Six spine surgeons offer advice to medical residents who are considering taking up spine.
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. We invite all spine surgeon and specialist responses. Next week's question: What are some cost-cutting initiatives you have implemented at your practice?
Please send responses to Anuja Vaidya at avaidya@beckershealthcare.com by Wednesday, Aug. 20, at 5 p.m. CST.
Question: What advice do you have for residents who are considering a spine subspecializaiton?
Neel Anand, MD, Clinical Professor of Surgery, Director, Spine Trauma, Cedars-Sinai Spine Center, Los Angeles: You have to love it and love it for the challenge it is – and the immense satisfaction of making patients better. It is an art. You may have two patients with the same symptoms but you may have to perform different types of techniques on each one depending on their other demographic characteristics
Hooman M. Melamed, MD, Orthopedic Spine Surgeon, DISC Sports & Spine Center, Marina del Rey, Calif.: I feel that residents should choose the field that they really enjoy and are happy to do. So, if they choose spine surgery, it should be because they truly love it and will have passion and absolute enthusiasm about it at all times. Obviously, you should consider all aspects of orthopedic surgery before jumping into spine surgery.
Spine surgery is completely different than the other aspects of orthopedic surgery. It's much more demanding, and the patients are definitely more fearful about the process. In general, the operations are longer than the typical orthopedic surgery procedures, and the rate of complication is a little bit higher than the other forms of orthopedic surgery. The more complex the spine surgery, the higher the rate of complications. Spine surgery requires a significantly intense concentration, and more time and compassion with the patients than other types of orthopedic surgery.
The good news is that there are very few absolute emergencies, so the lifestyle — as far as taking calls — is not as bad. Also, the majority of the cases are elective surgery, and there's definitely a good mix of outpatient and inpatient procedures. The satisfaction of relieving a patient's pain from spine surgery is very, very rewarding — immensely more so than with other orthopedic surgery procedures.
Brian R. Gantwerker, MD, The Craniospinal Center of Los Angeles: Be prepared for a fight.
Richard A. Kube II, MD, CEO, Founder, Prairie Spine & Pain Institute, Peoria, Ill.: Just as with any other job, do it for the right reasons. You will be spending many hours doing your job over the next few decades. If you do not truly enjoy what you have chosen you will not likely have the perseverance to excel in your field. Competition is getting tighter, so there is less room for average. I would advise going to a program that provides substantial operative experience. That experience should be tailored to the type of practice you want upon completion of your training.
Academic folks will want exposure to deformity and complex cases including tumor. Those going into community practices can benefit from that exposure as well but there needs to be an emphasis on the one-two level cases. Those are the types of cases a community surgeon will tend to face, and the evaluation and treatment of those ailments will the cornerstone of those practices. While you are there, see everything you can, it is your opportunity to do as much as possible "working with a net." Your mentors are valuable resources; ask them about all facets of the profession, they are typically more than happy to help you avoid some of their mistakes.
Douglas Won, MD, Founder & Director of SpineCARE and CMO of Star Medical Center, 
Irving, Texas: First, choose the fellowship that will provide well-rounded experience. Most residents wish to spend most of their time in operating room and neglect their duties of clinics. Making the correct diagnosis and indications are extremely important skills.
Also, rather than a fellowship that focuses on one aspect of surgical methods, such as minimally invasive surgery, it's very important for a fellowship to build a foundation of open surgery with a touch of minimally invasive exposure.
Ara Deukmedjian, MD, CEO, Medical Director, Deuk Spine Institute, Melbourne, Fla.: Try to find a group practice to join that really needs a spine surgeon to refer patients to. A strong referral base is the key to a successful practice. Learn the latest treatment techniques from pioneers in the field. Challenge yourself to critically assess both new and existing treatment options and separate the great from the bad.
As an example, lumbar fusion can be performed many different ways and each technique has its own advantages and disadvantages. Find the fusion technique that works best in your hands with the best outcome for the patient's symptoms having the highest efficacy and lowest likelihood of complications. Focus on "patient" reported outcomes and give less importance to "surgeon" reported outcomes, since we don't do spine surgery to make our peers happy — our first and only duty is to the patients' needs and health.
Learn new and better surgical techniques like minimally invasive spinal surgery and Deuk Laser Disc Repair, which is endoscopic and laser-assisted. Medicine has been built on progress, so never let yourself believe you know more or "better" than your peers, keep an open mind to new technology and always search for high quality patient-centered results.
As a resident in neurosurgery we were taught to laugh at the idea of using lasers in surgery and now lasers are used in brain surgery for treating many different conditions including fighting gliomas and epilepsy, pediatric neurosurgery for releasing tethered spinal cords, treating hydrocephalus and repairing spinal disc herniations. The lesson is never discredit someone else's work unless you have first personally critically evaluated it, because the new idea may become the next "big thing" in medicine. You have a responsibility to your patients to keep learning so you can provide them the best care possible when they ask you for help.
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