Patients who have had multiple spine surgeries and been told nothing more can be done are finding Steven Cyr, MD — often after running out of other options.
Dr. Cyr is the chief medical officer of Surgical Associates in Spine, known as SASpine, in Houston. He is dual board certified in orthopedic spine surgery and cosmetic surgery, trained at Rochester, Minn.-based Mayo Clinic, and spent 14 years on active duty in the Air Force before building a private practice concentrated on the hardest cases in spine: complex revision surgeries, deformities and multilevel fusions.
“I have people that reach out to me from every state in the country,” Dr. Cyr said during a recent “Becker’s Healthcare Podcast” interview. “I have people that reach out to me from overseas, and these are people who have already had surgery many times, who have been told there’s no hope for them.”
The demand reaching Dr. Cyr reflects a gap he said is widening. Medicaid cuts and declining reimbursement have put additional pressure on spine care access, while prior authorization requirements have added layers of administrative burden to an already strained specialty. But Dr. Cyr said the deeper issue is a supply problem that those pressures are accelerating.
“I think there’s going to be a massive physician shortage just overall, a general shortage of physicians that I think we’re all nervous about as potential future patients, not just doctors, but I think the writing is on the wall where people are leaving medicine, talented people’s children are not going into medicine because they see how challenging it is,” he said.
The shortage is most acute in the subspecialty he has spent his career building a practice around. The surgeons willing to take the hardest spine cases — revision surgeries, deformity corrections, multilevel fusions — are clustering in major academic medical centers. For patients outside the orbit of those systems, referral options are narrowing.
“The number of surgeons out there that are willing to tackle complex conditions like revision surgeries or deformities or multilevel fusions, I think the number of those is getting smaller and smaller,” he said. “Most of them are isolated in the big academic centers like Mayo and the Hopkins and the Harvards of the world, but patients don’t have access to those big facilities.”
The access gap is part of what drove Dr. Cyr to build an independent private practice when he left the Air Force and academia, rather than joining an established system. The mission was to deliver the level of care concentrated in major academic centers to patients who could not reach those institutions.
“One of the things that I sought to do in the very beginning when I left the military and left that academic world was to try to provide that level of care in the private community,” he said. “And I think that that has made a difference, and I think that resonates with people that come to see me. I think they see a difference in my approach. It’s not one based on numbers or speed or volume. It’s really based on delivering quality care and doing something I’m proud of.”
Bridging the gap at the practice level starts with how a complex spine surgeon structures the care that doesn’t require the operating room. His own answer has been to build a clinical workflow around well-trained physician assistants and a protocol that keeps conservative care at the front of every patient’s pathway, reserving surgical consultation for those who have exhausted every other option.
“My focus is always on conservative treatment first,” he said. “I don’t want to talk to patients about surgery until they failed everything else. And so the mid level providers have really helped me to see more patients more efficiently to make sure that they get the right nonoperative treatment they need and that access to that is a lot easier through them because I’m one person and I’m in the operating room.”
That model depends on a shift in how physician assistants are deployed — away from the close-supervision model that defined the role a generation ago and toward genuine clinical autonomy backed by rigorous training. That evolution has been both practical and philosophical.
“I can have really well trained PAs and mid level providers seeing patients for me, triaging them, doing follow ups,” he said. “As long as they’re well trained and talented, patients get amazing care without any compromise in their outcomes.”
The approach doesn’t solve the structural shortage of surgeons capable of taking the hardest cases. But it does allow one such surgeon to reach more patients — and to ensure that the ones who do need surgery have already been filtered through a conservative-first process before they arrive in an operating room.
Dr. Cyr has been searching for a partner surgeon capable of meeting that same standard and has not found one yet.
“It’s hard to find that, but I’m looking,” he said. “If you’re out there, let me know.”
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