The practice, and business, of medicine has evolved into a world very different from when the first ambulatory surgery center opened its doors in the 1970s. The history of rich, rapid growth is now over. Growth has plateaued and many of the physicians who have carried the industry this far are preparing for retirement. If existing ASCs want a sustainable future, their leaders must turn to the next generation of physicians.
Standing in the shoes of a younger physician
Physicians completing their training and entering practice face a combination of challenges that may tarnish the appeal of joining an ASC. "With higher school loan debt and decreasing reimbursement rates I think younger surgeons are more hesitant to jump feet first into an ASC. Many young surgeons are also choosing to become employed for job security so they can support their families," says Lindsay Rinnan, director of development and physician recruitment with Regent Surgical Health.
Older physicians, whether the founders of the industry or the second tier of physicians well-versed in the industry, have already shouldered risk and reaped the reward. It becomes difficult to envision the younger physician's perspective. "Older surgeons look at the ASC industry as a place where they have a voice. Younger surgeons have a different perspective initially," says Barbara Draves, CASC, administrator of The Surgery Center in Middleburg Heights, Ohio.
Younger physicians are tentatively interested in the ASC business, but it is a maturing industry with a growing number of sophisticated players. "They don't have the benefit of past experience. It is intimidating for them," says Arvind Movva, MD, CEO of the Heartland Clinic and Regional SurgiCenter in Moline, Ill. "There isn't a handbook when you graduate from medical school."
Engaging new talent
Considering the hesitancy to enter and invest in unfamiliar territory, established ASC leaders must be willing to find ways to engage and attract this group of newly minted physicians.
Fresh from training, many physicians are eager to use newer technology and techniques. Fortunately, the ASC industry is poised to take on a number of higher acuity cases, which are driven by the latest in minimally invasive techniques. "ASCs should work to offer more specialized care for those surgeons who want to offer higher acuity cases in a lower-cost setting," says Ms. Rinnan. "Centers that are more focused and driven by specific specialties like orthopedics and spine can offer higher rates of reimbursement." Adding higher acuity cases not only drives more revenue to a center, but serves as an attractive force for the next generation of physicians.
Independent physicians have been the bread and butter of the recruitment pool for years. ASCs still serve as an excellent vehicle for young physicians seeking to begin and maintain independent practice, but practice patterns are shifting and hospital employment is on the rise.
"In the changing landscape of healthcare, I think employed physicians are becoming more attractive and accessible to surgery centers," says Ms. Rinnan.
Don't be afraid to at least begin the conversation with employed physicians. Their hospital may be looking for an avenue to high-quality, low-cost care and physicians may be open to hearing about the quicker turnover times and lower infection rates an ASC can offer. "Many health systems are looking to partner with an ASC and no longer see them as a threat, but as a vehicle to offer a more specialized form of care to their network," says Ms. Rinnan.
Just as physician practice patterns are shifting, ASCs are no longer as dependent on independence as they once were. Joint ventures are an increasingly popular partnership model. A hospital partner may play a key role in attracting new talent. It is possible for physicians to enjoy the best of both worlds: the security of a larger partner and the convenience of the ASC environment. Additionally, a hospital partner can lend a helping hand in the early stages of a physician's career. "If your ASC has a hospital partner, work with the marketing department to help build those physicians' practices," suggests Robert Carrera, president and CEO of PINNACLE III.
Given the complexity of an industry well on its way to maturity, one of the best strategies for engaging and retaining a younger surgeon is creating opportunities for mentorship. "Align a veteran surgeon with a younger surgeon in your ASC. Schedule meetings to discuss how their practice is going and answer any questions," says Dr. Movva. "Once they understand the basics, the more they will want to be involved." Mentorship can be conducted within an ASC or even through agreements with neighboring centers.
Paving the way for your ASC's future
Forging relationships with the next generation of physicians is an investment in an ASC's business and continued success. Allow physicians to become accustomed to the ASC environment; they may not invest immediately. "Be cognizant that buy-ins at profitable centers are high," says Mr. Carrera. The key is to prepare the next generation to take on investment when older physicians begin to retire, not necessarily when they still carry a high debt load.
Alternatively, ASCs can create flexible investment options. "We welcome any amount of investment. It aligns physicians' priorities with the center," says Dr. Movva. "We invite surgeons to do cases as long as they are qualified, so they can dip a toe in. It is really about getting someone in there for the first time." It is essential for ASCs to be open to whatever options younger physicians are most comfortable with. "There are also lending agencies that specialize in working with physician owned ventures," says Ms. Rinnan.
"We love our senior surgeons because they built ASCs and set the bar for quality, but the reality of it is they will wind down and retire," says Ms. Draves. Younger physicians are your next generation. For long term viability, your surgery center needs to get them and keep them coming."