At the 12th Annual Spine, Orthopedic and Pain Management Driven ASC Conference in Chicago on June 13, Stephen Hochschuler, MD, chairman of Texas Back Institute, Anthony Yeung, MD, founder of Desert Institute for Spine Care, and Choll Kim, MD, PhD, of Spine Institute San Diego and Minimally Invasive Center of Excellence, shared their thoughts on what lies ahead for the spine surgery field in a session moderated by Scott Becker, JD, CPA, a partner with McGuireWoods.
Clinical developments
The spine surgery field is rapidly evolving with the advent of new technologies and techniques. "The area of minimally invasive surgery is the most exciting thing," said Dr. Kim. Dr. Hochschuler also observed that minimally invasive surgery is allowing surgeons to decrease patient recovery time and move many procedures to the outpatient setting. The spine field continues to advance through developments such as biologics, robotics, image-guided surgery.
Spine surgeon independence
Changes in healthcare are forcing physician specialties to consider the future of independent practice. The spine surgeon panelists predicted that spine surgeon employment will continue to rise, but those that strive to remain independent will be able to do so. "To be independent, find a niche. Keep track of your outcomes and use them to get better every year," said Dr. Kim.
Though independent practice may remain viable, it will take coordinated effort from the surgeons that want to remain self-employed. "Each surgeon continues to look out for his own interest," said Dr. Yeung. "Somehow we are going to have to come together for the sake of patients and payers."
Physician coordination
Texas Back Institute includes 17 spine surgeons and 20 physicians in different specialties such as pain management and vascular surgery. The practice has been able to expand its footprint with so many physicians working in tandem, but aligning that many independent surgeons is no small feat. "The need a common goal and common vision," said Dr. Hochschuler. "If you don't know where you are going, you will never get there."
Strategies for success
Reimbursement is declining and healthcare is shifting away from fee-for-service. How can spine surgeons still thrive in this environment? "We get paid slightly less every year. We can make up for it by being more efficient and working hard, but at some point we will need to regroup and demand more," said Dr. Kim.
Texas Back Institute is looking at growth beyond its central location to thrive. "We are looking at growing our footprint locally, regionally and nationally," said Dr. Hochschuler. The practice has even begun to open locations in China and Turkey. Dr. Hochschuler is also looking at stepping into the field of telemedicine. The business of spine and economics of spine are now critical areas for independent surgeons to focus on. "Put down your stethoscope and pick up your calculator," said Dr. Yeung.
The next generation
As the pressure in the day-to-day practice of a spine surgeon rises, how can young surgeons remain engaged and avoid burnout? "I don’t think you can teach a person to stay enthusiastic. If you have the energy and drive, I don't need to tell them anything," said Dr. Hochschuler. "I am 71 and haven't come close to burning out."
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