Spine surgeons on alert for these red flags when joining new groups


As with any job search, there are many factors to weigh when deciding to accept an offer. For spine surgeons, those considerations include contacts, ownership plans and communication.

Here are the red flags spine surgeons should know when looking at practices and health systems.

Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. Becker's invites all spine surgeon and specialist responses.

Next question: What are the green flags spine surgeons should consider when joining a practice or health system?

Please send responses to Carly Behm at cbehm@beckershealthcare.com by 5 p.m. CST Wednesday, April 24.

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

Question: What are the red flags spine surgeons should consider when joining a practice or health system?

Jeffrey Carlson, MD. Orthopaedic & Spine Center (Newport News, Va.): There seems to be many changes for ownership in practices and health systems. It is important to ask questions about ownership and how it could change in the next five years. New physicians will want to know that the organization they are joining will have the same administrative structure they are expecting for a long career. If the president or CEO of the practice opportunity is expecting to leave the job in three years, the physician will want to do more investigation. 

Brian Fiani, DO. Mendelson Kornblum Orthopedic & Spine Specialists (West Bloomfield, Mich.): Some red flags spine surgeons should consider when joining a practice or health system include high turnover rates among staff, poor communication between team members, a lack of access to necessary resources and equipment, limited opportunities for professional growth and development, and a history of patient complaints or malpractice lawsuits. It's important for spine surgeons to thoroughly research and evaluate potential practices or health systems before making a decision to join. 

Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: Over half of doctors, especially neurosurgeons, leave their first practice within the first one to two years. There are some red flags colleagues have talked about that are worth mentioning. There are two main ones to look out for: 1) promises made and promises kept; 2) not having everything in the paperwork. 

The first is, when you first start, and you were supposed to be doing your work in one area, and your partner or supervisor tells you at the eleventh hour that you are working somewhere else — either another location or another town completely, be careful. That means that there is a general feeling that you and your expectations are not being considered carefully. Contract negotiations can take a long time, careful planning — including getting a place to live, putting your kids in school, doggy daycare — it is not easy to suddenly have a huge commute to contend with. If your boss or partners do that, especially with a nonplussed attitude, beware.

Secondly, if you agreed on it and it's not in the contract, don't expect it to materialize. Call expectations, RVUs, salary and partnership track all need to be spelled out clearly. As you interview, you may encounter opportunities that offer you a letter instead of an actual contract — caveat emptor. Get everything in print. Remember, a contract can be a saving grace or just a guideline for litigation. Hopefully,. it will be the former.  

Alex Vaccaro, MD, PhD. President at Rothman Orthopaedic Institute (Philadelphia): Spine surgeons continue to be one of the most sought-after surgical specialties in healthcare. For spine surgeons evaluating their opportunities, the following are some key questions to pursue:

How is access to operating room time, including whether key specialists are available to support spine surgery, and if the tools to support high-quality spine surgery such as microscopes and navigation technology are available or will be purchased? In an ASC setting if there is a vascular or neurological intraoperative injury, what type of support, transfer mechanism is in place to ensure patient safety

What is the compensation framework, including what behavior is rewarded, and how is productivity measured? If productivity is measured in terms of cash collections, what is the performance of the revenue cycle and how are spine cases reimbursed in the commercial payer contracts relative to market norms? Is revenue shared equally among all providers or passed on work RVUs/collections.

Will the surgeon have the ability to participate in ASC joint ventures, shared savings program benefits for value-based care, and other forms of passive income generation?

How are non-financial terms navigated, including things like pathway to partnership/partnership criteria, restrictive covenants and noncompetes?

How quickly did the last new spine surgeon build his/her practice? What resources are available to support a surgeon building his/her practice? Has any spine surgeon ever left the group and why?

Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): Albeit most individuals are reluctant or even unwilling to readily disclose such misfortunes, the unreliable poison of any practice or health system would be local or federal inquiries into concerns over noncompliance or fraud with healthcare regulations. Any governmental agency investigating a practice for such allegations usually signals unsavory circumstances, bodes unwell prospectively, and may signal desperation by the hiring entity.  Forbidding behavioral issues such as infighting and tedious negativity should also be analyzed and pursued with caution. Economically, the red flags could be many, like excessive voids, adjustments or modifications to accounts receivable most likely represent issues and should trigger hesitance prior to scrutiny by a reputable accountant.

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