonstrated that they have a viable business. The groups that have sold to hospitals or already closed their doors have been weeded out through this challenging period."
Private practice offers orthopedic surgeons more opportunity for financial stability than hospital employment because they are able to control revenue generation. They can also benefit from ancillary services. Hospitals may offer perks and benefits in the initial contract, but there are other things private practices can offer surgeons to jump-start their careers.
"There are the usual benefit packages for surgeons interested in salaries," says Dr. Lubowitz. "Private practices can offer similar benefits and perks, but there are some ways they can offer benefits on a pre-tax basis that are legal and compliant, and that's a huge benefit for the private practitioner."
3. Employment stability. Hospitals can choose to fire or cut surgeons, but private practices typically can't fire surgeon-partners unless there is due cause. The hospital employment contract can also be renegotiated, and many surgeons are unhappy with renegotiated rates.
"Some surgeons are excited to become employees because they see the initial favorable contract, but when that contract expires they have to renegotiate," says Dr. Lubowitz. "In one case, an entire hospital offered their surgeons a 20 percent salary reduction. I've had colleagues who were excited to become a hospital employee, and a few years later the hospital decided they weren't going to renew the contracts. By and large, that doesn't happen in a private practice; autonomy and security are huge advantages."
With reimbursement decreasing and the number of insured Americans increasing, more people will be in a position to receive orthopedic care. Most orthopedic surgeries are elective, and elective surgeries are often dependably compensated.
"While orthopedic surgeons will render care regardless of the patient's ability to pay in cases of an emergency, it's rare that surgeons are able to perform free care for elective procedures," says Dr. Lubowitz. "Most of what we do is elective surgery, and soon there will be a higher volume of patients. Our reimbursement rates might be lower but the potential for volume is vast, so I'm optimistic about orthopedic surgery over the next five to 10 years."
4. Equal treatment. Many of the surviving private practice models treat all surgeons — whether experienced or brand new — as equals. In 2012, it is common that surgeons may rapidly advance from being a "junior partner," to reaping the economic and lifestyle benefits of full partnership.
"A key aspect of the private practice would be to have a culture within the practice that new surgeons are treated as peers so they can have the opportunity to quickly become equal partners financially and have the freedom to select their own hours, staff and subspecialty," says Dr. Lubowitz. "In addition, there needs to be fairness with regard to sharing, or at the very least, defining, call obligations and distribution of non-operative patients."
Depending on the community, these obligations will vary, but in an private practice setting, the opportunity for mutually respectful relationship with partner-peers results in an opportunity to negotiate as partners, rather than as employer-employee, where the hospital-employed physician is at a disadvantage.
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