Amit Jain, MD, sees one of spine care’s workforce problems in his own clinic. Patients arrive to see a surgeon even when they do not need surgery.
Some could have been evaluated first by physiatry, pain management, physical therapy or another nonsurgical service. But access is limited, referral pathways are fragmented and patients do not always know where to enter the system.
So they end up with the wrong clinician, or bounce between several. At a moment when healthcare leaders are worried about having too few people to meet future demand, Dr. Jain sees another problem hiding inside the shortage: Spine care is not always using the people it already has well.
“We are too siloed in our care delivery models,” Dr. Jain told Becker’s. “Instead of having integrated models for spine care or orthopedic care, we sort of have departmentalized each of these functions into different divisions or subgroups.”
Dr. Jain is chief of minimally invasive spine surgery and director of value-based care at Baltimore-based Johns Hopkins Medicine. He also helps lead the system’s spine fellowship and studies AI and surgical robotics.
From those vantage points, he sees the same conclusion emerging. Spine needs more clinicians. But it also needs a different workforce model.
The shortage begins before the surgeon
For many patients, there is no obvious front door to spine care. Some enter through primary care. Others start with pain management, physiatry, the emergency department, physical therapy or a surgeon.
When those services are not coordinated, Dr. Jain said patients either arrive at the wrong access point or get “ping-ponged” between specialties without a clear resolution.
Both waste time and can increase costs. Both become more consequential when clinical capacity is already tight.
Dr. Jain sees access to nonsurgical spine providers as a particular constraint. When those appointments are difficult to obtain, surgeons may end up evaluating patients who could have been managed elsewhere.
A better model would move patients toward the appropriate clinician earlier and preserve surgical capacity for those who actually need it.
“If we can get everybody working at the top of their license and get the right patient to the right clinician at the right time, we can unlock a lot of value,” he said.
That may be one of the fastest ways health systems can create capacity without adding another physician.
A surgeon is only as efficient as the team around them
The workforce problem does not stop at the clinic door. Spine surgery depends on nurses, radiology technicians, physical therapists, anesthesiology teams and other professionals whose availability and expertise directly affect how efficiently care can be delivered.
Dr. Jain sees that most clearly in the operating room. At Johns Hopkins, an experienced spine nursing team allows surgeons to perform complex procedures with a high degree of familiarity and coordination.
Change the surrounding team, and the same surgeon’s capacity changes.
“The team goes beyond physicians and other clinicians,” he said. “It takes an entire clinical ecosystem working together to deliver high-quality care.”
That broader workforce problem led Dr. Jain and Diane Santa Maria, DrPH, dean of UTHealth Houston’s Cizik School of Nursing, to argue in a recent Health Affairs article that physician and nursing shortages are not separate crises, but symptoms of the same workforce problem.
The bottlenecks occur at different points. Nursing schools face shortages of faculty and clinical training capacity. Physician training is constrained further downstream by graduate medical education capacity. Rural and lower-income students remain underrepresented before either pipeline fully begins.
The shortages look different. The system producing them is connected.
Spine can create capacity by redesigning care
Training more clinicians remains necessary. It is also slow. Dr. Jain believes health systems have another lever available now: redesigning how spine care is organized.
His model is an integrated spine unit in which surgeons work alongside physiatrists, pain specialists, physical therapists, pain psychologists, nurses and navigators rather than forcing patients to navigate each specialty independently.
The goal is not simply to add more people. It is to use each person differently. Nurses and navigators could handle education and health optimization. Physical therapists and pain psychologists could address rehabilitation and chronic pain. Nonsurgical specialists could manage patients who do not need an operation.
Surgeons could spend more of their time on decisions and procedures that require surgical expertise. That is workforce design as much as care redesign.
It is also central to how Dr. Jain thinks about value-based care. Poorly organized access destroys value when patients cycle through unnecessary appointments without getting closer to the treatment they need. Better coordination can improve quality while reducing avoidable utilization.
“At the end of the day, if you think about what value-based care is, it’s really just high-quality care at a lower price,” he said.
A health system, in other words, does not create capacity only by hiring another surgeon. It can create capacity by protecting surgeons from work that does not require one.
Training surgeons for the team, not just the OR
That model also changes what future spine surgeons need to learn. As a leader of the Johns Hopkins Spine Surgery Fellowship, Dr. Jain said the program deliberately thinks beyond technical training.
“We make it a point not just to train good surgeons, but to train good teammates,” he said.
Future surgeons will increasingly practice alongside advanced practice providers, navigators, nonsurgical specialists and technology-enabled systems. They may also work under payment models that reward performance across an episode of care rather than excellence inside a single procedure.
Technical skill will remain essential. But the workforce ahead will demand surgeons who can function inside a larger clinical system.
“What this really requires is team-based medicine, where everybody has a really important role to play,” Dr. Jain said.
AI can give scarce clinical time back
Dr. Jain also sees technology as part of the capacity equation. He leads National Institutes of Health-funded research involving AI and next-generation surgical robotics, but some of the most immediate workforce applications are less dramatic than autonomous surgery.
Patient education is one. AI can help patients understand diagnoses, treatment options and next steps without requiring a clinician to personally deliver every routine piece of information.
Navigation and follow-up are another. Johns Hopkins is using AI-enabled tools for patient education, reminders and identifying urgent concerns.
Then there is documentation. Dr. Jain uses an AI scribe during clinic visits.
“AI can handle tasks like note-taking while I focus on the patient and better understand their history,” he said.
That may be AI’s more immediate workforce promise. Not replacing clinical expertise. Giving clinicians more time to use it.
The spine workforce of 2035 starts with a different architecture
Asked how he would redesign the spine workforce for 2035, Dr. Jain did not start with a target number of surgeons. He started with the structure around them.
His model would include surgeons, physiatrists and pain specialists, but also physical therapists, pain psychologists, nurses and nurse navigators. Those teams could take greater responsibility for areas that are clinically important but often poorly rewarded under fee-for-service medicine, including osteoporosis management, patient education and health optimization. The payment model matters because care models tend to follow incentives.
“If we don’t do a good job owning population health, someone else is going to own it for us,” Dr. Jain said.
He believes clinicians need to remain involved in designing those systems because they understand the patients those systems are intended to serve. Otherwise, spine risks having new payment models and care pathways built around patients by people who rarely see them.
More people are still part of the answer
Better workforce design does not eliminate the need to expand the national pipeline.
In their Health Affairs article, Dr. Jain and Dr. Santa Maria called for a coordinated strategy spanning early exposure to healthcare careers, nursing education, clinical training and graduate medical education.
They also called for activating the National Health Care Workforce Commission, which was created under the Affordable Care Act but never funded. The national argument mirrors what Dr. Jain sees in spine.
Healthcare keeps treating connected workforce problems as separate ones: physician shortages, nursing shortages, limited nonsurgical access, allied health vacancies and poor patient navigation.
Patients experience them as one system. The U.S. will need more clinicians to meet future demand. But adding people to a poorly organized system will only go so far.
Spine can train more surgeons and still waste their time. It can hire more nurses and still deploy them inefficiently. It can invest in AI and still send patients through the wrong front door.
The workforce challenge is not only how many people spine care can produce. It is whether the system can finally organize them around the patient.
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