Here's what not enough spine surgeons are doing


Seven spine surgeons discuss the skills and practices they feel more spine surgeons should engage in.

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. Becker's invites all spine surgeon and specialist responses.

Next week's question: What spine procedure is best poised to move to the ASC next?

Please send responses to Carly Behm at by 5 p.m. CDT Wednesday, Aug. 2.

Editor's note: Responses were lightly edited for clarity and length.

Question: What's one thing not enough spine surgeons are doing today?

Nitin Bhatia, MD. UCI Health (Orange, Calif.): While there are many things that spine surgeons do well, there are various things which we could be doing better both individually and as a spine community, including the development and refinement of surgical techniques, analyzing and improving patient outcomes, and collaborating with each other and our patients to optimize clinical success. One item, however, that often is forgotten, is the need for all of us to advocate for our patients. Changes in reimbursement, governmental policy and the insurance approval process have the potential to detrimentally access care for all our patients. While patients also need to advocate for themselves, the spine surgeon community must work together to ensure that we can continue to provide our patients high-level care in a consistent manner by educating our policymakers about the negative effects of these changes on our patients' lives. 

Brian Fiani, DO. Mendelson Kornblum Orthopedic & Spine Specialists (West Bloomfield, Mich.): In recent years, there has been a shift towards motion-preserving techniques, such as disc replacement or dynamic stabilization. These surgeries offer the potential for improved long- term outcomes with reduced risk of adjacent segment disease complications or pseudoarthrosis. I believe there is still a need for more spine surgeons to consider these types of surgeries when evaluating surgical options.

Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: More spine surgeons should be using their hospital's old-school dictation system. I believe using speech recognition for your reports is unnecessary tech bloat. It eats up a ton of your time, and using templates in general is a no-no from a medical legal standpoint. I find that dictating your operative report captures the nuances of every surgery that templates steamroll over and open you up to questions in litigation. Also, it really paints a vivid picture and lets you "tell the story" as you go.

Marc Levine MD. Robert Wood Johnson University Hospital Hamilton (Hamilton Township, N.J.): Make no mistake, the dynamics of healthcare delivery in this country are changing daily, often without input from physicians. It is vital as spine surgeons that we are at the table as critical decisions and plans are put into place that will not only affect our ability to practice and deliver care to our patients but also that ability for future physicians. Regardless of the practice model for which each of us work, we must strive for an autonomy that allows us to provide excellent patient care while maintaining a dignified and rewarding lifestyle. I would strongly encourage all of my colleagues to get involved in critical decision-making.

Neil Patel, MD. Spine Team Texas (Southlake): As a spine surgeon, I believe we aren’t seeing enough collaboration in our field. I am fortunate to work at a multidisciplinary spine practice at Spine Team Texas, where we have variety of spine care specialists from physical therapists to PM&R physicians to Anesthesia/Pain Management physicians to spine surgeons. We discussed cases with each other on a daily basis to develop the most effective treatment plans. Spine is a team sport and we have to treat it as such in practice.

Vladimir Sinkov, MD. Sinkov Spine (Las Vegas): Not enough spine surgeons are standing up to the health insurance companies and government agencies that constantly create new unnecessary regulatory and bureaucratic burdens while decreasing reimbursements for the work done. The longer we wait, the harder it will become to run our practices and provide appropriate care for our patients.  

Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): Speaking for this community alone, and not nationally reported numbers, the "opt-out" of both the underinsured populace and Medicare patients have now become the charge of health-system physicians or those who continue to be societal-minded in their beliefs. Most refusals are initiated in private surgical offices or result in patient transfers to larger institutions. According to a recent Medicare Bulletin, 42 percent of behavioral health providers refuse Medicare patients, leaving a burgeoning patient population in the emergency room bound or not. Reasons aside, these actions obviously effectuate all facets and the recovering continuum of healthcare in any community.

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