Staff Surgeon Hardin Memorial Health Changes in General Surgery Private Practice since the Affordable Care Act: For Better or For Worse? David Crain, M.D. FACS General Surgeon Staff Surgeon Hardin Memorial Health

Hardin Memorial Hospital Elizabethtown, KY Introduce myself and tell how long in practice and the scope of my practice…insert story about Richard Schwartz here.

Faculty Disclosure Nothing to disclose.

Educational Need/ Practice Gap Gap=lack of understanding of characteristics of general surgery private practice Need=Better understand the model of general surgery private practice in the modern era

Changes in General Surgery Private Practice since the Affordable Care Act: For Better or for Worse? Objectives of presentation 1. describe how private practice surgical practice has changed in last decade. 2. Identify major characteristics of employed surgeon’s practice 3. Outline factors that surgical graduates must consider when choosing a practice.

Expected Outcome Become familiar with the characteristics of a private practice general surgery group and become more equipped to choose the proper practice post graduation.

Changes in General Surgery Private Practice since the Affordable Care Act: For Better or for Worse? Life before the Affordable Care Act “only game in town” Physician owned practice Physician owned building Physician owned surgical center, endoscopy center, etc. My practice set in a town of 40k people, only one hospital, only one surgical group

Changes in General Surgery Private Practice since the Affordable Care Act: For Better or for Worse? Life before the Affordable Care Act Business meetings monthly Negotiations with insurance companies Recruitment meant “buying in” to intangible and tangible assets Compensation was “eat what you kill” “profit sharing plan” Talk about HR issues, inability to recruit as uncertainty in market and hospital offered a larger guarantee…conpensation: more senior partners would “shift” cases to junior partners

Changes in General Surgery Private Practice since the Affordable Care Act: For Better or for Worse? Recall talk at Ky Chapter…initial impulse was “panic”….the world as we know it will come to an end…”the resistance to change is painful, not change….”

Changes in General Surgery Private Practice since the Affordable Care Act: For Better or for Worse? “I didn’t go to Med School to have a ‘boss’” “paper charting is faster, will never be able to see enough patients with EHR” “the first contract is the best, the second one is terrible”… Resistance to change….loss of autonomy…. Todd Marion story

Changes in General Surgery Private Practice since the Affordable Care Act: For Better or for Worse? After the fall out..how is life now? Positive benefits of being an employed physician: - no need to stress over SGR/ CMS reimbursement -hospital provides and maintains EHR -salary is predictable for time during contract -HR issues dealt with by employer -no pressure for “write-offs”, prof. courtesy

After the fall out..how is life now? Positive benefits of being an employed physician: -recruitment of partners done by employer -reimbursed based on productivity: wRVU’s -paid time off (attend meetings, etc) More time with family/ less entertaining potential partners…..every trip to the E/R is reimbursed

After the fall out..how is life now? Negatives of being an employed physician: Loss of autonomy…”yes Sir”… Expected to participate on “committees” Uncertainty looms over “next contract” Loss of “leverage” when negotiating compensation Can be reprimanded for being critical of employer “pressure” to settle malpractice lawsuits Humility surfaces…employer feels like if they pay your malpractice, they should have a say in “settlement”

Which practice is right for me? How to choose the right practice: -geographical location -larger city, more competition and perhaps lower compensation? -significant other’s happiness -presence of subspecialists in market -work out of several hospitals

Which Practice is Right for Me? How to Choose the Right Practice Entrepeneur or just want to practice surgery Ability to accept having a “boss”

Summary Times are always changing/ be flexible Life isn’t so bad after the Affordable Care Act “Happy People are Happy Wherever They Are” Pendulum swings both ways…