Retrospective Thoughts on Adapting to New Technologies
By John G. Kloss, MD
Thank you for the invitation to comment on the forces that may induce us to accept new technologies. Here is perhaps another perspective as to what that might mean from a business perspective.
Upon completion of a Hand Fellowship in Louisville, my wife and I moved to Boise, Idaho to work, live, and raise a family. I joined a long established orthopedic group as the first fellowship trained hand surgeon in Idaho. This provided a great opportunity for development. Within a few years, with the addition of other fellowship trained hand surgeons, we were able to establish a community-wide hand call, a hand therapy program, and a microvascular program including free flaps and replants.
Good things never last. The advent of wound VACs reduced the need for free flaps to the point that that program disappeared. At the same time, the practice of orthopedics changed with greater emphasis on subspecialty training. This had consequences for the practice of hand surgery in a multispecialty group with the stratification of subspecialties within orthopedics itself.
Our response (myself and my partner) to these forces was to leave our well-established multispecialty orthopedic practice to form a new independent practice limited to the treatment of the hand and upper extremity, the Idaho Hand Center. We left because of the constraints on our practice and because within the group we felt disadvantaged as hand surgeons.
At the time we made this decision I was 65 and theoretically close to retirement, but participating in the formation of the Idaho Hand Center was too great an opportunity to pass. This was one of the best decisions of my career. Starting a new practice and remaining independent required an immense amount of work including adaptation to new technologies normally managed by other people: setting up the administrative and benefits structures, finding staff, building a computer based office, establishing an electronic medical record system, learning the inner workings of coding, setting up our own therapy, etc. All this was effort well spent. The last ten years have been immensely enjoyable. The practice expanded to five hand surgeons with in-house therapy and an in-office procedure room for local cases (WALANT). We helped establish the Idaho Hand Society, bringing our own national mentors for our own annual scientific meeting. There was even the opportunity for outside involvement such as serving on the BOC of the AAOS.
Again, good things never last. The large hospital chains bought up most of our hand surgery associates, our community-wide hand call changed, and the Idaho Hand Society withered without their participation. Our former orthopedic group was acquired by a large hospital system and no longer exists as an entity. The Idaho Orthopedic Society withered with the loss of independent orthopedists.
Despite these changes and despite the pandemic, we are surviving as an independent hand practice in Idaho. The impetus for formation of the Idaho Hand Center may have been for professional/personal satisfaction, but to do so forced us to find and adapt to new technologies and continue to do so. We encourage others to maintain their independence.
John G Kloss, MD, now retired