Corporate Trends in Surgical Specialties

Concerning Trend

As I begin, know that you always have a choice: become a victim or victor. As surgeons, the ability to deliver quality care, competition for ideal patients, and appropriate payment for surgical services is under attack. Not to mention the uncertain economic times, rising cost of overhead, difficulty sourcing talent, and insurmountable student loans - many of us are realizing that we cannot do it alone. Strength in numbers is something that our national specialty organizations do exceedingly well in a way that has directly benefited myself and members across a wide range of practice models and locations. Likewise, practices are taking steps to mitigate risks and leverage resources as they begin to consolidate, both in a localized private-owned group practice model and in conjunction with private equity's buyouts and management service organizations (MSO’s). We are at a critical juncture in the world of surgical specialties where those who choose to engage, and lean in, will help to determine the path of our practice model that can exist in cooperation and harmony with the PE/MSO model. The trajectory is undeniable, yet the understanding of what is actually happening is fuzzy at best.

It is not entirely our fault as surgeons. Our high aspirations and relentless work ethic has won us the opportunity to become a “surgeon” and we thought that would be enough. Somewhere along the way, most of us have realized it takes more than actionable intelligence through highly technical procedures. It takes communication skills, leadership acumen, and emotional intelligence. And that is because what we do surgically does not happen in a bubble. It is surrounded by chaos and uncertainty and most notably flawed humans. Our teams and our patients are due a tremendous amount of grace and understanding as they are doing their best to navigate what is a changing world for us all. As for our response to chaos and uncertainty, we have the opportunity to plan not just for unforeseen challenges, but also unexpected opportunities. We are called as leaders in our dominion to have the humility to know that we do not have all the answers. Rather than elevating our importance, we must remain curious, opening our minds to new and potentially disruptive ideas.

Opinion Overload

Those “ideas” can be overwhelming as they come from unsolicited sources with unknown motivations, in a way that is difficult, if not impossible, to validate. Even prior to the current wave of consolidation, our practices have been targeted by a wide range of industries to tap into a business model that attempts to be a jack of all trades. Many of these individualized small scope companies have gained wide acceptance, leveraging new technologies and specialty services to enhance our ability to serve our patients high quality, dependable experiences. The outsourcing of critical elements of our practice does not explicitly deter from the underlying goal of delivering patient-centered care. It might be argued that a failure to introduce heightened improvement measures does the patient a disservice. Furthermore, the integration of these services does not distract from the surgeon’s clinical autonomy, in so far as the individual surgeon allows it. This clinical autonomy (patient selection, treatment planning, procedure selection, surgical techniques, medical judgment, referral and collaboration, place of service, continuum of care) and its valuable protection is at the heart of what is driving the current industry concerns.?

So that brings us to consolidation. This is not a new concept. Many industries have experienced similar tipping points where the internal and external stressors of a specific field of work have caused it to look outside of itself in a way that leads to collaboration. This joint effort can lead to new partnerships and combining of existing businesses, with or without the assistance of an outside firm (PE or non-PE). These new ventures can be positive or negative and have less to do with the nature of the business and more to do with the individuals involved. Those partnerships that are founded on common values in a way that puts the product and the customer above the bottom line profits are the ones that can be mutually beneficial to all parties involved. Amazingly, they also tend to achieve both. But just like relationships, not all of them work out.

Such is the nature of private equity. No two PE companies are alike and none share the same motivations. Like any industry, there are and will always be bad players. Those with the biggest offenses tend to make the most noise and get the most attention. This can skew our view of what can be a business model that is both patient focused and financially sustainable. Alignment of vision and agreement of boundaries allows win-win arrangements, but this doesn’t happen by accident. This takes deliberate and intentional work on both parties to seek correct terms and agreements. This means that great responsibility lies on those of us that choose to be active participants in this evolving approach to private practice. We set the path of those that will follow and that is not to be taken lightly.

Here is where you decide how you move forward. Take inventory of what is important to you, your practice, and your patients. Construct those thoughts in the form of a mission statement that states clearly who you are. Establish a vision of what that means from here moving forward. And, finally, establish values to guide your decisions moving forward. Do the work. From this you can establish what services and partnerships are worthy comrades and how they might fit into your plan. This is not about how you fit into theirs.

Ultimately we cast our vote for the future of our surgical professions by the choices we make. Ignoring the complexity of the issue and simplifying it to a matter of only good or only bad does not allow a deeper conversation of better.?I encourage you to actively engage - gather information, weigh the options, and pursue a path that holds the preservation of your surgical specialty at the forefront of its vision. This is how you control your trajectory in a world of unpredictability, not unlike the practice of a surgical specialty.