The 'new normal' in spine: 11 surgeon predictions


Eleven spine surgeons answer the question: What will the 'new normal' look like in spine post-pandemic.

Charles Branch Jr., MD. Executive Director of the Spine Service Line at Wake Forest Baptist Health System (Winston-Salem, N.C.): The new normal for spine surgeons will include more patient engagement through technology. It is quite possible that holographic imaging of patients in their home setting will allow for a more complete telehealth visit. Our clinic visits of the future will be a mixture of telehealth and face-to-face patient visits and the proportions will be driven by the practice type and patient demographics. In the near term, I am concerned that there will be a constriction in new technology availability for spine surgeons given the dramatic losses that healthcare systems have endured and will continue to expect in the future and in the weeks ahead. On the other hand, I believe we will be able to generate better and more evidence-based outcomes that will guide our decision making or give us valuable predictive analytics in the future.

Richard Wohns, MD. Founder and President of NeoSpine and Microsurgical Spine Center (Puyallup, Wash.): We are in uncharted territory and it is at least clear that we will not return to the 'old normal.' The 'new normal' will likely include a greater interest by all stakeholders in outpatient spine surgery centers, promotion of telehealth options for patient care, and a new awareness of the 'costs' of doing business. The 'costs' include risks to health care providers, the underlying economics of healthcare in hospitals, clinics and ASCs, plus the role of medical insurance.

A silver lining may be less numbers of frivolous lawsuits that plague the house of medicine, as patients will hopefully realize how many healthcare providers risked or lost their lives taking care of patients with COVID-19. This pandemic has been a severe shock to the entire healthcare delivery system and severe shocks historically lead to severe repercussions. At the end of the day, I am optimistic that we will have learned painful lessons that will help us provide better care to our patients.

Andrew Hecht, MD. Chief of Spine Surgery at Mount Sinai Hospital and Mount Sinai Health System (New York City): The new normal looks will be less outpatient and surgical volume until there is a vaccine, truly effective drug, or herd immunity. Surgeons and patients must now weigh additional risks related to COVID-19 when seeing a patient or scheduling a surgery.

Choll Kim, MD, PhD. Spine Institute of San Diego: For those of us who embrace the rapidly improving web-based remote technology, the new normal will be the ability to reach out to patients and colleagues without the limitations of distance. My goal is to create a group of spine surgeons working together to create a virtual center of excellence. The virtual center of excellence will allow like-minded surgeons from around the globe to share knowledge and insights to improve their practice.

Similarly, patients will be able to easily find and interact with such centers of excellence via telemedicine. With iterative improvements, I anticipate great advances in the field of spine surgery, especially in terms of developing and growing true centers of excellence.

Scott Boden, MD. Chair of the Department of Orthopaedics at Emory University School of Medicine and Vice President for Business Innovation at Emory Healthcare (Atlanta): The 'new normal' will likely mean seeing less patients less often in the office, but I don't see the need for spine surgery changing much. There will, of course, be continued screening and preoperative COVID testing of surgical patients at least until there is a successful vaccine.

Kern Singh, MD. Co-Director of the Minimally Invasive Spine Institute at Rush (Chicago): The new normal is a dramatically reduced volume of clinic and surgical patients. My practice was already shifted towards the ASC environment and now with hospitals still being shut down it has only hastened that transition. More outpatient surgeries as patients are reluctant to spend time in hospitals with others who are infected with the COVID-19 virus.

Mick Perez-Cruet, MD. Beaumont Hospital (Royal Oak, Mich.): Normal might take some time to achieve, at least till an effective treatment or vaccine is out. Until then precautions will be in place and we will just have to do the best we can. I do see more of a shift to doing cases at the ambulatory surgery center. Ultimately this might favored reduced spine care cost.

Dwight Tyndall, MD. Dr. Spine (Munster, Ind.): The new normal for the foreseeable future is employing all the social distancing protocols while seeing patients within an office setting and the use of telemedicine to allow patient access while allowing patients the security of limiting physical contact. Additionally, there will be the additional layer of patient and staff COVID-19 testing as a part of both the clinical and surgical practices.

Charley Gordon, MD. Precision Spine Care (Tyler, Texas): The new normal for spine surgeons is likely to be decreased volumes for the near term. Patients are going to be inclined to delay surgery and higher levels of unemployment are likely to further limit access to care. Longer term, I predict we will adopt more Asian customs such as wearing masks in public and greeting each other without shaking hands. If we look at those cultures as a model, spine surgery continues to flourish because ultimately what we offer are truly essential services.

Nick Shamie, MD. Chief of Orthopedic Spine Surgery and Vice Chairman of International Affairs at the David Geffen School of Medicine at UCLA (Los Angeles): We have implemented changes in our practice, like social distancing and following recommendations of CDC to keep our patients and staff safe while still offering the best care for our patients. This means more telemedicine, doctors and patients wearing mask during visits, and procedural changes in our day-to-day routines to increase efficiency and safety for all. But also, this 'pause' has forced us to realize how important it is to work together ... and together we will prevail. Perhaps the 'new norm' will encourage us to be better versions of ourselves.

Paul Slosar, MD. President of SpineCare Medical Group (Daly City, Calif.): I really didn't know how to define 'normal' in healthcare before this recent disruption, so what may be 'new normal' is not easy for me either. I am very concerned about how much we have frightened our patients, our colleagues, and the general population during this recent pandemic. Many of my patients are desperately afraid to come to the clinic or hospital, as they think it is 'radioactive' (like Chernobyl) with COVID-19.

It is now incumbent upon us and our institutions to educate patients, reduce their fears, and help them move forward with their medical care, be it surgical or otherwise. I think the spine and orthopedic surgeons can make a tangible and positive impact with patients, as we are, by definition, focused on restoring function. And that is exactly what we need now … to restore near-normal function as rapidly and safely as possible. My immediate concern is guiding my patients back into the healthcare delivery system, even if I have to do it one patient at a time.


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