What orthopedic experts said about consolidation in 2022

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Orthopedic practice consolidation remained strong in 2022. Here's what experts have told Becker's about the trend this year:

"Big hospitals will continue to buy smaller groups. The older partners will cash in, the younger members won't know any better. This isn't unique to spine or even medicine, nor is this new. Consolidation is part of capitalism. If you are good (profitable) and desirable, then a larger group will reward your efforts. I think part of the change could be instead of the "big general hospital" groups leading the way, possibly leaders in the orthopedic field will be the one's expanding. We have already seen this with Rothman Orthopaedics and Hospital for Special Surgery in Florida, but will a four-person spine group in Dallas be their next target? Time will tell." — Chester Donnally, MD, of Addison-based Texas Spine Consultants on consolidation in his market.

"There is no limit for how big an independent orthopedic group should be, so long as it is structured in a way that maintains efficiencies amidst growth. With 160 physicians and 60 office locations, my practice, The Centers for Advanced Orthopaedics, is considered a supergroup. When structured appropriately, the benefits of a supergroup of our size empowers physicians with the resources needed to navigate the rapidly changing healthcare landscape while retaining the independence to practice medicine the way they see fit." — Nicholas Grosso, MD, of The Centers for Advanced Orthopaedics in Bethesda, Md., on if orthopedic consolidation can get too big.

"There is definitely a sweet spot between leveraging scale and remaining nimble in your decision-making process. Ultimately this is dependent upon having the right people, processes and procedures in place. Even in a consolidated world, healthcare remains local. Certain models work in certain markets. Our model was designed to promote local independence to ensure specific needs and market drivers are met. I do not think there is such a thing as too big. Most groups experience difficulties when they fail to build the base infrastructure that provides the solid foundation for growth or diverge from the business where they experienced their initial success. While orthopedics is still largely fragmented, I do believe you will see practices continuing to consolidate in the years to come. Ultimately, physicians still control their own destiny. Yes, there are several outside pressures making it extremely difficult for the sole practitioner to survive in today's world, but those that are willing to roll up their sleeves are still able to be successful. That said, I don't believe you will see many physicians going out and starting their own practices in the current environment. Orthopedic surgeons coming out of fellowship today seek stability. Stability in the form of a pipeline of patients as well as clinical and administrative support. Staying independent can be the right plan, but having a plan is the most important initiative that a lot of practices lack." — Michael Doyle, CEO of Tampa-based Florida Orthopaedic Institute, on how he sees consolidation evolving.

"The size of any private practice group, whether it be two or 200, is immaterial. It is more about the leadership and culture fostered. Many times I have seen groups that should work on paper implode and scatter. When I have seen groups work, it is with a fair-minded and logical leader or leaders at the top. They encourage input from everyone, settle disputes openly and discourage backstabbing behavior. They emanate fairness because they operate on their own example. Inevitably, if it's "OK for me, but not for thee," the group is headed for dissolution. It is possible to maintain an "eat-what-you-kill" arrangement if the participating surgeons all see their goal is the same as everyone else’s in the room: survival and independence. Strong leaders should be strong not in being the loudest voice in the room but by their consistent confidence, fairness and clarity." — Brian Gantwerker, MD, of The Craniospinal Center of Los Angeles, on the size and scope of consolidated groups.

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