Spine surgeons and private equity investors have different jobs, but sometimes they come together to discuss where their interests converge.

The role of private equity in spine and orthopedics has been debated in recent years, and surgeons share what they want more from conversations with investors.

Note: Responses were lightly edited for clarity.

Question: What’s missing from spine surgeon conversations with private equity investors?

Brian Fiani, DO. Mendelson Kornblum Orthopedic & Spine Specialists (West Bloomfield, Mich.): Conversations between spine surgeons and private equity investors often overlook the intrinsic value surgeons bring to patient outcomes and business success. Key missing elements include discussions about fair compensation that reflects their expertise and the critical role they play in improving quality of care. Additionally, there’s a lack of emphasis on establishing long-term partnerships that prioritize respect for surgeons’ contributions rather than focusing solely on profit margins. Recognizing the importance of ongoing education, innovation, and collaborative decision-making could foster a more equitable and respectful relationship, ultimately benefiting both parties in the evolving healthcare landscape.

Mick Perez-Cruet, MD. Oakland University William Beaumont School of Medicine (Rochester, Mich.): Long-term expectations far beyond the initial pay out. What will be expected of surgeons who continue to bring cases to the ASC? What will be the ownership structure and who will be on the board making decisions about the ASC and how it is managed? Will surgeons feel like they have control of the ASC destiny or will private equity control it?

Lali Sekhon, MD, PhD. Spine Surgeon at Reno (Nev.) Orthopedic Center: Track records of happy groups who have done financially well over the long run and not had it affect junior partner/associate satisfaction. The reason is probably because this does not exist. Private equity has to make a profit and ideally turn things over within five years. Money advanced is often just future earnings and future associates just see the salary reductions which are inevitable without an initial pay off. Private equity doesn’t invest to lose money. Their profit has to come from somewhere — reduced physician payments over time, less staff, management fees.

Vijay Yanamadala, MD. Hartford (Conn.) HealthCare: The primary endpoint for private equity investors is return on equity. There is nothing inherently good or bad about this – investors who put in their money at risk expect a certain return to justify that risk. This is the case with bank loans and any other type of capital that flows into a business, including healthcare. The primary endpoint in healthcare has been and always has to be the quality of the care that we deliver. This is our true north star.

Unfortunately, quality is also vague. It is not always clearly defined, and this is certainly true in spine surgery. Is quality a lack of complications? Is it the appropriate selection of patients for surgery? Is it viewed through the lens of patient reported outcomes? In the absence of clear quality metrics and guidelines that serve as the north star, all too often, the goals of maximizing profits become front and center, and this may be the case whether or not private equity is in the picture. Even in large health systems, volume becomes a key metric because that drives revenue. When volume and profits overshadow quality, however, we enter a paradigm where profits are at odds with delivering high quality healthcare. This is ultimately what is missing from spine surgeons conversations with private equity. How do we simultaneously maximize profits through delivering the highest quality healthcare? How do we win by doing the right thing for each and every patient we see? How do we take a slightly longer term approach that may not immediately maximize volumes but in the long term maximizes the quality of the care we deliver, and in doing so maximizes the patients we see? How do we better translate quality of care into better profits? This is the Holy Grail of healthcare as a business.

Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): Inurement. Forfeiture of administrative oversights may have its advantages and disadvantages for most busy physician practices, but the overarching rebrand and expectation of investiture is growth and profit. These run counter distinct to the administration of medicine and healthcare as spreadsheets replace patient needs and best practice.