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Voice of Industry

Surgeon Stresses that United Voices will Drive Orthopaedics Forward

While business, regulatory and political pressures have put strain on device companies, surgeons and the relationship between the two, both sides must work together for the betterment of patients and industry. That was the message conveyed to Members at this year’s Symposium by Selene G. Parekh, M.D., MBA, partner at the North Carolina Orthopaedic Clinic and Associate Professor of Orthopaedic Surgery at Duke University.

Dr. Parekh outlined certain undue burdens impacting that relationship, as well as ideas for working through them.

Drop disenfranchisement. Orthopaedics as an industry can only evolve and advance if surgeons and device companies work together to innovate.

“We have to still continue to work together even though regulations are making it harder to do so,” he said. “As we move forward in industry, we have to learn to work together much more often than before. If you look at the business of medicine and the relationship of surgeons and industry, surgeons have been involved with founding some very transformative products for a long time.”

Push political boundaries. Letting politicians and lobbyists impact change in the Washington vacuum is not in anyone’s interest. Surgeons and device companies need to find a way to unite their voices.

Dr. Parekh recommended that surgeons and companies might organize through the American Medical Association. Though it’s not specialty-specific, an argument could be made that unifying the entire physician community could carry weight.

Other options: manufactures could align with AAOS, or perhaps help surgeons pull up a chair at AdvaMed’s policy table. “We’ll get to a critical point where it gets so bad for both of us that we’re forced to work together,” said Dr. Parekh. “That’s not good for either of us. Anytime we’re reactive, it hasn’t worked well for either of us.”

Fight against physician ownership pushback. Hospital systems are increasingly showing their muscle by banning companies from selling products into the system if physicians have a stake in company ownership or investment. This problem will grow if surgeons and industry don’t voice concerns.

Dr. Parekh even suggested that it might take class action lawsuits or surgeons and industry partners decreeing that the hospital is hurting a physician’s livelihood by forcing use of inferior products.

“Unfortunately, that costs money, that costs time, and most physicians are scared to be blacklisted from hospitals,” Dr. Parekh says.

Outline reimbursement transparency. Physician reimbursement has come into focus with Open Payments (the Sunshine Act), but questions remain.

“The question becomes, are physicians going to be reimbursed on tasks or hourly reimbursement?” he says. “What’s fair market value? Is fair market value going to be dependent on your opportunity cost? Your reputation? Your volume? I don’t know the best answer, because I can make arguments against and for each. That has to be defined and standardized across industry.”

Surgeon involvement isn’t just tied to implants; they’re working in IT, venture capital firms, even health insurance to move innovation and industry forward.

To accomplish that together, “You have to be able to adapt, you have to be relevant, you have to be able to do it in the right context.”

Dr. Parekh discussed innovation and the interdependency of medicine and business in an ORTHOPRENEUR article, "Think Like an Innovator: Tips from a Surgeon Entrepreneur".