Why Do Spine Surgeons Choose Private Practice or Hospital Employment?

Seven spine surgeons discuss their choice to enter into private practice or hospital employment. Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. We invite all spine surgeon and specialist responses. Next week's question is: Have you seen patient volume go up or down over the past few years?

Please send responses to Laura Miller at laura@beckershealthcare.comThis e-mail address is being protected from spambots. You need JavaScript enabled to view it by Tuesday, Feb. 14 at 5pm CST.

Q: Why did you choose private practice or hospital employment?

Dennis Crandall, MD (Medical Director, Sonoran Spine Center, Mesa, Ariz.): It all comes down to the surgeon's quality of life. During my 20 years of practice, all of the hospitals in my community have changed CEOs, alliances, insurance carriers, visions of future direction and associations with other physicians both employed and independent.  To work for a hospital is to turn over autonomy in planning, patient care decisions, and other things that impact surgeons' quality of life, to an ever changing bureaucracy whose loyalty to a surgeon is directly proportional to the goals of the current hospital administration. No hospital CEO was ever hired because he was the kindest person who insisted on the best care for patients.

Ara Deukmedjian, MD (Founder, Deuk Spine Institute, Melbourne, Fla.): I was employed for three years by a hospital then started my own practice. There were many problems with my employed experience including poor billing and collecting efforts by hospital, clinical/office staffing challenges, payor contracting issues [and] inefficiency in many aspects of the practice.

J. Brian Gill, MD (Spine Surgeon, Nebraska Spine Center, Omaha): I am not employed. I enjoy the freedom that comes with being an independent physician. I have more autonomy over my practice and employees.

Michael Gleiber, MD (Founder, Michael A. Gleiber, MD, PA, Jupiter, Fla.): I enjoy the business aspect of running my practice. However, if you do not have a strong business sense and do not surround yourself with the right ancillary personnel in your office, then I believe it may be best to be employed by a hospital.

Purnendu Gupta, MD (Medical Director—Chicago Spine Center at Weiss Memorial Hospital, Associate Professor of Surgery in Orthopedics and Rehabilitation—University of Chicago): I've always been a salaried surgeon in a medical school type of environment. I have enjoyed my time there because my decisions are always patient-centered and patient-focused. In addition to that, my other mission is to teach residents and others involved in healthcare at our medical center. I enjoy this tremendously because it allows me to take care of patients with complicated spinal disorders.

Brian Subach, MD (Director of Research and Spine Surgeon, Virginia Spine Institute, Reston): I believe that my interests as a physician may not coincide with the interests of the hospital. In becoming an employee, I would lose my identity, my autonomy and my ability to make the best patient care decisions.

Michael Weiss, DO, FAOAO (Chairman of Surgery, Laser Spine Institute, Scottsdale, Ariz.): Before I was with Laser Spine Institute, I was a partner with a conventional group practice and on staff at anywhere from three to five hospitals. During my 15 years there, we also had a relationship with a surgery center. I think the allure of Laser Spine Institute was that it offered the best of both worlds: a state-of-the-art surgery center that allowed me to perform surgeries on a daily basis and see patients in the clinic — which is attached to the surgery center.

The convenience and efficiency is incredible since we do only minimally invasive outpatient spine surgery. Patients get the complete clinical evaluation of the patient at the same place they do the imaging, diagnostic testing, surgery and follow up. The process is so streamlined that it really allows you to set yourself aside from the big political machinery of the hospital. That makes it very attractive from a surgeon's perspective.

We also report lower complication rates than most hospitals. And our infection rate is .07 percent while the national hospital average is about 6 percent. That's huge when it comes to surgery.