The Plastic Surgeonʼs Role in Multispecialty Group Practice: A Recipe for Success and Longevity

Abstract

Sir: As the authors attended the senior residents' conference this past year (2009), they were surprised that their fellow trainees did not express interest in multispecialty group practices. Although 67 percent of graduates plan to enter private practice with no further specialty training, only 9 percent planned to join a hospital or multispecialty group practice.1 The majority (76.3 percent) plan to enter solo or small plastic surgery practices. Both of the authors chose “the road less traveled” and joined multispecialty groups composed mainly of primary care physicians, but also specialists. Sixty-five percent of practicing plastic surgeons are currently in solo practice, in contrast to 26.7 percent of all physicians.2 As Zook suggests, this individualism may be correlated with plastic surgery residents' past interest in individual rather than team sports and an overall desire to “do their own thing.”3 This inclination is also in contrast to a recent trend among all physicians to seek out larger medical groups.4 Despite these findings, the authors have found plastic surgeon participation in multispecialty practice beneficial to the plastic surgeon and the specialty itself. Rohrich et al. noted that among the top reasons for career dissatisfaction influencing the decision to retire were the stress of practice and malpractice cost.2 The authors have found that multispecialty group practice can mitigate these challenges of solo or smaller practices in many ways, as follows: There is less need to seek referrals, particularly for reconstruction, because of the group's network. Advertising and marketing costs are funded by the multispecialty group and managed by a team of experts. Malpractice costs are often subsidized, or the group may be self-insured. A billing department reduces (but does not eliminate) stress and time associated with coding and correspondence with third-party payers. Physicians share medical records, increasing efficiency and decreasing time in correspondence. The plastic surgeon can avoid substantial “buy-in” costs, preventing excess early practice debt (over half of senior residents in plastic surgery estimated greater than $100,000 in existing educational debt).1 The production component of compensation is often implemented early and can be competitive with a similar solo or small group practice, at similar overhead rates, using a percentage of collections or a relative value unit–based calculation. With relative value unit–based compensation, each patient is seen as equal, with less incentive to make clinical decisions based on reimbursement. The specialty itself benefits by inclusion of plastic surgeons into the health care “team” in a tangible way, as follows: The plastic surgeon's participation raises awareness of the importance of plastic surgery as a specialty and its complementary role to other specialties in the group. The plastic surgeon is viewed as a “team player” involved in group and/or hospital activities. The plastic surgeon is viewed as useful to “the team” in an immediate, concrete way. Finally, the authors are pleasantly surprised that these benefits did not require unreasonable compromises. Specifically, the authors are invited to decide on recruitment of management and office staff, marketing, and strategic growth. The specialty can be practiced the way it should: giving maximal attention to patients; optimizing outcomes; and allowing time for research, teaching, or family. New graduates would do well to consider the multispecialty model. As the authors have found, being part of a team can be immensely satisfying and surprisingly liberating. Jeffrey R. Scott, M.D. Plastic and Reconstructive Surgery Providence Physicians Group Everett, Wash. Scott D. Imahara, M.D. Plastic and Reconstructive Surgery Palo Alto Foundation Medical Group Palo Alto Medical Foundation–Santa Cruz Santa Cruz, Calif.