As the spine surgery landscape shifts, so does the workforce needs at spine practices. Evolving complexities in both spine care and billing needs have created gaps where crucial roles are harder to hire and retain.
Spine leaders discuss how they approach these challenges.
The six leaders featured in this article are speaking at Becker’s 23rd Annual Spine, Orthopedic and Pain Management-Driven ASC + The Future of Spine Conference, June 11-13, 2026, at the Swissotel Chicago.
If you would like to join the event as a speaker, please contact Carly Behm at cbehm@beckershealthcare.com.
Editor’s note: As part of an ongoing series, Becker’s is connecting with healthcare leaders who will speak at the event to get their insight on thought-provoking questions within the industry. The following are answers from event speakers, lightly edited for clarity.
Question: What’s the hardest role to fill or retain in your practice right now, and what does that tell you about where the field is headed?
Bryce Basques, MD. Brown University (Providence, R.I.): One of the hardest roles to fill and retain right now is experienced operating room staff for our ASC who are comfortable with complex spine procedures and rapidly evolving technology. As more complex spine procedures are now moving to the ASC environment, including disc replacements, fusions and endoscopic surgery, this creates a steep learning curve and requires a highly coordinated team. Experienced OR nurses and scrub technicians are in high demand across hospitals and ambulatory surgery centers, and there is significant competition for hiring and retaining good people in these roles. I think this reflects where the field is headed: As more complex spine surgery procedures move to the outpatient setting, the success of a program depends as much on building and keeping a skilled operative team as it does on the surgeon or technology itself.
Ben Burch, MD. Atlanta Spine Institute: Spine care billing is uniquely complex and requires deep expertise in instrumentation coding, biologics, multi-level fusions, prior authorizations, workers’ compensation claims and aggressive payer denials on high-dollar cases. The constant pressure of chasing appeals while staying current with ever-changing regulations leads to rapid burnout, making it difficult to build and maintain a stable, knowledgeable billing/[accounts receivable] team.
This ongoing challenge reveals that spine surgery is shifting toward a more administratively complex and efficiency-focused future. With rising case volumes driven by an aging population, successful practices will prioritize robust revenue cycle infrastructure through AI-powered billing tools, automated denial management, specialized team training, and tighter integration between clinical and financial operations. The era of straightforward fee-for-service is fading; long-term viability will depend on strong payer contracting, minimized financial leakage and technology that allows surgeons to focus on clinical excellence rather than revenue cycle. Practices that solve this staffing and process bottleneck first will be best positioned for sustainable growth.
Tan Chen, MD. Inova Health (Fairfax, Va.): Some of the hardest roles to fill and retain in a spine practice are the team members patients build real relationships with, especially our nurses, medical assistants and surgical coordinators. They’re the ones answering anxious phone calls, helping patients navigate surgery and making people feel cared for during an incredibly stressful time. I think that says a lot about where healthcare is headed. Patients still want expertise and great outcomes, but they also value connection, communication and trust. The future of spine care is not just about better technology or implants, but about creating a team and experience that truly supports patients from start to finish.
Ramis Gheith, MD. DxTx Pain and Spine (Chicago): One of the hardest roles to fill and retain today is the fellowship-trained anesthesiologist specializing in interventional pain medicine. There is a significant national shortage of these physicians, while demand for advanced spine and pain procedures continues to rise. As a result, the field is becoming increasingly inclusive of physicians from backgrounds such as emergency medicine, family medicine, radiology, physical medicine and rehabilitation, and neurology who pursue additional pain training. This shift reflects the growing need for multidisciplinary collaboration and procedural competency rather than reliance on a single traditional training pathway. Ultimately, practices that adapt by building strong, diverse clinical teams will be best positioned for the future.
Vamsi Kancherla, MD. Specialty Orthopaedics (Gainesville, Ga.): At Specialty Orthopaedics, the hardest role to fill and retain right now is our certified surgical technologists and perioperative nurses who are truly fluent in ultra-minimally invasive endoscopic and robotic spine procedures.
This tells me the field is rapidly shifting from hospital-based open cases to high-volume, technology-driven ASC models where the entire team — not just the surgeon — must master evolving tools and workflows to deliver faster recoveries and superior value.
Jennifer Schoenig. Executive director at Long Island Spine Specialists (Commack, N.Y.): At Long Island Spine Specialists, PC, our practice sees the highest turnover with our medical assistants. We find during our recruiting efforts the top candidates are typically Gen Z using the role of a medical assistant as a way to earn money to pay for nursing or medical school. Typically our most talented recruits have high ambition and use the position of a MA as a stepping stone to earn money while getting real world experience and mentorship from an established doctor. Being an MA is not typically the final destination for those that perform at a high level in the position and we need to expect higher than average turnover as a result.
Alex Vaccaro, MD, PhD. Rothman Orthopaedic Institute (Philadelphia): In spine surgery today, one of the hardest roles to recruit and retain is the highly skilled perioperative and longitudinal care team member, In today’s spine surgery field, one of the most challenging roles to recruit and retain is the highly skilled member of the perioperative and longitudinal care team. This includes experienced physician assistants, nurse practitioners, operating room nurses and surgical coordinators who specialize in complex spine care. The difficulty in finding these professionals is not merely due to a workforce shortage; it reflects the dramatic evolution of the field.
This evolution indicates that the future of spine surgery will rely less on individual surgeons and more on integrated, highly specialized systems of care. The practices and institutions that will succeed are those that can build resilient teams, invest in professional development and create environments that mitigate burnout while maintaining autonomy and a sense of purpose.
At the Becker's 23rd Annual Spine, Orthopedic and Pain Management-Driven ASC + The Future of Spine Conference, taking place June 11-13 in Chicago, spine surgeons, orthopedic leaders and ASC executives will come together to explore minimally invasive techniques, ASC growth strategies and innovations shaping the future of outpatient spine care. Apply for complimentary registration now.
