It's well documented that spine surgeons have been struggling with rising costs, declining reimbursements and administrative burdens.
In the wider field, misinformation, false advertising and pharmaceutical companies and implant developers underreporting product complications have also contributed to difficulties in the profession.
Here, four spine surgeons discuss the biggest obstacles in spine and how to combat them.
Question: What is the biggest challenge facing spine providers today?
Note: Responses are lightly edited for style and content.
Martin Quirno, MD. New York University Hospital for Joint Diseases (New York City): As a young spine surgeon in private practice I realize it's becoming harder to reconcile rising overhead costs with the constant decrease in surgical reimbursements. We need more staff in our office to help deal with the increasing amount of logistics and paperwork. However, in order to have competent staff we have to provide a competitive salary, while our own reimbursements are actually decreasing.
We are expected to provide flawless care. Patients' expectations are very high. Therefore, it's very important to have a strong internet presence detailing your expertise and experience, to help accurately portray your practice with surgical reviews and patient experiences. This also costs money and time.
Eugene Carragee, MD. Stanford University Medical Center (Palo Alto, Calif.): The current spine provider is overwhelmed by the quantity yet dubious quality of literature purporting various therapeutic options and innovations. There is little time to thoroughly examine the literature in detail and many of the groups providing guidelines or systematic reviews have various agendas. The most prudent clinician is often unable to decipher what entities are promoting a product based on information readily available.
In the past few years there have been the largest litigations against drug and device manufactures for false promotion of products — including some of the largest indictments and cash settlements ever in U.S. history. The largest pharmaceutical and device corporations have been implicated in underreporting complications, duplicate publications, ghost writing and misleading promotion of products in the market.
John Spitalieri, DO. The Spine Center at Yavapai Medical Center (Prescott, Ariz.): All the usual suspects: payer denials, declining reimbursements, commodification of our profession and misinformation online. However, at the end of the day, it's our patients who suffer most. We need to be adaptable, caring and focused on our mission: managing and removing these obstacles as best we can for our patients so they can get the care they deserve.
Christian Zimmerman, MD. Saint Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): In my opinion, the largest hurdle facing all specialty spinal surgeons is the insurance approval process and escalating denial rhetoric, which in most instances, is baseless. When surgical decisions and discernments are based on physical and radiologic findings, most submissions are honored for their presentation and thoughts. Hopefully these trends are changing.