surgeons was $419,103. The mean level of relative
value units (RVUs) in which an incentive began
above the base salary was 5,562 RVUs. For those
surgeons who dedicate more than 80 percent of
their time to bariatric surgery, the mean compensation was $445,314. The mean level of RVUs at
which incentive began above the base was 6,003
RVUs. For private practice, the variation was
greater, but for private practice owners, median
income was $509,297, whereas for private practice
nonowners it was $315,652.18
In addition to income issues for bariatric surgeons in private practice, insurance company
payments often are delayed or denied, and their
requirements change and are inconsistent, which
leads to the need for more time and administrative effort. Government insurance and even some
surgical specialty society regulations have become
more challenging for the private practice surgeon.
Recently, hospitals have purchased more practices
and are, thus, in control of more patient lives. The
private practice surgeon needs to be concerned
about these issues and the diminishing referral
Survival of the bariatric
surgery private practice
Over the years, bariatric surgery has become
safer, better accepted, and more reliably performed. A large share of this work has been
achieved through the private practice community. And, today, most metabolic and bariatric
surgery cases continue to be performed in the
private practice setting.
The private practice community in bariatric
surgery has a rich past and a record of surgical
excellence. Metabolic bariatric surgery patients
have been, and continue to be, cared for extremely
well within the private practice environment. It is
important that our professional surgical societies
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2. Cummings DE, Cohen RV. Beyond BMI: The need
for new guidelines governing the use of bariatric and
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The employed surgeon: A changing professional paradigm.
JAMA Surg.2013;148( 4):323-328.
4. Kane CK. Physician practice benchmark survey. Policy
research perspectives. Updated data on physician practice
arrangements: Physician ownership drops below 50 percent.
American Medical Association, 2017. Available at: www.
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5. Frezza EE, Robinson M. Bariatric and associated operations
in private and academic practices. Obes Surg. 2004; 14( 10):1406-
6. Wittgrove AC, Clark GW, Tremblay LJ. Laparoscopic
gastric bypass, Roux-en-Y: Preliminary report of five cases.
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7. Johnson EE, Simpson AN, Harvey JB, Simpson KN. Bariatric
surgery implementation trends in the USA from 2002 to 2012.
Implement Sci. February 2016. Available at: www.ncbi.nlm.
nih.gov/pmc/articles/PMC4761154/. Accessed February 12,
8. American Society for Metabolic and Bariatric Surgery. Dr.
Edward E. Mason historical library. Available at: https://
asmbs.org/mason-library#. Accessed February 12, 2019.
9. Fobi MAL. The history of bariatric surgery: Forty years in
bariatric surgery. Bariatric Times. 2015; 12( 8): 10-12.
10. American Society for Metabolic and Bariatric Surgery.
Introduction: Private practice solution series. September
2017. Available at: https://asmbs.org/resources/introduction-private-practice-solutions-series. Accessed February 12, 2019.
11. Pratt GM, McLees B, Pories WJ. The ASBS Bariatric Surgery
Centers of Excellence program: A blueprint for quality
improvement. Surg Obes Relat Dis. 2006; 2( 5):497-503.
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