Question: How has neurosurgery transformed since you started practicing?
Dr. Andrew Kokkino: Obviously, transformation has been ubiquitous. Technically, the greatest change has come from performing more minimally invasive procedures in both brain and spine surgery. The evolution of endovascular neurosurgery has been rather successfully managed as we neurosurgeons have remained a part of the solution and not become part of the problem or become obsolete. Within radiosurgery, we have demanded a spot at the table and have successfully led many scientific trials, as the brightest neurosurgeons continued to put out peer-reviewed scientific articles in the field of radiosurgery. The healthcare economics of neurosurgery have drastically changed as we have lost the vast majority of independent private practices in a model that dates back 50 years and is never coming back.
From the perspective of your organization, this last point is probably the most interesting. I do not believe that the hospital employment model is the ideal model as most hospital organizations are actually healthcare organizations that are struggling between how they provide inpatient and outpatient services. When they employ specialists, those two different components of the healthcare organization fight over the best utilization of physician services. Finally, I very much wonder about the evolution of the corporate hiring of physicians to provide clinical medicine. We see this as a major corporation purchases one of the nation's largest cancer networks. It may only be a matter of time before the largest healthcare corporations begin purchasing large blocks of orthopedic or spine surgeons.
Q: What are the key opportunities & challenges neurological surgeons face today?
AK: Many of these are mentioned above. Opportunities and challenges depend on the phase of your career. If you are at the beginning of your career and are heavily in debt, many surgeons choose the best financial opportunity over the better long-term organization within which they can grow. On the flip side, independent private practices have a very hard time competing with revenue-rich employers who can offer top dollar on the front-end of an employment contract.
The issues for the surgeons in the middle of their careers involve basically how to navigate an ever-complex system as we fight with a revolving door of hospital administrators to get our jobs done, balance more burdensome call schedules and try and learn negotiating tactics with third-party payers or employers on the fly. The other major challenge is the evolution to electronic health records and incorporating them comprehensively into the entire spectrum of our patients' care.
Q: How will MIS for spine care continue to evolve in the coming years?
AK: Technically, the evolution has been rather dramatic. The issue now will come down to providing scientific evidence. Ultimately, we want minimally invasive surgery to translate into shorter patient stays, diminished complication rates, and a faster return to work. If MIS does not meet those standards, it needs to be reevaluated and restructured.
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