How to Choose a Practice as a Surgeon

Whether starting your first job after surgical training or moving to a new area of the country mid-career, surgeons are ultimately faced with deciding from which hospitals and surgical facilities they will seek privileges. Broad considerations include whether the facility’s services are safe and modern to provide care for your patients and how supportive the facility is to its surgeons. In this article, I will share some important points for consideration when evaluating surgical facilities.

1. Facility Accreditation and Standards

Accreditation demonstrates that the facility meets a certain level of regulated quality and safety standards, which are a reflection of the facility’s commitment to patient care. Ensure that the surgical facility is accredited by reputable organizations such as The Joint Commission (TJC) or the Accreditation Association for Ambulatory Health Care (AAAHC). Keeping up-to-date accreditation can also reflect how committed the facility is to remaining viable.

2. Surgical Team’s Expertise and Qualifications

The skills and experience of the team supporting the surgeon are crucial for successful outcomes and patient safety. Inquire about the experience of the nursing staff and surgical technicians. Are there dedicated teams for certain specialties or procedures (e.g., urology, total joint arthroplasty, etc.)? Find out the ratio of anesthesiologists to nurse anesthetists, and who typically supports the cases that you plan on doing at the facility. For example, will you be comfortable if you are the only physician in the operating room?

3. Surgeon’s Privileges and Experience

What kind of board certification, years of experience, and subspecialty expertise is needed to be credentialed at the facility? Verify that you will have the opportunity to perform the surgeries that you foresee doing at the facility. What are the pre-planning steps needed when posting a case that has never been done at the facility before? Ask other surgeons about their experience with the facility and their case volumes performed. Who gets priority for surgical scheduling? Is there block scheduling? How do add-on cases work? How does weekend scheduling work? What are turnover times? For an Ambulatory Surgical Center (ASC), which surgeons are directly invested and what percentage is their case volume?

4. Technology and Equipment

Modern surgical technology and equipment can improve surgical precision, reduce complications, and enhance patient outcomes. The building does not necessarily have to be brand new, but the facilities and equipment should reflect contemporary advancements. Does the facility use modern surgical equipment? Does the facility offer advanced imaging (MRI, CT scan)? Are minimally invasive surgical options available? Is the facility equipped for advanced endoscopy and robotic procedures? Are the sterilization protocols sufficient?

5. Safety and Outcomes Data

The surgeon should assess the facility’s performance in terms of patient safety, complication rates, and surgical success rates. The facility should be able to share with you data on admissions, discharges, readmissions, and re-operation rates on specific procedures performed at the facility. The facility should also share data on complication rates, such as infections and adverse events. What other safety protocols are the facility willing to share?

6. Costs and Billings

Surgeons should seek to understand the facility’s billing practices to ensure that the patients, and the surgeon, are being treated fairly. Is the facility transparent in the detailed costs for each procedure? Obtain data on facility fees, surgeon fees, anesthesia costs, medications, and any additional expenses. What kind of insurances are accepted (and specifically not accepted) by the facility? Confirm whether the center will be in your insurance network. What are potential out-of-pocket costs? If an ASC is looking for you to invest in them, it could be a good idea to find a local bank that offers physician loans. Tell them you want to take out a loan for an ASC buy-in. They will obtain the financials, review them, and let you know if it is a good investment, even if you do not take the loan.

7. Patient Experience

A supportive and pleasant environment can enhance the patient experience and recovery. Is the first impression of the facility clean, well-maintained, and professional? Is the facility equipped with a comfortable waiting room? Are the postoperative rooms spacious and available for a family member to sit with a patient? Are there dedicated units for specialized care (e.g., orthopedics, trauma, rehabilitation, etc.)? What protocols are in place to prioritize patient-centered care?

Final Thoughts

Every surgeon is faced with deciding where they would like to perform their surgeries. Not every surgical facility offers the same capabilities. Take the time to research and compare different facilities. Beware of facilities that are not up to date or unwilling to share their data. Performing due diligence to assess how surgical facilities can provide safe, effective, and efficient care will position you for surgical success.