Hospital vs Surgery Center - Why More Podiatrists Should Consider Using the Hospital for their Surgical Practice....
For the past three years, Tuesdays have served as my favorite day of the week. Full day block time in the operating room at my local hospital where I have the pleasure and good fortune of serving as Surgery Department Chairman and Chief of Surgery of the largest hospital in Southwest Louisiana. The coveted ‘Doctor’s Lounge’ for years at my hospital has served as a safe space to openly discuss topics without fear or judgement from non-physician staff members.
Every Tuesday morning, orthopedic surgeons, general surgeons, cardiothoracic surgeons, neurosurgeons, anesthesiologists, my wife (also a podiatrist with block time), and I gather in the Doctor’s Lounge briefly before starting our busy day. We discuss a variety of topics including recent vacations, children, EMR pitfalls, and LSU football to name a few. The camaraderie that has developed over the years with these individuals has led me to the distinct conclusion: No one cares about those initials behind your name! Whether it’s MD, DO, DPM; when we are all in that room together, we are all the same. Any doctor or surgeon who is critical of me because of the initials behind my name says much more about that person and the insecurities they are dealing with, than me and my abilities to help my patients.
So why do I prefer a hospital vs a surgery center? The answer is simple. Unless you are an Ambulatory Surgery Center (ASC) majority owner or minority owner receiving significant Return on Investment (ROI) from surgery center buy-in shares OR employed by a podiatry/orthopedic/multi-specialty group with a vested interest in a particular ASC; operating at a hospital offers more advantages to your practice than that of a surgery center. Here’s why:
From the time I step out of my car and walk to the first patient’s room in day surgery to identify and sign consent forms, I have seen, waved, or been greeted by at least 25 people. As I continue to the dressing room, doctor’s lounge, operating room, PACU, that number has at least doubled. After performing 5-8 surgeries every Tuesday and eating lunch in the doctor’s dining room, by the end of the day I have seen, waved, or been greeted by 75+ people. And that is not including making rounds on the floors for inpatients. Making a concerted effort to learn everyone’s name goes a long way and I do mean everyone! This includes day surgery nurses, PACU nurses, OR circulating nurses, surgery director and front desk staff, scrub nurses, OR assistants, CRNAs, anesthesiologists, scrub technicians, physical therapists, surgeons, and physician assistants. My visibility and availability through time spent at the hospital, talking with other physicians, staff members, and administration surely played a large role in the opportunity I received to serve as Chief of Surgery. I know for certain this would not have been possible if I spent most of my time in the local surgery center.
We are fortunate to see and treat many patients that are employees at our local hospital. Whether it be referrals from other physicians/surgeons, word of mouth, or direct interaction with myself or my wife; our availability and visibility has led to a significant increase in employee referrals. I don’t believe this to be a coincidence. I have seen more hospital employees these past two weeks as patients than I ever did while working out of a surgery center earlier in my career. Not to mention all of the referrals we receive from physicians, nurse practitioners, and wound care nurses we have met along the way. It is much easier to work with a physician you know well and one who is readily accessible through text or call than a physician whom you have not met or see on occasion. Primary care physicians continue to be a large referral source for podiatric physicians and they rarely hang out at surgery centers!
I hear and read podiatrists frequently commenting on my different social media platforms “How did you get the hospital to approve that implant?” or “My hospital won’t stock this skin graft substitute”. My question in return is simple: what have you done for your hospital to buy or approve those items? Believe me when I tell you, hospitals want our business. I will say it again for those that didn’t read this correctly the first time, HOSPITALS WANT OUR BUSINESS! Bring 15 surgery cases to your hospital consistently for two or three months, and revisit that graft or implant you wanted to use and I promise the hospital may sing you a different tune.
For practical purposes, the costs of a bone anchor, a few cannulated mini or small fragment screws/locking plates or amniotic membrane products pales in cost in comparison to the custom total knee implant from a 3D reconstructed CT scan that the orthopod is using in the OR next door. The only time I have been told I cannot use a certain implant has been, you guessed it, at a surgery center.
The Downside is Small
Does the hospital present its own problems and pitfalls? Of course it does! Longer turn over times, cases getting bumped for emergencies on occasion, less than punctual start times, higher costs for patients with high deductibles, more complicated electronic medical documentation, etc. However, despite all the negative marks against operating at a hospital, I do believe the positives vastly outweigh the negatives.
I have had the extraordinary opportunity to educate nurses, CRNAs, anesthesiologists, orthopedic surgeons, cardiothoracic surgeons, hospital internists, neurosurgeons, and general surgeons as to what it is a capable, board-certified, three-year residency trained podiatric surgeon has to offer patients and the value we serve in the medical community. More importantly, my wife and I have developed relationships with other specialties to help our patients in need. I have performed joint cases with orthopedic surgeons to manage polytraumas with significant upper and lower extremity injuries. We have teamed with general surgery and vascular surgery for skin grafts and full thickness flap harvests for lower extremity, non-healing wounds.
The ability to educate others about this great profession and learn from other specialties by working side by side is far more compelling and far more valuable long-term for my practice than any ASC can provide in my area. And I certainly do not fault or condemn any podiatrist who prefers the confines of a surgery center. After all, ‘different strokes for different folks’ is how the old saying goes. But to those working out of an ASC with no financial ties or interest, I would ask you one simple question. How much is that surgery center giving back to you in return?