8 Ways for Spine Surgeons to Leave a Lasting Mark on the Field


Spine surgeons have a huge responsibility to provide safe, effective and cost-effective care to patients on a daily basis. However, for surgeons who want to go the extra mile to impact spine care beyond their practice, there are several avenues worth exploring.
Dr. Scott Boden on spinal surgery"As a surgeon you can affect peoples' lives with the patients you touch with your own hands," says Scott Boden, MD, Director of the Emory Orthopaedics & Spine Center in Atlanta. "For some of us, we feel we can have a bigger impact and pay back if we can help patients beyond those we can touch with our own hands. I've been lucky because I have the satisfaction of helping my patients like any other surgeon as well as helping other surgeons create an environment where they can help their patients. It's really a unique situation to be active and contribute in those different domains."

Here are eight ways spine surgeons can step outside their practice and make a mark on the field.

1. Train the next generation of spine surgeons. One way spine surgeons can impact the future is through educating the next generation of spine practitioners. Whether in a faculty position at medical school or training residents or fellows, providing this expertise can make a tremendous difference for developing spine surgeons.

"We can train the next generation of spine surgeons with the philosophy and techniques that have worked well for us," says Dr. Boden. "Spine surgeons are trained nowadays in the traditional academic settings as well as private practices. At Emory, we are training multiple spine fellows, but also orthopedic and neurosurgical residents, which means there is a broader potential to be a role model and inspire future generations to learn how to do the right thing."

Dr. Robert Bray on spinal surgeryAdditional educational opportunities include speaking at meetings, training surgeons in new techniques and presenting research at a national level. "These are the single-biggest ways people can make a difference, and it's something most young surgeons don't often do," says Robert S. Bray Jr., MD, founder and neurosurgeon at DISC Sports & Spine Center in Marina del Rey, Calf. "They are trying to build their practice, but they neglect the teaching part of it. Their time isn't reimbursed for teaching, but it's the most important part of building a reputation and becoming involved."

2. Lead or participate in research and development.
There are many opportunities to engage in research and development in the spine field. Surgeons who have a strong interest in solving a particular problem, improving outcomes or making healthcare more accessible for a broader range of patients can design a variety of research studies and publish their results.

"I pride myself in the fact that despite being in a private practice, I'm also involved in academia, residency instruction and publications," says Eli M. Baron, MD, a neurosurgeon at Cedars-Sinai Medical Center in Los Angeles. "I'm constantly pushing on that level. Manuscripts are very important because at the end of the day, people look at publications and you have literally educated others as well as yourself. Always take on projects and look to expand."

Technology and technique development is another way spine surgeons can make their mark for future generations.

Dr. Eli Baron on spine surgery"I've tried to contribute beyond my own patients through research and developing new technologies," says Dr. Boden. "You can touch more lives by working on these projects. I've had the privilege to work on projects to accelerate the development of bone biologics, such as bone morphogenetic protein for challenging cases. Moving forward, I'm working on a new paradigm for us to regenerate bones that would be more compatible with the future of healthcare economics. I've been heavily involved with trying to engineer the next generation of bone-growing products that are more cost effective and efficient. That's how I contribute."

3. Create a stable spine care environment.
Another way for spine surgeons to contribute to advancing the field is through innovation with collaborative spine practice and department models. Healthcare is moving more toward comprehensive and coordinate care, which leaves plenty of opportunities to develop the spine care model of the future.

"One of the challenges we have in academic environments is creating a stable environment where you can attract and maintain the best surgeons on a long term basis," says Dr. Boden. "That has historically been a problem for academic medical centers and I've tried to have an impact by creating practice delivery models that are compatible with tracking and keeping surgeons in the academic environment."

The key to keeping surgeons in the academic setting long term, says Dr. Boden, is shared decision-making and investing the time to create a team culture.

"If people are going to work together, they need to have a common vision and shared values, and approach coming challenges together," says Dr. Boden. "Create a culture of mutual respect, transparency and accountability in achieving this vision."

Dr. Sean McCance on spine surgery4. Advocate for healthcare policy.
As healthcare reform moves forward, it will be crucial for spine surgeons to participate in local and national advocacy efforts to positively influence healthcare policy. Surgeons understand what their patients need and have several options to ensure their voices are heard.

"One of the big things surgeons can do today is advocating for health policy to protect the ability to provide patient care, access to care and procedure coverage," says Sean McCance, MD, co-director of spine surgery at Mount Sinai Hospital and director of Spine Associates in New York. "There are several things surgeons can do at the grass roots level, including speaking to patients about what is happening to healthcare, as well as at the policy level. Work directly with legislators to make sure they understand the issues we face every day; in these interactions, educate them."

Surgeons can also write letters or contact their representatives personally and contribute money to representatives supporting their values. Spine surgeons can also contribute to political action committees at the local and national level. The North American Spine Society's PAC funds efforts to lobby congressional members in Washington, DC, for surgeon and patient interests.

"The denial of care is more frequent now and it's hitting home as more surgeons and patients become aware of it," says Dr. McCance. "This is leading people to become more involved and contribute in any way they can."

With reimbursements dropping as well, advocacy is more important now than ever. "In your advocacy efforts, make the importance of being a good clinician and achieving good outcomes your focus," says Dr. Baron. "As financial opportunities drop and the government looks at reimbursements, you have to ask yourself what the field is about and make sure there is still nobility there when the financial incentives are gone."

5. Document your outcomes and share with others.
Data is king in a pay-for-performance healthcare model, which is where most providers are heading. Payers, hospital employers, patients and even malpractice insurance providers are looking for data to support treatment at the global and local levels.

"You have to know what you're going to do with each patient and what the outcome will be," says Dr. Bray. "Too many times people are doing things that aren't critically looking at how the individual patients will do. Gather your own information and share it with others as it comes out."

Electronic medical records will make it easier to gather and mine data about patients with very specific conditions to more accurately predict how future patients will fair. This data will become increasingly important to achieve reimbursement.

"It takes a lot of extra work, but it's critical for surgeons to show the insurance companies their last 2,000 procedures and what the outcomes were," says Dr. Bray. "Gather information about blood loss, postoperative pain scores, how long patients stayed in bed post-surgery and recovery times before returning to work. Make sure you are up to standard and share your data with others to improve overall care."

6. Be an early adopter for new and appropriate technology.
Spine is a rapidly developing field and adopting new technology early will establish you as a leader in the field. However, make sure this new technology is appropriate and safe for your patients before incorporating it into your practice.

"Look carefully at data behind these technologies to see what is appropriate," says Dr. McCance. "If you are inclined, work with industry to develop these technologies to meet the needs of the field."

Once you achieve good outcomes with the new technology, you can teach and mentor others. However, be aware of financial incentives from device companies and always disclose any conflicts of interest.

"You don't want to develop a negative reputation by taking money out of the system," says Dr. Bray. "Develop new technologies and train other surgeons for the purpose of teaching. National meetings now require disclosures of bias, and there are sometimes so many things people are paid for it's difficult to give the presentation honestly. If you are going to teach and document, do it in an honest, non-biased, non-paid fashion."

7. Become an accurate and trusted voice for spine patients online.
Patients are increasingly turning to the internet for information and education about their medical conditions, and some of the information posted is inaccurate. Spine surgeons and specialists devoted to patient education can develop written or video content to point patients in the right direction.

"There is a huge educational possibility for physicians who want to have an impact beyond patient care on the internet," says Dr. McCance. "There is a lot of market-driven commentary on the internet about spinal implants or procedures, and it's important for competent physicians to provide educational information about the realities of spine surgery for patients."

Much of the fear of spine surgery today stems from inappropriate information people find online about failed surgery, without hearing the success stories. "Experts can debunk myths about spine surgery and give a voice to accurate research data and clinical outcomes," says Dr. McCance. "This information can be used to counteract the unfiltered and inaccurate information that can be found on the internet."

8. Participate in local charities.
The local and medical community alike respect surgeons who give back to charities, whether they are specialty-related or not. Choose a project or cause you're passionate about and pursue opportunities to make the community better.

"One the community level, you want to be visible and involved in local charities, and put yourself out there as someone who is trying to help make a difference," says Dr. Baron. "By trying to do the right thing and being benevolent and philanthropic, you are gaining the respect of others. I also pass this on to my residents and fellows to perpetuate this philosophy in the operating room."

More Articles on Spine Surgeons:

8 Key Considerations for Spine Surgeon Personal Finances

5 of the Biggest Challenges in Spine Surgery

5 Areas for Spine Surgeon Leaders to Pave the Way Today From Dr. Richard Wohns

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