Jeremy Smith, MD, has big plans for Hoag Orthopedic Institute's spine program. He was named spine surgery chief in May, and one of his key goals is to develop a center that brings orthopedic surgeons and neurosurgeons closer together.
Dr. Smith spoke with Becker's Spine Review about those goals and his advice for aspiring spine leaders.
Note: This conversation was edited for clarity and length.
Question: What are your top three goals this year serving as Hoag’s spine surgery chief?
Dr. Jeremy Smith: My top three goals are to really expand spine surgery across the subspecialties of neurosurgery and orthopedics to bring us together. In the past in most programs there were divisions that prevented us from moving forward and advancing the field. I think there's room for us to come together as specialties and really advance the field. So one of my big goals is to work with neurosurgeons and to be able to develop a spine center that is able to do that. Both fields of orthopedics and neurosurgery are really two different origins, but in this day and age, we treat the same patients with the same surgeries.
The second one is incorporating this in a multidisciplinary effort, both through the pain management and injection side of care for spine patients, physical therapy, the non-operative modalities and really trying to be comprehensive and not just focus on the surgical side of things, but to be able to looking at care for a spine patient. It really isn't just surgical. It has to be utilizing non-operative fields such as physical medicine, rehabilitation, anaesthesia, pain management, trying to bring together these fields and create more of a comprehensive program.
Number three is educating future spine surgeons. So we have a fellowship, and we want to grow that fellowship, become a national name, and we want to develop a reputation where we are really a premier fellowship program in the United States that's respected. We want to be able to continue to grow and have multiple fellowships and really provide the training for multiple spine surgeons throughout our country.
Q: Where do you see the biggest gaps between neurosurgeons' and orthopedic surgeons' understanding of each other?
JS: I think history tells us that we're supposed to be enemies. I think that if you look at the foundation for training for neurosurgery and orthopedics, orthopedics is based in the musculoskeletal system and biomechanics, where neurosurgeons are based in neurology. With those pathways really it's the spine that's exactly the combination of the two. So I think there is some training that orthopedic surgeons lack and vice versa. There's probably a bigger answer to that question that's being asked nationally and how we train spine surgeons. Ultimately, I think the training program will change and be very spine-specific. However, to bridge the gap at our level, I think is the first step and being able to change the training programs and how we train our spine surgeons.
Q: Where are Hoag's patient-volume levels compared to before the pandemic?
JS: It's busier than it's ever been, to be quite honest. During the pandemic, we saw a lot of emergency use and a lot of cases that were needed because of a progressive neurologic deficit. Now we're seeing patients who weren't seeing doctors that are becoming active and injuring themselves. We're seeing patients who are scared, who didn't want surgery, who are progressively worsening.
So the pandemic really did change that. I thought it would change things for the worse with regards to volume. But it's actually increasing at this point. I don't know how things will change as we move forward and open back up again. But so far, the projections tell me that it's just going to get busier. I'd say my clinics are filling up and, you know, I see at least 50 to 70 patients a day in the clinics.
Q: What areas in spine surgery do you hope to raise public awareness on most?
JS: There are a lot of techniques out there that patients see through marketing or hear about through their friends or neighbors. But they may not have the science behind it, and I'm looking to help define a little bit better what is appropriate and not appropriate for a specific diagnosis or treatment strategy.
That's something that doesn't really exist in, say, total joint replacements, where you really have one or a few procedures that are for one or a few diagnoses, whereas spine has different diagnoses. Helping narrow down some of what may be considered not appropriate because of a lack of a foundation in research and science would be a primary goal for me.
In addition, I want to educate the public on the options of not just surgery, but the comprehensive options. So I want to educate the communities to try and lessen the amount of spine surgeries. I think spine surgery is overdone, and what happens when it's overdone is there's an effect of one surgery leading to another surgery.
Q: What advice do you have for young spine surgeons who want to become leaders?
JS: I've learned from my mentors that it's really nice to be able to take someone's point of view or perspective, however, you may not believe in it and to try to understand it. That's the only way to really build and to be respected is to really see all sides of the equation and in order to do so, you have to be able to respect the qualities of each individual surgeon or whoever is building this empire. You have to be able to respect and to listen and to be able to have an open mind and not a one-sidedness or help to build those relationships that are essential.