Healthcare is an ever-evolving field and spine surgeon leaders are beginning to step forward as experts in practice management, hospital service line management and policy making decisions in addition to the traditional research and technique development arena.
"Leadership can be manifest in a few different areas and it seems more common that the leadership is really in individual areas, not across the spectrum," says Dennis Crandall, MD, founder of Sonoran Spine Center in Mesa, Ariz. "Surgeons are either leaders in their group by virtue of a leadership position within their department or practice — those are surgeons who are excellent in developing a practice or business models — and surgeons who are leaders in areas of governmental affairs, issues and lobbying. A surgeon might also be a chairman in the academic department with leadership in research and innovation as well."
Several spine surgeons discuss the most important qualities for leaders in the future.
1. Provide good clinical quality care. Spine surgeons will not gain the respect of other surgeons until they gain the respect of their patients. They do this by making the right clinical decisions, providing good quality care and achieving great outcomes.
"One of the things surgeons are always aware of as they look at people in a leadership role is what the record of this particular doctor is in terms of quality care and patient safety," says Dr. Crandall. "They want to know whether this person has a track record of taking good care of patients or keeping patient care a first priority. Those who are very good doctors are good role models and from there you can get involved in research and leadership, business development and other areas."
Once other surgeons have confidence in your background to provide good quality care, they can go to the next level and really engage in a relationship with their peers.
"If they reach out, they will have a broad network within the specialty because people know and trust their work," says Dr. Crandall. "This should be a social network of peers and all of these relationships expand their influence. It's hard to have a lot of confidence in a leader if there isn't a sense that at his core he is a good surgeon."
Patients and referring physicians should know you'll point them in the right direction, whether that includes surgery or not. Other providers and insurance companies will start to notice when patients are satisfied, have good outcomes and return to work quickly.
"If you are doing the right thing for patients, the group's success will grow and you'll gain the attention of insurance companies and hospitals to replicate your success," says Burak M. Ozgur, MD, director of DISC Sports & Spine Center in Newport Beach, Calif. "With evolving healthcare, if you have a successful cohesive group and hospitals respect you, you'll be thrust in a position of authority and asked to comment on healthcare reform and how to translate your success to a national arena."
2. Communicate your success with others effectively. Communication is a key factor for leaders in spine surgery. This means communicating with others to provide great care and advance the field, as well as communicating your outcomes to patients, payors and referring physicians.
"You might do well clinically, but you have to communicate those things locally and nationally so people know about it," says Sheeraz Qureshi, MD, MBA, associate professor of spine surgery in the department of orthopedics and chief of spine trauma at Mount Sinai School of Medicine in New York City. "Most spine departments and practices aren't just trying to look out for their own interests, but growing with their partners and others they are working with."
For patient marketing efforts, you can communicate your patient satisfaction scores, outcomes and testimonials on practice websites or social media. Become engaged in community events and let people know how they could benefit from your services. Equally as important, communicate unique skills to referring physicians and make sure they know you will take good care of their patients.
3. Participate in groups, organizations and committees. Tomorrow's spine surgeon leaders will be those who are actively involved in different groups, organizations and committees at the local and national level today. With all the changes occurring in healthcare, it will be critically important for surgeons to participate and shape the future of the nation's healthcare.
"People who have a passion for government issues and lobbying will be looked at as being leaders in that area because of the sheer volume of work they've done that others haven't," says Dr. Crandall. "Someone who wants to be an academic leader would need to have a productive research program ongoing and be involved with innovation within the specialty, and try to be involved in leadership positions within the department or practice with hospital staff."
Participation in these groups will help you stay informed on the most important issues in healthcare and give you the opportunity to become more engaged.
"You have to stay informed, not put your head in the sand," says Andrew E. Wakefield, associate director of neurosurgery at Hartford (Conn.) Hospital. "Things are changing — nobody knows how but they will — and we need input from physicians on how changes come about. Hospitals are looking for that, and in my experience the government is as well, but you have to work for it and become an active participant. If you don't jump on the train, it will run you over."
The hardest part is often taking the plunge to become involved; once there, it's easier to network with colleagues and work with people who have similar views and ambitions.
"At times, it's very frustrating, but other times it's very rewarding because you actually see progress," says Dr. Wakefield. "In a year, you actually see changes because of your input. That's the only way to move forward; people have to pick up and do something. You have to be engaged."
4. Take risks at the right time. The most successful leaders are those who are willing to take risks and accept losses to achieve their ultimate goal. It takes a great deal of time and effort to oversee new projects, and the bigger risks taken could yield more significant rewards.
"You have to be willing to take the chance that you won't get what you want, especially if money is involved," says Dr. Wakefield.
If you are a leader at the group practice level, you'll have more flexibility to make changes quickly. If you are working with the hospital, it will take more time to shift policies and see results. If you are working with healthcare reform on a national level, it could take years to see even minute changes fall into place.
"You have to put the time in, which means giving up time for other things," says Dr. Wakefield. "This is time you need to put in, otherwise you are sitting back. If you are willing to complain about something than you should be willing to do something about it — whether that's dealing with nursing services on the floor or developing quality measures for improving patient care or engaging hospital administration to invest in new technology to do a good job for your patient."
5. Be willing to compromise. It will be necessary for leaders of the future to learn how to compromise during conflict so all stake holders see some benefit.
"See changes not only from your perspective but also from the perspective of other physicians, colleagues, payors and the public," says A. Nick Shamie, MD, Co-Director of UCLA Comprehensive Spine Center. "As a leader, you can't be self-serving. I think in order to get a good resolution you have to take into account the interest of all the parties involved and you have to encourage other parties to be honest with their interests, which requires you to be honest with your interest first."
Compromise means give-and-take from all sides. Leaders should recognize where others are willing to budge and find room to budge themselves.
"You may not get what you want when dealing with insurance companies or trying to move a policy forward at the national level, but that's the compromise," says Dr. Wakefield. "Doctors are used to having a problem, identifying the problem and solving the problem. Leadership doesn't always lend itself to this system, and it requires give-and-take. It also doesn't always happen on your time schedule."
6. Respect other surgeons and referring physicians. If you exhibit qualities to gain the respect of other surgeons and referring physicians, you will gain a reputation as a good clinician and leader within your community. This requires the surgeon to practice honest and open communication with others and display integrity at all times.
"If you don't have a basic skill set and respect from patients and other surgeons, you aren't clinically successful and you don't have any hope of being a leader," says Dr. Ozgur. "Then it comes down to being honest, trustworthy and integrity. If people know you are skillful, honest and have integrity that goes a long way in being a successful physician and leader."
Spine practice leaders should show they always keep the best interest of the group in mind. Sometimes, this could mean making an unpopular decision for the benefit of the whole group instead of caving to the whims of one surgeon.
"A lot of things happen behind the scenes, so the group needs to trust their leader is making the best decisions for the group," says Dr. Ozgur. "Surgeon leaders should have an open line of communication; lack of communication leads to so many problems in society, in the world and in business. If the communication lines are open and everyone knows the plan, they will be comfortable with the decisions. When things are hidden and people hear a rumor, that's when they start to doubt the leader."
7. Understand how the healthcare system works. If you want to become a leaders within the healthcare system — whether it's at the local hospital, group practice or among the national political leaders — you must understand how the healthcare system works. This means you must know how the decisions are made from the bottom up and the top down.
"If you want to be a leader within the current system, first you have to understand the system and then how to help the system," says Dr. Shamie. "Align yourself with other key players who will work with you toward the common goal of making healthcare delivery in the future more efficient and higher quality."
This is something that isn't taught in medical school or fellowships, so it's up to the individual surgeon to seek this education. "You can't work in a system and try to move the system in one direction or another, or have a voice in the system that helps move policy and procedures forward at the hospital or national level unless you know how the system works," says Dr. Wakefield.
8. Stay abreast of current affairs in healthcare. Authenticate your engagement by staying abreast of current affairs in healthcare. This means understanding healthcare legislation, how health systems are changing across the country and where the trends are headed in the future.
"It's difficult to be a leader if you don't have a sense of how we will be affected by healthcare changes," says Dr. Qureshi. "We have to have a good understanding of these changes and become an advocate for improving patient care. We need to make sure they have access to care. Every decision we make not only has an impact on our selves and the patients, but also on the impact of the system as a whole."
A recent issue has been which patients need additional imaging tests before surgery. These tests are costly and surgeons are encouraged to use them more sparingly these days.
"Ten or 20 years ago you were able to practice in a vacuum and say ordering a test for every patient before surgery was the best thing to do no matter what anyone else said," says Dr. Qureshi. "You can't do that now in terms of taking care of patients. We have to really understand the tests we order and treatments we recommend to avoid unnecessary costs. Having an understanding of the system-based practice is very important.
Surgeons can stay on top of these issues by reading news publications or networking with colleagues locally and nationally.
"Right now, the current issues include the relationship between physicians and hospitals, physician and industry and hospitals and industry," says Dr. Crandall. "The spine surgeon has to be familiar with all of these relationships, with the government's role in these relationships as the overlying theme."
If surgeons are able to connect these differing interests, they will become an intelligent part of the solution.
"Our need for spine surgery leaders in today's healthcare environment has never been more important and with the dawn of dramatic changes in healthcare, this will continue," says Dr. Crandall. "If spine surgery is to have a voice at the healthcare providers table, we need leaders who are good doctors, have a broad sphere of influence, confidence and an understanding of the issues over the next five years."
9. Know what technology is coming down the pipe. Leadership can also take the form of cutting-edge innovation and development of surgical technique. Surgeons who are interested in device and implant development can work with companies to improve their products and forward surgical technique.
"It's difficult to say you're a leader in spine surgery still doing the same procedure surgeons did 70 years ago," says Dr. Qureshi. "You can't be a leader and say you don't believe in minimally invasive surgery or motion preservation. As the field matured, we learned from our mistakes and we can do these procedures better. We get better results for our patients and you can't talk about these things if you haven't done them in your own practice. If you talk about something you haven't used in your practice, people who work with you won't respect you as a leader."
Even if you aren't interested in directly working with these developments, surgeon leaders should know what is happening and advocate for the solutions that work.
"You need to know what is going on from a technology standpoint because the advancement in all of surgery, but spine surgery in particular, is rapidly moving forward," says Dr. Wakefield. "You have to be well versed in what is coming down the line. You have to be involved with the hospital trying to bring technologies to the patient and practices. You also have to be involved with third party payors to use these technologies with their patients."
One of the issues surgeons run into today is showing the quality improvement from a new device or technique justifies its high cost. While healthcare reform efforts focus on both increasing clinical quality and decreasing cost, some believe the emphasis on cost cutting unfairly outweighs the potential for clinical benefits.
"They seem to focus too much on trying to control cost and the patient is being lost in the fog generated by these efforts," says Dr. Wakefield. "It's the physician and healthcare professional's responsibility to take care of the patients. Surgeons are the ones that are going to bring that to the table more than anyone else involved moving forward."
However, this doesn't necessarily mean you should jump on ever new piece of equipment. Make sure it's safe and effective first. "Don't be the guy who when someone comes into the office with something new you shut it out right away," says Dr. Qureshi. "Listen and understand the technology and if it makes sense give it a try. That's the only way you can become a leader and people will only listen to you if you've tried it."
10. Maintain a healthy academic part of your practice. Whether you practice in an academic medical center setting or not, it will be important to collect outcomes and do research in the future. Patient volume and reimbursement is increasingly dependant on collecting positive outcomes data, and cost-effectiveness data will help advance the field.
"It's important to have the clinical experience of taking care of patients, but it's also important to look back on your experience and have an academic part of your practice as well," says Dr. Qureshi. "Something simple, like studying the incidence of back pain after open surgery, can be helpful."
Most spine surgeons who perform open procedures say their patients don't have pain postoperatively, but they haven't followed-up with their patients to support these claims. Following up with those patients will give you a better understanding of their actual post-surgical state.
"Understand what is allowing your patients to do well and what your patients are having issues with," says Dr. Qureshi. "Discuss your findings with colleagues, industry members and the government to show the best way to provide long term care for patients."
More Articles on Spine Surgeons:
20 Spine Surgeons Leading Charitable Care Efforts
8 Steps for Best Results When Hiring a Spine Practice Manager
5 Factors for Spine Surgeons to Negotiate Better Payor Contracts
"Leadership can be manifest in a few different areas and it seems more common that the leadership is really in individual areas, not across the spectrum," says Dennis Crandall, MD, founder of Sonoran Spine Center in Mesa, Ariz. "Surgeons are either leaders in their group by virtue of a leadership position within their department or practice — those are surgeons who are excellent in developing a practice or business models — and surgeons who are leaders in areas of governmental affairs, issues and lobbying. A surgeon might also be a chairman in the academic department with leadership in research and innovation as well."Several spine surgeons discuss the most important qualities for leaders in the future.
1. Provide good clinical quality care. Spine surgeons will not gain the respect of other surgeons until they gain the respect of their patients. They do this by making the right clinical decisions, providing good quality care and achieving great outcomes.
"One of the things surgeons are always aware of as they look at people in a leadership role is what the record of this particular doctor is in terms of quality care and patient safety," says Dr. Crandall. "They want to know whether this person has a track record of taking good care of patients or keeping patient care a first priority. Those who are very good doctors are good role models and from there you can get involved in research and leadership, business development and other areas."
Once other surgeons have confidence in your background to provide good quality care, they can go to the next level and really engage in a relationship with their peers.
"If they reach out, they will have a broad network within the specialty because people know and trust their work," says Dr. Crandall. "This should be a social network of peers and all of these relationships expand their influence. It's hard to have a lot of confidence in a leader if there isn't a sense that at his core he is a good surgeon."
Patients and referring physicians should know you'll point them in the right direction, whether that includes surgery or not. Other providers and insurance companies will start to notice when patients are satisfied, have good outcomes and return to work quickly.
"If you are doing the right thing for patients, the group's success will grow and you'll gain the attention of insurance companies and hospitals to replicate your success," says Burak M. Ozgur, MD, director of DISC Sports & Spine Center in Newport Beach, Calif. "With evolving healthcare, if you have a successful cohesive group and hospitals respect you, you'll be thrust in a position of authority and asked to comment on healthcare reform and how to translate your success to a national arena."
2. Communicate your success with others effectively. Communication is a key factor for leaders in spine surgery. This means communicating with others to provide great care and advance the field, as well as communicating your outcomes to patients, payors and referring physicians.
"You might do well clinically, but you have to communicate those things locally and nationally so people know about it," says Sheeraz Qureshi, MD, MBA, associate professor of spine surgery in the department of orthopedics and chief of spine trauma at Mount Sinai School of Medicine in New York City. "Most spine departments and practices aren't just trying to look out for their own interests, but growing with their partners and others they are working with."For patient marketing efforts, you can communicate your patient satisfaction scores, outcomes and testimonials on practice websites or social media. Become engaged in community events and let people know how they could benefit from your services. Equally as important, communicate unique skills to referring physicians and make sure they know you will take good care of their patients.
3. Participate in groups, organizations and committees. Tomorrow's spine surgeon leaders will be those who are actively involved in different groups, organizations and committees at the local and national level today. With all the changes occurring in healthcare, it will be critically important for surgeons to participate and shape the future of the nation's healthcare.
"People who have a passion for government issues and lobbying will be looked at as being leaders in that area because of the sheer volume of work they've done that others haven't," says Dr. Crandall. "Someone who wants to be an academic leader would need to have a productive research program ongoing and be involved with innovation within the specialty, and try to be involved in leadership positions within the department or practice with hospital staff."
Participation in these groups will help you stay informed on the most important issues in healthcare and give you the opportunity to become more engaged.
"You have to stay informed, not put your head in the sand," says Andrew E. Wakefield, associate director of neurosurgery at Hartford (Conn.) Hospital. "Things are changing — nobody knows how but they will — and we need input from physicians on how changes come about. Hospitals are looking for that, and in my experience the government is as well, but you have to work for it and become an active participant. If you don't jump on the train, it will run you over."
The hardest part is often taking the plunge to become involved; once there, it's easier to network with colleagues and work with people who have similar views and ambitions.
"At times, it's very frustrating, but other times it's very rewarding because you actually see progress," says Dr. Wakefield. "In a year, you actually see changes because of your input. That's the only way to move forward; people have to pick up and do something. You have to be engaged."
4. Take risks at the right time. The most successful leaders are those who are willing to take risks and accept losses to achieve their ultimate goal. It takes a great deal of time and effort to oversee new projects, and the bigger risks taken could yield more significant rewards.
"You have to be willing to take the chance that you won't get what you want, especially if money is involved," says Dr. Wakefield.
If you are a leader at the group practice level, you'll have more flexibility to make changes quickly. If you are working with the hospital, it will take more time to shift policies and see results. If you are working with healthcare reform on a national level, it could take years to see even minute changes fall into place.
"You have to put the time in, which means giving up time for other things," says Dr. Wakefield. "This is time you need to put in, otherwise you are sitting back. If you are willing to complain about something than you should be willing to do something about it — whether that's dealing with nursing services on the floor or developing quality measures for improving patient care or engaging hospital administration to invest in new technology to do a good job for your patient."
5. Be willing to compromise. It will be necessary for leaders of the future to learn how to compromise during conflict so all stake holders see some benefit.
"See changes not only from your perspective but also from the perspective of other physicians, colleagues, payors and the public," says A. Nick Shamie, MD, Co-Director of UCLA Comprehensive Spine Center. "As a leader, you can't be self-serving. I think in order to get a good resolution you have to take into account the interest of all the parties involved and you have to encourage other parties to be honest with their interests, which requires you to be honest with your interest first."Compromise means give-and-take from all sides. Leaders should recognize where others are willing to budge and find room to budge themselves.
"You may not get what you want when dealing with insurance companies or trying to move a policy forward at the national level, but that's the compromise," says Dr. Wakefield. "Doctors are used to having a problem, identifying the problem and solving the problem. Leadership doesn't always lend itself to this system, and it requires give-and-take. It also doesn't always happen on your time schedule."
6. Respect other surgeons and referring physicians. If you exhibit qualities to gain the respect of other surgeons and referring physicians, you will gain a reputation as a good clinician and leader within your community. This requires the surgeon to practice honest and open communication with others and display integrity at all times.
"If you don't have a basic skill set and respect from patients and other surgeons, you aren't clinically successful and you don't have any hope of being a leader," says Dr. Ozgur. "Then it comes down to being honest, trustworthy and integrity. If people know you are skillful, honest and have integrity that goes a long way in being a successful physician and leader."
Spine practice leaders should show they always keep the best interest of the group in mind. Sometimes, this could mean making an unpopular decision for the benefit of the whole group instead of caving to the whims of one surgeon.
"A lot of things happen behind the scenes, so the group needs to trust their leader is making the best decisions for the group," says Dr. Ozgur. "Surgeon leaders should have an open line of communication; lack of communication leads to so many problems in society, in the world and in business. If the communication lines are open and everyone knows the plan, they will be comfortable with the decisions. When things are hidden and people hear a rumor, that's when they start to doubt the leader."
7. Understand how the healthcare system works. If you want to become a leaders within the healthcare system — whether it's at the local hospital, group practice or among the national political leaders — you must understand how the healthcare system works. This means you must know how the decisions are made from the bottom up and the top down.
"If you want to be a leader within the current system, first you have to understand the system and then how to help the system," says Dr. Shamie. "Align yourself with other key players who will work with you toward the common goal of making healthcare delivery in the future more efficient and higher quality."
This is something that isn't taught in medical school or fellowships, so it's up to the individual surgeon to seek this education. "You can't work in a system and try to move the system in one direction or another, or have a voice in the system that helps move policy and procedures forward at the hospital or national level unless you know how the system works," says Dr. Wakefield.
8. Stay abreast of current affairs in healthcare. Authenticate your engagement by staying abreast of current affairs in healthcare. This means understanding healthcare legislation, how health systems are changing across the country and where the trends are headed in the future.
"It's difficult to be a leader if you don't have a sense of how we will be affected by healthcare changes," says Dr. Qureshi. "We have to have a good understanding of these changes and become an advocate for improving patient care. We need to make sure they have access to care. Every decision we make not only has an impact on our selves and the patients, but also on the impact of the system as a whole."
A recent issue has been which patients need additional imaging tests before surgery. These tests are costly and surgeons are encouraged to use them more sparingly these days.
"Ten or 20 years ago you were able to practice in a vacuum and say ordering a test for every patient before surgery was the best thing to do no matter what anyone else said," says Dr. Qureshi. "You can't do that now in terms of taking care of patients. We have to really understand the tests we order and treatments we recommend to avoid unnecessary costs. Having an understanding of the system-based practice is very important.
Surgeons can stay on top of these issues by reading news publications or networking with colleagues locally and nationally.
"Right now, the current issues include the relationship between physicians and hospitals, physician and industry and hospitals and industry," says Dr. Crandall. "The spine surgeon has to be familiar with all of these relationships, with the government's role in these relationships as the overlying theme."
If surgeons are able to connect these differing interests, they will become an intelligent part of the solution.
"Our need for spine surgery leaders in today's healthcare environment has never been more important and with the dawn of dramatic changes in healthcare, this will continue," says Dr. Crandall. "If spine surgery is to have a voice at the healthcare providers table, we need leaders who are good doctors, have a broad sphere of influence, confidence and an understanding of the issues over the next five years."
9. Know what technology is coming down the pipe. Leadership can also take the form of cutting-edge innovation and development of surgical technique. Surgeons who are interested in device and implant development can work with companies to improve their products and forward surgical technique.
"It's difficult to say you're a leader in spine surgery still doing the same procedure surgeons did 70 years ago," says Dr. Qureshi. "You can't be a leader and say you don't believe in minimally invasive surgery or motion preservation. As the field matured, we learned from our mistakes and we can do these procedures better. We get better results for our patients and you can't talk about these things if you haven't done them in your own practice. If you talk about something you haven't used in your practice, people who work with you won't respect you as a leader."
Even if you aren't interested in directly working with these developments, surgeon leaders should know what is happening and advocate for the solutions that work.
"You need to know what is going on from a technology standpoint because the advancement in all of surgery, but spine surgery in particular, is rapidly moving forward," says Dr. Wakefield. "You have to be well versed in what is coming down the line. You have to be involved with the hospital trying to bring technologies to the patient and practices. You also have to be involved with third party payors to use these technologies with their patients."
One of the issues surgeons run into today is showing the quality improvement from a new device or technique justifies its high cost. While healthcare reform efforts focus on both increasing clinical quality and decreasing cost, some believe the emphasis on cost cutting unfairly outweighs the potential for clinical benefits.
"They seem to focus too much on trying to control cost and the patient is being lost in the fog generated by these efforts," says Dr. Wakefield. "It's the physician and healthcare professional's responsibility to take care of the patients. Surgeons are the ones that are going to bring that to the table more than anyone else involved moving forward."
However, this doesn't necessarily mean you should jump on ever new piece of equipment. Make sure it's safe and effective first. "Don't be the guy who when someone comes into the office with something new you shut it out right away," says Dr. Qureshi. "Listen and understand the technology and if it makes sense give it a try. That's the only way you can become a leader and people will only listen to you if you've tried it."
10. Maintain a healthy academic part of your practice. Whether you practice in an academic medical center setting or not, it will be important to collect outcomes and do research in the future. Patient volume and reimbursement is increasingly dependant on collecting positive outcomes data, and cost-effectiveness data will help advance the field.
"It's important to have the clinical experience of taking care of patients, but it's also important to look back on your experience and have an academic part of your practice as well," says Dr. Qureshi. "Something simple, like studying the incidence of back pain after open surgery, can be helpful."
Most spine surgeons who perform open procedures say their patients don't have pain postoperatively, but they haven't followed-up with their patients to support these claims. Following up with those patients will give you a better understanding of their actual post-surgical state.
"Understand what is allowing your patients to do well and what your patients are having issues with," says Dr. Qureshi. "Discuss your findings with colleagues, industry members and the government to show the best way to provide long term care for patients."
More Articles on Spine Surgeons:
20 Spine Surgeons Leading Charitable Care Efforts
8 Steps for Best Results When Hiring a Spine Practice Manager
5 Factors for Spine Surgeons to Negotiate Better Payor Contracts