Seven spine surgeons reflect on their career and the state of the field today to offer emerging surgeons best practices for establishing themselves.
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 your best practices for implementing a new spine procedure?
Please send responses to Alan Condon at firstname.lastname@example.org by 5 p.m. CST Wednesday, Dec. 16.
Note: The following responses were lightly edited for style and clarity.
Question: What advice do you have for emerging spine surgeons looking to establish their practice? How should they be looking at the future?
John Burleson, MD. Hughston Clinic Orthopaedics (Nashville, Tenn.): In my experience, joining a group that already has some experience is key. For your first job, you want to focus on becoming a surgeon. So, joining a group that has a marketing department, staff that know how to run clinic and book cases, and senior partners are very important. Even if you join a group without a spine surgeon, they will have a lot of other things figured out. Sharing costs for office space, EMR and other overhead expenses is huge. Find yourself a group that is looking to add you for the right reasons (needs a spine surgeon to complete their complement of offerings, has a spine surgeon that is way too busy, or has a retiring surgeon, etc.) instead of the wrong reasons (wants a surgeon to cover more overhead costs, hasn't done any market research, or wants a spine surgeon just to increase income at their surgery center, etc.)
Grant Shifflett, MD. DISC Sports & Spine Center (Newport Beach, Calif.): My best advice for new spine surgeons is to avoid hubris and make friends. Finishing fellowship, you feel like you are at the top of your game, but spine surgery is a humbling profession and being too cavalier early on can result in complications that will ruin your reputation before you even have a chance to prove yourself. In that same vein, make an effort to get to know and learn from those more senior physicians in your practice and in the community. They have a ton of experience — which you do not have — and instead of making your own mistakes (which you will definitely still do), you can learn from their mistakes and stay out of trouble, allowing your practice to mature more quickly.
Robert Bray Jr., MD. DISC Sports & Spine Center (Newport Beach, Calif.): For the developing surgeon, I have only two simple suggestions. Learn and become adept with a microscope. Find a practice that fits your future and has the ability for outpatient site-of-service. The migration of high acuity spine surgery to ASCs is moving quickly, and providing quality care in a cost-efficient manor will drive a bright future.
Brian Gantwerker, MD. Craniospinal Center of Los Angeles: Three rules to live by in spine surgery:
1. Always operate on indications, not for a payday or film.
2. Follow your postoperative patients like a hawk. You will avoid most post-op morbidities by close (albeit unpaid) follow-up — do not farm this out to a mid-level. Your eyes are always the best.
3. Make sure you return phone calls to referring physicians. You would be surprised what cache you can get from just being good about returning calls.
Jeffrey Deckey, MD. Hoag Orthopedic Institute (Irvine, Calif.): Emerging spine surgeons should most importantly concentrate on providing high-quality care for their patients and communicating with their referring physicians. Over time, these satisfied patients and physicians will be one's best referral source. In addition, when establishing a new practice, one should spend extra time developing and educating their staff in the clinic, the operating room and on the orthopedic floor. This will result in optimal outcomes, improved efficiency and ensure that one is surrounded by a team of people that share a similar philosophy.
Additionally, emerging spine surgeons should continue to work on improving their surgical skills and continue to educate themselves. Even after 20 years of practice, I continue to read, attend meetings and lecture at courses. My techniques and treatment algorithms continue to evolve. In addition to improving one's clinical knowledge, it is equally important to learn about various aspects of the business side of their practice. Over time, one should thoroughly understand the inner workings of their practice, including billing and collections, insurance contracts, compensation formulas and overhead calculations. This will allow one to position their practice for long-term success.
Todd Lanman, MD. Lanman Spinal Neurosurgery (Beverly Hills, Calif.): Spine surgeons finishing training who wish to work in healthcare have two choices. One is to work in the private sector, and the other to work in a large hospital-based or university practice. The current markets are shifting more toward the latter type of practices or large medical groups, such as a university, foundation or other hospital-based system, which seem to have many benefits for young surgeons. However, they're a bit restricted in their development and use of newer technologies, so surgeons who are a bit more aggressive and really want to be leaders in motion-preservation spinal technologies certainly have more within their reach in the private practice realm.
Christian Zimmerman, MD. Saint Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): My advice to the emerging spine surgeon is those words bestowed upon me during my fellowship training at Barrow Neurological Institute in Phoenix: Do the right thing, treat the patient first. Be practical and conservative and be the proud legacy of the program that accepted you and expanded your skill and knowledge. Medicare and its unforeseeable future will dictate all our futures. Their unrelenting cost shifting will plague our practices forever, yet still allow us to practice the medicine needed. The trade-off was and remains rewarding. It depends on the individual's outlook and the engaging nature of the person.
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