Physicians' biggest opportunities for growth

From declining reimbursements to increasing practice costs, the current healthcare landscape has made it difficult for many physicians to thrive, but some healthcare leaders say there are distinct opportunities for physicians to prosper in the next five years. 

Nine physicians joined Becker's ASC Review to discuss some of the biggest opportunities for physicians. 

Editor's note: These responses were edited lightly for clarity and brevity. 

Question: What's the biggest opportunity for growth for physicians in the next 5 years? 

Andrew Kaplan, MD. Director of electrophysiology and clinical research at Southwest Cardiovascular Associates (Mesa, Ariz.): Physicians should focus on value-based care initiatives, orient toward collaborative relationships with patients, be driven by guideline-directed medical therapy and shift services to the outpatient environment through reliance on ASCs and office-based Centers of Excellence. Those that can capture technical revenue traditionally going to the hospitals will have the capital to offer broad-based services and attract patients and new providers into their practices.

Carl Dettwiler, MD. Gastroenterology Specialist at Clearwater Gastroenterology and Gem State Endoscopy (Lewiston, Idaho): Establishing physician-owned practices with or without ASCs in the medium-to-smaller communities that are very underserved. We have a severe physician shortage in the U.S. Physicians in underserved areas should do quite well.  Physician-owned practices have more freedom and flexibility and can adjust practice faster to meet changing needs than can any hospital-owned practice or private equity-owned practice. In gastroenterology, we usually make more money but have less charges than hospital-owned practices. 

H. Parker Eales. Executive Consultant in Chapel Hill, N.C.:The majority of insurance is self-insured employers. The opportunity ahead of us is to directly contract with self-insured employers and offer them real, predictable budgets and savings for effective channeling of patient volumes to specific physician enterprises. The other is to understand the enormous opportunity in providing care to self-pay patients with price transparency with no insurance burdens. The financial value of this is radically underappreciated.

David Hardin, MD. Chief of Medical Innovation at Healogic (Denver, Colo.): Given the difficulty with regulation around government and other third-party payers, the biggest opportunities for growth exist in companies that contract directly with patients and employer groups. Cash-pay surgery centers, disease-specific Centers of Excellence and direct primary care all offer improved outcomes and lower cost by removing much of the administrative cost created through the traditional third-party payer system. Companies like Crossover Health, Walmart and the Surgery Center of Oklahoma are addressing these issues. Direct primary care, in particular, has built up a large grassroots foundation through organizations like the Direct Primary Care Alliance. 

Grace Terrell, MD. Primary Care Physician at Atrium Health Wake Forest Baptist (Winston-Salem, N.C.): The biggest opportunity for growth for physicians over the next few years will be in alternative care models that integrate virtual care, home-based care, remote monitoring, point-of-care machine-learning based diagnostic capabilities and precision medicine personalization with old-fashioned physician-patient relationships built upon trust and empathy. These opportunities will require new payment models that, if engineered correctly, will free up healthcare providers from the current hamster wheels they are working on that generate burnout and destroy value.

Steve Hamilton, MD. Orthopedic Surgeon at Beacon Orthopaedics & Sports Medicine (Cincinnati, Ohio): The biggest opportunity for growth will be the shift of historical inpatient procedures to the outpatient setting. This trend has already started with total joint arthroplasties.  We performed over 2,000 outpatient total joint arthroplasties at our surgery center in 2021. The shift toward the outpatient setting will make it advantageous for orthopedic groups to consolidate. Whether choosing a traditional merger to form a "supergroup," or partnership with a private equity-backed management service organization, consolidation will allow for the vertical integration of patient care, cost synergies and improved patient outcomes.

Jason Zook, MD. Orthopedic Surgeon at EmergeOrtho (Morgantown, N.C.): Robotic-assisted technology is here to stay. Applications for different procedures will continue to evolve and allow for increasingly complex procedures to be performed with less patient morbidity and decreased surgeon fatigue due to the enabling tech such as accurate screw and cage placement. With augmented reality and predictive analytics for preoperative planning, surgeries can be done more quickly and accurately with less radiation to the surgeon.  We will likely see smaller-footprint robotics and/or navigation at a more reasonable price point make their way into the ASC realm which will provide the best of both worlds; accurate safe surgery in an outpatient lower-cost environment.

David Kalainov, MD. Orthopedic surgeon at Northwestern Medicine (Chicago): The biggest opportunity for growth of physicians over the next five years is assuming more leadership roles in hospitals and healthcare systems to navigate through the complexities of workforce shortages, declining reimbursement, rapidly evolving software/hardware technologies and increasing costs of care. Front-line providers, arguably, understand many of the pain points in providing the best of patient care at affordable costs.

Kevin Bonner, MD. Orthopedic surgeon and Director of the Jordan-Young Institute (Virginia Beach, Va.): It's clearly not profound when I say that continued transitioning of a significant percentage of arthroplasty procedures to the outpatient ASC setting is where we will see continued growth. The key is optimizing patient selection, which prioritizes safety while providing high-level, cost-effective care and patient satisfaction. Additionally, I feel there is an opportunity for orthopedic surgeons to develop nonoperative arthritis treatment clinics that provide responsible evidence-based care. Unfortunately, many of these clinics are currently being opened and marketed without any actual oversight from orthopedic or rheumatology experts. For obvious reasons, many patients are allured by nonorthopedic providers to receive "novel" treatments promising to cure arthritis pain without the need for surgery. It is important that these nonoperative options are discussed and implemented responsibly. I feel there is an opportunity for orthopedic practices to offer these types of programs.

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