Becker's ASC Review

9 ASC MANAGEMENT What's driving the next generation of physicians to private practice? By Patsy Newitt B etween rising costs, physician burnout and increasing consoli- dation, physicians are increasingly choosing hospital employ- ment over private practice. Becker's spoke with 21 physicians on what's driving physicians to pri- vate practice over hospitals. Editor's note. ese answers were edited lightly for brevity and clarity. Eugenio Hernandez, MD. Vice President of Clinical Affairs for Gas- tro Health (Miami): To attract the next generation of top physicians, private practices will certainly need to remain competitive with overall compensation and work-life balance. Beyond compensation, private practice may offer important benefits that other employment mod- els cannot, such as a higher degree of autonomy in clinical decision- making and work schedules. Furthermore, private practices can show value by providing a culture of active mentoring. Experienced physi- cians can demonstrate how to build relationships with referring physi- cians, operational management of staff and understanding the financial skills necessary to run a business. Private practices can offer additional income opportunities with partnership in ASCs, imaging centers, phar- macy services, real estate and even potential equity in a larger private practice organization. Given the current competitive labor market and the anticipated physician shortage, the total value of private practice is more important than ever. Joseph Anderson, MD. Professor of Medicine at Dartmouth Geisel School of Medicine (Hanover, N.H.): Autonomy. Small private prac- tices give physicians the ability to provide the best care for their patients and to adapt to changes quickly and effectively. Small private practices are the lifeblood of U.S. medicine, and their ability to survive is vital to healthcare in this country. David Johnson, MD. Gastroenterologist in Norfolk, Va.: Private practice"as we know it will progressively evolve with new restrictions as we see the consolidation of practices under equity buyout models. New- er physicians will face increasing pressures on maintaining revenues to meet the equity partners expectation for returns on their investment for buy out. Bertrand Kaper, MD. Chairman of Orthopedics at HonorHealth ompson Peak (Scottsdale, Ariz.): Attracting the next generation of orthopedic surgeons to private practice is a daunting proposal. e ex- panding complexities of managing the business side of a practice will stymie the motivation for most. e cost of doing business has been steadily increasing, especially in an era where workforce recruitment is extremely difficult and therefore more costly. Offering competitive salaries and benefits to personnel has become the largest cost center in private practice. Meanwhile, insurance companies are becoming more data-driven in regard to surgeon outcomes and costs. Accordingly, it is becoming more difficult to find leverage in contract negotiations for solo or small-group practices. ose who still decide for private practice will most likely find their best option [is] to join one of the super-groups in their locale. Michael Moustoukas, MD. Orthopedic surgeon at Kennedy White Orthopedic Center (Sarasota, Fla.): Practice autonomy and ancillary revenue are the main drivers of the next wave of orthopedic surgeons to pursue a private practice. e "eat what you kill" model incentivizes increased revenue. Additionally, changes in patient care are much easier to implement within a group compared to hospitals. ASCs are becom- ing more utilized in the surgical treatment of patients. Many orthope- dics cases that were once done in the hospital are now being safely per- formed in the outpatient setting. e opportunity for ancillary revenue streams become eliminated with hospital employment. Kenneth Rubin, MD. Gastroenterologist at Gastroenterology Group of New Jersey (Englewood): I believe private practice will always ex- ist, but it will continually change and adapt to the changing healthcare landscape. e attraction of private practice is controlling your own des- tiny while continuing to provide the best in patient care. Smaller private practice models will thrive, perhaps as a concierge model, while larger subspecialty providers will form large group practices with a private eq- uity model. ese types of entities will allow private practice models to be much more attractive to future physicians than the salary model and will have prospects for future growth and also provide the personal satisfaction of having a significant role in decision-making moving for- ward. Obviously, other private practice models will continue to evolve and will allow the best practices to be competitive as healthcare evolves further away from the hospital-based practices to advanced outpatient care … all of which will be healthy for some form of private practice. Alok Sharan, MD. Spine surgeon at NJ Spine and Wellness (East Brunswick, N.J.): To date there has been a swing toward physicians becoming employed by hospitals. Initially, joining an academic medi- Average ASC case mix by specialty: 2022 By Patsy Newitt O n average, gastroenterology makes up 32 percent of an ASC's case mix, according to VMG Health's "Multi-Specialty ASC Benchmarking Study" for 2022. Here's the average ASC case mix by specialty: • Gastroenterology: 32 percent • Ophthalmology: 26 percent • Pain management: 22 percent • Orthopedics: 21 percent • Otolaryngology: 11 percent • General surgery: 9 percent • Urology: 8 percent • Oral surgery: 8 percent • Gynecology: 7 percent • Plastic surgery: 6 percent • Podiatry: 5 percent. n

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