Is the Private Practice Model Sustainable?

One of the growing and insistent debates among orthopedic surgeons today, according to Dr. Jack Drogt, president and CEO of Summit Orthopedics, concerns the benefits and risks of the private practice model of delivery of care versus an employee model. He notes the pressure orthopedics is under from the reimbursement standpoint. “Reimbursement is going down and expenses are going up, ” he said “So the challenge going forward is, can private practice in orthopedics continue. Is it a sustainable model?”

At present, Drogt believes there is a place for both. “Many great physicians in private practice bring a lot to the market place through the care and service that they provide, ” he says. But he also understands the benefits that can come from an employee model that integrates physicians with different specialties. “We are a single specialty group, ” he says, ” but at the Mayo Clinic, for example, all those specialties and docs are under one house. I understand that too.”

While the private practice model still dominates in orthopedics, Drogt thinks that will change. The question is to what degree. He foresees that the

economic pressure and regulatory pressures are going to drive some private practice orthopedics into the employed model.

Summit Orthopedics, of Woodbury, Minnesota, is an exemplar of the private practice model of patient care. Drogt joined Summit Orthopedics in 1987 when it was a five-man (no women yet) group practicing in St. Paul. At that time there were three orthopedic groups in the city. The second was called Landmark and the third was St. Anthony. In 1996 Summit and Landmark came together; St. Anthony dissolved as an organization, and subsequent mergers created the present organization of 25 partners and 39 physicians called Summit Orthopedics—now the largest in the Twin Cities east metropolitan area. “Everything east of the Mississippi River toward Wisconsin is what we do, ” said Drogt.

Dr. Jack DrogtAnd that is a lot. Between St. Paul and the St. Croix River border with Wisconsin lie a collection of the fastest growing communities in the state. Woodbury, where Summit Orthopedics is located, was populated by a handful of dairy farmers until the 1970’s. In 1980 the population reached 10, 000. Woodbury is now estimated to be home to over 60, 000 and is rated one of the top 10 places in the country to build a home and rear children. Summit Orthopedics grew along with Woodbury.

Drogt agrees that location has been a factor. “As the east metro has grown” he said, “so have we. Our biggest single facility is at Woodlake where we have our own office building, a two floor facility with a clinic, and spaces for physical therapy, an MR, a back program and pain management program.”

Drogt credits Summit’s growth to the public’s desire for a “one-stop shop—a demand for sub-specialization. People want to go to a doctor for just what they need. You don’t want to go to someone who does hand and foot surgery for your sore back. You want to see a back specialist. Everyone [orthopedists] is being sub-specialized now.”

Because patient’s expectations are so much higher now than they used to be, Drogt is focusing more and more on the service aspects of patient care. “The care is what you get when I operate on you, ” he says. “The service is what you get when you come to the office—are you treated right by the staff—do you have to wait long in the waiting room.” He finds that providing the service aspect is, at times, the more challenging.

Physicians are better trained now, Drogt points out, so there is more consistency in the quality of care that they are able to provide than was true in the past. What distinguishes one physician from another now is the level of service they give their patients. Drogt believes it is all about the attention to detail.

We want people to know that quality care and service are the most important things to the doctors at Summit. We aim to create an environment that is conducive to great care and exceeds their expectations in service—an experience for patients that is second to none.

Drogt referred to the McDonald’s hamburger chain that serves food that is always hot, fast and consistent, no matter where you buy it. “To do those three things right—deliver food hot, fast and consistent no matter where you go across the county—they have to do a hundred things right, ” he points out. “For us to deliver quality orthopedic care and great service that exceeds expectations there are hundreds of things we have to do right behind the scenes. It is paying attention to detail, it is putting the right people and processes in place, having the right relationships with the healthcare plans, it is understanding the needs of our patients, our referring physicians, the health care system and the payers, and delivering value.”

“I pay a lot of attention to the personal approach, ” he says, “It is a cultural thing that is developed in a group. For us to be the orthopedic surgical practice of choice I have to be the employer of choice, the place where physicians want to practice and do best what they do on a daily basis, which is caring for patients and seeking success with each one. It is establishing the culture of quality care, exemplary service at a level of cost that the market is willing to bear.”

On its web site, Summit Orthopedics not too modestly points out that the practice has been rated “Top Doctors” by Mpls- St. Paul Magazine 85 times by its peers—more than any other orthopedic group in the Twin Cities. Despite the recognition Drogt says the practice has room for improvement. For one thing, only 2 of the 39 orthopedists practicing at Summit are women. “I wish there were more, ” he says. He is encouraging his medical school-bound daughter to consider entering her father’s field.

The growth in orthopedics has been driven, in recent years, by the availability and success of replacement hips and knees, Drogt’s specialty. The demand is going up, he says, because people expect more. “We have an aging population and a growing population” he notes. While he previously did joint replacement on people in their 70’s and 80’s, he is now doing the same procedures on people in their 50’s and 60’s and is seeing more and more in their 40’s. “The people in their 40’s ask themselves, why wait until I am 60 or 70? Why not get it done now and not be uncomfortable for a decade?”

Drogt attributes the increase in the number of patients with back pain on obesity, smoking and sedentary life-style choices. “Even our children are heavier.” Drogt observes. “These place stresses on the health care system. People have a responsibility to take care of themselves.”

Drogt himself is a slim, youthful-appearing man of moderate height, wearing jeans, a black T-shirt and jacket. He loves orthopedics because of the high level of innovation in the field and the way it gives him an opportunity to make good things happen in people’s lives. He says that he could “live a life time in this field and always be learning. Every day there is a different thing to learn.”