Beyond Treating Patients: Non-Clinical Practice Is Viable Option for Retiring Orthopaedic Surgeons

At some point in every orthopaedic surgeon’s career, retirement is imminent. Those who are not ready for retirement or who want to continue to contribute to patient care have the option of non-clinical practice. In such settings, orthopaedic surgeons can support their practices in administrative and strategic ways. For example, in non-clinical practice, surgeons can help streamline new patients to partners by ordering advanced imaging studies, conducting laboratory studies before initial encounters, and creating standardized order sets.

For AAOS Now, Xavier A. Duralde, MD, FAAOS, emeritus physician at Peachtree Orthopedics in Atlanta, Georgia, shared his experience transitioning to non-clinical practice, the structure and requirements for his new role, and how he strategically supports his orthopaedic partners in this position. See the Sidebar at the end of the article for more recommendations about transitioning to this structure of practice.

AAOS Now: Briefly describe your career trajectory.
Dr. Duralde: I was in practice for 35 years as a shoulder surgeon, 30 years of which were with Peachtree Orthopedics. They had never had a non-clinical orthopaedist until I proposed it. I was ready for retirement financially, but I knew that I could still teach, mentor, and do some of the less desirable administrative duties for my group. I proposed a 2-day-a-week schedule to oversee onboarding of new partners, set up a quality-improvement program, standardize our outpatient total joint protocols, and scrub with junior partners as needed, among other duties.

What other tasks do you perform in a non-clinical practice?
There are innumerable time-consuming tasks that I was interested in doing. Over the last couple of years [prior to my transition], we expanded our outpatient total joint service but had not worked on standardization of care. For example, our group had quality and safety metrics to be established, reviewed, and updated periodically. I offered to establish the standardization of preoperative workups, postoperative order sets, and inclusion and exclusion criteria for outpatient arthroplasty procedures.

As I have been in a leadership position for many years, I have seen the evolution of healthcare and am interested in making sure that the group is ready for the next iteration of that-which I believe is value-based care. I worked with our chief operating officer to make sure that we set up the mechanisms necessary to be ready to compete in that arena. I also worked with several partners to finish research projects and get them submitted for publication. These are all tasks that I find interesting but are time consuming. I now have time to do them while my partners, who are busy caring for patients, appreciate the fact that I can help them in carrying these out.

How did you demonstrate your value to your group in this new role structure?
First of all, it is important for me to log my time on every task accepted or performed. When I was reviewing the literature on outpatient procedures, I maintained a reference list and the time spent reading each article.

Likewise, I logged all time spent mentoring and onboarding new partners. This included Zoom meetings as well as luncheons once they were onsite. After the first few new partners joined, the time spent on every new partner thereafter became standard. We agreed on 2 days a week for work, which varied slightly from one week to another, but I made sure not to bill more than that.

What licensure and certifications are required for non-clinical practice?
My board certification status never became an issue because I started in the office well before it was set to expire. Of course, I still attend most of the major orthopaedic meetings and lectures on a regular basis, so having enough annual CME credits for my state license was never an issue either. Liability insurance coverage was continued by the group because they wanted me to maintain my ability to operate to help young partners if necessary.

I did not have to seek a solo practitioner policy, which would have been cost prohibitive.

What is your compensation model for this type of practice?
I offered to work 2 days in the office, or 16 hours a week. We intentionally stayed below 32 hours a week so that benefits would not kick in as an added expense to the practice. The hourly rate is something to negotiate with your group, but as a general rule, medical doctors are considered to be fairly compensated at $200 to $300 per hour. The hourly rate will be less important if you have planned wisely during your practice years and if one is truly interested in staying active and contributing to orthopaedics at this stage in their career.

Daniel R. Schlatterer, DO, MS, FAAOS, is the former chairman of the orthopaedic surgery residency program and former chief of orthopaedic trauma at Wellstar Health System in Atlanta. He is a member of the AAOS Now Editorial Board.

Recommendations for transitioning to non-clinical practice

Before retiring and fully taking on non-clinical practice, orthopaedic surgeons should:

• slowly decrease operative cases so that few patients require postoperative management, including possible revision surgeries
• begin scrubbing with junior partners to establish a routine with all concerned

Surgeons considering non-clinical practice can prepare themselves for the administrative duties associated with this role by:

• volunteering on hospital committees
• assuming time-consuming tasks that others in the group lack interest or time for, such as quality and safety metrics