STICKTOITIVENESS Ophthalmologist Lee Birchansky, MD, has finally received a certificate of need to reopen an eye surgery center.

Days after Florida's first freestanding surgical center announced it was closing its doors last month after a 43-year run, an Iowa ophthalmologist finally got state permission to reopen his freestanding center for eye surgery after a 10-year fight to obtain a certificate of need.

One door closes, one door opens. Isn't that how they say life goes?

But we celebrate both the death notice for the pioneering doctors in Florida and the birth announcement for the persevering doctor in Iowa.

In 1974, a group of 26 physicians on staff at Memorial Hospital in Hollywood, Fla., bolted the big box to build the Ambulatory Surgical Facility. It was Florida's first freestanding ambulatory surgical center, built 4 years after the nation's first ambulatory surgery center opened in Phoenix, Ariz., in 1970. Many surgeons would follow the path those docs blazed in Florida. Today there are nearly 450 ASCs in the state.

The founding group of surgeons saw the opportunity to bring efficiency to surgery. OR space to perform elective surgeries was in huge demand. Some doctors found their patients had to wait as long as 6 weeks to get elective surgery in area hospitals. It was not unusual for emergencies to bump outpatient cases.

But all good things must come to an end. Local surgeons are drawn to newer facilities, some owned by hospitals and insurers (none of that was around in 1974!). The partnership that owns the facility, comprising 40 local surgeons and a financial investor, is moving most of the cases and employees to a newer facility the partnership owns on a hospital campus.

"There's a sense of sadness, but also a realization that it had a good run," James Seymour, the center's administrator, tells the Florida Sun Sentinel. "It's time to move to a newer location."

This brings us to our Lone Wolf in Cedar Rapids, Iowa, an ophthalmologist named Lee Birchansky, MD, who doesn't know the meaning of the word quit. After applying 5 times in more than a decade for state permission to open an outpatient eye surgery center, Dr. Birchansky was finally given the go-ahead. That decision came on a 3-2 vote despite letters of opposition from five Eastern Iowa hospitals and hospital-affiliated surgery centers. It only took him 10 years to become an overnight success.

"My patients have been waiting for this day to come. They've been extremely supportive and patient throughout the years," says Dr. Birchansky.

Dr. Birchansky has tirelessly argued that certificate of need laws in 34 states stifle competition by letting hospitals and other established healthcare centers oppose upstarts. He views CON laws as government-imposed, artificial restrictions on the supply of medical care.

If success is getting off the mat one more time than you were knocked down, then Lee Birchansky can raise his hands high in victory. OSM