Spine surgeons have mixed feelings about what's to come for the next generation of spine surgeons.
Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. Becker's invites all spine surgeon and specialist responses.
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Please send responses to Carly Behm at cbehm@beckershealthcare.com by 5 p.m. CST Wednesday, Nov. 13.
Editor's note: Responses were lightly edited for clarity and length.
Question: Should early-career spine surgeons be optimistic or nervous about the specialty's future?
Tan Chen, MD. Geisinger Musculoskeletal Institute (Danville, Pa.): I believe spine surgery is still expanding much like the early days of hip and knee arthroplasty, and early-career surgeons should remain cautiously optimistic about the future of the field.
Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: Nervous mostly. I think early-career surgeons should try to spend time with more senior surgeons as much as they can. Current enabling technologies can make one too reliant on the technology. It's best to do a few cases "old school" and be able to bail yourself out if things malfunction. Also, understanding the softer skills that are being taken away and otherwise abandoned in favor of throughput. We are being rushed more and more to churn and burn and if we can find a way to reevaluate what we are being told to do, we can find a better way forward.
Brandon Hirsch, MD. DISC Sports & Spine Center (Newport Beach, Calif.): Early-career spine surgeons should be optimistic about the future of our specialty. I believe the tide is turning back toward surgeon autonomy and independent practice for surgeons who are interested in that practice model. Enabling technology that makes our practices more efficient and care quality already exists and is constantly evolving. Advances in spinal endoscopy now afford us exceptionally high-resolution intraoperative visualization not possible with traditional surgical microscopes. Minimally invasive techniques can provide life-changing solutions to patients' spine-related pain with a dramatically shortened and less painful recovery. As a result, routine spine surgery often does not require hospitalization. I believe advances in artificial intelligence are on the horizon that will soon allow us to obtain even more precise diagnoses and provide even more reproducible surgical outcomes. Spine surgery and the healthcare system will always be challenging but I believe the future of our field is very bright.
Yu-Po Lee, MD. University of California Irvine: Spine surgeons have much to be optimistic about the future of spine surgery. The past has seen tremendous growth and innovation which has made spine surgery safer for patients and improved outcomes. Past innovations have included antibiotics and sterile techniques to reduce the rate of infections. Advances in imaging have improved our ability to diagnose disease. Innovations in instrumentation have improved our ability to correct deformity, treat fractures and tumors, and improve overall outcomes. Improvements in biologics have improved our fusion rates with fusion surgeries and this has also improved overall outcomes.
Current technologies are helping to shape the future. The use of navigation and robotics allows spine surgeons to place spinal instrumentation more accurately. The side benefit of the use of this relatively new technology also decreases radiation to surgeons, patients, and operating room staff. We do not know what benefits this may have in reducing the incidence of cancer in patients, surgeons, and operating room staff. However, it is more likely than not that there is some benefit. The evolving use of endoscopic spine surgery and minimally invasive spine surgery will allow surgeons to treat older and sicker patients. This is especially important in an aging population. Also, the emergence of artificial intelligence will most likely lead to new innovations that can be helpful in charting, patient screening, and other administrative tasks that will free surgeons from the mundane tasks so that we can spend more time with patients and our families.
I am very optimistic about the future of spine surgery. I believe that most of the readers would agree that I would be much more comfortable having spine surgery today versus 20 years ago. I am very excited and curious about how spine surgery will be twenty years from now.
Jason Liauw, MD. Hoag Orthopedic Institute (Laguna Hills, Calif.): I think early career spine surgeons should always be optimistic of their field, but cautious at the same time. I think there are a lot of people who take advantage of early career surgeons including healthcare conglomerates, insurance companies, and even other surgeons. Everyone has an angle: this can range from instances that include restricting what surgeons can use to improve profitability of a hospital system to underpricing call reimbursement to denying surgeons onto an insurance panel unless they take bargain basement rates.
It's for these reasons that I feel spine surgeons should be nervous about the specialty's future. I think to prevent the decline in our subspecialty and medicine in general, it's time for surgeons to engage in advocacy efforts and to keep fighting the good fight to improve access to new technologies and to continuously re-evaluate the reimbursement for call pay so our field doesn't get commoditized or taken advantage of.
Kenneth Rieger, MD. New Jersey Spine Center (Chatham): Spine surgery continues to evolve and improve at a tremendous rate, creating an energy and enthusiasm for innovation seen by few other specialties today. Opportunities remain for early career spine surgeons to practice however they choose — from private practice to academic to fully employed. The growth of surgical options, as well as the choice of practice model, together should make the field of spine surgery a desirable one for the foreseeable future.
Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): Reluctantly, both. The level of scrutiny of all surgical specialties, (derived from overestimated CMS preterition) has settled with expanded unease. As part of CMS's goals to improve patient health outcome, providers now participate in value-based payment programs; the Merit-Based Incentive Payment System (MIPS) and the Hospital Readmissions Reduction Program. Arguably necessary, the impetus to avoid complex and underinsured patient pools has become more prevalent, leaving more of these patients to larger health systems and excluded from other maladroit centers. The economics of late has also steered patients clear of expensive surgery and prolonged recovery because of time off for work and sabbatical.
The future will most likely continue to draft case acuity to the more willing and sophisticated for care and tightening criteria for case approval and reimbursement. Hopefully, the economy will be reinvigorated after last Tuesday evening.