Editor’s Note: This account describes a nuanced approach to providing orthopaedic care in a financially restrictive marketplace.
The final job in my career involves employing myself. I am in solo practice. The reimbursement system for health care in this country does not adequately support private orthopedic care. Each of us must adjust or adapt our practices to allow for the best care we can deliver but still “keep the lights on”.
To provide “whole person care”, to continue to be innovative, and to be true to my values, I have split my practice into two portions. The first is standard orthopedic care which often involves procedures or surgery. Standard billing is performed.
The second is concierge care for those who desire and can afford to pay cash for the services my practice offers. This incorporates an hour or more of my time, the services of an athletic trainer and a nutritionist as well as access to timely MRI or testing services as needed. As an example, when a woman aged 47 comes in with a frozen shoulder and has other complaints suggestive of perimenopause, we discuss it and do an appropriate work-up to confirm. If she has no history of breast cancer or other complex entities, I will prescribe hormone treatment along with care for her adhesive capsulitis. This treats the entire person along with her shoulder. If an MRI is necessary, my staff will set it up at an outside facility and will follow up on the results. This allows me to “close the loop” with the patient and engenders their trust. My staff and I believe in this approach. It enhances care of the whole person. Patients from around the country are seeking out my approach to care for their orthopaedic problems.
Interestingly, the skills I first learned as a nurse have played a major role in my subsequent profession as an orthopaedic surgeon. If I were to live my career over again, I would not change anything.