Access to Physicians: 3 Major Challenges Facing ASCs

The survival and success of ASCs relies on recruiting physicians who can bring patients to the table, and having enough physicians and cases to keep ASCs profitable. But many ASCs are finding that recruiting new physicians to help the facility grow or replace exiting physicians is becoming more of a challenge. Here are three major issues identified by Rajiv Chopra, principal and CFO, for The C/N Group, impacting access to the physicians.

1. Shortage of specialists. On the macro level, there are simply not enough physicians, especially in key specialties, to meet the needs of the current patient base, let alone the additional 32 million people that will become insured under the new health reform law, Mr. Chopra says.

"If you're an ASC and you've got five orthopedic surgeons and they're all 60 years or older, access to physicians is going to be a challenge simply because you're going to have an unprecedented retirement of the boomer level specialists and it's not clear that a sufficient number of young physicians are stepping in to fill those shoes," he says.

2. Employment of physicians by hospitals. Mr. Chopra is seeing an increase in the number of hospital-employed physicians.

"That pendulum is again swinging back towards direct employment models," he says. "If you're an independent ASC relying on the 'free agents' — the orthopedic surgeon, ENT or ophthalmologist that might be part of a practice that's 1-3 individuals — you may face a challenge.

"If those physicians are getting snapped up by hospitals or retiring and their replacements are hospital-employed groups, if you're not aligned with that hospital then it's going to difficult for the ASC if that hospital tries to bring those folks to their campus or they develop or already have a competing ASC," he says.

3. Consolidation of groups. Mr. Chopra says there is a shift away from smaller physician groups and a surge in larger practices, which can create new challenges for ASCs.

"The days of the solo practitioner are going away in certain markets," he says. "You're seeing it very prevalent in areas such as orthopedics — large orthopedic practices where you have 10, 15, 20, even 50 orthopods."

Mr. Chopra says these larger practices will often create 'one-stop shops' where they have a center of excellence approach with physician offices, rehab/physical therapy, imaging and then surgery as well, which may not only remove some physicians from the market but may also challenge existing ASCs for surgical cases.

In light of these challenges, ASCs must continue focusing on fundamentals for the delivery of care to recruit and retain physicians. Physicians remain attracted to a patient-centric mindset, flexible scheduling, excellent equipment and physical plant, and high quality clinical support staff. By excelling in these areas, ASCs can counteract some of these evolving market threats.

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