From New Jersey Monthly

Happier or Not? Independent Doctors Join Larger Groups

Wayne J. Guglielmo


November 03, 2017

In This Article

"If You Can Possibly Do It, Be Your Own Boss."

There's an old photograph of Francis Rombough that conveys the independent spirit of the man. Wearing lumberman's garb and leaning against a hollowed-out tree into which concrete has been poured—an old technique known as "cavity work"—he looks every bit the rugged westerner, although "Jack," as he was known to his friends and family, was a lifelong New Jerseyan.

In 1934, Rombough and his brother Alexander founded American Tree Experts, located in Montclair, New Jersey. In time, two of his sons, Richard and Ronald, joined the family business. A third son, Gary, spent summers helping out, but by college he had set his sights on another career. After earning a BS at Penn State in 1972, he was admitted to Albany Medical College, where he completed his MD degree; interested in the surgical specialties, he did his internship in general surgery at Mount Sinai Hospital and then returned to Albany for a residency in orthopedic surgery.

It was a far cry from tree work. But when he mulled over his practice options, Gary Rombough recalled a bit of wisdom from his father: "If you can possibly do it, be your own boss."

Rombough took the advice to heart. In 1981, he established a solo practice in Verona; four years later, he moved to Montclair, opening an office on the bottom level of a three-story colonial, the top two floors of which were reserved for the family's living quarters. (Married twice, he has five children.) A novice at running his own business, he turned for tips to more experienced colleagues and trade journals. His staff was minimal: two secretaries and an X-ray technician.

By 2013, after more than three decades, he was still enthusiastic about his work and eager to practice for at least another 10 years, taking him into his early 70s.

But the business was changing. Under the pressure of rising costs and radical changes ushered in by the Affordable Care Act (ACA) of 2010, President Obama's signature healthcare law, medicine was morphing into a team sport. Rombough sensed the need for a larger staff and access to newer technology. Gee, I don't know if I'm going to make it alone for another 10 years, he thought to himself.

Rombough is not alone. Nationwide, doctors increasingly are abandoning solo and small private practices to become part of larger groups. Some join doctor-run practices—either multispecialty or single specialty. Others opt for a hospital-affiliated group. Whatever the choice, the doctors gain access to the modern equipment, imaging devices, administrative support, and financial and intellectual resources needed to stay current with the changing state of healthcare.

For Rombough, the right fit was Summit Medical Group (SMG), New Jersey's largest for-profit, doctor-owned multispecialty group, with more than 350 physicians in 76 medical specialties at individual and group offices throughout the state. Upon joining SMG on May 28, 2014, Rombough had immediate access to an electronic health record (EHR) system—a new necessity to carry out provisions of the ACA—as well as a level of administrative and clinical support that a solo practitioner can only dream about.


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