Josephine Coury Whalley, MD, is beginning her spine surgery career with more technological guidance than any previous generation received.
Software can help plan an operation before the incision. Navigation can track instruments in three dimensions. Robotics can guide implants along a predetermined path. AI can draft clinic notes, measure deformity and help patients understand diagnoses before they enter the exam room.
Dr. Coury Whalley welcomes those advances. She expects them to raise the standard of care and make good surgeons better. But she has also seen what happens when technology is wrong and the surgeon does not recognize it.
“When a human is uncertain about the correct starting point for a screw, the consequences are usually limited because the surgeon is working carefully with their hands,” Dr. Coury Whalley told Becker’s. “But when a robot is off and the surgeon doesn’t recognize it, that’s when someone could be paralyzed.” The warning is not an argument against robotics. It is an argument for judgment.
Dr. Coury Whalley is completing an advanced pediatric spinal deformity fellowship at NewYork-Presbyterian Morgan Stanley Children’s Hospital and Columbia University Irving Medical Center in New York City. She will soon join Texas Children’s Hospital and Baylor College of Medicine in Houston as a pediatric spine surgeon.
Her training has placed her between two eras of spine surgery. One was built on apprenticeship, anatomy and the accumulated instincts of surgeons who operated before navigation became routine. The other is being shaped by robotics, AI, increasing specialization and patients with unprecedented access to medical information.
Dr. Coury Whalley believes the field needs both. The next generation’s challenge will be using technology without surrendering the skills required when it fails.
What the great surgeons do differently
Dr. Coury Whalley trained under surgeons who helped define modern spinal deformity and cervical spine surgery, including Lawrence Lenke, MD; K. Daniel Riew, MD; Ronald Lehman Jr., MD; Michael Vitale, MD; and Benjamin Roye, MD.
Their technical abilities were obvious. That was not, in her view, what most distinguished them.
“There are a lot of technically amazing surgeons out there,” she said. What set her mentors apart was the attention they gave the person behind the operation.
She watched them spend hours speaking with patients, studying symptoms and reconsidering plans before and after surgery. The procedure was never simply a technical problem to solve beautifully. It was one part of a larger obligation to improve an individual patient’s life.
That lesson becomes more important as the forces surrounding care accelerate. Robotics and AI can make surgery more efficient. Health systems and private equity-backed organizations may seek greater patient volume. Documentation and operational demands can compress the time available for conversation.
Dr. Coury Whalley worries the sophistication of the operation can distract from its purpose. “Every surgeon I just mentioned has spent countless hours talking with patients about their symptoms and how best to care for them,” she said. “As my generation enters medicine alongside this technology, it always has to come back to helping the individual person.”
Technology may make surgeons more capable. It cannot be allowed to make medicine more impersonal.
The surgeon still has to know
Dr. Coury Whalley learned to operate with navigation and robotics. She also learned to operate without them.
Her mentors taught freehand techniques, anatomic landmarks and how to work from conventional radiographs. If navigation loses accuracy or fails entirely, the operation does not become impossible. The surgeon remains responsible for knowing where the implant belongs.
“I still know how, if all technology fails, to do this procedure completely freehand, based on anatomy with a plain old X-ray,” she said.
That dual training will shape how Dr. Coury Whalley teaches her own residents and fellows. When a machine performs a task reliably, surgical education must decide how much time trainees should continue spending on the manual skill beneath it.
Spine surgery makes the consequences unusually clear. A surgeon who does not know what a correct trajectory looks and feels like may not recognize when the robot is leading the instrument toward danger. Technology can produce confidence before it produces competence. Dr. Coury Whalley believes attending surgeons will be responsible for preventing that gap.
“My training after medical school was seven years,” she said. “There’s plenty of time to make sure you still know the fundamentals.”
The next generation should not reject technology to prove it can operate without assistance. It should be trained well enough to know when the assistance is wrong.
Spine may be too large for the generalist
Technology is not the only force changing the specialty. Spine surgery is becoming more specialized within itself.
Orthopedic surgery already divides the body into distinct practices. A joint-replacement surgeon may concentrate largely on hips and knees. A hand surgeon develops deep expertise in a defined region. Spine has traditionally maintained a broader identity despite containing vastly different anatomy and procedures.
A spine surgeon may be expected to understand the cervical, thoracic and lumbar spine; anterior, posterior and lateral approaches; decompression, fusion and arthroplasty; degenerative disease, trauma and deformity.
“There are probably hundreds of different spine surgeries that you could perform,” Dr. Coury Whalley said. She believes it is unrealistic for one surgeon to perform all of them at the highest level. At Columbia, she saw a model in which surgeons concentrated deeply on particular regions and pathologies. Dr. Riew, for example, also focuses exclusively on the cervical spine.
That repetition can transform the operation. A procedure that takes a less experienced surgeon most of the day may take a subspecialist a fraction of the time, with a more refined understanding of the anatomy and complications.
The stakes are especially high in spinal deformity. A long fusion places the spine in a position intended to withstand gravity and aging for years. An alignment error can begin a cascade of degeneration, mechanical failure and revision surgery.
Dr. Coury Whalley has seen patients referred after operations that placed the spine in an unsustainable position, sometimes because the original surgeon lacked current knowledge about alignment goals.
The first operation can shape every one that follows. That is why she believes the most complex deformity cases should be concentrated at centers where several specialists can study them together. At major academic institutions, multidisciplinary conferences allow surgeons to review the same images, challenge one another’s plans and draw on collective expertise before committing a patient to a life-changing reconstruction.
“I think it makes sense for those highly complex surgeries to happen at those institutions rather than in a private practice with just one person,” she said. The argument is not that academic medicine owns complex care. It is that the concentration of expertise should match the concentration of risk.
Training should be humane. It cannot be easy.
The culture of surgical education is also changing. Previous generations often treated exhaustion as evidence of commitment. Today’s residents speak more openly about burnout, family life and sustainability.
Dr. Coury Whalley supports that shift. She trained in a residency with protected vacation, duty-hour limits and support from nurse practitioners, physician assistants and other clinical staff. She sees no educational value in forcing a resident to transport patients or perform work another team member can handle.
AI could reduce some of that burden. Ambient documentation may allow physicians to complete notes during a clinic visit. Automated imaging tools can calculate measurements that once consumed several minutes per case. Those saved minutes can accumulate into more time with patients and family.
But Dr. Coury Whalley draws a line between removing waste and removing pressure. “I don’t think that we should lean so far that it becomes easy,” she said.
The first time a surgeon is truly responsible for another person’s life can be overwhelming. Dr. Coury Whalley remembers being alone in the middle of the night during fellowship, credentialed as an attending and knowing the patient trusted her to make the correct decision.
The nearest preparation came years earlier as a second-year resident, facing a crowded emergency department and a list of consultations that felt impossible to complete.
The environment was stressful, but it was not unsafe. Senior residents were available if she truly needed help. That distinction matters. Training should expose residents to responsibility while preserving a safety net. They should experience the weight of being overwhelmed before they carry it alone.
“There’s nothing else like that feeling,” she said. “It’s important to experience that level of stress, to feel overwhelmed, even frightened, before you become an attending.”
A residency that removes all discomfort may postpone the hardest lesson until the surgeon has no supervisor. Complications do not respect vacations. A postoperative patient remains the surgeon’s responsibility even when the physician is away.
Medicine should no longer glorify unnecessary suffering. It also should not conceal the demands of caring for another human being.
Work-life integration, not separation
Dr. Coury Whalley prefers the term “work-life integration.” Balance suggests two competing forces held at equal weight.
Surgery rarely behaves so neatly. A physician may leave the hospital and continue thinking about a patient over dinner. A complication may interrupt a trip. Family life and professional responsibility must coexist rather than remain in separate compartments.
Dr. Coury Whalley saw that modeled by her mentors. The stereotype of the great surgeon once included repeated divorces and absence from family life. That was not the model she observed at Columbia.
Her mentors built demanding academic careers while remaining closely connected to their families. They showed her that excellence did not require indifference to life outside the operating room. Technology may make that integration easier. It cannot make the professional obligation disappear.
The difference between mentorship and sponsorship
Dr. Coury Whalley was the first woman among more than 125 fellows trained by Dr. Lenke. She does not describe her own experience at Columbia as isolating. She felt supported by mentors who did not treat her as less capable because of her gender.
Several went beyond giving advice; they promoted her. Dr. Coury Whalley distinguishes mentorship from sponsorship. A mentor helps a trainee navigate a decision. A sponsor uses their own credibility to recommend the trainee and create opportunities.
Her male mentors did both. Still, she hopes women entering spine surgery 10 years from now will not need as much imagination to picture their futures.
Dr. Coury Whalley could look at leaders like Dr. Vitale, and recognize the kind of surgeon, academic and family life she wanted. What she could not see was a woman living that exact career.
She has already begun providing that image for someone else. A college student who shadowed her later said meeting Dr. Coury Whalley made pediatric spine surgery feel achievable.
“She realized that it was something she could picture herself doing,” Dr. Coury Whalley said. Representation can sound like an abstract institutional goal. In practice, it can be a trainee seeing the life they want already being lived. Dr. Coury Whalley wants the next woman entering spine surgery to need less faith.
“She can look at me and say, ‘She can do it. She’s balancing her family. She’s balancing being a spine surgeon. I can do that, too,’” she said.
The patient arrives informed
Technology is also changing the person across the exam table. Patients can now use AI tools to summarize a diagnosis, review a physician’s note and generate questions about the risks and benefits of treatment. Dr. Coury Whalley sees that as progress.
For decades, surgical consent could depend heavily on authority. The surgeon recommended an operation. The patient trusted the surgeon and agreed.
Trust remains essential. It is no longer sufficient. Patients may arrive knowing the names of procedures, possible complications and alternatives. The surgeon’s role is not to resent that knowledge. It is to help the patient understand what matters.
AI can generate a long list of risks. The physician must explain which are common, which are catastrophic but rare and how the patient’s anatomy or health changes the calculation.
AI can tell the patient what questions to ask. It cannot determine which answer should carry the most weight for that individual.
“I think it’s excellent that patients are more informed than ever,” Dr. Coury Whalley said. “Then it’s on us as surgeons to not get frustrated, but to answer the questions and give the whole truth and the whole picture.”
The informed patient does not weaken the physician-patient relationship. Handled well, the questions deepen it.
The higher bar
Dr. Coury Whalley expects robotics, navigation and AI-assisted planning to become ordinary parts of spine surgery rather than features that distinguish one surgeon from another.
That will not make surgeons less important. It will make the remaining differences among them more meaningful. When every surgeon has access to the same planning software, judgment matters more. When implants can be guided precisely, choosing the right operation matters more. When every patient can obtain medical information instantly, communication matters more.
When administrative work becomes automated, the saved time must return to the patient rather than simply create room for greater volume. Technology will raise the floor only if surgeons refuse to let it replace the foundation.
Dr. Coury Whalley’s generation will inherit tools capable of making surgery safer, faster and more reproducible. It will also inherit the responsibility to know when the machine is wrong, when an operation belongs in more specialized hands and when efficiency has begun to displace care.
The next era of spine surgery will not be defined by whether surgeons use AI or robotics. It will be defined by what they refuse to surrender when they do.
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