'It is changing rapidly': The must-knows for the next generation of spine surgeons


A spine surgeon's career can be highly rewarding, both personally and financially, but the road to get there is not easy, and there are many factors to consider before deciding on a surgical specialty.

Six spine leaders share key considerations for the next generation of medical students who wish to pursue a career in the specialty.

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 will spine surgery look like at hospitals in 10 years? What can/will hospitals do to slow outpatient migration?

Please send responses to Alan Condon at acondon@beckershealthcare.com by 5 p.m. CDT Wednesday, Oct. 6.

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

Question: What's the one thing medical students considering a career in spine surgery should know about your specialty? 

John Koerner, MD. Rothman Orthopaedic Institute (Philadelphia): If considering a career in spine surgery, the first thing to figure out is which path you will take to get there. Spine surgeons are either trained in orthopedics or neurosurgery for their residency, where a portion of the time is dedicated to spine surgery. Most people then do a fellowship specialized in spine surgery, regardless of which residency is completed. It is important to spend some time during medical school with both orthopedics and neurosurgery to see which specialty (outside of spine) is of more interest. Many physicians take trauma call in their first few years of practice, where they treat nonspinal conditions, so it is important to have interest and enjoy treating the conditions outside of spine. 

Han Jo Kim, MD. Hospital for Special Surgery (New York City): Spine surgery is one of the most exciting fields in medicine today. Not only are there tremendous opportunities for innovations in technology, data analysis and patient care, but there are also opportunities to advance surgical techniques as the field continues to evolve and our understanding of the best treatments for our patients improve. This means that you can have a significant influence in the field, with the ability to change patient care and outcomes. However, the Peter Parker Principle is especially relevant: "With great power comes great responsibility." At times, spine surgery can be extremely stressful, and although it can also be extremely rewarding, we must always recognize that stress in your career can have effects on other aspects of your life. Nonetheless, we are fortunate to have leaders in the field today who are fully committed to the excellence and pursuit of perfection that is necessary to provide the best possible outcomes for our patients, and I look forward to the future generation of leaders to come and encourage you all to explore an extremely rewarding field of medicine.

Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: It is changing rapidly. You should always teach yourself "the old way" of doing things, because technology is fallible and gives you false sense of security. Practice putting in screws with your attending using just fluoroscopy and anatomic landmarks. You should learn the anatomy of the C1-2 space and learn how to identify the medial pars when placing a C2 pars screw, and where important anatomical areas should be identified and protected. It is OK to be slow initially. Take your time and read, read, read.  

Philip Schneider, MD. The Centers for Advanced Orthopaedics (Bethesda, Md.): I can't boil it down to just one thing, as there are several aspects of a spine surgeon that medical students should be aware of. Spine surgery — whether orthopedic or neurological — requires longer training than many other specialties, with residency and fellowship lasting five to seven years. Spine surgery does not come with a fixed working schedule, and often requires long working hours with late nights and weekends, especially in the case of emergency surgery. Spine surgeries last four hours on average, so a surgeon must be prepared to maintain extreme focus for long periods of time. However, contrary to popular belief, spine surgeons are typically not performing surgery all day long. Much of the job is treating patients' spine issues with nonsurgical methods like medication and physical therapy, which is quite rewarding.

Richard Chua, MD. Northwest NeuroSpecialists (Tucson, Ariz.): Extremely gratifying for how spine surgeons help patients with pain, disability and enhancing their quality of life.

Ali H. Mesiwala, MD. DISC Sports & Spine Center (Newport Beach, Calif.): Spine, be it an orthopedic or a neurosurgical subspecialty, is an ever-evolving field. Medical students interested in this specialty should consider their commitment to constantly educating themselves in emerging technologies and techniques, while building a solid foundation in the principles of spine surgery. Like any other surgical specialty, it is a lifelong commitment and should only be pursued if there is nothing else in medicine that will make you equally happy. The time commitment and sacrifices along the way are not worth it if one does not truly enjoy the specialty. On the other hand, there are few specialties that are as rewarding and impactful in patients' lives. There are unique opportunities in the outpatient setting that didn't exist many years ago, and inpatient work will gradually shift to the treatment of medically complex patients, or those with complex spinal problems.

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