Bethwel Raore, MD, overcame several challenges in 2020 to start his own practice — Columbus, Ga.-based APEX Spine & Neurosurgery.
Dr. Raore joined "Becker's Spine and Orthopedic Podcast" to discuss the early challenges of starting his practice and his advice for other spine surgeons.
Note: This is an edited excerpt. Listen to the full conversation here
Question: What prompted that move to go independent, and how's it been in the last four years?
Dr. Bethwel Raore: It hasn't been easy. We were not very good at telling the future because we left employment right before the COVID-19 pandemic hit. But the reasons we decided to not be employed still made sense that we go independent. As employed surgeons, you have a very good floor, you have a good base, but you also have a roof. You have a ceiling on your head of how far you can go. And being the people who are creating the value in patient care, we are not only doing the surgery, but we generate all the other ancillary incomes for the hospitals. Our goal was to maximize the value that we bring into the system. And as a surgeon, as a physician, there's really no way you're going to maximize it unless you get a role in the ancillaries and the surgical centers, etc., which is part of the value that you bring to a hospital system.
Another reason was we just wanted to take care of our patients better. We wanted to have a more active role in being in charge of the experience that our patients have. You know when you're employed, obviously your employer determines how many support staff you can have, and sometimes that does affect the quality of care that you're able to give.
In February of 2020, when we wrote our resignation letters, COVID-19 hadn't shown up. So it's been rough trying to manage and stabilize. I believe we are at a good point currently. Obviously [there were] all the challenges of a startup — getting the right employees who want to do the right thing with the market the way it was coming out of COVID-19 and trying to be competitive in the salaries that you're paying in the rough climate was quite a challenge. But I believe we've surmounted all of those challenges at this point, and our practice is actually growing.
Q: For any neurosurgeons and spine surgeons who are thinking about following in your footsteps, are there one or two key pieces of advice that you'd have for them?
RB: Well, the first piece of advice out of our experience is to know the contract you signed for your employment. We actually got sued for a noncompete. That took us out of our area where we had the sweet spot and we had to stay out for two years, but we eventually came back into the area where people knew us and people trusted the quality of our work. So know your contract. Even before you know your contract, I would suggest not to think of leaving if you're not confident of the quality that you're going to provide to patients out there. You have to care for your patients, and you have to really love taking care of your patients, because that's what comes through.
Starting a practice is uphill. Starting any startup is always uphill. You have to have some finances stored up because everything in healthcare takes time. If you do a case, the insurance company will pay you in two or three months, but the people who work for you want their checks every two weeks. So there is a big hurdle but it's surmountable.