Dr. Jonathan Rasouli: Key thoughts on the spine fellowship process + the most important considerations for emerging spine surgeons

Laura Dyrda -   Print  |

Jonathan J. Rasouli, MD, is a neurosurgery chief resident at Mount Sinai Health System in New York City.

Question: What are your thoughts on the spine fellowship process today? What are the challenges for surgeons and potential areas for improvement?

Dr. Jonathan Rasouli: The spine fellowship match is a simultaneously challenging and rewarding year in the lives of neurosurgical and orthopedic residents. Having participated and successfully matched during the 2017-18 academic year, I can say it was quite an exciting and interesting process! Ultimately, I was fortunate enough to be granted acceptance into the Cleveland Clinic. Based on my experiences, I have several tips and tricks for this year's group of applicants and the match process, as a whole:

  • Apply early
  • Choose your mentors and letter of recommendation writers wisely
  • Get involved with national/international conferences, present research, network with other spine surgeons

It goes without saying that you should submit your complete application to the San Francisco Match as early as possible. Balancing application preparation, interviews and the clinical demands of your residency program can be extremely challenging. For most people, it is very difficult to go on more than 10 or 15 interviews without raising a few eyebrows from your administrators. Therefore, I suggest you only interview at places in which you would be perfectly satisfied to match. This is generally within the ballpark of 10 to 15 programs.

Your letters of recommendation are also extremely important as they are the main source of information for your interviewers during the interview day. The letters should make mention your accomplishments during residency, publications and research interests, intraoperative technical skills, and your clinical performance. For the neurosurgery applicants, I would also recommend getting a letter from an orthopedic spine surgeon in addition to neurosurgical spine surgeons to keep your application well-rounded.

Lastly, it is generally a good idea to present research at popular national spine conferences such as North American Spine Society or Cervical Spine/Scoliosis Research Societies. Ideally, you will be able meet, network and share ideas with some of the top names in the business. Even a simple handshake or greet at a conference can leave a lasting positive impression. Therefore, I would recommend getting involved in spine research early during residency and try to present at as many conferences as possible. Even if the research does not ultimately lead to a publication, the ability to meet and network with the 'movers and shakers' of the field can make these meetings very productive.

The whole fellowship process is an exciting and grueling process and the statistical odds of matching are generally in your favor – good luck!

Q: What are you most excited about in terms of technology advancement in the spine space? Where do you see the best opportunity for growth?

JR: The past few years have been quite exciting in terms of newly released spinal technologies and instrumentation. I am most excited about Mazor XTM robotic guidance system from Medtronic and the WalterLorenz surgical assist arm from Zimmer Biomet. I think the combination of both technologies will make a noticeable impact in the workflow in a sophisticated spine surgery operating room. Our operating rooms have become increasingly reliant on stereotactic and robotic-navigated systems which could eventually open doors to artificial intelligence assisting us during cases.

I am also interested to see how the surgical exoscope will be incorporated during spine surgery. At the Mount Sinai Hospital, we recently used the Synaptive Modus VTM with great results. While it certainly has different haptic feedback compared to the traditional surgical microscope, we found it to be quite ergonomic and easy to use. It will be noteworthy to see if the spine community ultimately adopts it into more widespread utilization.

Without question I see the best opportunity for growth in minimally invasive spine technologies such as endoscopic and robotic spine. There are more and more studies supporting their use for 'bread-and-butter' spine cases such as microdiscectomies and foraminotomies with outstanding results. In addition, when offered a broad choice of options, patients generally prefer minimally invasive approaches over open approaches. One only has to look at the prevalence and success of robotic surgery over laparoscopic in the realm of urologic surgery as a herald for a similar revolution that will be coming to spine. In addition, there is growing support for spine surgeries to be performed in an outpatient setting, which is further evidence that these minimally invasive technologies will be disruptive to our current practices. I strongly believe that the future of spine surgery lies with the advancement of these technologies.

Q: How do you see your practice growing or evolving in the next five years?

JR: As an up-and-coming spine surgeon, I have been following the rapidly evolving nature of our healthcare system from a macro-level and how these changes will directly affect my practice. As congressional leaders battle over the Affordable Care Act, bundled payments for surgical therapies become increasingly commonplace, and obtaining reimbursement for our surgeries becomes more challenging we are about to see changes in the healthcare system unlike ever before.

The question, then, for a rising surgeon such as myself is the differences between academia or private practice and which areas of spine surgery hold the most promise (MIS, deformity, robotic, endoscopic, etc.). I cannot predict what the healthcare landscape will be like in the next five years other than it will be markedly different to what we have now. There was an outstanding article recently written by Dr. Pedro Ramirez that detailed the numerous disruptive forces for the private practice neurosurgeon (link). It is my belief that these forces, namely, the transition to value-based care and physician incentive programs will be the main drivers of change in the next five years. In addition, the rapidly changing environment for health insurance payers will be another major driver. We are certainly living in interesting times!

Jonathan Rasouli, MD is Chief Resident of Neurosurgery at the Mount Sinai Health System in New York and will be completing the Combined Neurosurgery and Orthopedic Spine Surgery Fellowship at the Cleveland Clinic during the 2019-2020 academic year. He is a graduate of the Albert Einstein College of Medicine. He has research interests in global neurosurgery, spinal deformity, and minimally invasive spine surgery.

To participate in future Becker's Q&As, contact Laura Dyrda at ldyrda@beckershealthcare.com

For a deeper dive into the future of orthopedics, attend the Becker's 17th Annual Future of Spine + Spine, Orthopedic & Pain Management-Driven ASC in Chicago, June 13-5, 2019. Click here to learn more and register.

More articles on orthopedic surgeons:
Dr. Gaetano Scuderi: The biggest challenges for orthopedists and their patients
3 core business trends affecting orthopedic practice from Resurgens' Dr. Bennett Grimm
The forces changing orthopedics in 2019: Key thoughts from Dr. Nikhil Verma

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