Spine surgeon education needs to go beyond the technical skill and include greater emphasis on understanding data, conservative care and business structures.
Four surgeons discuss what they would redesign in spine training, along with the non-negotiables all surgeons should undergo.
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: How do you approach informed consent differently today than you did early in your career, especially around long-term implant considerations?
Please send responses to Carly Behm at cbehm@beckershealthcare.com by 5 p.m. CDT Tuesday, June 2.
Question: If you could redesign spine surgery training from scratch, what clinical experience or business competency would you make non-negotiable that programs currently treat as optional?
Bayan Aghdasi, MD. DISC Carlsbad (Calif.): If I could redesign spine surgery training from scratch, the one non-negotiable element I would prioritize is the cultivation of moral responsibility and ethical leadership alongside technical excellence.
The greatest need in spine surgery today mirrors one of the greatest shortages in society at large: moral energy. Our institutions, healthcare systems, and educational structures are increasingly strained under the weight of transactional thinking, short-term incentives, and cultural normalization of self-interest. As moral energy declines, systems become progressively more convoluted, defensive, and inefficient. Spine surgery is not immune to this reality.
Technical proficiency alone is insufficient. True clinical excellence emerges from clarity of purpose, intellectual honesty, courage, humility and genuine selflessness in service of patients. At its highest level, medicine should develop clinicians who are not only highly skilled, but morally grounded, God-fearing in the sense that they recognize accountability beyond ego, prestige, or financial incentive. Surgeons entrusted with life-altering decisions must possess the humility to understand that their responsibility extends beyond technical execution into stewardship of human suffering and public trust.
Ironically, these same virtues also create sustainable business success and financial solvency. Long-term value is created by advocating for truth, exercising sound judgment, and consistently acting as a trustworthy moral force for patients, hospitals, staff, and the broader healthcare system.
Training programs should therefore select for and reinforce ethical seriousness, accountability, resilience, humility, service-oriented leadership, and disciplined moral character just as aggressively as they select for academic performance or surgical skill. Residents should graduate not only understanding biomechanics and operative technique, but also stewardship of healthcare resources, responsible indications for surgery, leadership under pressure, communication, and the ethical obligation to place patient welfare above ego or profit.
The future prosperity of spine surgery will not be secured solely through innovation in implants, navigation, robotics, or biologics. It will depend on whether we can develop surgeons whose character is strong enough to responsibly wield those tools in service of the public good.
Vijay Yanamadala, MD. Hartford (Conn.) HealthCare: There are two things: one clinical and one structural.
Clinically, every spine surgery fellow should spend meaningful time embedded in a conservative spine care practice. Physical therapy, pain psychology, physiatry, primary care spine clinics. The goal is not to become competent in those disciplines but to develop genuine respect for what they can accomplish, and to understand the patient’s experience before they reach a surgeon’s office. Most of us in training learn the full arc of spine disease only in retrospect, when patients return having failed everything else. We should learn it prospectively.
Structurally, health systems literacy — how hospitals are organized, how surgical decisions interact with reimbursement, what a value-based contract actually requires of a surgeon’s behavior. We train surgeons to be excellent technically and send them into one of the most economically complex environments in American healthcare with almost no preparation. The result is physicians who are either naive about the incentives shaping their practice or who absorb those incentives uncritically. Neither serves patients.
One non-negotiable is every trainee should be required to examine their own surgical outcomes rigorously from complication rates to patient-reported outcomes before graduating. Accountability to your own data is the foundation of surgical integrity.
Siamak Yasmeh, MD. DISC Tarzana and Marina del Rey (Calif.): If I could redesign spine surgery training, I would make business and practice management education a required part of training rather than something surgeons are expected to learn on their own after graduation. Most surgeons finish training well prepared technically, but with very little understanding of contracts, coding, practice finances, or the business side of healthcare. Those issues have a major impact on physician autonomy, burnout, and the ability to build a sustainable practice.
Clinically, I would place more emphasis on surgical judgment and long-term patient management. Learning when not to operate is just as important as learning how to operate. I also think trainees need more exposure to spinal alignment, complication management, and revision surgery, because those experiences develop decision-making and accountability in ways that case numbers alone cannot.
Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): Recently attending a medical school graduation steered my observations to a number of conclusions, reflecting the state of medicine, its culture and society as a whole. The encircling message to the newly hooded class was one of progression, forward thinking and educational continuance. This was satisfyingly coupled with beneficence, community-minded care and a strong reminder of application of one’s aptitude to all patients.
A restorative message that harkened upon graduates and attendees. Synchronously, it was conspicuously obvious that so few chose a surgical specialty as a career, attaching conclusions of societal bias or individual choice based on circumstance.
By this author’s preference, a redesign of the spinal surgery curriculum would include the principled ethos of all surgery as a powerful medical intervention that can save or improve lives, but the forbearing iteration it is not always required. The patient’s overall health and anesthetic condition are paramount.
Lastly, is addressing the identity of physicians and their societal impact on a community and this nation. Earning and maintaining a relevant and honored stature in society is a constant only sustained through meritorious action and deed.
At the Becker's 23rd Annual Spine, Orthopedic and Pain Management-Driven ASC + The Future of Spine Conference, taking place June 11-13 in Chicago, spine surgeons, orthopedic leaders and ASC executives will come together to explore minimally invasive techniques, ASC growth strategies and innovations shaping the future of outpatient spine care. Apply for complimentary registration now.
