Surgeons are holding MSO and health system partners to a different standard today than in the past, putting a new premium on transparency and flexibility.
While organizations have the playbook down in the courtship phase, many fall short in their ability to protect physicians from business aspects they don’t control, leading to lost trust among physicians, according to Thomas Fondren, CEO of Tulsa-based Advanced Orthopedics of Oklahoma.
Mr. Fondren recently connected with Becker’s about how surgeons are rethinking potential partnerships with MSOs and health systems.
Note: Responses were lightly edited for clarity and length.
Question: How have the expectations of spine and orthopedic surgeons seeking a partnership with a health system or MSO evolved over the past few years?
Thomas Fondren: I think there continues to be an evolution of change when talking about partnerships. Surgeons are asking harder questions about the compensation and governance within the partnership. Current partnership compensation models are losing favor, especially to independent physicians who are accustomed to a production model, because they don’t reward the things surgeons actually control, including efficiency and patient retention. I feel there is a growing interest in models tied to cash collections or true profitability, because surgeons have realized that volume-based collections can go up while take-home pay goes down if they lose all control of clinic operations.
There’s a real premium on transparency and the ability to make change if needed. They want partners that are honest with the financials and ones who can pivot if needed. What works for one group may not work for another.
Q: In your opinion, are most organizations meeting surgeons’ expectations?
TF: Honestly, probably not. A lot of health systems and MSOs are good at the courtship — the governance seat, the “nothing changes” language — and then day-to-day, decisions get tied up in hospital committees. Many times, the decision makers don’t feel the financial pressure that the physicians do. This friction is felt almost immediately in the clinic walls.
Where I think organizations fall short most often is in compensation model transparency and in genuinely protecting physicians from the parts of the business they don’t control — payer contracting, overhead creep and corporate overhead allocation. Surgeons will tolerate a lot if they trust the model is fair and stable. What erodes trust fast is when compensation metrics change quietly, or when “partnership” starts to feel like employment with non-productive tasks.
The organizations that are getting it right tend to be the ones that keep the structure physician-led. They can focus on real clinical decision-making, compensation structures tied to something surgeons can actually influence, and governance that is meaningful to physicians and patients.
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