Business sense: What spine surgeons wish they'd known at the start of their medical careers


Five spine surgeons discuss the business of medicine and the knowledge that would have been useful earlier in their careers.  

Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. We invite all spine surgeon and specialist responses.

Next week's question: What is the best book you have read in the past year that has made an impact on your career?

Please send responses to Anuja Vaidya at by Wednesday, March 29, at 5 p.m. CST.


Question: What business aspect of spine care do you wish you had known more about before starting your career?


Brian R. Gantwerker, MD. Founder of the Craniospinal Center of Los Angeles: This is a difficult question, because there are a lot of things I wish I had done differently from a business standpoint. I think primarily that knowing people are willing to pay for good work and that not to get discouraged by the shenanigans so many carriers play out. If I were to advise the me of seven years ago, I would have started my own practice first and built my brand from day one.


Plas T. James, MD. Spine Surgeon at Atlanta Spine Institute: I think just knowing more about basic accounting and business models would be helpful. In medical school, we didn't really learn a lot about business when I was training 20 years ago. I also think human resources, or just learning to manage people in general, is a skill that would have been very helpful to learn early on before medical school or during medical school.


Vladimir Sinkov, MD. Spine Surgeon at New Hampshire Orthopaedic Center (Nashua): All of them. I had no formal training in the business and marketing aspects of medicine and surgery or how to run a private practice. I had to learn on the job, sometimes through trial and error but more often through advice of my senior peers. I do my best to educate students that rotate with me about the business of medicine so that they have easier time starting their careers.  


Richard Kube, MD. Founder and CEO of Prairie Spine & Pain Institute (Peoria, Ill.): I guess you could, in some way, say all of it because I think most fellows are ill-prepared to be business owners upon graduation. In particular, I would have liked to have known more about ambulatory facilities earlier. That has been a very rewarding part of our practice and had I known more earlier, we would have likely started our facility sooner. I think it would also be good to have a greater understanding of human resources and the hiring process. That can be a very time-consuming part of the practice if there is turnover, and it is financially inefficient as well.


Kern Singh, MD. Co-Director of Minimally Invasive Spine Institute at Midwest Orthopaedics at Rush (Chicago): Marketing and image is something I think surgeons aren't constantly aware about, especially not in the thick of training, but it is a necessary component of one's practice. From the presence that you have online to the way that you portray yourself in patient encounters, it is important to be mindful of the reputation that you portray to the public. That can be incredibly helpful or devastating in your professional growth.


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