For 44 years, Wichita Surgical Specialists has weathered a lot of change.
The area’s largest group of surgeons – and one of the nation’s largest independent surgical groups – has remained intact despite a health care industry structure susceptible to change brought about by Washington politics and new payor — i.e., insurance companies — policies.
At no time is that more evident than now, as a massive federal health law is slowly being implemented, creating a level of uncertainty in the industry as to whether it’s better for providers to create large alliances through acquisitions or mergers with other providers or hospitals in order to meet the law’s definition of something called Accountable Care Organizations.
But at Wichita Surgical, the intent is to continue to remain an independent organization of surgeons, said Alex Ammar, a vascular surgeon and chief executive of the group of 31 surgeons who practice in 14 specialties, including burn surgery, pediatric surgery and neurological surgery.
To lose their independence to an organization not controlled by physicians would prevent them from doing what they think is in the best interests of their patients. It’s that philosophy of putting the patient at the forefront of what they do that has enabled the firm to prosper and grow, said Ammar and other surgeons in the group.
The practice was started in 1967 by surgeons George and Jim Farha and called Wichita Surgical Group. Until 1995 it was a private practice owned by the Farhas — who are brothers — and surgeon David Street.
That year the three men opened ownership of the group to all its surgeons, who until then were employees of Wichita Surgical Group. With the ownership change came a slightly altered name, Wichita Surgical Specialists.
A little more than a year later, Mid-Kansas Ear, Nose & Throat Associates merged with WSS, becoming a separate division of the surgical group.
WSS operates six locations in Wichita, while Mid-Kansas operates two.
WSS also has three “subdivisions”: Breast Care Specialists, Vein Care Specialists and its newest, Plastic Surgical Specialists. The group has 85 full- and part-time employees.
Ammar said the group operates on the principles of the three A’s: availability, affability and ability.
“That’s how you build a practice,” said Ammar, who grew up in Virginia and has been with the group for 29 years.
Last year, the group saw 28,000 patients. It would not disclose annual revenue, but Ammar said, “We are as financially viable as we have ever been.”
Ammar said the group’s biggest challenges are the implementation of electronic health records — “We’re on the computer instead of paying attention to the patients” — competing for new surgeons with hospitals that he said are willing to “overpay” them, and the unknowns of the new federal health care law.
As a way to be able to react to the changed law, Ammar said, WSS has organized the Specialty Independent Practice Association, comprising 125 specialists that “we put together to be able to respond to the new health care reform.”
Size and influence
WSS’ biggest defense — and offense — to a changing business landscape is its size.
“Because we are a big group we have more resources, and we can handle the changes,” whether it be health reform or the cost of buying new technology, said Kari Clark, WSS administrator since 1997.
Ammar said being a large group also gives it more clout when it comes to legislative, business or community health issues. Local and state officials said the group has effectively used its size to lobby.
The group, said Medical Society of Sedgwick County executive director Jon Rosell, has a lot of influence on the local medical community. He said that influence is most visible as a patient advocate.
“WSS has a long legacy … as it relates to patient care, improving patient care, making sure patient care comes first,” Rosell said.
One of the group’s heart surgeons, Thomas Estep, will begin a yearlong stint as MSSC president in January.
At the state level, “it’s been a group that’s been very much involved,” said Jerry Slaughter, executive director of the Kansas Medical Society. “A number of (WSS surgeons) have served time and again on various committees and task forces.”
Slaughter said that level of involvement extends back to its founders, George and Jim Farha. A large physician group typically will be involved in organizations such as his because there are more physicians available to volunteer, he said. But there’s no real requirement that they volunteer their physicians’ time and resources.
“There was a time when they were the largest, independent free-standing group of surgeons in the country,” Slaughter said. “I think that’s a credit to its founders and current leadership.
“In everything going on in health care … it’s tough to keep groups like that together. It’s a credit to any group that can stay together.”
As important as the group is to its professional associations, so too is its involvement in the University of Kansas School of Medicine-Wichita. George Farha was a strong advocate for establishing a Wichita branch of the medical school in 1974, and was its first head of the department of surgery.
Today, nearly all of the group’s surgeons have teaching appointments at the school. Ammar is chairman of the school’s surgery department.
While it’s always been a large group by the standards of the different eras in which it has operated, WSS has not always been the size it is today.
Heart surgeon Douglas Milfeld was the 10th surgeon to join the group, in 1979. A St. Louis native, Milfeld had done his undergraduate, medical school and residency at Baylor University in Texas. He had a job lined up at Baylor’s campus in Houston after he completed his residency.
But at the recommendation of a fellow surgical resident at Baylor, he contacted Wichita Surgical, which was looking for a heart surgeon.
When he came to Wichita to interview, “They treated me like a first-round draft pick,” Milfeld said.
Most importantly, he said, they requested that his wife come up to the interview, too.
“Their premise was if your wife isn’t going to like it, you’re not going to like it.”
Milfeld said it was a combination of those and other factors — the opportunity to teach surgical residents, to have time with his family, to work in an environment where staff and surgeons get along and support each other, and to work at a practice that embraces new technology and surgical techniques — that has kept him at the only practice he’s ever known.
One thing that Milfeld said underscores the culture of Wichita Surgical was when he was ill two years ago and couldn’t work.
“They do everything they can to help you through that so it doesn’t become a financial hardship,” he said.
Ammar and Clark said the group works hard at recruiting surgeons that are looking to stay for the long term. It doesn’t always work.
Sometimes they leave because their spouses want to live someplace other than Wichita. And some surgeons are, as Milfeld said, lone wolves.
“We have had turnover, but not anything like other groups do,” Milfeld said.
Vanessa Voge is the group’s newest surgeon. She’s also heads its new plastic surgery subdivision.
A Wichita native, Voge joined the group in October. She said she was recruited by them even though it didn’t have a plastic surgery practice. With Voge it now does.
“It came down to I like the group, what they do and what they believe in,” she said, “especially working with breast cancer patients.”
Its size and tenure were equally attractive to Voge, who said she had opportunities to work elsewhere inside and outside of Wichita.
“Since it’s a large group, sometimes having more numbers is being able to have a larger voice in the health care community,” she said. “And definitely stability of the group was a big component, especially one that’s been so sound.”