3 spine surgeons' toughest financial decisions


The business side of spine surgery poses many crucial financial choices. Here's how three spine surgeons manage those challenges.

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 question: What technology will define spine surgery in five to 10 years?

Please send responses to Carly Behm at cbehm@beckershealthcare.com by 5 p.m. CST Wednesday, Jan. 24.

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

Question: What's the hardest financial decision you had to make in your career? How did you approach it?

Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: Closing one of my satellite offices was very difficult for us. The location where my practice had originally launched was very dear to my heart. With the pandemic of 2020, it became glaringly obvious that location was costing us money each and every clinic day we were there. The patients were mostly post-ops and the payer mix was only so-so. It was hard, as a lot of the patients were older as well, and could have been my own mom or dad age-wise. But we did it with lots of advance notice to my patients and of course, there was gnashing of teeth and many complaints, each of which we listened to and made sure the folks were all clear of the timeline, and where the other office is located. Overall, it was tough and felt like a failure, but in the end, it was the right decision to stay lean and increase my time with my family.  

Todd Lanman, MD. ADR Spinal Restoration Center (Beverly Hills, Calif.): The hardest financial decision I had to make in my career was dropping insurance plans as an in-network provider. I had to make that decision because insurance companies kept lowering reimbursements, following Medicare's lead. This makes it impractical for the physician to continue participating in private and governmental insurance programs because the reimbursements do not cover costs. Many physicians are forced to rush through consultations to try to make up the shortfall in volume and the quality of care almost always suffers. Despite the financial risks, I refused to practice medicine this way.

Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): Fortunately, my hardest financial decisions were positively influenced by contemporaries with long-term goals and insights about prospective monetary planning. Career choice and domestic stability had their fortuitous privilege, allowing auspicious investment in good times and mitigating losses during the unexpected downturns.

The hardest financial decisions were real-estate purchases, and aptly, as the decisions were based on family needs and not rapid turnover, resulted in choice outcomes. The strategic process of purchase followed what was best for family and utilization within that sphere of location and usage. Avoiding medical properties and most certainly, competing with larger health system interests applied as well. 

The best piece of advice received to date (and passed on if approached) was from a neuroradiologist who cautiously advised: "Buy a nice home, save your money and marry well."  

Words of experience, I'm sure.

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