Richard Meyrat, MD, of Methodist Brain & Spine Institute in Dallas, shares his thoughts on the evolution of the neurosurgery field and key challenges neurosurgeons face.
Question: How has the neurosurgery field evolved in the last decade?
Dr. Richard Meyrat: Neurosurgery has become extremely crucial in enabling hospitals to offer more comprehensive care. Neurosurgery is essential in supporting hospital programs including stroke, oncology, trauma, emergency department and neuroradiology. Consequently, hospitals have increasingly become aggressive in recruiting and accommodating neurosurgeons. Call pay has exponentially increased over the last decade and support for their practice has diversified. Most modern neurosurgeons have physician extenders and hospital services (eg. trauma team) to assist them in completing their extremely busy days.
Inevitably, neurosurgeons have become more and more integrated with hospitals (eg. hospital employment), thereby drastically improving neurosurgeons' lifestyle. Although pure private practice continues to have the potential to create high income, neurosurgeons coming out of training are becoming more interested in a balance between lifestyle, job satisfaction and salary. Neurosurgery is one of very few fields in medicine where income has continued to increase in the last decade, particularly those with hospital-based practice.
Q: How do you think value-based care will impact the neurological surgery field?
RM: Given the changes described, I think neurosurgeons are well positioned to take advantage of value-based care since our specialty extends across many other specialties. Neurosurgeons create value in many non-surgical conditions, which only adds to our surgical importance for the hospital's daily function.
Q: What core challenges do neurosurgeons face?
RM: The excesses of spine surgery and its questionable efficacy (especially lumbar surgery) is becoming a focus of attention. It is becoming harder and harder to offer surgical treatment to those suffering from chronic back pain and chronic radiculopathies. We need to be more organized in ensuring our patients have access to surgical treatment for spine conditions.
I also think that as neurosurgeons we need to incorporate ourselves (like the anesthesiologists) as one big group so we can have our voices heard and be able to negotiate directly with the government, insurance companies and hospitals.