Spine surgeons, look for these green flags in practices, health systems

Question: What are the green flags spine surgeons should consider when joining a practice or health system?

Joel Beckett, MD. UCLA Health/DISC Sports and Spine Center in Marina del Rey, Calif.: 

1. Strong Leadership and Clear Vision: A fundamental green flag is a well-defined leadership structure that articulates a clear and progressive vision for the future. Leadership should be transparent in their operations, demonstrate ethical integrity, and foster a culture of inclusivity and respect. Surgeons should look for systems where leaders are approachable, value staff input, and invest in their team’s professional development.

2. Commitment to Clinical Excellence: Practices emphasizing quality patient care, continuous improvement, and clinical outcomes are ideal. This includes access to the latest technology and techniques, involvement in clinical trials, and support for innovative treatment approaches. Facilities that encourage attending national and international conferences or participating in continuing education signal a dedication to staying at the forefront of medical advancements.

3. Collaborative Culture: An environment that promotes teamwork and multidisciplinary collaboration can enhance treatment outcomes and professional satisfaction. Look for practices that facilitate regular team meetings, case discussions, and peer reviews. Furthermore, explore the hierarchical culture of the surgeons within the department — will your senior partners support your growth?

4. Supportive of Research and Innovation: For those inclined toward academia, a practice that supports or actively engages in research can be a significant green flag. This includes funding opportunities, resources for trial design and implementation, support for publishing and a culture that values protected time to accomplish these endeavors.

5. Comprehensive Compensation and Benefits Package: Attractive and fair compensation, including benefits beyond salary (e.g., health insurance, retirement plans, malpractice insurance coverage), is a positive indicator. Additionally, transparent policies regarding time off, professional development allowances, and support for work-life balance reflect a system’s commitment to valuing and retaining its surgeons.

6. Positive Workplace Dynamics: The overall morale and dynamics of the current team can be very telling. Engaging with potential colleagues during the interview process and observing interactions can provide critical insights into the daily working environment. Positive staff relationships, low turnover rates, and good communication indicate a healthy workplace.

Jeffrey Carlson, MD. Orthopaedic & Spine Center (Newport News, Va.): Those practice characteristics that are most desireable will be different for every physician. Certain positions have characteristics that will be a very good gauge of each practice. If practices use every effort to make the new physician successful, you will have a good starting point. The new physician having the priority of the practice to fill their office and their surgical schedule with the new practice patients. The practice supporting the new physician with a reasonable starting salary and productivity bonus. Be careful of a practice that is adding doctors too fast to support each new physician and practices that are promising an extraordinary starting financial package, as healthcare systems and practices will taper the salary in subsequent years by what the system can collect in revenue from the surgeon’s work.  

Quentin Durward MD. CNOS (Dakota Dunes, S.D.): These are the important factors to consider when evaluating a neurosurgical/spine practice :

1. I can ramp up my practice quickly, because there is a surgeon in the group who is slowing down or retiring and whose practice I can assume.

2. The gross revenue receipts that the practice is receiving and the variation amongst the individual partners supports more than adequate income potential for me.

3. The overhead is under control and not rising, both fixed and variable, and it is substantially offset by ancillary services such as MRI, CT, and PT owned by the practice.

4. The partners have ownership in a Surgical Specialty Hospital (or ASC) commensurate with their work there, and the buy-in is included in partnership.

5. I will be immediately on a partnership track and the buy-in is supported by a strong business plan and will be financed through a bank loan arranged by the practice.

6. When I assume partnership, I will have substantial latitude to control my study leave and vacation time.

7. Ownership and income from the ancillary services and the SSH/ASC are only held and received by partners in practice, and not retired non-producing ex-partners.

Brian Fiani, DO. Mendelson Kornblum Orthopedic & Spine Specialists (West Bloomfield, Mich.): Some green flags spine surgeons should consider when joining a practice or health system include strong communication and collaboration among staff, ample access to necessary resources and equipment, opportunities for professional growth and development, positive patient feedback and reputation, and a supportive and inclusive work environment. It’s important for spine surgeons to feel valued and supported in their practice setting. 

Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: One of my fondest experiences was discussing things with potential partners, having similar training backgrounds, growing up in similar areas, or mutual friends is always a good sign. It is not a guarantee things will work out. I feel if you manage issues the same, both enjoy the job AND your families and have hobbies and interests outside of work that make you passionate, there will likely be a mutual respect for one another’s time and lives. It is when there is a feeling of you being less than, or being a resident again that things will likely not work out. You might be a junior, but you are not anyone’s gopher.

Richard Menger MD, University of South Alabama (Mobile, Ala.): The first issue is looking at the fit of the practice. Does the practice have a need and does that need match surgeon interest? Why is the practice hiring someone? If you want to focus on MIS work and the group just acquired an ASC and the current surgeons don’t push that space, that’s an excellent baseline for creating a really valuable opportunity.   

The second is that you have to look at the character of your partners. How long has everyone been there? What do people say about them? As you navigate the evolving world, a contract cannot cover every possible event, you need to trust the people you work with.

The third is that your entity (hospital, practice, academics, etc.) is positioned well within the community. You can be the world’s best-trained surgeon, but the acquisition of primary care practices is a thinly veiled mechanism for internal referrals to hospital employed surgeons. In the regional market sphere, is this entity going to win?

Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): The absolute basics of surgical necessities for a practice success are committed colleagues and administrators to the practice of complex spinal disorders. Inclusive to this list are capital budgets assigned to incoming surgeons for equipment purchase and designated time allotment in the OR. Strong intramural referral patterns from parochial specialties including occupational medicine and relationships with state insurance funds being present. And of course, working partner approvals and support by existing members who are also dedicated to growth and education. Tacit acceptance leads to animus and failure. Financial and communal stability in an organization is an imperative as the road ahead in challenging healthcare sustenance becomes ever so apparent.