How to improve your surgeon utilization

By Stephen W. Earnhart, MS
Earnhart & Associates
Austin, TX

Getting surgeons to operate out of your ORs shouldn’t be an issue. Surgery is up everywhere, and while 200 new surgery centers are under construction right now, there is not a glut of places where surgeons can operate.

So why is surgeon utilization an issue? Fact: Old habits are hard to break.

I work with inpatient and outpatient surgery issues — in the hospital setting as well as the freestanding ambulatory surgery center (ASC) arena.

The problem is about the same in both areas: The surgeons don’t operate where we think they should. We build surgery centers, add new operating rooms in the hospital, and buy all the expensive equipment they request, but where are they? There are exceptions (always).

You would think that after the time and expense in setting up their own ASC, they would be motivated to perform virtually all their procedures in their own shop. Au contraire! While we have some very hungry, entrepreneurial surgeon investors who are using their investment well, there still are those who drag their feet and hang on to what’s familiar.

Likewise, many hospitals have gone out of their way to ensure they keep the surgeons there by giving them what they want, such as new equipment, larger operating rooms, dedicated staff, and rapid turnover time.

After dealing with this issue for almost 17 years, I have some insight that might help you understand why, or at the very least, let you know that you are not alone in your puzzlement. Many of the surgical specialists rely heavily on referrals from others for their surgical volume.

Usually those referrals come from family practitioners and internist. Those referrers often are very loyal to the hospital and become upset when a surgeon leaves the hospital and works at a surgery center.

They think taking cases out of the hospital can hurt the bottom line of the hospital and hence cause the hospital to cut back on programs that might cut into their referrals (that come from the hospital). Thus, it often is not easy for surgeons to completely stop using the hospital for their cases.

They often will have to appease their source of cases by doing a certain amount of surgery at the local hospital.

You also have pressure on the surgeon from their own partners who, naturally, want to enhance their investment in the surgery center by having everyone do all their cases there.

Then you have the surgeons who have no interest in a surgery center at all but flip between two or three hospitals to perform their cases. Again, it usually is because of where the referrals are coming from that dictates where surgeons will do their surgery. For what it is worth, most surgeons would love to consolidate their surgical volume in one location, but that just isn’t going to happen for most of them.

Much attention is focused on ASCs; however, the bulk of surgery still is performed in the community hospital setting. The hospital managers are shaking their head in puzzlement as well.

Many senior partners in specialty groups are very loyal to the hospital and try to show it by using it as much as possible. It often is difficult for these large practices to keep everyone supporting the hospital when investment opportunities abound elsewhere.

With some surgeons going between two and three hospitals and another couple of ASCs to do their surgery, everyone loses. The hospitals are gaining momentum in capitalizing on their reputation, their referral networks, and the development of their own internal and/or external surgical programs. Getting the surgeons to use them, even after the hospitals have provided just about everything the surgeons have requested, still is a challenge.

There are ways that you can steer more cases to your location. Just asking and making the surgeons feel guilty usually isn’t enough. They need something that will justify their going against the wishes of their referrers or senior partners — something that will make it worthwhile to jeopardize that long-term relationship. Money is not always the answer.

The primary reason that surgeons will start surgery centers is because of time efficiency. If you can give them back time by being incredibly efficient in start times, turnover times, and posting time, you have a good shot at getting more of their cases. Many successful hospitals have started their own programs to do just that.

The surgeons then can go back to their referrers (the internists, family practice groups, senior partner, etc.) and tell them, "If the hospital can give me 10 minutes turnaround times, good start times, and let me post the cases in a reasonable timeframe, then I would do more work there." Those reasons alone can justify the surgeon taking his/her cases elsewhere. We need to give them a reason, excuse, and justification to break old habits.

(Editor’s note: Earnhart & Associates is an ambulatory surgery consulting firm specializing in all aspects of surgery center development and management. Do you have additional questions? Contact Earnhart at 3112 Windsor Road, Suite A-242, Austin, TX. 78703. E-mail: Web: