The best advice for aspiring spine surgeon entrepreneurs


Five spine surgeons share advice for becoming an entrepreneur within the spine industry.

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 are the habits you have adopted to avoid physician burnout?


Please send responses to Anuja Vaidya at by Wednesday, Jan. 31, at 5 p.m. CST.


Question: What advice do you have for young spine surgeon entrepreneurs?


Brian R. Gantwerker, MD. Founder of the Craniospinal Center of Los Angeles: For the young entrepreneur, align with people who are smarter than you, but also who have complimentary talents. Whatever your ideas are, make sure you have nondisclosure agreements in place. If you are inventing things or creating intellectual property, find a worthwhile attorney. Understand the realities, though, that you are a doctor first and business person second, but the two roles are not necessarily mutually exclusive.


J. Brian Gill, MD. Spine Surgeon at Nebraska Spine Hospital (Omaha): I would tell young entrepreneurs to invest in yourself and not to be afraid of failure as both lead to success. Additionally, always put yourself in a place to succeed with your skill set that you have by knowing your personality, strengths and weaknesses. Finally, I think every young surgeon needs a mentor(s) clinically and professionally, either the same person(s) or different person(s).


Richard Kube, MD. Founder and CEO of Prairie Spine & Pain Institute (Peoria, Ill.): You have to be willing to go "all in" and accept risk. You have to be committed to the point of being willing to face failure. Many professionals are actually just involved rather than committed to their business. You have to be the latter. If you are wondering about the difference, someone once told me to picture a bacon and eggs breakfast. The chicken was involved. The pig was committed. When you are that committed, it improves focus and helps you to take risks because you believe in your model and are completely driven to succeed.


Inertia kills a lot of businesses. You have to make decisions and live with them. Of course you need to analyze each situation and make the best decision you can. Remember that in every instance, you can either make a good decision, a bad decision or no decision. Two out of three of those is wrong. Make a plan and stick with it. When you make a bad decision, recognize it and recover as quickly as possible. If you are thoughtful, calculating and nimble, a bad decision should not lead to an extinction event. Learn from it and move on.


Payam Farjoodi, MD. Orthopedic Spine Surgeon at Spine Health Center at MemorialCare Orange Coast Medical Center (Fountain Valley, Calif.): The opportunities for spine surgeon entrepreneurs are growing more limited as the result of the misconduct of some in the past. Although spine surgeons are best equipped to develop new technology for use in the operating room, many hospital systems have moved away from doing business with any physician-owned entities. I think we will certainly see a slowdown of innovation as a result of this. I think young spine surgeons should be cautious about joining ventures that they are unsure about. It is always a good idea to seek the advice of a healthcare attorney when approached with an opportunity.


Michael Gordon, MD, Spine Surgeon at Hoag Orthopedic Institute (Irvine, Calif.): Let's be practical about the early years of spine surgery — setting up your practice and your personal interactions with other physicians will occupy your focus for the first few years after training. Recognize that there are two different monetary aspects of your professional life — generating revenue through the practice of medicine and generating revenue through the business of medicine. Patient care and excellence comes first. Once you are set up, what then about other revenue generation?


Closest to practice are revenue streams from ancillary office opportunities, including in-office MRI imaging, close association with ASCs and providing nonsurgical therapies, such as injections and radiofrequency ablation therapies. These can generate additional revenues but must comply with strict Stark regulations and ethical constraints. They can be very expensive to set up and require additional managerial commitments. Hospital directorships can also be lucrative. If you have a special talent and cutting-edge skills, hospitals will pay for your expertise, [especially] if you are positioned correctly. Don't expect to take over right away in the healthcare delivery system which is densely populated with other spine surgeons. You should always be considering how best to control the healthcare dollar, because administrators, government and insurance companies see the partitioning of those resources as a zero-sum game.


Spine surgeons are among the most ingenious and motivated of surgical subspecialists. We sit in an unusually fluid intersection of patient care and evolving technologies, and are constantly reinventing surgical procedures. There are multiple opportunities for intellectual property development, and good ideas can come frequently if you are willing to change your mindset to "how can I do this procedure more effectively?" One thing I've learned, if it's a good idea in the operating room, someone else probably thought of it too, so be quiet, sketch it out and immediately file for a patent. You may not get a patent issued, but you are protected, and "first to file" is the rule for ownership of a new idea. If you are lucky and persistent, you may be able to bring a surgical device to market. You will need legal protection and a business entity. Your device can generate revenue, but only if you are picked up by a larger company or your volume is unusually large.


Teaching and consulting agreements with industry are common in spine surgery but ethical considerations must be considered, and "pay to play" is both unethical and illegal. If you enjoy teaching and lecturing, that can be professionally fulfilling, but also time consuming. Throw many ideas against the wall every day and something will stick eventually.


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