From connections within training programs to personal bonds with a city, spine surgeons must weigh many considerations when deciding where to work.
Eleven spine surgeons told Becker's Spine Review the factors in their decisions.
Editor's Note: Responses were edited for style and length.
Question: Why did you choose to work where you are now?
Vladimir Sinkov, MD. Sinkov Spine Center (Las Vegas): I love living and working in Las Vegas. It is a vibrant and growing city that offers numerous opportunities for me to build and grow my high-quality solo spine surgery practice exactly the way I envisioned. We have looked at many places when we decided to escape the cold and snowy winters of New Hampshire, and this was our No. 1 choice. The area has great weather with lots of sun, great hiking and other outdoor activities, and an easy way to drive or fly out to any part of the country or the world.
Philip Louie, MD. Virginia Mason Franciscan Health (Seattle): There were a lot of factors that I considered, the main three being:
1. Geography/family: I am from the Seattle area originally and have much of my family and community here. I wanted to raise my kids with their grandparents and other family members nearby and grow up in the most beautiful area of the country! I also wanted to go back and work with the community that I grew up in and give back to those who shaped so much of who I am today.
2. Team dynamics and collaboration: Understanding that I see and interact with my colleagues more than my family throughout the week, it was important for me to join a group that treated each other like family and that I would enjoy spending time with.
3. Academics: I enjoy teaching and engaging in all aspects of research. I wanted to join a hospital system and group that shared my passion and valued the importance of structured research and academics to improving patient care.
George Galvan, MD. Texas Neurosurgical Spine (San Antonio): I chose to work in San Antonio because I trained here for residency. After spending years in training, the city became part of me, and I did not want to leave all the relationships I created behind. I interviewed all over the West Coast because that is where I thought I wanted to be. However, in the end, after evaluating all my options it came down to knowing for years the group I was going to join since I rotated with them, continuing to grow and develop existing relationships and the comfort of living in a city where I felt part of the community.
Joshua Prickett, DO. Aiken (S.C.) Regional Medical Centers: When I was looking for a place to start practice, I wanted to find a balance between finding enough cases, in particular intracranial cases, and the type of environment we were looking for to raise our family. I am from a small town outside of Houston, and my wife is from Danville, Va. I had prior experience in rural central Florida and then as an osteopathic medical student my clinical training was at a moderate size community hospital in South Alabama. I wanted to find a hospital where there is strong interaction and collaboration among the medical staff and that you are not simply a 'cog in the wheel.'
Since coming to Aiken Regional Medical Centers two years ago, I have been surprised by the pathology and the opportunities to serve this vibrant community in the Central Savannah River Area. It has been relatively underserved and only staffed by a single neurosurgeon for nearly 10 years prior. Many of the cases — and certainly more complicated cases — were migrating out of our community and into Georgia, which can complicate issues for coordination of care and insurance authorizations, as well as be less convenient for patients and families requiring neurosurgical care. The hospital had allowed its trauma designation to lapse. The hospital made an investment in updating the equipment required and a commitment to building the neurosciences. This gave me the opportunity to assist with improvements in care for stroke, our upcoming redesignation as a trauma center, as well as care for the cases that were previously leaving the community.
Kern Singh, MD. Rush University Medical Center (Chicago): I was fortunate enough to be given an opportunity to stay at a program where I trained. Gunnar Andersson, MD, my former chair, mentor and giant in the field of spine surgery, approached me during the latter half of my chief resident year. It was an opportunity I could not pass up. The opportunity to work with world-class orthopedic surgeons who are not only pioneers in their respective fields but also serial entrepreneurs and just good people. I am forever grateful. I literally feel like I won the practice lottery.
Peter Derman, MD. Texas Back Institute (Plano): As a Dallas native who spent 15 years away studying and training, I was fortunate to have Texas Back Institute in my hometown backyard. TBI is the perfect environment for me. It is a 'privademic' practice that combines the nimbleness and patient-centered focus of private practice with the benefits of teaching, society involvement, industry partnership and research. Furthermore, our size allows my partners and me to focus on what excites each of us the most about spine care. This has afforded me the opportunity to become super-specialized in my favorite niche of spine surgery — minimally invasive and endoscopic procedures. I couldn't be happier.
Craig Kelman, MD. Aspirus Health (Wausau, Wis.): I considered several factors, including quality of the health system, case mix, call frequency, operative technology, contract specifics, who my partners would be and location. I also trusted how I felt after the interviews. Ultimately, I found a Watson Top 15-rated health system, with collegial partners, near family and that has high-level operating room technology. I have been here for three years and am happy with my career decision.
Louis Nkrumah, MD, PhD. Nkrumah Neurosurgery & Spine (Lake Success, N.Y.): I worked as a hospital-employed neurosurgeon for two years after completing my complex spine fellowship. However, after the two years, I decided to set up my own private practice so that I can have more control in the day-to-day activities and decision-making around my patients.
I chose to come back to New York where I completed my medical school, and I had quite a lot of friends in healthcare to reconnect with. It is definitely a competitive market, but it also offers more opportunities for private practice than many other places around the country, in my opinion.
Randall Porter, MD. Barrow Neurological Institute (Phoenix): I have been very fortunate to be part of the Barrow Neurological Institute for 28 years, more than half my life. I completed a seven-year residency from 1993 to 2000 and have been on the faculty for the past 21 years. I was interested in academic neurosurgery, but probably not in the most common and usual sense. Although I have more than 100 peer-reviewed publications and well over 200 presentations, I would consider myself less a neurosurgeon-scientist (as I do not have a laboratory) than a clinician-scientist. I strive to mentor residents and fellows and hopefully offer an example of how to treat patients, family and staff. I seek to make operative decisions based on what I would recommend to a family member, not on what enhances my reputation in a meeting, presentation, or research paper. My goal is to teach the next generation to be compassionate physicians first and neurosurgeons second. My focus in research has evolved as well, emphasizing how patient experience and communication affect healthcare.
Furthermore, being in a 'privademic' setting that combines business aspects of private practice and academia creates flexibility and independence without the usual constraints of a university academic program. This setting also allows me to express my opinions without the fear of retribution; on the clinical side, we function as a private practice, with everyone having an equal vote. This emphasis on self-determination has always been a strength of Barrow. The hybrid structure of the institution tends to attract independent-minded people and, in my opinion, great leaders in each subspecialty.
Finally, I also wanted to carry on the traditions demonstrated to me by my mentors, Robert Spetzler, MD, and Volker Sonntag, MD. Their dedication to education, research, residents, family, leadership and decency has inspired me throughout my career. I hope to continue that legacy.
David Essig, MD. Northwell Health (New Hyde Park, N.Y.): From an employment standpoint, I was looking for a position that allowed me to treat a variety of pathologies among a diverse patient population. I wanted access to academic opportunities, including access to teaching, research and colleagues who could assist me in the care of complex patient cases. Finally, I was seeking a geographic locale that allowed me to have easy access to family and friends, as well as recreational opportunities.
Miki Katzir, MD. University of Nebraska Medical Center (Omaha): As the director of surgical spine oncology at the University of Nebraska Medical Center, Fred and Pamela Buffett Cancer Center, the focus of my practice is surgical resection of spine tumors. UNMC and the Fred and Pamela Buffett Cancer Center is the only NCI designated cancer center in Nebraska.
Aviva Abosch, MD, PhD, the neurosurgery department chair at UNMC, recruited me after graduating from my fellowship at the Ohio State University James Cancer Hospital Solove Research Institute in Columbus.
The moment I started the interview process, I was thrilled to meet the excellent team from medical, neuro, radiation oncology and neurosurgery that I'm about to join. Treating cancer patients was always my goal and luckily today, metastatic or primary spine cancer does not mean the end of the road for patients.
I love the Midwest; the people, the culture and the family friendly environment all played a major role in my decision to choose Omaha as my family's new home. In my second year here, thanks to the many friends we have here in and outside the hospital, I truly feel that we made the right choice.
Note: This article was updated 3:45 p.m. Sept. 10 to add a response.