Alejandro Fernandez has spent roughly three decades building the business machinery around physician specialties — gastroenterology first, then dermatology, and now orthopedics as CEO of Synergy Orthopedic Specialists in San Diego. Along the way, he developed a shorthand for how they differ.
“GI, I think of them as plumbers, and orthopedics, I think of them as our carpenters, just in the way that they go into their passion,” Mr. Fernandez said during an episode of the “Becker’s Healthcare Podcast.”
The metaphor carries a serious operating thesis underneath it. Across GI, dermatology and orthopedics, Mr. Fernandez has run the same play: build physician-owned ancillary infrastructure around the core clinical service and keep the economics inside the practice. What changes is the specialty. The model does not.
He learned it in gastroenterology. As CEO of Gastro Health, Mr. Fernandez said he helped grow the group into the first GI platform north of $100 million in business, assembling surgery centers, anesthesia and even a pharmacy around the screening colonoscopy franchise.
“We literally own the overall program and the integrated delivery around screening colonoscopy in our marketplace,” he said.
That is the template he is now applying at Synergy, an independent, physician-led musculoskeletal group with more than 60 providers. The platform pairs a surgery center with in-house anesthesia, advanced imaging, durable medical equipment and physical therapy — the same vertical-integration logic rebuilt around orthopedics and spine. The goal, Mr. Fernandez said, is an integrated MSK platform owned and governed by independent physicians.
Getting there is harder than listing the pieces. The build has meant absorbing staffing, workflow, payer and partner-governance pressures at the same time.
“The operational is brutal,” Mr. Fernandez said.
To add operational scale without surrendering the physician ownership at the center of the model, Synergy brought in a management partner, Dallas-based United Surgical Partners International.
“We wanted somebody that allowed physician ownership and clinical control, but at the same time brought in all the economics,” Mr. Fernandez said. He noted that he has been involved with many surgery centers over his career but tends to gravitate toward the physician-practice-management side of the business.
The early returns, he said, are concrete: bringing imaging in-house has reduced turnaround times, and the group has structured its anesthesia coverage to control costs while creating an ancillary revenue stream even amid a clinician shortage.
Mr. Fernandez’s operator instincts trace back to a front-desk job he took while putting himself through college, before earning a bachelor’s degree in healthcare administration and an MBA from the University of Miami in Coral Gables, Fla. He came up through the revenue side of physician practices rather than the hospital-administration track — a distinction he sees as formative.
“I really love the independence of physician practice, the entrepreneurial life that they live,” Mr. Fernandez said.
He is candid that his role is not clinical. He describes himself less as an administrator than as the person keeping a complex enterprise pointed in one direction.
“I’m more like the producer of the show or the guy that’s running the circus more than the lion tamers,” Mr. Fernandez said.
For orthopedic and spine groups weighing how far to push vertical integration, Mr. Fernandez’s cross-specialty vantage offers a reminder: the ancillary-ownership model that reshaped gastroenterology economics is not specialty-specific. The carpenters, in his telling, can build the same house the plumbers did.
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