“Everything can be taken from a man but one thing: the last of human freedoms—to choose one’s attitude in any given set of circumstances, to choose one’s own way.” – Viktor Frankl, psychiatrist and Holocaust survivor
When one surgical team, led by visionary Michael Meneghini, M.D., had to stand by and watch as its program was gradually dismantled and with patient care in the balance, they decided to do the only logical thing when one feels thrown under the bus—they bought a van. (More on that later)
“I had to witness the slow erosion of our program,” said Dr. Meneghini, founder and CEO of Indiana Joint Replacement Institute, to OTW, “one that my team and I had meticulously built over the years. Administrative ‘creep’ became increasingly worse, there were dwindling resources, and more dedicated and high-quality clinical staff left every day. As we are seeing in many large healthcare systems nationwide, the right hand doesn’t know what the left hand is doing.”
“Clinical and research productivity used to be rewarded by hospitals and medical schools, but in many now there is a regression down to the mean. Our team tirelessly gave it our all, only to have what we built whittled away at. It wasn’t necessarily intentional…and the pandemic just threw fuel on the fire.”
Mass Exodus
Witnessing a parade of new administrators come through the front door as clinical staff left through the back, Dr. Meneghini—and his entire team—had seen enough. “More and more administrators and managers were being hired and this is not sustainable…in hospitals, the care providers are the revenue generators.”
Finally, it appears to be culminating in the inevitable, says Dr. Meneghini. “News and media headlines have recently reported that hospitals are cutting administrative positions—because there is a widespread nurse and doctor shortage so they can’t afford to make cuts there.”
“Although the Indiana legislature eliminated non-competes for all primary care doctors this year, surgical specialists like us are stuck with them—as is the case for all states except California and Massachusetts.”
Faced with a 50-mile, two-year non-compete, Dr. Meneghini “thought outside the hospital” and came up with a truly unique solution, essentially pulling up stakes and betting on the enduring excellence of his team.
The Indiana Joint Replacement Institute was born.
Sometimes Backwards IS Forwards
“We built a statewide hip and knee program in reverse order,” states Dr. Meneghini to OTW. “Most practices begin with a central location and then expand into new markets. We launched in two markets while abiding by my non-compete—while we are concurrently building a new facility in Indianapolis. We were able to start with an innovative hospital partner in my hometown of Terre Haute, Indiana, established a professional service agreement with Union Health, and then we bought a percentage of an ASC [ambulatory surgery center] in Fort Wayne. It is the only independent ASC in that market.”
In the Indianapolis Metro area, Dr. Meneghini learned of a unique opportunity to build a flagship hip and knee replacement focused facility. “A city just north of Indianapolis where my wife grew up, called Noblesville, was starting a project called ‘Innovation Mile’ and generously incentivized us with a land grant worth nearly $1 million for our joint replacement facility. There is a stipulation to hire a number of people as part of our agreement that will help stimulate economic development and medical technology innovation in the city.”
The Man, the Plan, the Van
Now set for their new facility’s groundbreaking in Noblesville on September 6, 2023, Dr. Meneghini is becoming the Pied Piper of devalued and disillusioned surgeons. “I am fielding calls from so many of my colleagues who are trapped in non-competes and unhappy. Many of the doctors that call me are trainees either in fellowship or residency and the other surgeons are wanting to get out of a hospital system with a non-compete. These young surgeons are looking at either hospitals or large groups or private equity backed groups and they just don’t know where to turn. A few months ago, a former partner and surgeon colleague called and said, ‘My parents and fiancée are in Naples, Florida…could you help me start a practice there?’”
The Indiana Joint Replacement Institute, a private practice focused on patient care that is supported by the latest research and education, is on the move. “We bought a Mercedes Sprinter van with Wi-Fi so that we can work, eat, and sleep en route. My entire team and I drive 1.5 hours each way to the two markets outside of my non-compete to practice. On most days we depart at 5am and arrive at 6:30am for surgery at our ASCs or hospitals.”
And there are more people hopping on the Meneghini bus. “Because I have trained so many residents and fellows through the years, I am fortunate to have a strong recruiting pipeline of talented surgeons. Our hospital partner in Terre Haute is even releasing one orthopedic surgeon from his employment contract so that he can work with us while remaining partnered with the hospital through the Professional Services Agreement.”
Freedom in Uncharted Territory
Most healthcare providers these days are not saying, “I am having a ball at work!” And then there is Team Meneghini.
“We are absolutely working very hard and sacrificing a lot, but we are having fun! We deeply value the work done by all patient caregivers and we are trying to give surgeons back their professional quality of life and autonomy. Surgeons are also appreciative of our vertically integrated care model where we have hired our own talented anesthesiologists so they can function autonomously and remain focused on what they do best.”
“It’s not about compensation for most doctors. What makes surgeons satisfied boils down to being able to independently manage patient care, feeling valued, and being treated with respect. Health systems tend to view physicians as widgets, are not transparent with financials, and micromanage doctors and other care providers.”
“There are so many downward and inflationary pressures on orthopedic surgeons, and surgeons are struggling to remain independent amidst overly restrictive hospital non-compete agreements. It is a systemic healthcare transition where high performing doctors are gradually—and often inadvertently—devalued by the healthcare system.
On the personal front, staying in his Indiana home despite the non-compete was right for Dr. Meneghini’s family. “Our four young children are happy in school, and my two older children are both in college here in Indiana. Most importantly, my wife and I are happy here in the state where we both grew up. My mother suffered a long battle with Alzheimer’s dementia, and I was able to see her frequently right up to the end of her life.”
Surgeons give patients back their lives…Michael Meneghini is giving surgeons back theirs.
