Key Advice for a Successful Practice: 5 Spine Surgeons Weigh In

Here are five spine and neurosurgeons discussing the best advice they ever received and how they incorporated it into their professional careers.

Question: What is the best advice you have received in your professional career?

Neel Anand, MD, Clinical Professor of Surgery & Director of Spine Trauma, Cedars-Sinai Spine Center, Los Angeles: Do the right thing and do the right thing for the patient. That is the most important advice I have ever received and I have always tried to follow it. Another piece of advice is to examine the patient and make a clinical diagnosis. Talk to the patient. Medicine is an art and talking to the patient will tell you around 95 percent of the things you need to know.

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Mark Kurd, MD, Spine Surgeon, OrthoCarolina, Charlotte, N.C.: The best advice I have received throughout my career is to treat every patient as I would treat a family member. I was actually given this advice a number of times from a number of my mentors throughout my orthopedic residency and spine fellowship. As the business of medicine continues to infiltrate our daily practices, patients can often get left behind. I think treating every patient as if they were a family member keeps a doctor grounded and forces us to consider and understand the patient's perspective.

Q: Did you receive any words of wisdom during your training that made an impression?

Dennis Crandall, MD, Sonoran Spine Center, Mesa, Ariz.: There are three bits of advice I heard during my training that turned out to be very useful. The first I heard during my internship. A wise old general surgeon nearing retirement told me the key to his busy and successful practice was to be "available, affable and able, in that order." Twenty years later, I still think those three are important, though maybe not necessarily in that order.

The second I heard during my first year in practice. I worried about building my patient base. It was my nurse who told me, "Just take good care of your patients, and you will become as busy as you want to be." That advice formed the cornerstone of every other practice building strategy I have used.

And lastly, a colleague advised me to collect clinical and radiographic outcomes on each patient I operated on and enter it into a database for future use. What great advice! I now have a mature and thorough database that is useful for producing several clinical research papers each year, for providing insurance companies our track record during negotiations and for giving us a clear view of our outcomes for purposes of contracting with ACOs and other payers in the current changing environment.

Christian Zimmerman, MD, Neurosurgeon, Idaho Neurological Institute, Boise: I did my fellowship at Barrow [Neurological Institute] and my mentor was Volker Sonntag, MD. He was almost fatherly in his advice to me — always do what is right for you and your family. And I thought that was strong and straightforward advice.

Andrew M. Cash, MD, Desert Institute of Spine Care, Las Vegas: The best advice that I received in my professional career was towards the end of my fellowship with Dr. [Robert] Watkins at the Los Angeles Spine Surgery Institute. Dr. Watkins, who has treated more professional athletes with spinal injuries than any surgeon in the world including Peyton Manning and Dwight Howard, recommended that I stay current on the available surgical options to optimize care for my patients' spinal conditions.

Q: How have you adapted that advice into your practice to stay viable in the changing healthcare landscape?

Dr. Anand: I just follow that advice. Do what is right for the patient. Sometimes they don't need surgery. If it is the right thing to not operate then don't. Be good to your patients and they will be good to you.

Dr. Cash: Dr. Watkins' advice has enabled me to adapt to the changing healthcare landscape. I have promoted and advanced the use of minimally invasive spinal surgical techniques, including oblique lumbar interbody fusion, which improves outcomes, enhances recovery and minimizes complications for patients.

These minimally invasive spine surgery techniques have allowed major surgical interventions to be performed in outpatient surgery centers and serve as a cornerstone for the medical tourism initiative that I am developing at the Desert Institute of Spine Care.

Dr. Zimmerman: In my practice, the advice carries over to the people I work with, who are like a second family to me. It involves treating them with respect and taking care of both your co-workers and your patients. I think there is a lot of uncertainty in medicine. Hospitals and healthcare facilities are seeing major reimbursement cuts and that is going to affect all of us.

Q: Has this advice put you in a better position for success in the future?

Dr. Crandall: In the current environment, those who have demonstrable outcomes, cost and utilization numbers and a negotiating group of sufficient size seem to have an advantage. The "available, affable and able" motto has evolved into a different meaning than it was 20 years ago.

Being "available" is now probably interpreted as having the ability to cover a larger group of patient lives, over a larger geographic area and with continuous coverage. This is possible only through size. Being "affable" now is probably best interpreted as having high patient satisfaction reviews that are tracked and trended. Being "able" now probably means having quality metrics that reflect cost savings such as lower infection rates, fewer hospital readmissions, fewer repeat surgeries within 90 days, etc.

In some cases, being "able" probably also means being able to handle complicated patients without the need to refer them out-of-network for care.

Dr. Kurd: I use this advice in my approach to every patient I treat. I have found that treating patients as you would a family member often simplifies my treatment algorithms and solidifies my indications. Although some people might feel this would lead to inefficiency, I have found the opposite. This advice has lead to better a physician-patient relationship, which in turn allows me to be more efficient with my time, have fewer unpleasant patient interactions and get more patient referrals.

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Key Advice for a Successful Practice: 5 Spine Surgeons Weigh In

Here are five spine and neurosurgeons discussing the best advice they ever received and how they incorporated it into their professional careers.

Question: What is the best advice you have received in your professional career?

Neel Anand, MD, Clinical Professor of Surgery & Director of Spine Trauma, Cedars-Sinai Spine Center, Los Angeles: Do the right thing and do the right thing for the patient. That is the most important advice I have ever received and I have always tried to follow it. Another piece of advice is to examine the patient and make a clinical diagnosis. Talk to the patient. Medicine is an art and talking to the patient will tell you around 95 percent of the things you need to know.

Mark Kurd, MD, Spine Surgeon, OrthoCarolina, Charlotte, N.C.: The best advice I have received throughout my career is to treat every patient as I would treat a family member. I was actually given this advice a number of times from a number of my mentors throughout my orthopedic residency and spine fellowship. As the business of medicine continues to infiltrate our daily practices, patients can often get left behind. I think treating every patient as if they were a family member keeps a doctor grounded and forces us to consider and understand the patient's perspective.

Q: Did you receive any words of wisdom during your training that made an impression?

Dennis Crandall, MD, Sonoran Spine Center, Mesa, Ariz.: There are three bits of advice I heard during my training that turned out to be very useful. The first I heard during my internship. A wise old general surgeon nearing retirement told me the key to his busy and successful practice was to be "available, affable and able, in that order." Twenty years later, I still think those three are important, though maybe not necessarily in that order.

The second I heard during my first year in practice. I worried about building my patient base. It was my nurse who told me, "Just take good care of your patients, and you will become as busy as you want to be." That advice formed the cornerstone of every other practice building strategy I have used.

Christian Zimmerman, MD, Neurosurgeon, Idaho Neurological Institute, Boise: I did my fellowship at Barrow [Neurological Institute] and my mentor was Volker Sonntag, MD. He was almost fatherly in his advice to me — always do what is right for you and your family. And I thought that was strong and straightforward advice.

Andrew M. Cash, MD, Desert Institute of Spine Care, Las Vegas: The best advice that I received in my professional career was towards the end of my fellowship with Dr. [Robert] Watkins at the Los Angeles Spine Surgery Institute. Dr. Watkins, who has treated more professional athletes with spinal injuries than any surgeon in the world including Peyton Manning and Dwight Howard, recommended that I stay current on the available surgical options to optimize care for my patients' spinal conditions.

Q: How have you adapted that advice into your practice to stay viable in the changing healthcare landscape?

These minimally invasive spine surgery techniques have allowed major surgical interventions to be performed in outpatient surgery centers and serve as a cornerstone for the medical tourism initiative that I am developing at the Desert Institute of Spine Care.

Dr. Zimmerman: In my practice, the advice carries over to the people I work with, who are like a second family to me. It involves treating them with respect and taking care of both your co-workers and your patients. I think there is a lot of uncertainty in medicine. Hospitals and healthcare facilities are seeing major reimbursement cuts and that is going to affect all of us.

Q: Has this advice put you in a better position for success in the future?

Dr. Crandall: In the current environment, those who have demonstrable outcomes, cost and utilization numbers and a negotiating group of sufficient size seem to have an advantage. The "available, affable and able" motto has evolved into a different meaning than it was 20 years ago.

Being "available" is now probably interpreted as having the ability to cover a larger group of patient lives, over a larger geographic area and with continuous coverage. This is possible only through size. Being "affable" now is probably best interpreted as having high patient satisfaction reviews that are tracked and trended. Being "able" now probably means having quality metrics that reflect cost savings such as lower infection rates, fewer hospital readmissions, fewer repeat surgeries within 90 days, etc.

In some cases, being "able" probably also means being able to handle complicated patients without the need to refer them out-of-network for care.

Dr. Kurd: I use this advice in my approach to every patient I treat. I have found that treating patients as you would a family member often simplifies my treatment algorithms and solidifies my indications. Although some people might feel this would lead to inefficiency, I have found the opposite. This advice has lead to better a physician-patient relationship, which in turn allows me to be more efficient with my time, have fewer unpleasant patient interactions and get more patient referrals.

Key Advice for a Successful Practice: 5 Spine Surgeons Weigh In

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