With many new spine residencies in full swing, veterans in the specialty share their advice for the next crop of physicians.
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. Becker’s invites all spine surgeon and specialist responses.
Next question: How do you respond to the argument that some new spine technologies are “solutions in search of a problem” — and what metrics should we use to justify adoption?
Please send responses to Carly Behm at cbehm@beckershealthcare.com by 5 p.m. CDT Tuesday, Aug. 26.
Editor’s note: Responses were lightly edited for clarity.
Question: What advice would you give spine surgeons who are starting their residencies?
Joel Beckett, MD. DISC Sports and Spine Center in Marina del Rey, Calif.: Residency is the foundation for everything you will do as a spine surgeon, and the habits you form now will follow you for the rest of your career. Approach it with the “loose-tight” mindset: be loose enough to stay adaptable, humble and receptive to learning, but tight in your standards for precision, safety, and professionalism. The ability to flex and adjust in complex situations while holding yourself to non-negotiable core principles is what separates competent surgeons from truly exceptional ones.
I would also urge you to embrace the spirit of “A Message to Garcia” by Elbert Hubbard: when given a responsibility, execute it fully, without waiting for perfect conditions, excessive guidance, or reassurance. In residency, the people who excel are those who take initiative, solve problems, and deliver results reliably. The more you can demonstrate self-direction and follow-through — while still knowing when to ask for help — the more you’ll earn trust from your mentors and colleagues.
If you keep those two ideas at the center of your training — adaptable discipline and decisive initiative — you’ll not only master the technical aspects of surgery but also cultivate the judgment, independence, and integrity that define a leader in our field.
Tan Chen, MD. Geisinger Musculoskeletal Institute (Danville, Pa.): Junior orthopaedic and neurosurgical residents should focus on the fundamentals of their respective fields before investing their limited time into spine surgery. Remember, the in-training and board examinations test a multitude of topics outside of spine, and this is especially true of orthopaedics. The time to truly focus on spine is during fellowship. Enjoy residency for what it is, learn as much as you can, be humble, and remember that you have to crawl before you walk, walk before you run.
Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: I would tell them assist in as many cases as you possibly can – but read on. Read the important books and focus on healthy eating habits. Get exercise, give yourself grace, get to know your co-residents and build friendships. Go home when you can, visit those older relatives whenever you can. Don’t sweat the idiosyncrasies of your attendings but do pay attention as to WHY they do it. You want to learn from them, not be them. Don’t neglect your significant other nor your kids. At the end of the day, they won’t remember you doing more cases, just that you weren’t there.
Raymond Gardocki, MD. Vanderbilt University Medical Center (Franklin, Tenn.): I would urge budding spine surgeons to seek out a fellowship that exposes them to the full spectrum of modern spine surgery. You don’t need to master every technique, but exposure to the full gamut — deformity corrections, minimally invasive wizardry, tumor resections, navigation, and good old open surgery — is crucial. Few programs offer the breadth that we do at Vanderbilt University Medical Center: from 360 en bloc spondylectomies and navigated deformity revisions to awake, outpatient endoscopic discectomies.
Philip Louie, MD. Virginia Mason Franciscan Health, (Seattle): Yes — your main goals will be to learn the principles of orthopaedic/neurosurgical care and develop the technical skills to be safe as you enter practice. But remember, master carpentry does not make up for poor indications and tight indications do not make up for poor carpentry.
However, I do think that there are other important areas outside of the traditional education!
Here is my advice on those.
1. Commit to lifelong learning beyond the OR.
Your clinical and technical mastery is essential, but leadership, communication, and adaptability will define your long-term impact.
2. Develop emotional intelligence early.
Understanding how to work with people (patients, peers, nurses, staff) is just as critical as knowing anatomy and the pathology.
3. Learn the basics of change management.
Healthcare is evolving rapidly, and those who understand how to lead change can shape systems rather than be shaped by them. We are living examples of this struggle right now.
4. Don’t wait to lead.
Leadership isn’t about title or seniority, it’s about taking responsibility, solving problems, and lifting others around you. You will have opportunities to practice and act immediately in practice.
5. Stay grounded in patient care.
No matter how complex the system gets, your ability to advocate for and care for patients is your anchor, and your power. It is easy to forget this on a day-to-day basis, but take moments to take a step back and remember why you are sacrificing so many years. Spine care and technology changes fast and you will get to help a lot of people along the way.
Jonathan Rasouli, MD. Northwell Health (Staten Island, N.Y.): Focus on becoming a great surgeon first. Master the fundamentals, be obsessive about technique, and take ownership of your patients. Don’t rush into branding, social media, or industry – those things will come in time. Get involved in research early and attend spine conferences to network and explore the field. Figure out what area of spine surgery truly excites you, whether it’s degenerative, deformity, oncology (or something else) and pursue a fellowship that aligns with your interests. The best opportunities come when you’re excellent at what you do and trusted by your mentors and patients alike.
Casey Slattery, MD. Hoag Orthopedic Institute Surgery Center Aliso Viejo (Calif.): Spine surgery stands out as a unique specialty, arguably deserving its own residency due to its high level of complexity. The training is extensive, and even after residency and fellowship, fully mastering it can feel elusive. My advice to aspiring spine surgeons beginning their residency is to dive in deeply. Start early understanding the anatomy, learn diligently throughout your training, and attend as many hands-on spine surgical labs as possible to build a solid foundation for fellowship.
William Taylor, MD. UC San Diego Health: Make sure to concentrate on understanding, databases, and ways to participate in national meetings. My surgery center offers a unique opportunity to do this in any sort of practice. Advancing the field and understanding your patient population will pay dividends.
Timur Urakov, MD. University of Miami: As intern class begins their residencies in Neurosurgery and Orthopedics some of them believe right from the start that Spine surgery is what they will end up doing after graduation. It is great to have such focus and my recommendation is always to keep an open mind. Do not neglect other fields of your training. The harsh truth of the matter is that not everyone who wants to be a spine surgeon is destined to be one. Yes, show dedication to the field but keep your options open and always be honest to yourself.
Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): Most neurosurgical residencies are quite comprehensive in their spinal emphasis, allowing most graduates to be well versed in spinal surgery and instrumentation. Arguably, additional training in the form of a fellowship (thought by many as redundant), however this allows for empiricism and its exposure to a more complex patient populace and their given variables. While elective practices are exact in their expectation and prosaic cases are managed by all, the larger health systems bring much more complex caseloads to bear.
My advice to the up and coming is to manage your patients within your boundaries and seek experience and assurances for issues that arrive before, during and after one’s management. Collective opinion and reasonability are the expectation in our spinal continuum, whereby safety and outcome are paramount. Less is better, and cost is scrutinized.
