5 insights from Dr. Alex Vaccaro to know in 2023

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Alexander Vaccaro, MD, PhD, president of Philadelphia-based Rothman Orthopaedic Institute, has provided his insight on a range of topics in spine and orthopedics this year.

Here are five key quotes:

On orthopedic competition in Florida: "Florida is replete with competent orthopedic providers. Many outside forces are entering the Florida business market, including private equity. This waits to be seen on the effect it will have on patient care and physician satisfaction. Florida has many well respected medical universities and large private orthopedic groups. The combination of these organizations contribute to robust competition that will hopefully improve the patient experience and lower the cost of care."

On ChatGPT: "In academic research, ChatGPT can serve as a useful tool for researchers to increase research efficiency as well as improve their writing. As ChatGPT is trained on a database up to the year of 2022, it is able to summarize scientific information up to that point in time. By entering any scientific prompt, researchers can quickly assess an overview of the subject and better understand the pre-existing literature. ChatGPT is also able to analyze a written work and correct grammatical mistakes, check citations, as well as offer stylistic improvements. However, when using ChatGPT to generate text, care must be taken to ensure accuracy of the text as well as avoiding plagiarism. Although it cannot replace the role of an orthopedic surgeon, ChatGPT may provide patients with information on orthopedic diagnosis and management. When given a patient history of shoulder and elbow symptoms, ChatGPT chose the diagnosis made by a shoulder and elbow specialist in 93% of the patients and correctly managed 83% of the patients."

On mergers and acqusitions in healthcare: "We are all watching the trend among insurance companies and healthcare centers to get bigger through mergers and acquisitions. This will only be successful if it decreases the cost of care and provides an improved quality of care. If the cost of care eventually increases due to these trends, what will the federal government's response be to that? At the end of the day, every move we make has to make it less expensive for families to access healthcare. If that does not occur, then we will see the regulators intervene on behalf of the patient."

On his goals for the remainder of 2023: "As an organization, we continue to navigate the challenges of a post-COVID labor market, which includes inflationary pressures, staffing shortages and increased cost of working capital. Fortunately, Rothman as an organization has experienced a positive trend of strong year-over-year volume growth including new patient visits and surgical volume. Internally, clinical staff and X-ray tech positions are in high demand. The anesthesia labor market is disrupting the ability to provide services in all facilities, including specialty care hospitals and ASCs as nurse anesthetists have discovered premium wage hikes in smaller boutique venues such as stem cell, GI and gynecologic clinics. Patient demand for orthopedic care at this time is high but services are challenged as a result of these staffing disruptions. The specter of additional Medicare reimbursement cuts is deflating for physician morale, [and physicians] continue to face increased regulatory expectations for how care is delivered. The path forward includes partnerships with other allied groups that provide the needed services an orthopedic provider traditionally had no direct access to. This includes nonoperative specialists, nurse anesthetists and partners with access to competitive wage staffing solutions."

On patient misconceptions of spine surgery: "One of the most important roles of an academic spine surgeon is training the next generation of spine surgeons. Patients often fear that because of this training environment, their surgeon isn’t the one actually performing the surgery. It’s important to clarify that this is simply not true and it is imperative that the lay public understand what it means when one receives care at a training institution. All surgeries, whether in academia, combined academia and private practice or private practice, require more than one operator. In private practice, that operator might be a surgical assistant, while in academia it is often a surgeon-in-training — i.e. a resident or fellow. One of the main advantages of being at an academic center is that the teaching environment and attending-trainee relationship necessarily fosters an environment of curiosity, questioning and learning, which in turn forces the teacher to continually strive to become more self-reflective, well-read and skilled so that we can continue to teach effectively at the cutting edge. Training the next generation of surgeons of course involves teaching them surgical skills, but they learn in an apprenticeship model observing an attending surgeon. The attending surgeon always performs the key elements of a procedure, or for the layman, the most crucial components of a case, and trainees are allowed to gradually increase their skills as they progress in a monitored fashion."

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