Can the Surgicalist Model Solve OR Staffing Challenges?

A number of factors are driving doctors out of the medical field, and our country’s healthcare system is at a crossroads. There are two important things healthcare leaders can do to ensure physicians working in critical roles, such as surgeons and anesthesiologists, stay in the profession and continue providing patients the care they deserve.

First, we need to ensure our surgical departments are adequately staffed. Second, we need to rethink how we staff and manage our surgical departments, especially when it comes to on-call duties.

Thankfully, there is a solution that helps hospitals and healthcare systems address these issues in a more strategic and effective way. But before I go into that — why are we having this conversation about retaining doctors in the first place?

Where Have All the Doctors Gone?

A number of factors are impacting physician retention and patients’ access to care. One is a surge in demand: 10,000 baby boomers are turning 65 every day, which is increasing the demand for age-related services, such as orthopedic surgeries. Meanwhile, doctors are aging, and there is a shortage of medical school graduates to fill their roles. According to the Association of American Medical Colleges (AAMC), within the next 10 years there could be a shortfall of between 15,800 and 30,200 surgeons.

Additionally, our healthcare system is still feeling the impact of the COVID-19 pandemic. Not only did the pandemic leave patients with more complex healthcare needs, it left doctors feeling burned out and disillusioned. The rate of suicide among physicians is staggeringly high, and according to the American Medical Association (AMA), record numbers of doctors are leaving or planning to leave their profession at a time when we need them most.

For nearly every hospital, surgery is one of the specialties driving the most revenue. However, without a fully staffed surgical team that includes qualified surgeons, anesthesiologists, and advanced practitioners, hospitals are not able to meet patient demand for care and fill their surgical blocks. These factors are contributing to declining hospital revenues, cuts in service, and a protracted healthcare professional shortage in our country.

These pressures, along with continually expanding duties and demands, are driving doctors out of the profession. AMA experts have found that more physicians are making plans for early retirement. Of those not leaving, one third of them would like to reduce their work hours at a time when demand is rising.

How to Staff Up and Rethink On-Call Duties

When physicians are burned out by the demands of on-call duties on top of their normal administrative requirements and in-clinic hours, this leads to a reduction in the number of hours they’re able to work as time goes on. This in turn creates longer wait times for appointments or procedures, resulting in care delays and negatively impacting the patient experience.

However, there is an underutilized solution to this issue that enables hospitals to staff adequately, manage their programs effectively, and build centers of excellence while allowing doctors to live their best lives professionally and personally. It’s called the Surgicalist Model, and it’s already being used by hospitals nationwide.

Under this model, “Surgicalist” surgeons, as well as anesthesiologists and other advanced practice professionals, work pre-set shifts supporting hospital emergency on-call needs or covering full surgical departments. This specialized model gives the Surgicalist the flexibility to work 7-10 consecutive days per month, allowing for predictable blocks of time off. It also allows the private practice surgeons they are supporting to care for their patients with limited or no emergency department on-call responsibilities, eliminating care conflict. Because they have the support of Surgicalist doctors who cover on-call shifts, private practice surgeons in a hospital system or other healthcare practice can take time off, leave work at work, and return refreshed for the next day’s patients.

Surgicalists function as a clinical team (usually a team of three), all of whom are assigned coordinated shifts covering emergency department on-call needs or who support a full surgical program for emergent, elective, and inpatient consult needs. Surgicalist teams work coordinated shifts 24/7/365, with detailed handoffs. Surgicalists are independent contractors like temporary locum tenens physicians, but unlike locums, Surgicalists are dedicated to a single hospital facility. They will continually return to the same hospital for their shift, serve on committees, engage with the community at large, and work side-by-side with the hospital’s other medical staff physicians and employees as a true team member.

The Surgicalist Model can also deliver major benefits to hospitals and healthcare organizations in the form of increased surgery volume and improved patient satisfaction scores — even in difficult-to-staff areas like rural regions and certain metropolitan locations. I worked with one rural hospital system in West Virginia that employed the Surgicalist Model to establish, develop, staff, and grow an orthopedic surgery program; they reported its surgeons have achieved 90% or higher patient satisfaction and have supported a 40% increase in patient volume, allowing more patients to get the care they need locally, instead of needing to travel long distances for care.

March 25-31 is National Physicians Week, a time when we should recognize the hard work of our country’s doctors. It’s also a time for us to take action to change our healthcare system in a way that makes surgeons and anesthesiologists want to stay in the profession and provide their essential skills to the patients and facilities that desperately need them. Staffing and managing these clinicians in a way that helps all doctors live their best lives helps to improve the lives of patients, which is the ultimate goal.

Richard Makowiec, MD, MBA, is an orthopedic and hand surgeon in the greater Indianapolis area. He is also the chief surgical officer of Synergy Health Partners.