Becker's ASC Review

36 Thought Leadership The worst decision a surgeon can make when entering practice: Dr. Alexander Vaccaro By Alan Condon S urgeons are faced with a variety of critical decisions to make at the beginning of their careers to build a successful practice, such as choosing the right orga- nization to grow, signing a fair contract, developing their surgical technique and building a patient base. Alexander Vaccaro, MD, PhD, president of Rothman Ortho- paedic Institute in Philadelphia, told Becker's Spine Review about one investment that early-career surgeons should avoid when it comes to their finances. Question: What is the worst investment or decision you made in your career? If given the opportunity, what would you do differently? Dr. Vaccaro: The worst decision or investment I've made in my life is listening to financial advisers when I first entered practice, believing they were truly fiduciaries of my hard- earned money and abandoning the simple strategy of index fund capital allocation as a method of building long-term financial security. When you're young and naive, you're often influenced by savvy, smooth-talking financial advisers and disability brokers on the importance of letting them manage your money. What I found over time is that simple dollar cost averaging, exploiting index funds and therefore minimizing unnecessary fees, and maximizing tax-deferred investment opportunities including 529 plans for education- al purposes was the most efficient way to develop wealth over time. Why pay on average 60 to 100 basis points to a broker with additional hidden fees when a standard wholesale brokerage firm can provide similar outcomes for 14 to 20 basis points on average? Remember to diversify index fund investments depending on market trending covering the gamut of treasuries, mutual funds, low, mid and large caps, as well as international securities. Never ignore maxing out tax-deferred investment opportunities such as your 401(k) and 529 plans. Let your money work for you as you are car- ing for those in need. n Telemedicine, other trends enable care for poorest patients, says CEO of Chicago ASC By Marcus Robertson W ith ASCs increasing their ability to perform procedures at lower costs than hospitals, Andrew Shadid, CEO of Chicago-based Genesis Orthope- dics & Sports Medicine, said his practice is determined to provide care to those with the greatest financial need. is is an edited transcript. Question: What makes your practice unique? Andrew Shadid: We're on a mission to in- crease access to orthopedic care for all people, including those that are uninsured — those that we traditionally think can't afford our ser- vices as one of the most expensive specialties. Q: That's a fascinating mission. How are you able to do that and make it make financial sense for your center as well as the community at large? AS: Our practice was probably like most for 20 years since our founding in which we took care of the patients that really made financial sense. We looked at the issue of rising Med- icaid numbers and uninsured numbers. … And as we learned more and more about the economics of healthcare, but also about the social despair that many of these patients had, we decided that we needed to make this part of our mission. We started taking on more and more patients of different socioeconomic backgrounds, with probably what many people would call a worse payer mix. We just call it a different one. is different payer mix required us to really think of a different economic model to service that, and we've spent the last five years really trying to cra what that model looks like. Ironically, it's using a lot of the things that we saw making headlines back during the early days of the COVID-19 pandemic, which is telemedicine and what we call a theme of having people operate at the top of their license so that you're not asking expensive labor to do things that other people can be doing. But it's caused us to have to really rethink our operating model from the beginning in order to make a suc- cessful care delivery model that at the end of the day pays all the bills and hopefully rewards the physician for their innovation. n

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