What's keeping spine surgeons up at night?


From increasing regulatory changes to the possibility of a single-payer system, the concerns of spine surgeons are many. Here's a look at what's weighing on the minds of four. 

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 is the most dangerous trend in spine surgery today?

Please send responses to Alan Condon at acondon@beckershealthcare.com by 5 p.m. CDT Wednesday, June 2.

Note: The following responses were lightly edited for style and clarity.

Question: What keeps you up at night as a spine surgeon?

Richard Kube, MD. Prairie Spine (Peoria, Ill.): I worry about rule changes. Specifically, I worry what regulation or rule will be passed, which adds little if any value to patient care, but creates administrative burden for our practice. These types of changes are hard for smaller organizations to handle. That leads to the second item: employee job satisfaction, and third, physician job satisfaction.

Human nature is to desire success. While we all define success a little differently, in general, people wish to have clear tasks. They want to know that they can achieve their tasks. They want to be liked by their peers. They want to avoid tasks that appear meaningless or without impact upon what they feel is important. As market forces driven by large health entities and the government squeeze smaller independent health providers, there is less focus on the individual. There is less autonomy for the individual. That is not a good thing. Employees and physicians alike feel unheard and unappreciated. I love what I do, and I believe our employees love working for us. I would like to see that continue well into the future.

Brian Gantwerker, MD. Craniospinal Center of Los Angeles: Firstly, I have found myself worrying about when the pandemic will end, and what will happen if we lose ground and fall back into a serious morass. It will be very hard to recover from a third downturn, fiscally and morally. If anything, surviving practices have become more erudite and flexible. But everything has a breaking point.  

Next, I think the specter of a single-payer system weighs heavily, not just on me, but all of us who still practice independently. I think some politicians are falsely equating single payer with the survival and success of our current healthcare system. But as with many things, newest is not necessarily the best. Universal coverage should be the goal, not universal payer. I think a single payer will discourage innovation and stymie any efforts at improving outcome — what will be the motivator?  

Lastly, I worry about what will be left for my son. When he becomes old enough to have a family of his own, I am unsure of what things will look like. Will he have the ability to choose a doctor? To be able to choose where he goes to have surgery? What about his own surgeon? Can he pay for his premiums? Will an illness ruin him financially? Our system has persisted for the last six or so decades. I think it can be fixed, so that my son can still have choices for he and his future family, without abdication of choice.  

Guy Lee, MD. Rothman Orthopaedic Institute (Philadelphia): As is everything in life, it's all about relativity. My friend is an electrician and he lays awake at night worrying that he did not connect wires together or run something properly. Obviously, I can't see how I would worry about something minor like that, but it's relative to what we do for a living.

First and foremost, the thing that keeps me up is the worry that maybe I did not do a good enough decompression, or is my pedicle screw perfect, or is the wound closed well? As I lay there and think, I know I did a good job, but still sometimes wonder and believe maybe I could've done a better job.

The next thing is worrying about patient issues. The patient calls with recurrent leg pain, back pain or maybe some weakness. After lying there for a while, I start thinking should I get a CAT scan or a new MRI, or just send the patient to the ER? But after a while I'm sure everything is fine, so I call and check on them the next day to make sure.

The last thing I worry about is the state of the healthcare system. I think of how difficult it is to provide high-quality care to patients without the hassle. I'm consistently trying to get approvals for MRIs or CAT scans, and ultimately surgery approval. Unfortunately, trying to provide good-quality care has become more difficult. It certainly has affected physicians in general, and even more importantly, patients.

Neel P. Shah, MD. DISC Sports & Spine Center (Newport Beach, Calif.): Dealing with insurance companies is at the top of the list of things that keep me up at night currently. It seems that an increasing number of imaging and surgical requests are going to peer review. Meanwhile, the guidelines to approve imaging and surgery have increasingly become more restrictive and convoluted, and many such restrictions do not appear to be based on high-level, peer-reviewed data. As a result, the time spent dealing with peer reviews continues to increase as payments decrease, and the bureaucracy of insurance companies is weighing our staff down as well. This trend has worsened even in the short time I have been in practice.

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