The Modern OB/GYN: Clinician, Surgeon and Business Operator - PART 2

Second in an AIMIS series examining the clinical, economic and technological forces reshaping women’s health practice.

For generations, the professional identity of the OB/GYN has been relatively easy to define: physician, surgeon and caregiver across some of the most consequential moments in a woman’s life.

That identity remains intact. But the environment surrounding it has changed considerably.

Today’s OB/GYN is practicing in a healthcare system shaped not only by clinical outcomes, but also by reimbursement pressures, workforce shortages, consumer expectations, technology adoption, site-of-care changes and the growing importance of practice economics.

As a result, another role is increasingly being added to the traditional definition of the OB/GYN: business operator.

That does not mean physicians must become MBAs. It does mean that understanding how a practice functions economically is becoming increasingly important to the ability to deliver high-quality care.

Clinical Excellence Is No Longer the Only Variable

The traditional assumption was straightforward: build a strong clinical reputation, provide excellent care and the practice would follow.

Clinical excellence remains foundational. But increasingly, it exists within a much more complex operating environment.

·       Which services should remain in the hospital and which can migrate to an ambulatory or office setting.

·       Whether new technologies improve clinical outcomes, practice efficiency—or both.

·       How to create the appropriate balance between obstetrics, gynecology and surgery.

·       How to respond to declining or changing reimbursement.

·       Whether ancillary services make strategic sense.

·       How advanced practice providers should be integrated into the care model.

·       How the practice communicates value to increasingly informed healthcare consumers.

These are business questions, but they are also clinical questions because they ultimately influence how, where and sometimes whether patients receive care.

The OB/GYN Practice Is Becoming a Portfolio

Perhaps one of the most important changes underway is the evolution from a practice built around a relatively narrow set of services to one encompassing a broader continuum of women’s health.

For many physicians, the modern practice may include some combination of obstetrics, preventive gynecology, minimally invasive surgery, contraception, fibroid and endometriosis management, menopause care, obesity and metabolic health, pelvic-floor disorders, sexual health and office-based procedures.

Not every practice will—or should—offer all of these services. The larger point is that physicians increasingly have choices regarding the type of practice they want to build.

Rather than viewing obstetrics, office gynecology and surgery as competing priorities, successful practices may increasingly view them as components of a broader women’s health platform.

Surgery Remains a Critical Part of the Equation

Any discussion about the changing business of OB/GYN must be careful not to suggest that the future lies in moving away from surgery. Quite the opposite.

Surgical expertise remains one of the defining competencies of the specialty, particularly as minimally invasive technologies continue to advance.

What may change is the role surgery plays within the economics of the overall practice.

A physician treating a patient with fibroids, endometriosis or abnormal uterine bleeding may participate in that patient’s care through diagnosis, medical management, office-based treatment, surgery and long-term follow-up.

Viewed through that lens, surgery is not an isolated episode. It is one component of an integrated clinical relationship. That distinction may become increasingly important.

The question is no longer simply: How many procedures does the physician perform? Increasingly, it may also be: How does surgical expertise fit within the broader continuum of care the practice provides?

The Economics of Time

Perhaps the scarcest resource in an OB/GYN practice is no longer technology, operating-room access or even capital. It is physician time.

The economics of a practice are therefore increasingly connected to how physician time is deployed.

The practices that answer these questions well may not simply become more profitable. They may become more sustainable.

And sustainability is becoming a significant issue in a specialty facing physician burnout, call burden and persistent workforce pressures.

·       Which activities truly require the physician?

·       Which can appropriately be supported by an advanced practice provider or another member of the care team?

·       Which administrative processes can be automated?

·       Which patient encounters benefit from telehealth?

·       Which procedures can safely and effectively migrate from the operating room to an ambulatory surgery center or office?

Technology Is Becoming a Business Decision

Technology adoption has always been part of medicine. What is different today is the pace—and breadth—of that adoption.

Robotics, artificial intelligence, digital health, advanced diagnostics, office-based procedural technologies and new therapeutics are arriving simultaneously.

Each potentially creates clinical opportunity. But every technology also creates an economic decision.

The physicians and organizations that can evaluate technology through both a clinical and operational lens will be better positioned to determine which innovations genuinely improve women’s health—and which simply add complexity.

·       Does it improve outcomes?

·       Does it make care more efficient?

·       Does it improve the patient experience?

·       Does it allow care to move to a more appropriate setting?

·       Does it create a sustainable return for the practice or health system?

Patients Are Consumers as Well as Patients

Another fundamental shift is taking place outside the examination room.

Women increasingly approach healthcare with expectations shaped by nearly every other consumer experience in their lives. They expect convenient scheduling, rapid access to information, digital communication and greater transparency.

They also have unprecedented access to information about conditions and treatments. That does not diminish the physician’s role. It may actually make the physician’s role more important. But it changes the relationship.

The modern OB/GYN practice must increasingly compete not simply on clinical reputation, but also on access, responsiveness, convenience and the overall patient experience.

Thinking Like an Operator Without Losing the Mission

There is an understandable discomfort in medicine when the words business and patient care appear too closely together. But the two do not have to be in conflict.

A financially healthy practice can invest in new technology. It can recruit and retain talented staff. It can create better patient access. It can support physician education. And it can give physicians greater autonomy over how they practice medicine.

The objective is not to commercialize the physician-patient relationship. It is to create practice models capable of sustaining that relationship. That distinction is important.

The Expanding Definition of the OB/GYN

The modern OB/GYN will continue to be what the specialty has always demanded: an exceptional clinician capable of managing complex medical and surgical conditions across a woman’s lifetime.

But increasingly, that physician may also need to understand reimbursement, technology, workflow, patient acquisition, staffing, site of care and the economics of the services being delivered.

In other words, the future OB/GYN may simultaneously be: Clinician. Surgeon. Innovator. And operator.

The practices that successfully integrate those roles may be the ones best positioned not simply to survive the changing healthcare environment—but to shape what women’s healthcare looks like next.

NEXT IN THE SERIES

Building a Sustainable OB/GYN Practice—What Has to Change?