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6 Spine Surgeons Give Advice to New Practitioners Featured

Written by  Heather Linder | Thursday, 28 February 2013 10:01
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Six spine surgeons discuss advice for a spine surgeon just beginning his or her career.
Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. We invite all spine surgeon and specialist responses. Next week's question: What characteristics will future spine leaders need to possess?

Please send responses to Heather Linder at This email address is being protected from spambots. You need JavaScript enabled to view it. by Wednesday, March 6, at 5 p.m. CST.


Vincent Arlet, MD, Orthopedic Spine Surgeon, KneeFootAnkle Center of Kirkland (Wash.): Do a two-year spine fellowship that would be comprehensive and allow [you] to tackle the whole spine spectrum.

Ara Deukmedjian, MD, Neurosurgeon and CEO, Deuk Spine Institute, Melbourne, Fla.: Try to learn from the best in the business. If you know a successful spine surgeon, then make every effort to spend time with him or her and "learn the ropes" on both the clinical and business sides. Practicing medicine has become the equivalent to walking through a mine field with 1,000 mines underground and nowhere to go but forward. Good luck!

Jeffrey Goldstein, MD, Director of Spine Service, NYU Langone Medical Center's Hospital for Joint Diseases: When beginning your career, don't forget the three A's you heard about in medical school: affable, available and able. Additionally, there is a fourth A — affordable. When you start, you will be considered "able" by your community until you prove otherwise. Choose your surgical cases wisely and appropriately. Probably better not to come out flexing your muscles and pounding your chest and take on the "horendioma" that nobody else wants to touch (likely for good reason). As one of my mentors, Kingsbury Heiple, used to say, "Good judgment comes from experience and experience comes from bad judgment."

You need to be available. Remember the 5 p.m. Friday consult you hated getting as a resident? Take it. Now you're the "go to" guy and you'll also get the next consult, which hopefully will be during regular office hours. Finally, don't plan on going into practice and not participating in any insurance programs. If that's the track you take out from the gate, you'll have a lot of time at your desk to ponder your future.

Richard Kube, MD, Spine Surgeon, CEO and founder of Prairie Spine & Pain Institute, Peoria, Ill.:
There are so many things to say to a young surgeon starting out.  First, know your limits. This goes for all things. Do not schedule cases beyond your comfort level or set patient expectations too high, either. You will be pulled in a multitude of directions to market yourself, befriend partners and engage in your community. Know your limits of time and do not over commit or overpromise, especially at the expense of your family.

Early on, focus on the cases with predictable outcomes. Your stress level will be less and you will be able to meet expectations of referring providers. Once you have built confidence in yourself and those sending you patients, then consider wowing them with more challenging cases. It’s better to enter the big leagues hitting singles but go 20 for 20 than aiming for the fences and striking out 2/3 of the time. Also, have patience. If you do a good job, the cases will come, and your practice will grow.

Gaetano Scuderi, MD, Orthopedic Spine Surgeon, Jupiter, Fla.: This is very apropos question for me as I recently relocated from an academic practice at Stanford University to South Florida. The number one thing I would recommend is to immerse yourself in the community. You can't sit around in your office waiting for patients to come to you. If you recently graduated, you probably have some talks that you've given. I would recommend offering up a CME to a local hospital to engage other physicians. Additionally, you can offer community service talks on uncommon maladies of the musculoskeletal system of which you are an expert in. Often times there are volunteer positions that will assist you in interacting with others in the community. The overall message is to establish yourself as a resource so people feel comfortable in going to you for consultations.

Jeffrey Wang, MD, UCLA Spine Center: The biggest thing to keep in mind is to put your patients first. With all the financial issues, new regulations, starting a practice and determining time for research, clinical work and family, it is hard to find the right balance. I would advise them to try to find the right balance and to be honest with yourself on what you like to do, and what you do not like to do. With all the problems one may face starting his or her career, do not lose sight that the ultimate goal is to make your patients better. All that you do in your career, whether it's leadership in a society, performing research, or administering a practice or a department, do not lose sight of your largest responsibility — your patients.

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Last modified on Thursday, 28 February 2013 10:39
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