Rami E. Lutfi, MD, FACS, Chair,
ASMBS Independent Practice Committee

Published in April Issue             

1. Why was the ASMBS Independent Practice Committee formed?

Rami Lutfi, MD

Over half of our members are private practitioners or employed in community hospitals. I believe the number may be even closer to 70%. While this group of surgeons was the backbone of the society and the main force in bariatric surgery in the past, their involvement has in general faded for many reasons as the burden of maintaining a profitable practice has become more challenging.

Luckily, we have now a president who has the innovative vision and understands the importance of mobilizing these surgeons. Dr. Rosenthal thought that having a committee for these surgeons to voice and address their issues would be helpful to the entire membership and would provide important insights to ASMBS leadership. As this committee grows, we will learn from those on the front lines what is needed most and how we as a society can better serve their needs.

2. What are the challenges that private practitioners face today and how have they changed over the years?

Healthcare is changing rapidly. The challenges are many and are rapidly driving private practitioners to sell their practices to hospitals and become employees.

In our world of bariatric surgery, to have a high quality program and to be a center of excellence, a large team must be assembled. At the least, a full time dietitian, front desk person, medical assistant, special data collector (usually a nurse), maybe a physician extender (PA or NP) and a covering bariatric surgeon, all need to be employed and most will not be able to bill for their services. This overhead, in addition to malpractice insurance, which in most cases increases with the practice of bariatric surgery, makes it difficult to make a profit.

This has become worse recently especially with the often costly (but justified) MBSAQIP requirements. This forced many to align with the hospital to share the cost of the staff as well as the profit, or be completely employed by the hospital. Reimbursement is in constant decline and new insurance entities often make profit on low premiums by having very high deductibles. These high deductibles practically make the first procedure of the calendar year an out-of-pocket expense that is difficult to afford.

3. What plans does the Committee have to address these challenges?

We first plan to listen. While I described several of the issues and challenges I see, I believe members have additional issues. We plan to send a survey with an open-ended brief questionnaire to have people tell us what they think are the challenges, how they feel the ASMBS can best serve them, what they feel ASMBS is missing, and most importantly, what changes they feel are necessary to better serve their needs. Once we understand these and other points, we will form a plan.

4. What other activities are planned for the Committee this year and next?

The plans that are being discussed are at an early stage. In brief, we are planning to have a practice management course during the Spring Meeting and hope to have a more robust course geared toward running the business of bariatric surgery during ObesityWeek 2016. There are also discussions about adding social events for our surgeons to better network and discuss relevant issues in a more relaxed setting. In addition, we are hoping to have some type of town hall meeting for our private practice members with ASMBS leadership during our national meetings so they can better share concerns.

5. What is the long-term vision of the Committee?

The long-term goal is to have private practitioners gain back the momentum we once had. We want them to come to meetings, engage in committees, and become part of leadership. We also want to be able to better serve our members by understanding their issues and needs. We want to educate them and help them face the rising healthcare challenges. After all, most bariatric operations are performed in community hospitals. By helping our surgeons in the community grow and deliver better care, we are helping to achieve the goal we all have of increasing access to better bariatric service and care.