Becker's Spine Review

54 ASC How will the impending physician shortage affect ASCs? By Patsy Newitt T he U.S. is expected to reach a shortage of 37,800 to 124,000 physicians by 2034, and while some ASC leaders think this could be an advantage for physicians, many are concerned that it could be detrimental to the provision of outpatient services. Fourteen ASC leaders spoke with Becker's ASC Review on how they believe the physician shortage could affect the industry. Question: How do you predict the aging physician popu- lation and physician shortages will affect the ASC indus- try in the next three years? Christina Holloway, RN. Administrator of Ambulatory Surgery Center of Bala Cynwyd (Pa.): ASCs are likely to be hugely impacted by the physician shortages associated with aging out and recent compli- cations in education for graduating classes. A large percentage of these facilities are physician-owned in some fashion. Our facet of healthcare will not only lose providers for the patient populations served but also supportive funding. When taking these future complications into ac- count, along with the potential upcoming CMS amendments to elective procedures, the next three years will truly navigate how outpatient ser- vices will suffer or survive as a viable option for care. Gregg Florentin. CEO of Michigan Orthopaedic Surgeons (South- field): e country's rapidly increasing demand for physicians over the next three years will outpace its supply, leading to a huge shortage. It's an unbalanced scale — as the population ages, they are living lon- ger and requiring more care later into life, thus driving growth in the demand for surgical services, while the aging physicians squeeze into retirement. Physicians already suffered high levels of job-related burn- out and depression before COVID-19 arrived, and the exacerbation of those feelings caused by the pandemic could sway older doctors to accelerate their plans to retire. Andrew Lovewell. Administrator of Surgical Center at Columbia (Mo.) Orthopedic Group: e U.S. faces a potential shortage of sever- al primary care, surgical and hospital-based physicians in the near fu- ture. ese shortages are going to cause a ripple effect throughout the healthcare continuum, not just for ASCs. However, the ASC industry is going to have to work hard to assure that the physician base for surgical referrals is solid in the future. Many of the cases that ASCs do come from one surgeon or a handful of surgeons, and if one or more of those surgeons decides to retire at the same time, it can be detrimental to the ASC. If ASCs and outpatient private physician groups do not have a forward-thinking approach to physician recruitment and re- tention, we will see many ASCs struggle in the future. Adam Bruggeman, MD. Surgeon at Texas Spine Care Center (San Antonio): e majority of retirements in the next few years will likely have minimal impact on ASCs. Many of the physicians who are per- forming higher-complexity cases tend to be younger and are not near retirement. Scott ellman, MD. President at Lawrence (Kan.) Plastic Surgery: As the generation of independent surgeons that founded many ASCs 20 to 25 years ago approach retirement, there may be fewer surgeon investors available to replace them. As more surgeons are now em- ployees of health systems, there will be pressure to partner with these systems and develop strategies that allow for employed surgeons to share ownership in ASCs. e health systems can look at the cost efficiencies historically seen in ASCs and recognize that they are at- tributable to the surgeons having a direct financial stake in a center. Physician ownership preserves efficiency, is a great recruitment tool and keeps costs down for our patients. Alfonso del Granado. Administrator of Covenant High Plains Surgery Center (Lubbock, Texas): We have not begun analyzing the physician shortage nor how it is likely to affect ASCs, but I believe our current fee-for-service model will continue to motivate physicians to pursue surgical disciplines, and I do not foresee any impact in the next three years. On the primary care side, mid-level practitioners and other extenders may free up time so that more physicians can enter surgical disciplines. However, on the surgical side, I don't see the kind of advanced training taking place that could enable surgical assistants to take the place of assisting sur- geons or co-surgeons. Henry Leis, MD. Surgeon at Bienville Orthopaedic Specialists (Gautier, Miss.): With the pending physician shortage expected in multiple specialties by the year 2025, I believe you will begin to see a higher percentage of patients being moved to the outpatient surgi- cal setting. In addition, patients will likely experience longer waiting periods for access to subspecialty appointments and, subsequently, surgical procedures. Trey Sampson III. Administrator of Newport Beach (Calif.) Sur- gery Center: It's almost a certainty that every administrator will face this issue at some point. I believe an aging physician population will adversely impact the ASC industry by significantly decreasing the vol- ume of outpatient surgeries aer physician retirements. e pace of physician retirements have greatly increased during the COVID-19 pandemic, due in part to physician illness as well as physicians decid- ing that it's finally time to hang up the stethoscope and spend quality time with family. We are also seeing a large number of independent physician prac- tices being sold to hospital systems and redirecting their outpatient procedures to hospital-owned surgery centers. I think the pandemic severely affected the sole-practice physicians, as many of them sold to hospital systems to cut their losses and sustain their careers. "If ASCs and outpatient private physician groups do not have a forward-thinking approach to physician recruitment and retention, we will see many ASCs struggle." - Andrew Lovewell, Surgical Center at Columbia Orthopedic Group

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