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10 ASC MANAGEMENT cal center or hospital system is a great start for physicians coming out of training. Un- fortunately, many physicians become dis- gruntled along the way and get stifled by the bureaucracy of these organizations. Many physicians, and surgeons in particular, are very independent in their thinking. is leads to many physicians leaving an employed po- sition and joining a private practice, either their own practice or a group. Private practice is most suitable for physicians who are entre- preneurial in thinking. Ideally, an individual in private practice has to be creative and origi- nal with their ideas, while also willing to take risks. In addition, physicians have to enjoy the business of medicine, a topic they do not know much about. Ben Bradenham Jr., MD. Gastroenterolo- gist at Gastrointestinal Specialists (Rich- mond, Va.): e organizations that are going to attract the highest quality physicians in the future are those with cultures that do more than lip service to create a work environment that understands what it takes to be physi- cian and a parent. Specific examples include: a part-time work model (most important), flexibility at the beginning and end of the day to facilitate child care drop-off and pickup from school/day care, having a 'hard stop' at the end of the day to allow parents to know they can make it home by 6 p.m. to take Alex to her soccer game and flexibility in employ- ment track. Part-time employment opportunities have been difficult to implement in both surgi- cal fields and procedurally heavy medical specialties. As a gastroenterologist in private practice, I believe that those willing to be flex- ible in their employment models are the orga- nizations that will thrive and be the most ef- fective in attracting the next generation's best physicians. Eric Mehlberg. Anesthesiologist at Com- prehensive Pain Specialists (Golden, Colo.): e No. 1 draw for private practice has been, historically, remuneration. I am not sure that is really true any more. Going forward, as in- surers gobble up providers and hospitals gob- ble up providers, I believe the biggest attrac- tion to independent practice will be avoidance of moral hazard and autonomy. ese are the values we should be concerned about losing as medicine becomes 'Kaiserified.' Endrit Ziu, MD. Neurosurgeon in Jackson- ville, Fla.: Private practice already has sev- eral advantages compared to academic prac- tice. Private practice is more lucrative and better compensated, and the work hours are more suited to physician lifestyle. e disad- vantage is that the education of the next gen- eration is missing. Teaching is a choice and not a requirement, and many private practice physicians went into private practice because they do not enjoy the burden of educat- ing the next generation. In order to attract that physician population that has inclines to education but also likes the advantage of private practice, associating the practice with academic institutions and creating a 'privademic' situation will offer an advantage in recruiting the next generation. Hospital- based employment is a different scenario. e biggest problem in the hospital-based scenario is loss of physician autonomy. e daily practice becomes a box check that the hospital imposes on physicians. In a hospital environment, I think hospitals that are run by physicians and are more open to physi- cian autonomy will have an advantage. Jack Bert, MD. Orthopedic surgeon at Woodbury (Minn.) Bone & Joint: Private practice allows the physician to have some control of his 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. Ancillary service revenue can reflect up to 50 percent to 60 percent of a private practicing physician's income, which, unfortunately, short of gain- sharing opportunities or partial ASC owner- ship, is usually unavailable in large healthcare system-employed practice situations. Some employed physicians, however, have negoti- ated with their hospital or large healthcare system which employs them, to obtain a por- tion of the system-controlled ASCs in order to drive outpatient surgeries through their hos- pital outpatient department or privately man- aged ASCs. It is critical for the healthcare sys- tem-employed physician to understand that a negotiating tactic to increase their salary is to compare their compensation with the private practicing physicians in their community in order to increase their relative value unit re- imbursement to reflect the equivalent surgeon pay occurring in their community. Alyson Engle, MD. Assistant Professor of Anesthesiology and Pain Medicine, North- western University Feinberg School of Med- icine (Evanston, Ill.): Transparency is essen- tial to the next generation of physicians. ey desire transparency in terms of how they will be compensated, the path for promotion, con- tractual obligations and the financial health of a practice. Other primary determinants of whether they choose private practice or hos- pital systems will come down to compensa- tion and autonomy. is generation of phy- sicians seeks a better work-life balance with schedule flexibility and autonomy of how they practice clinical medicine. One of the many frustrations of hospital systems is the lack of autonomy, feeling like an employee, and lack of opportunity for higher pay despite academ- ic promotion. Private practices that offer eq- uity, partnership and promotion tracks with the opportunity for higher compensation are and will be the preferred path. Henry Backe Jr., MD. Orthopedic surgeon and partner at Orthopedic Specialty Group (Fair- field, Conn.): Practices that are well-funded and aligned with major health systems to ensure a steady and reliable flow of patients will attract the bright and well-educated young physicians. Private equity deals that make accommodations for the younger associates to generate revenue and sustain reasonable salaries will be attractive. Ancillary services and real estate opportunities that augment physician revenue are a key to hir- ing and retaining physicians. Chandoo J. Kalmat, MD. Anesthesiologist at Zona Spine and Pain (Goodyear, Ariz.): Many physicians are being absorbed by large hospital groups. Fewer physicians are inde- pendent. Physicians in training should speak to their program directors to see if they can shadow private practice physicians. e free- dom of creating your own schedule and hav- ing staff answer to you and being your own boss has much value. Joe Greene, MD. Co-founder of Louisville (Ky.) Hip and Knee Institute: Ownership is primary. e next-generation physicians have now seen the pros and cons of hospital em- ployment. Many see that the lack of control from an office and clinical setting negatively affects patient care. e ability to control their own protocols and office efficiency has driven many of the training physicians I work with to want to have their own practices. Paramount to the success of those private practices is ASC ownership. ASC ownership has financial gains in itself but also enables a much more productive and happy work experience. Elisabeth Lernhardt, MD. Internal Medi- cine Specialist in Penn Valley, Calif.: I can tell you what attracted me to the practice of medicine was a fascination with the function of the human body and how to fix it. Due to vast improvements in science, we are even more in control of our health today. But as a physician, I am no longer in control of my profession and my daily work. We have be- come clerks for the insurance industry and the government. Total control has stifled the creative and compassionate side of the profes- sion. Naveen Reddy, MD. Gastroenterologist at Palm Beach GI (Jupiter, Fla.): e autono- my to shape their practice should be the No. 1 driver of any physician wanting to go into private practice. Private equity offers a big upfront payment when you sell your practice,