The choice between independent practice versus hospital employment is a difficult one, as each option has its own sets of pros and cons. In independent practice, physicians have greater freedom as well as greater responsibility. On the other hand, hospital employed physicians don’t have to take care of administrative staff but they’re also unable to conduct their practice and business autonomously.
Only 22 percent of residents currently plan on becoming a partner or owner in a practice, according to a Medscape Resident Salary & Debt Report 2016, down slightly from the 26 percent of residents who reported the same in 2015.
Typically, the words 'independent/solo practice' invoke images of late nights and administrative burden.
But, according to Richard Wohns, MD, JD, MBA, founder and president of Puget Sound-based NeoSpine, it doesn't have to be that way.
"A lot of neurosurgeons and orthopedic spine surgeons tend to take what comes to them," says Dr. Wohns. "They perform both brain and spine procedures. But they don't have to do both if they desire a better work-life balance. Focusing on elective spine procedures in an outpatient setting is is one way to have more control over one's life." It offers more potential control than full-spectrum neurosurgery. However, many neurosurgeons go into neurosurgery to do just that, full-spectrum brain and spine surgery.
The case for outpatient spine
Intracranial surgery accounts for approximately 20 percent of the average neurosurgeon's workload. If neurosurgeons abandon brain procedures and focus on outpatient spine surgery, with a lower percentage of inpatient spine cases, they will have greater control over their schedule, notes Dr. Wohns. The question is whether the average neurosurgeon would give up brain surgery.
Independent practice focused on outpatient spine cases allow surgeons to better define their days so they work from morning until the cutoff. They will almost never run late or have to perform surprise emergency procedures.
"Essentially, you have your evenings free," says Dr. Wohns. "You aren't working with inefficient inpatient surgical lists or being bumped or delayed in the hospital." After more than 25 years doing brain and surgery spine, Dr. Wohns now focuses only on spine surgery. Approximately 60 percent of his practice involves outpatient spine procedures.
When a neurosurgeon has an outpatient spine surgery practice, every patient goes home the same day as their surgery. The surgeon, therefore, has fewer, if any, patients to see on rounds. Surgeons who continue to perform larger spine cases requiring inpatient stays will continue to make rounds,and the outpatient portion of their workload will diminish the amount of time on rounds.
How Dr. Wohns does it
In 2001, Dr. Wohns founded NeoSpine, which includes an Accreditation Association for Ambulatory Health Care-accredited Microsurgical Spine Center. Within the first year or two of establishing NeoSpine and the ASC, Dr. Wohns began to define his own cutoff time of 5:00 p.m.
"With experience, we were able to figure out how many cases we can do, and reliably be done by 5 o'clock," he said.
Dr. Wohns typically performs five or six cases each day. He performs a mix of cervical and lumbar outpatient spine cases, and since he and his staff is familiar with these cases, it became easier to map out the day.
Since 60 percent of Dr. Wohns' workload is outpatient, while the other 40 percent is inpatient, he runs a very efficient operating room schedule in both the outpatient surgery center and in the hospital. He can perform approximately six to seven outpatient surgeries per outpatient operative day, and he can perform around six cases per inpatient operative day, shifting between two operating rooms at a hospital. Years of experience has also taught his staff what to expect from any given inpatient or outpatient procedure day. The staff in the surgery center is motivated to work efficiently to leave every day after the last case is discharged.
"Everybody in the surgery center is on the same page," he says. "Everybody wants a better work-life balance. We are motivated to be done at the same time everyday and stick to our defined hours. Nobody wants to get stuck in an inefficient hospital system."
Advice for a better work-life balance
Here are four best practices for maintaining a good work-life balance utilizing the benefits of a neurosurgery practice focused on outpatient spine surgery, according to Dr. Wohns:
1. Maximize the number of outpatient cases. When scheduling cases at an ASC, consider block scheduling to maximize ASC case volume. Do at least one full day of procedures at an ASC, and if you also perform inpatient procedures, do those on other days. Try not to mix inpatient and outpatient cases in the same day to avoid inefficiencies.
2. Standardize your cases. Perform the same types of cases in the same way so that everything about the procedure is routine and standardized. Do the cases you can reliably perform in a certain time frame. Once you and your staff are familiar with those cases, you will know how many you can do in one day.
3. Schedule cases according to type. Dr. Wohns suggests scheduling cervical cases first, followed by longer then shorter lumbar procedures.
4. Pursue varied interests. Performing a majority of cases as outpatient procedures frees up Dr. Wohns' time to pursue numerous other interests and spend time with his family.
"I have much more time to spend with my family, and also have time to work out in the gym, play tennis and do Tae Kwon Do," he says. "The weekends are much more reliably free for family, cycling, hiking, or skiing."
Dr. Wohns is a competitive tennis player and a 4th degree black belt in Tae Kwon Do. He served as medical director of the Ultima Thule Everest Expedition in 1984, and performed high altitude brain research on Mt. Everest.
"I can do all that I do only because I have a reliable schedule," he says. "Work doesn't take over my life as I can reliably limit my work to a certain number of hours in a day and a certain number of days in a week."