Every year, a small number of neurosurgery departments land near the top of U.S. News & World Report’s rankings, and the chairs who lead them are watching many of the same forces reshape their field.
In separate interviews with Becker’s, three chairs at the top-ranked hospitals for neurology and neurosurgery — Edward Chang, MD, of the UC San Francisco; John O’Toole, MD, of Chicago-based Rush University Medical Center; and E. Sander Connolly Jr., MD, of Columbia University in New York City — described where they see the field heading. Their answers point to three trends: a mix of hopeful and hesitant approaches to AI implementation, the migration of complex procedures into outpatient settings and a reimbursement and affordability squeeze to which even the most prestigious programs are not immune.
1. AI’s promise and its limits
Dr. Chang said UCSF’s neurological surgery department is dedicated to the application of AI across neurosurgery and believes AI and its integration into technology will be able to advance beyond what human hands and vision can accomplish.
“From AI vision of scans to thinking about robotics, kind of reinventing what intelligence looks like in the operating room,” he said.
He pointed to a tool developed by colleagues that can diagnose brain tumors in the operating room within seconds, a process that previously required sending tissue to a pathologist for a manual read that could take an hour.
Dr. O’Toole described a more cautious posture at Rush toward the technology’s ability to do more than predict.
“We’re quite cautious because I think the promise in AI is huge, and the reality has continued to lag behind,” he said. “It’s getting really good at predictive analytics. But where we all want to go with this is prescriptive — at least where the AI can tell us what we need to do in any particular case, and we’re clearly not there yet. But it’s coming, and we want to be able to be a part of that.”
2. Advancements are redefining what surgery can treat
Dr. O’Toole said the migration of complex procedures out of the hospital is already reshaping where and how his department operates. Spine surgery moved into ASCs years ago, he said, and cranial cases are following.
“We’re now seeing the migration of certain cranial procedures into the outpatient setting, including even now, endovascular procedures,” he said. “There’s no doubt that more of that is coming.”
At UCSF, Dr. Chang pointed to advancements expanding which conditions are treatable at all. Faculty have developed closed-loop adaptive deep brain stimulation systems that adjust to a patient’s brain activity in real time, he said, with applications now being explored for chronic pain, depression and obsessive-compulsive disorder.
“These are new frontier areas that are going to really change what neurosurgery is going to look like in the future,” he said. He also cited faculty using gene editing to target some of the most inoperable brain tumors and single-cell sequencing research he said could eventually allow aneurysms to be sealed with biologic therapies rather than devices.
Dr. Connolly, chair of Columbia’s neurological surgery department, said the definition of what belongs in a neurosurgeon’s operating room is still shifting. He pointed to headache as an example, a condition long treated as strictly neurological.
“There might be surgical solutions for that,” he said. “And there are a whole host of others, so I think it’s a very exciting time.”
3. A universal affordability problem
Dr. Chang said one of the more important aspects of his position is balancing the competing demands of an academic mission that values research and innovation and the economic demands that come with a complex hospital system.
“One of the most important things I do as department chair is making sure that we do both,” Dr. Chang said.
Dr. Connolly said reimbursement pressure is reshaping decisions well beyond the operating room. He pointed to insurance dispute resolution processes and the prospect of unionization among residents and medical staff as two developments his department is tracking closely.
“As more and more of the healthcare dollar is controlled through government insurance, either through an aging population or through just shifts in the economy, I think the elite institutions are going to have to find a way to deal with that from an affordability standpoint,” he said.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
