Selby Chen, MD, is a board-certified neurosurgeon and an assistant professor of neurosurgery at the Mayo Clinic in Jacksonville, Fla.
Here, Dr. Chen discusses current challenges in spinal medicine, how he stays mentally strong and what advice he has for physicians considering a career in spine.
Question: What do you see as the major challenges currently facing spinal medicine?
Dr. Selby Chen: Trying to find alternatives to spinal fusions, including biologic and biophysical treatments for degenerative spine disease, continues to be the biggest challenge facing spine care. Stem cell treatments are still in the experimental phase, and the difference in the biochemical and physical microenvironment of a degenerated disc versus a young biologically immature disc may prove a difficult obstacle to overcome. Biophysical agents, such as gel-based implants, are still in the developmental phase. The value of spinal fusions is often questioned by healthcare economists and trying to establish a value-based approach to spine care is critical in light of the growing Medicare population.
Q: Despite its challenges, neurosurgeons rank highly in physician satisfaction levels. What are the challenges that drive you as a neurosurgeon? What do you most enjoy?
SC: Addressing complex diagnostic challenges is often the most satisfying aspect of neurosurgery. For neurosurgeons, and specifically spinal neurosurgeons, trying to identify the true cause of a patient’s symptoms can often be a difficult task. Being able to diagnose a pain generator and tailor the appropriate treatment to achieve a good patient outcome creates a sense of purpose and fulfillment that engenders a great deal of job satisfaction.
Q: What are your best tactics for combating mental fatigue or burnout?
SC: The most important tactic in battling burnout is maintaining a sense of purpose in your career. Keeping in mind the overall good you bring to the health of your patients helps mitigate the negative impact of complications, lawsuits, etc. Additionally, being involved in the education of residents, fellows, and other healthcare providers adds a different facet to your professional life that can bring enjoyment as well.
Q: What advice would you offer to younger physicians considering a career in spine?
SC: 1. Critically evaluate new technologies. In a multi-billion dollar industry, new products are often brought to market that do not add any clinical benefit to patient care, only to patient, and hospital, expense. However, once you have determined that a new technology is truly beneficial your patients, do not be afraid to be an early adopter.
2. Know that you will have a significant proportion of patients whom you cannot help. Whether they are not candidates for surgery, or well-selected patients who undergo a perfectly executed surgery who do not do well, there will be a group of patients that weigh on your mind. Do not let those patients distract you from the patients whom you can help and detract from the attention you give to them.
Q: What methods do you use to help yourself stay in a good frame of mind?
SC: I would say there are days where I will have to take a minute, close my eyes, and take several deep breaths. This serves to release stress and recenter my focus on the task at hand, whether that be surgical or clinical. Also, I recommend keeping a database of patient outcomes, both good and bad. During times of stress, it helps to reflect on all the good outcomes that you have had to remind you of the reason why you entered the field of surgery: to help people in need.
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