'Banning noncompete language is overstepping': What experts told Becker's in April

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Spine and orthopedic experts shared with Becker's insights about physician autonomy, workforce policy and more in April.

Here is what those experts had to say on …

Orthopedic autonomy

"As an orthopedic surgeon, I've observed a concerning trend of diminishing autonomy compared to what we had 25 years ago. This shift is influenced by various factors reshaping medical practice. Firstly, payers exert more control, imposing pre-authorizations and guidelines that limit our decision-making, potentially compromising patient care and disrupting the surgeon-patient relationship. Secondly, private equity groups and hospital systems dominate, dictating every aspect of practice management, leaving us feeling disempowered within our own practices. Additionally, government regulations have increased, adding bureaucratic hurdles and emphasizing cost control, leading to care rationing strategies that compromise patient outcomes. As an orthopedic surgeon, we must regain control and take responsibilities into our own hands." — Nicholas Grosso, MD, of the Centers for Advanced Orthopaedics in Bethesda, Md.

How today's spine surgery will be seen in the future

"In 2034, I think we will look back at 2024 and actually be proud of ourselves! There is such a great emphasis on concepts such as pelvic parameters, adult spinal deformity following 1 level fusions and motion preservation techniques. People understandably want a one-and-done fix; this applies to house repairs, car maintenance as well as spine surgery! Of course some of the need for revision surgery is age, genetics and wear-and-tear, but we as a spine community are doing a much better job at identifying risk factors for ASD. We are definitely on the right track!" — Chester Donnally, MD, of Dallas-based Texas Spine Consultants

The FTC's vote to ban noncompetes

"Banning noncompete language in contracts is overstepping. When you sign a contract, you do so freely. If restrictive covenant is a problem, negotiate it out of your contract. This decision adversely affects small medical practices. Bringing a spine surgeon into a practice is a several hundred thousand to million dollar investment that takes a few years to recover. If that individual can simply cross the street or be poached by the local hospital system, it is hard to justify the hire. Hospitals or institutions that have multiple downstream revenue verticals unavailable to private practice have a competitive advantage in hiring as they recover investment faster and can therefore weather an early departure of a physician. 

"The bottom line is without a way to protect an investment in new employees, there is no incentive to hire them. There is zero chance we will hire new docs if we cannot protect our investment. This will cause small practices to go extinct over time." — Richard Kube II, MD, of Prairie Spine & Pain Institute in Peoria, Ill.

The future of ACDF

"Anterior cervical discectomy and fusion is a well-evolved procedure with documented excellent outcomes for appropriate indications. As material science continues to advance, we will see cages that are no longer inert spacers but rather actively participate in the fusion process. This will be coupled with advanced biologics that lead to more reliable and rapid fusion or cage bone ingrowth, 'welding' the spine together. This will allow patients to more rapidly resume unrestricted activities. 

"As total disc replacement has evolved, surgeons are stretching the indications and claiming excellent outcomes, typically with one-day follow up and 'peer reviewed' images posted on LinkedIn followed by the echo chamber adulation. Rigorous study is needed to define the place of TDR and ACDF in the spine surgeon's armamentarium." — Frank Phillips, MD, of Chicago-based Midwest Orthopaedics at Rush  

One physician's routine for long workdays

"I have found the best way to prepare for [busy] days is to try to stay in my routine. Get a good night's rest, get my regular exercise early in the morning prior to work. Before bed, make sure I am prepared and have all necessary materials with me. I think it's helpful to pack a mobile office so to speak, making sure I have access to any necessary charts or information that I need to deal with throughout the day, that way I can be efficient in between surgeries. I try to plan my day, and during short breaks do my rounding tasks, phone calls, follow ups, dictations and things of that nature. I try to be as efficient as I can throughout the day so I do not have a large volume of work to do at the end of the day." — Chris Cornett, MD, of Omaha-based University of Nebraska Medical Center

Why spine surgeons should be optimistic

"If you are a spine surgeon, you should be grateful that we are in a highly dynamic field marked by great strides in our capabilities. I am optimistic that the convergence of endoscopic and minimally invasive technologies, intraoperative navigation and robotic assistance, together with sophisticated data acquisition and analysis (turbo-charged with AI capabilities) will empower us to better care for our patients. As our overall population continues to age, spine surgeons and orthopedic surgeons will be in great demand." — Choll Kim, MD, PhD

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