Leadership in healthcare today is defined by several characteristics, and not every surgeon can be a leader among their peers. "There are a lot of young surgeons out there who are great surgeons, but they aren't changing the field," says Robert S. Bray, MD, founder of DISC Sports & Spine Center in Marina del Rey, Calif. "The leaders are those who are passionate about the field and put time and effort into their contributions. This could be a university surgeon or private practice surgeon, and take the form of a hospital-based structure or developing a program in a Kaiser-like structure. It's not the pathway, it's the person. Within each structure, you see the leaders emerge."
Dr. Bray discusses six characteristics to look for in tomorrow's spine surgeon leaders.
1. Dedication to developing the practice of spine surgery. Whether the surgeon has an orthopedic spine or neurosurgical background, those who truly dedicate themselves to the practice of treating spinal disorders will raise to the top of the field. These are the surgeons who develop new techniques, technologies and research to advance the field.
"No matter what background you come from, you need dedication to the field," says Dr. Bray. "The fields of neurosurgery and orthopedic spine surgery cross so much now because neurosurgeons are doing stabilizations and orthopedists are doing microsurgery. As we turn to emerging leaders, we are looking for the ability to unify surgeons and their approaches no matter what training program or fellowship they went through."
Surgeon leaders will likely also need to bring non-surgical specialists into the mix and spine care continues to rely on pain management and other conservative treatment options in addition to surgery.
"Surgeons have to put time into their practice — not just going to the OR and doing cases," says Dr. Bray. "I look for surgeons who are dedicated to anything from research to fellowship training to helping understand the business of spine practices."
2. Ability to develop a multidisciplinary spine practice. Spine surgeon leaders of the future will need to recognize and work with non-surgical as well as surgical specialists from various backgrounds when treating their patients. Surgeons who have built multidisciplinary practices, or corralled diverse physicians to treat their patients, will be sought after in the future.
"There is such a broad spectrum of spine care, so you need to get all of those specialists together," says Dr. Bray. "A leader must be open minded and dedicated enough that they will put the time into getting all those people into the same room and talking. The North American Spine Society has done that and is transitioning us for that future."
Pain management physicians, physical medicine specialists, chiropractors, massage therapists and acupuncturists can all be part of the team. Merging all types of specialists into one group can be difficult and will take a great deal of effort.
"I call trying to put together a group of physicians trying to herd cats," says Dr. Bray. "Now our practice has more than 40 multidisciplinary physicians. When we first started, we just had surgeons, but patients need a broad base thinking group that looks at how to solve problems together."
3. Teach and learn continuously. Leaders are often chosen from those who are willing to share their expertise. Regardless of age or experience, spine surgeons at the top — or on the rise — should be willing to share their technique with others and learn from their colleagues. This could be through research, surgical training or advocacy efforts.
"It takes a huge amount of time to be involved in politics and develop relationships with others, but it builds the field," says Dr. Bray. "Research isn't only for academic institutions anymore; you can participate in FDA studies, clinical outcomes studies and basic science research. Leaders show dedication to passing on their knowledge base."
It takes time and energy to cultivate these efforts, but spine surgeons who do give back to their colleagues and innovate in the field will become natural leaders.
"You are looking for the person who gives a lot back," says Dr. Bray. "You are trying to develop spine as a field. It's not just performing surgery; it's integrating all of the multidisciplinary specialties. These people have to have passion. They must love what they do and give a lot of time and effort to it."
4. Open mindedness when leading a group. Whether it's leading a small subcommittee for the state medical association, running a successful spine practice or sitting at the helm of a national advocacy campaign, spine surgeon leaders must keep an open mind when approaching the group. All surgeons involved are coming from different places and leaders must be mindful of their situations.
"Think about putting a meeting together once per month with 25 to 30 physicians who are different ages, with different interests and at different places in their lives," says Dr. Bray. "I have grandkids, but some of the others just had their first child. Be really open-minded and look at all the individual needs and family needs. There are so many needs that it becomes difficult to herd them all down one pathway."
However, even though everyone should be considered, the leader must also be able to charge forward and lead the program.
5. Develop outpatient surgical skills. Spine surgery is trending toward less invasive procedures and many are moving into an outpatient setting. Outpatient spine surgery places less economic burden on the healthcare system and patients are able to recover more quickly. There will still be some patients and procedures that will need inpatient stays, but leaders must be proficient with techniques at the forefront of the field.
"A big challenge for the next generation of leaders will be to develop outpatient minimally invasive surgery," says Dr. Bray. "We'll be looking to see where outpatient will go, where it will grow up. Spine surgeons will have to combine with business-minded people to become part of outpatient surgery centers."
Just being able to perform the surgeries isn't enough — the leaders will need to have proficient skills and consistently good outcomes.
"You aren't going to emerge as a good leader without being a good clinician," says Dr. Bray. "You have to be a good doctor making good decisions about what can be done."
6. Willingness to go the extra mile. In addition to engaging in research, education and advocacy efforts, tomorrow's spine surgeon leaders will also be willing to go the extra mile for their patients and partners. Patients should have good outcomes and an even better experience at your office or surgery center.
"If you want to get into a leadership role, there are a lot of extra miles," says Dr. Bray. "For some people, that's not what they want. They will be good doctors within their structure, but another person will take over and drive the structure. If you don't go the extra mile, someone else emerges as the leader."
However, be careful not to over-extend too much. Going the extra mile is important, but going the extra 10 miles might be overdoing it, with unfortunate consequences. Don't forget about your family and personal life, which play an important part in your success.
"Find balance," says Dr. Bray. "Trying to do all of this on top of being a good doctor and surgeon can be really consuming. Balance can take many versions from spending time with family and sports, but you can't let it all consume you. If you are good, you have to be grounded and balanced. Put energy into the projects you have to stay grounded."
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