Rachel Bratescu, MD, is the first female spine surgeon at New York City-based Och Spine at NewYork-Presbyterian, and she hopes more will follow her lead.
With dual fellowship training in orthopedics and neurosurgery, she spoke with Becker's about the importance of mentorship and interdisciplinary teamwork in spine surgery.
Note: This conversation was edited for clarity and length.
Question: What is the spine industry doing right when it comes to supporting women in the field, and where can there be improvement?
Dr. Rachel Bratescu: I'm finishing up a big project with Roger Härtl, MD, where we looked at this very issue. We found that in the academic spine setting on the orthopedic side, women comprise only 4% and 9% on the neurosurgery side, and that's incredibly low. I'm hopeful that while I'm the first adult female spine surgeon at Och Spine, and the first to have both orthopedic and neurosurgery training, that I'm not going to be the last.
I've learned a great deal about the importance of mentorship. I think that is the biggest extrinsic factor that really affects the types of subspecialties that women go into. In particular for young women in STEM fields having a great mentor, and especially if it's a female mentor, is great. This highlights the importance of pipeline programs in high school, college and medical school levels of education, because that's the way that the young women get exposed to fields that they wouldn't have previously considered due to these ingrained societal beliefs. When you even narrow it down further, these surgical subspecialties are guarded by gender. So that makes me even more excited to serve as a teacher and a mentor to aspiring surgeons.
Q: Who've been some of the prominent mentors that you've had in your career?
RB: I've been really fortunate from the beginning. One of the mentors that I had that got me into orthopedic spine surgery is Rex Marco, MD. When I was a resident at Houston Methodist, he was just an incredible influence. I did a four month rotation with him as a junior resident. He was an adult and pediatric spinal deformity surgeon as well as a musculoskeletal tumor surgeon, and he is an amazing educator and advocate. Unfortunately when I was a third year resident, he was in an accident which left him quadriplegic, but he has been the single greatest force that inspired me to go into spine surgery, and he has remained a friend, mentor and and just a great resource and inspiration to me.
Moving forward in my training at NYU where I did my orthopedic spine fellowship, Themistocles Protopsaltis, MD, a spinal deformity surgeon and chief of spine, has been an excellent mentor from an academic standpoint and a surgical standpoint. Then, of course, Dr. Härtl has been an incredible mentor.
I strongly believe that training in both orthopedics and neurosurgery is incredibly important in order to care for the full spectrum of spinal disorders. Obviously, there are very well-rounded spine surgeons in the world. But orthopedic surgeons, for example, may have more experience with spinal deformity instrumentation and procedures that are bone-based to correct deformities. Whereas this year I'm learning that neurosurgeons have more experience with intradural work, including things like spinal cord herniations and both tumors within the dura and within the spinal cord. They're very comfortable handling the neural elements and from having exposure in formal training in both of these areas.
I think that allows me to give patients the most comprehensive spine care possible. Your spine is not just the bones, and your spine is not just the spinal cord. It's all of these things together.
Q: How much collaboration are you seeing between orthopedic spine surgeons and neurosurgeons?
RB: One of the things that I think is so great about Och Spine is that Dr. Härtl is the co-director along with Lawrence Lenke, MD. We have both a neurosurgeon and an orthopedic surgeon who are in charge of that whole program. On the Cornell side where I am this year, I work with both orthopedic spine surgeons and neurosurgeons. We all attend conferences together, perform cases together all the time. Bigger cases like some of the deformity cases or revisions will often have a neurosurgeon and an orthopedic spine surgeon together doing those cases. I've had a really great experience with the collaborative environment between those two departments there, and they're not even separate departments. It's the spine surgery department, which has neurosurgeons and orthopedic spine surgeons, which is really nice because that's not the case everywhere.