Becker's ASC Review

18 ORTHOPEDICS Employment vs. private practice: Factors influencing spine surgeons' decisions By Carly Behm S pine and orthopedic surgeons' decisions on where to practice is a consequential one whether they go to a hospital or a private group. Amid economic headwinds and workforce challenges in healthcare, the choice holds more weight than ever. Both options have many key considerations to know. Considerations for hospital employment 1. Orthopedic surgeons are paid on average more in a hospital setting compared to a single-specialty or multispecialty group, according to Physicians rive's 2023 Physician Compensation Report. Hospital employed orthopedic surgeons earned $675,000 while single-specialty group surgeons earned $650,000. Multispecialty physicians earned $663,000. 2. Hospitals will have to strategize and execute smartly in 2024 to rebound from rising expenses, according to Moody's. Stabilization is already starting, however, as revenue growth is outpacing expense growth in October, according to KaufmanHall. Discharges have also increased 5% in October, and average lengths-of-stay dipped 7%. is news bodes well for spine and orthopedic surgeons who have already leveraged outpatient surgery and minimally invasive techniques. 3. It might be harder for spine surgeons to feel connected in a hospital employed setting, according to Peter McCunniff, MD. He stepped away from a hospital to work in private practice "Despite significant efforts and extra time devoted to creating a spine program in the hospital employed set up, I found that there were still significant barriers to having a successful spine practice due to the disconnect between administration and those of us tasked with building a new spine program within a large healthcare system and also being productive spine surgeons throughout the process," he told Becker's. "Spine surgery is different from both general orthopedic surgery as well as general neurosurgery. e large healthcare systems are able to engulf practices with those broader scopes and apply basic templates that are easily adhered to within their established system with relative success, but there's more nuance involved in elective spinal surgery that those general orthopedic and neurosurgical clinic templates will set the spine surgeon up for failure." 4. Noncompete contracts in private practices, hospital partnerships or hospital employment may cause ris if surgeons want to pivot their careers. e majority of physicians — 87% polled by Doximity — support the Federal Trade Commission's proposed rule that would ban employers from imposing noncompetes. Considerations for private practice 1. ASCs are a bright spot for independent spine and orthopedic practices. Minimally invasive spine and orthopedic techniques are growing, and the technology to support it is robust. e outpatient setting also provides opportunities for specialization and increased efficiency, according to Akshat Gargya, MD. "e outlook for independent ASCs is generally favorable and promising," Dr. Gargya told Becker's. "ASCs are known for providing surgical care at a lower cost compared to hospitals, have shorter patient stays and lower overhead costs, making them a cost-effective Spine surgeon pay hits $844k By Laura Dyrda T he average orthopedic spine surgeon salary nationwide is $844,422, according to the 2022 Medical Group Management Association Compensation & Production Report. Physicians Thrive noted some orthopedic spine surgeons make much more. Surgeons on the 90th percentile make $1.4 million while those on the other end of the spectrum, the 10th percentile, make $468,787, according to MGMA. The report also noted spine surgeons earn around 7% more in multispecialty practices than single-specialty practices, and surgeons in a physician-owned facility typically make 5% more than their colleagues working at a hospital. Despite the higher pay in physician-owned practices, many spine surgeons coming out of training are opting to sign hospital contracts. The highest compensating practice location is metropolitan areas with a population of fewer than 250,000 people, where the median salary is $882,502. In more densely populated cities where the market is potentially saturated, orthopedic spine surgeons earn between $589,540 and $831,366. Spine surgeons can add to their income through a variety of ways, including ownership in a surgery center. As more spine procedures are approved for the outpatient setting, surgeons are taking action. "Considering the looming cuts in Medicare reimbursement for our services in the setting of increased expenses, we are facing significant headwinds that make the practice of medicine almost untable for surgeons, and our industry partners alike," said Peter Whang, MD, professor in the department of orthopedics and rehabilitation at Yale University School of Medicine in New Haven, Conn. "In response to these challenges, I believe that we will see an even greater shift of orthopedic and spinal procedures to the outpatient setting in an attempt by surgeons to establish more diverse income streams while providing more cost-effective care." n

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