We must engage and innovate for a reimagined orthopedic practice
Every aspect of life has been consumed by the impact of the COVID-19 pandemic. Many orthopedic surgeons have experienced reductions in surgical and clinical practices. Private practices have made difficult financial decisions to meet fixed financial obligations and maintain long-term solvency. Government subsidies, when available and if eligible, have barely helped soften the impact of lost revenue. Employed physicians in health care systems have been better protected financially, but many orthopedic surgeons have been repurposed to help care for patients with COVID-19.
Home life also has been affected in ways never experienced. Many households have every family member home for the entire day. Families have established new rhythms to work from home, educate from home, and ensure enough resources for meals and personal care. Plans for vacation, summer camp and college are put aside to manage the current challenges.
There is a sense of anxiety among us. These stressors are present in our patients who are dealing with the same uncertainty, often with fewer resources to buffer the impact of the shutdown of the United States. They have challenges with transportation, food, unemployment, mental health and delays in medical care, including access to medications. Decisions about orthopedic care, especially surgery, may be delayed or canceled, due to the need to return to employment, re-establish more normal home life or the fear of COVID-19.
Our leaders have been challenged with crisis management at a level never seen before and now are transitioning to a careful strategy for return to work. For some, preventing a practice from going into insolvency, then restarting operations and delivery of care are signs of good business acumen. For others, the transition is less likely to be financially challenging.
Orthopedic surgeons will need to transition to a “new normal,” including social distancing, depersonalized care with wearing masks and limited physical contact, use of telehealth and virtual access points to the practice. There may be fewer patients motivated to seek care, rationalized services based on revenue value, and likely a surge in consolidation of private practices or moves to an employment model. Patient care may begin to pace toward previous levels. However, anxiety over safety and socioeconomic factors will affect practice volumes for at least the next 6 to 12 months.
The overall assessment of the effectiveness of leadership will be seen in the third phase of the crisis. It will reimagine or innovate the business model to meet new parameters of patient care, value-based outcomes, revenues and the retention of key members of the practice. It will focus on new methods to reach patients, improve safety protocols and eliminate services that fail to show value.
Evolving our practice environments will make us more effective and efficient. However, our greatest asset is the quality people who define our organizations. Critical decisions regarding employment, furloughs, compensation and repurposing may have a negative impact on personnel. Effective leadership will be confirmed by the retention of talented people who witnessed the level of communication, transparency, trustworthiness and strategies of the practice.
More subtle, and perhaps more impactful, will be the sense of value the practice has on one’s individual development, engagement in critical issues, professional and personal growth opportunities, and inclusion in the process developed from the stress of the crisis to establish the foundation for the future. We will see changes that suggest while focusing on the management of urgent issues, successful leaders also find a way to focus on what is important long-term while they engage, embrace and develop the people responsible for the culture, commitment and innovation of the reimagined orthopedic practice.
Disclosure: Romeo reports he receives royalties, is on the speakers bureau, is a consultant and does contracted research for Arthrex; receives institutional grants from MLB; and receives institutional research support from Arthrex, Ossur, Smith & Nephew, ConMed Linvatec, Athletico and Wright Medical.