Why private practice is right for spine surgery

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Spine surgeon Peter McCunniff, MD, took the leap from working as a hospital employee to a private practice, and he says the move has been beneficial. 

Dr. McCunniff, of the Pain Center of Arizona in Peoria, told Becker's about what he's learned from the transition and why he's excited about the collective power of physicians.

Note: Responses were lightly edited for clarity.

Question: What are you most proud of from the last year?

Dr. Peter McCunniff: Over the past year I made a change from a hospital-employed to a private practice model that is closely partnered with interventional pain services. We're now utilizing the model that I believe in and although it's early on, I am very happy with our success and what the future holds. I learned so much from my early experience in the hospital-employed model that has given me the perspective and experience to cut out the inefficiencies and allow the most streamlined care for my patients while also providing me great balance both professionally and personally.

Despite significant efforts and extra time devoted to creating a spine program in the hospital employed set up, I found that there were still significant barriers to having a successful spine practice due to the disconnect between administration and those of us tasked with building a new spine program within a large healthcare system and also being productive spine surgeons throughout the process. Spine surgery is different from both general orthopedic surgery as well as general neurosurgery. The large healthcare systems are able to engulf practices with those broader scopes and apply basic templates that are easily adhered to within their established system with relative success, but there's more nuance involved in elective spinal surgery that those general orthopedic and neurosurgical clinic templates will set the spine surgeon up for failure. I think most surgeons would agree that there are so many inefficiencies within a large system that waste time and don't contribute to positive patient care or improve their work-life balance. I believe that, in time, our practice model can represent an option for spine surgeons to maintain their autonomy and be very successful when other surgical subspecialties are being forced into hospital-employed positions to remain viable.

Q: What are the biggest trends you're following in healthcare right now?

PM: I am a huge proponent of navigation and robotics as someone who focuses the majority of their practice on utilizing minimally invasive and minimal access techniques to enhance patient care, improve safety, and patient outcomes. I strongly believe that total navigation and robotics will be the standard of care in the future and have many benefits that are often overshadowed by the cost of these technologies. Minimally invasive surgeons are well aware of the occupational health hazards associated with the increased amount of fluoroscopy required to perform minimally invasive surgery. Just like we would advocate for the hospital to provide us lead aprons for safety. I believe that in the not too distant future we should be able to make the argument for navigation systems as a way to almost eliminate radiation to ourselves and our teams in the OR while also minimizing complications and returns to the OR for inadequate decompressions or misplaced hardware. As more and more companies become involved in the development and distribution of these technologies, it creates a more favorable environment to get away from a one- or two-vendor monopoly and drive down costs to make these emerging technologies more widely available. This holds true for both navigation and robotics. There are software updates being developed frequently that improve these products as time goes on, so hopefully hospitals and ASCs can make these investments without fear they will be obsolete in a matter of months or years.

Q: What are you excited about for 2024?

PM: I believe that we are witnessing the power that we have as physicians, surgeons and advanced care providers when we come together for a common cause. There've been physicians strikes in the United Kingdom, as well as resident strikes here in the U.S., and I believe that we have reached this tipping point where physicians can no longer stomach all of the extraneous duties and inefficiencies that prevent us from directly caring for patients or being present and active in our personal lives and in those of our family members. We physicians are collectively a group of very altruistic people who really want to help others, and frequently we forget to stand up for ourselves because of some of those traits that make us great doctors. I want to be clear, I'm not advocating that we all need to go on strike! However, I am pleasantly surprised with the results that certain physician groups have demonstrated is still possible in a time when we have a profession united for our own well-being, and with that better care for our patients. This ties into my previous discussion about lobbying for technologies and equipment that can improve patients' safety and our efficiency. Rarely is the request of one surgeon or physician going to result in a significant change or capital purchase, depending on the situation, but when we take the time to organize and come together you can see the dramatic effect it has and the swift changes that can result. I hope to see more collaboration amongst physicians in general and for us to gain back some control of those things that directly impact our efficiency, production, job satisfaction and improve patient care.

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