Key mistakes young spine surgeons make & how to avoid them


Four spine surgeons share advice on avoiding missteps early on in one's career.

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 advice do you have for spine surgeons who want to get involved in device/technique development?

Please send responses to Anuja Vaidya at by Wednesday, Oct. 3, at 5 p.m. CST.

Question: What are some of the common missteps spine surgeons make early in their career, and how can they be avoided?

Rob D. Dickerman, DO, PhD. Director of Neurosurgery at Presbyterian Hospital of Plano (Texas) and Director of Spine Surgery at Medical Center Frisco (Texas): Use experienced attorneys for medical contracts before signing and committing to any program, company or affiliation. Tripe check references on third-party entities that are in place to help your practice, like billing and coding practices. Utilize experts in their respected fields to allow you to be a physician only. I also highly recommend using financial advisers early on in your career to help manage medical school debt and to protect your practice.

Brian R. Gantwerker, MD. Founder of the Craniospinal Center of Los Angeles: Common errors I have seen can be broken down into three categories: assumptions, expectations and resistance. Assumptions are [having] thoughts [that by] showing up to a practice, you will automatically have patients and work. The unfortunate thing about employed positions is it misleads the new surgeon that work will be a turn-key situation. It is a unicorn and does not exist.

Expectations are notions about your current and future situation that are simply not true. One cannot expect everyone will welcome you, that all your cases will go brilliantly and that your colleagues will accept you. Let go of that thought early because it is awfully close to dangerous hubris.

Resistance is refusing to accept that change will come. This can be true for both early and mid-career surgeons. We must be ready to accept change not just in practice, but also to consider new technologies. Sometimes this technology can be things like stand-alone interbody fusion devices, interlaminar stabilization devices or spinal cord stimulation.

Richard Kube, MD. Founder and CEO of Prairie Spine & Pain Institute (Peoria, Ill.): I have often heard the statistic that 50 percent of spine surgeons change jobs in their first two years out of training. I am one of those doctors myself. I do not believe that there is enough time spent truly examining a prospective employment relationship. It is serious, much like a marriage. There is often an assumption that there will be change within a group, or that there will be compromise with new ideas being brought forward. While this can happen to some degree, always remember that the tail cannot wag the dog. You cannot expect to change a culture, or at least realize you will likely grow frustrated prior to making a significant change occur, if at all.

If there are significant differences in ideology, move on to the next opportunity. There are a lot of jobs out there. Find one that suits your goals, intentions and desires as related to patient care, work ethic, business ethic, etcetera. Ask critical questions. You need to know who these people are. Time up front will save even greater time and money on the back end.

Payam Farjoodi, MD. Orthopedic Spine Surgeon at Spine Health Center at MemorialCare Orange Coast Medical Center (Fountain Valley, Calif.): I think the best advice I received is always believe the patient. When they have a complaint, no matter how strange it seems, make sure you do a thorough workup and evaluation. Do not discount what the patient is telling you, even if there are confounding factors.



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