Same-Day Surgery Manager: Why are some surgeons returning to hospitals?

By Stephen W. Earnhart, MS
President and CEO
Earnhart & Associates
Austin, TX

As this industry continues to expand and reach new levels of acceptance and opportunities, the need for quality surgeons utilizing our programs grows with it.

I remember vividly the days of going around to the surgeons’ offices, hoping to catch them in a weak moment, and convincing them that they "need to try our surgery center for just one case."

I told them if we didn’t live up to the hype, we would leave them alone. Shock of all shocks, we are doing that again. There is a situation happening that many of you may not be aware of: Surgeons are going back to the hospitals to perform their ambulatory surgery cases!

"What?" you say. "How can this be? We are so cool!" As cool as dedicated ambulatory surgery centers (ASCs) are, "the times they are a changing." While many hospitals are joint venturing surgery centers with surgeons and continue to expand, there are some hospitals that refuse to join the party. They are holding fast to providing very efficient, cost-effective service to the end user. With so many ASCs in diverse markets across the country, posting of cases at the local hospital can be far easier than at the busy ASC.

However, the inability of hospitals to share equity with the surgeons will continue to plague them. That’s unfortunate, in a way, because many hospitals are trying to correct past mistakes and become more user-friendly. With a significant number of surgery centers boasting 25% to 200% returns on their investment, it is unlikely that the high-volume surgeon will forgo that opportunity just to post cases faster.

Chances are, these big cutters will migrate and develop their own center before they go back. But to the newer surgeons without cash to invest and/or not enough cases to be attractive to the for-profit sector, they are finding comfort in the not-for-profit hospital sector. And they are finding a kinder, gentler hospital in which to work.

Several hospitals are changing rapidly the way they conduct themselves with their surgeons. Many are adopting the lifestyle of the for-profit sector without the sharing of revenue with their surgeons. "Attention to detail" is the new war cry of the not-for-profit hospital industry. Changing personnel, benchmarking, throwing out antiquated thinking and concepts, thinking before acting, listening to what works, exploring other options, lowering their egos — these actions are making hospitals a potential viable new opportunity for surgeons. Suddenly hospitals have become the new underdog, and Americans love the underdog.

The concept of a surgery center on every street corner is not as popular as it was once. What goes around comes around, and I see a curve ahead in the road. ASCs need to focus on customer service and market to the surgeons.

Time and time again, I hear the surgeons complaining to me about how their surgery center has become more difficult to work in. They say there are too many cliques or the centers are too focused on money; they are catering too much to one specialty or surgeon; turnaround time is getting longer and longer; or staff are not as receptive to changes as they once were. In an industry that is 100% dependent upon the surgeon using the facility, more attention needs to be focused on the core business and not the other "business."

What we starting doing 20-plus years ago was a good thing. It worked then, and it still does; but the paradigms are shifting. Watch what is happening in the industry. One of those changes is that hospitals are waking up and regrouping. I always have maintained one of the reasons surgery centers are so strong is because there is a robust community hospital in town. With surgical volumes increasing every year, there is ample business for both. This is just a heads up that our surgeons are always going to be looking for efficient, user-friendly environments. Don’t get too hung up on the idea that it always is going to be you.

(Editor’s note: Earnhart & Associates is an ambulatory surgery consulting firm specializing in all aspects of surgery center development and management.

Contact Earnhart at 8303 MoPac, Suite C–146. Austin, TX 78759. E-mail: Web: