Q: How can Spine Surgeons just coming out of their fellowship position themselves for success in the future?
Ara Deukmedjian, MD, Founder, Deuk Spine Institute, Melbourne, Fla.: Simple: redefine the word "success." Ok, it was a bad joke; but it does draw attention to the obvious, how does one define success? I think it is very important for each surgeon to spend some time thinking about the meaning of success for themselves. If success is a busy spine oncology practice then that surgeon will need to look for a large academic center needing a chief of spinal oncology. On the other hand if the surgeon values family time and wishes a successful relationship with their spouse then a practice that allows them to focus on delivery of care without the headaches of running their own practices is advisable. Deuk Spine Institute is recruiting and we have some very successful spine specialists.
Walter Eckman, MD, Founder, Aurora Spine Center, Tupelu, Miss.:
1. Focus on the common problems which are degenerative spine conditions.
2. Become proficient and committed to minimally invasive surgery.
3. Develop the skills which allow almost every patient to go home the day of surgery.
4. An absolute commitment to clinical outcome studies.
5. Develop effective treatments for patients who don't necessarily need surgery (our choice has been aggressive strengthening programs).
6. Conscious effort with professional grooming and appearance, friendly interactions and an attempt to own the patient's problems. Many patients feel that most surgeons are not truly concerned about their chronic spine pain (if the answer is not obvious from imaging, many will not go the extra mile). The surgeon should take it as their responsibility to reveal the answer. There is always something wrong but it is not easy to find in many cases. The excitement of searching for the answer and finally achieving a great result for the patient is what makes this field so rewarding.
J. Brian Gill, MD, Spine Surgeon, Nebraska Spine Center, Omaha: Newly trained spine surgeons need to understand very quickly how to run a business and understand the economics of our healthcare system in order to be successful and a viable business. More importantly, treating others (patients, employees, staff, etc.) the way you would like to be treated goes a long way in determining how successful one is in their community.
Michael Gleiber, MD, Founder, Michael A. Gleiber, MD, PA, Jupiter, Fla.: Do not choose a position out of fellowship based on first and second year guaranteed salaries. It's critical to be happy where you end up and if fellows realize that it takes at least five years to build a fairly mature practice and reputation, then one must appreciate the fact that location is very important. Being surrounded by family and friends are vital if you have a spouse and/or children. Also, when choosing a position, it's important to know the ins and outs of the finances of the practice as well as the time to partnership/buy in. There must be transparency and a high degree of trust on both ends. Meeting the partners in a social environment and watching them get along is helpful in getting to know their personalities as well as building camaraderie. Lastly, a fellow should choose a position only if there is a strong need for them within the group. Be careful about practices that have brought someone else on in the same subspecialty within the past two to three years as this may slow down your professional development and productivity.
Richard Guyer, MD, Spine Surgeon, Texas Back Institute, Plano: The three A's that are often quoted, "Availability, Affability and Ability" have stood the test of time. Certainly, a new surgeon coming out has to be willing to meet and visit the surrounding physicians, whether primary care, general orthopedic surgeons, pain management specialists, as well fellow spine surgeons. If one is ever asked to see a consult, the answer should always be "yes" with no hesitations or preconditions. If the physician wants them to be seen that day, the answer should always be "send them over right away."
In addition, one should always remember to treat their patients as you or your family would like to be treated. I call this "Golden Rule of medical practice." If there is ever a difficult decision that comes up about patient care, I always try to do what I would want for myself or for a family member. One has to be compassionate and empathetic and has to listen to their patients. Also, when seeing a patient for a second opinion, one should never say derogatory comments or even give a negative facial grimace about a fellow physician.
If the spine fellow graduate has a special interest whether in minimally invasive surgery, spinal deformity, spine trauma or some other niche, this will help to give him an advantage and may encourage other surgeons to refer their difficult cases. One should not tackle things that are over your head and don't be embarrassed or ashamed to ask for help. When a patient questions whether or not you've had experience in some procedure, be very honest and frank with them and again, use the family test.
Last but not least, providing the best possible care to your patients is the most important point. Your practice will flourish and you will have a fruitful and success practice throughout your career.
Paul Slosar, MD, President, SpineCare Medical Group, San Francisco Spine Institute: Work hard and be willing to see any patient referred to see you as soon as possible. Reach out to the referring doctors and keep them informed. Remember, once you get out of training, the days of "limited" work hours are over. The harder you work the better you do.
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