'What's not to like?': Key factors driving orthopedic, spine surgeons into private practice


Factors including disrespect from hospitals, the need for more independence and the ability to control their own schedules are driving young orthopedic and spine surgeons into private practice. 

Here is what seven orthopedic, spine and neurosurgeons told Becker's about the pros of opening one's own practice. 

Editor's note: Responses have been lightly edited for length and clarity. 

Abilio Reis, MD. Spine surgeon at OrthoVirginia (North Chesterfield): It is the independence to provide quality care for patients without the bureaucracy of an employed position.

Brian Gantwerker, MD. Neurosurgeon at the Craniospinal Center of Los Angeles: First off, it is a wonderful thing to be still talking about private practice. For the last two to four years, we have been hearing from various soothsayers (mostly those who sold their practice or retired) that private practice is dead, or going to be dead within a few years. I am seeing more young surgeons opting to strike out on their own. I was recently on an American Medical Association private practice section call, and we had several spine surgeons. 

Seeing many of their attendings and other community members become frustrated, termed out, or being replaced like a used spark plug has turned many off of employment. There is a strong streak of independence intrinsic to medicine, especially in surgeons. Self-reliance, a doubting eye and a desire to constantly improve really help one  "catch the bug " of being into your own practice. 

I think the bad behavior of hospital administrators and other corporate employment entities is finally catching up with them. This inability to treat not just physicians, but also their staff, with respect has caused many people to seek drier land. The corporate practice of medicine doesn't work for patients. Only doctors (and other healthcare workers like nurses and other important members of the team) work for their patients. And I think a desire to practice good medicine is at the heart of anyone who hangs their shingle. 

Issada Thongtrangan, MD. Spine surgeon at Microspine (Scottsdale, Ariz.): Private practice allows the physician to have autonomy. The physician will have some control of his or her practice hours and, hopefully, eventual subspecialty practice environment, with the additional revenue possibilities of ancillary services, including ASC ownership, physical therapy, MRI, occupational health and medical equipment, etc. You can deliver quality care in a private practice setting. You can lower the practice expenses and adjust how you see fit without disrupting patient care. 

You will have very little autonomy working as an employed physician as you have to fulfill  "numbers " to satisfy your employer. The only good thing is that they can negotiate the payment rate on your behalf, and also you don't have to worry about the management aspect of the practice because it is not your practice.

Jason Huang, MD. Chair of the Department of Neurosurgery, Baylor Scott & White Medical Center (Temple, Texas): Private practice offers young spine surgeons the opportunity for ownership in ASCs, private hospitals, imaging centers, physical therapy clinics and more. This can be particularly attractive to business-oriented spine surgeons who value ownership and autonomy. Private practice also offers more freedom and flexibility compared to being employed by a particular institution, which may have more rules and regulations.

Kris Radcliff, MD. CEO at Spinal Disc Center (Somers Point, N.J.): Orthopedic surgeons are accomplished, competitive people. We labor for years in order to earn the right to control our own destinies. With employment, surgeons often trade control and autonomy for perceived security. Someone else decides when you start and end office hours, when you take calls, when you can travel and even your professional identity and brand. Although private practice has unique challenges, the ability to control destiny and brand is its own reward.

Lali Sekhon, MD. Neurosurgeon at Reno (Nev.) Orthopedic Center: Young surgeons coming out of fellowship have several options, which include nonclinical roles as well clinical roles that can be academic, employed or private practice. The private practice model is attractive for the following reasons:

1. Autonomy — most groups are run by physicians. 

2. Incentivized for success — the more you do, the more you get reimbursed. 

3. Control — you get some say in organizational structure and your needs. 

4. Vertical integration — most groups have extensive ancillaries that cover durable medical equipment, imaging, physical therapy, urgent care and surgery centers. This can elevate partner incomes by a significant amount.

At the end of the day, a partner in a larger orthopedic group can benefit from a huge ancillary pool, be rewarded financially for hard work, have more job security and know that fellow surgeons are guiding the ship, not capricious hospital administrators. What's not to like?

Peter Derman, MD. Spine surgeon at Texas Back Institute (Plano): Every practice environment has its pros and cons. The key is identifying the setting that best suits you. I personally enjoy the autonomy of private practice — I am my own boss, and I dictate my own schedule. I keep my surgical indications very tight, and it is nice that no one is looking over my shoulder and pressuring me to do more surgery. I also enjoy the entrepreneurial nature of this practice setting. While I do not have the security of a base salary, I benefit more fully from the upside of developing a successful practice. It is very personally rewarding to build my brand.

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