Academicians are often considered the surgeon-scientists who will contribute most to the research and development of spine surgery, but the private practice spine surgeons also have many opportunities to meaningfully advance the field. "There doesn't have to be a difference between private practice and academics in the advancing of the science," says Andrew Sama, MD, a spine surgeon and spine fellowship director with Hospital for Special Surgery in New York City. "There are more private practice surgeons than academics, so they have more of an impact on how spine surgery is perceived around the world. The academicians write the papers, but private practitioners are also involved in clinical research."
Here are five ways spine surgeons in private practice can contribute to the body of research making an impact on the field today.
1. Collect and examine individual data. With the proliferation of electronic medical records, individual spine surgeons, practices and hospitals are now able to easily store and extract data about patient care. Spine surgeons who are interested in contributing to the field can gather their personal data and publish the results.
"Based on how patients do, you can conclude that performing a certain procedure in a particular hospital with their nursing staff is good, bad or doesn't make a difference," says Dr. Sama. "I think demonstrating the effectiveness and cost effectiveness of different procedures and surgeries is going to be of paramount importance as the field tightens its belt. We have to demonstrate that what we do makes a difference for the patients and is sustainable within our system."
Publishing individual data can also become a ready benchmark for other surgeons locally and across the country. If you are more efficient than others, you can share your methodology to improve outcome across the board.
"Insurance companies are becoming more stringent with what they approve and don't approve," says Dr. Sama. "We should be advocating for ourselves by providing meaningful data, which is typically outcomes data."
2. Participate in regional and national registries. Spine surgery registries are becoming more prominent around the country and they will be a useful tool for mining data in the future. Surgeons in private practice can contribute data from their cases to these registries for others to examine during retrospective studies, or they can conduct research using the registry data themselves.
"Enlisting patient outcomes in registries is a powerful way to gather great swaths of data for patient treatment," says Dr. Sama. "Big facilities are already placing patients on registries and documenting their follow up treatment. This will become a good research tool over time. If you have a busy private practice, you could cross pollinate with the registry to build a stronger conclusion that supports the advancement of new procedures in spinal surgery."
Private practice participation in these registries is also important because researchers want to examine outcomes for patients in all types of settings, not just academic medical centers. Most spine patients seek treatment with individual spine surgeons, so including them within the registry will be very beneficial going forward.
3. Develop protocol based on research. Private practice spine surgeons might not have a laboratory where they research biological reactions or spine biomechanics, but they can pose practical patient treatment questions and answer them through research. For example, surgeons can work with other specialists to design treatment pathways and protocols for the best possible care.
"You have a common goal of improving the patient's quality of life, and you can take a multidisciplinary approach to researching those pathways," says Dr. Sama. "That's why we've been able to make some strides. This goes across all fields, whether private practice or academic practice."
In the future, additional focus will be placed on the important technological advances beyond surgery to treat patients with back pain. This includes imaging, physical therapy and pain management procedures. It will also be important to consider the costs of each treatment.
"Does what we do really matter and is it sustainable financially?" says Dr. Sama. "That's how I think about new developments. Medicines have changed the way we treat conditions, including rheumatoid arthritis in the neck. A lot of those surgeries have fallen off because the medicines have really changed the face of the disease. Joints are better preserved and necks aren't as unstable anymore."
4. Partner with device companies. Big device companies typically ask academicians to partner with them on new projects, but the majority of people who will be using the new implant will be in private practice. Independent spine surgeons can develop a relationship with these companies to help develop and streamline their new products.
"They could be helpful in designing and streamlining the process of bringing these products to the market by demonstrating the effectiveness and applicability of the technology in their practices," says Dr. Sama. "I've been involved with this for the better part of my career, and it keeps the field fresh for me. When you get into a lab and talk to an engineer, you see an old idea from a new prospective."
Participating in development or clinical trials for spine devices can make the product safer and more useful in preparation for the final launch. "It's kind of fun and if you can make a procedure better and safer, that's fantastic," says Dr. Sama.
5. Network with other surgeons. Beyond research and product development, spine surgeons can become involved in local and national societies and network with other surgeons to educate or be educated about new developments. Societies also unify surgeons in support of ethical behavior.
"The annual meetings for societies include a social and networking side where people are at the same place at the same time, so you can visit with other surgeons from all over the world," says Dr. Sama. "Societies are also making sure surgeons are doing things ethically and within the patient's best interest. They have done a good job of being hands-on in the administrative tasks to keep us on the true path."
Keeping patients at the front-of-mind and advocating for treatment coverage, guidelines and protocols is an important way for surgeons to participate in bettering the overall care of their patients.
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