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successful practice management. In spine care, this means integrating operative and non-operative caregivers. “It’s important to have an integrated practice because if you are trained to perform surgery, you need to spend time in the operating room,” says Dr. Cammisa. “In my practice, we make sure operative and non-operative specialists are available so everything runs efficiently and the patient has a good clinical experience.” By having non-operative specialists on hand, patients who don’t need surgery won’t have to wait for a surgeon with a busy operating schedule. “Seeing patients in a timely manner gives them a good feeling about their care and they will refer you to their friends,” says Dr. Cammisa. “The best referrals are patient-to-patient.” 7. Figuring out how to support new innovation. Reform of the Food and Drug Administration’s medical device approval process was one of the key initiatives in healthcare reform. The FDA’s approval process is now stricter about the data needed for clearance, which is forcing companies to jump through several hoops just to put their products on the market. This is a concern for spine surgeons because it could slow the rapidly evolving field of spine innovation. 16 Spine “It is becoming more and more difficult to get innovation from the bench because it’s hard to get through all the regulatory hurdles,” says Dr. Cammisa. “There is concern that innovation is going to slow down because of costs in today’s regulatory environment.” 8. Defining minimally invasive spine surgery. There are several spine surgeons around the country performing “minimally invasive surgery,” but the term doesn’t describe one uniform procedure; some procedures are proven in the literature as superior to open surgery while others may not have long-term success. “What I think is important over the next few years is that we sort out what really works,” says Dr. Cammisa. “There are several surgeons calling their procedures minimally invasive, but they have very little outcomes research to back up their use. I think spine surgery is going to improve because we will sort out what works and what doesn’t. That’s where we’re headed in the future.” n Dr. Stephen Hochschuler: 8 Changes to Ensure a Brighter Future for Spine Surgery By Laura Miller Stephen Hochschuler, MD, co-founder of Texas Back Institute and past president of the International Society for the Advancement of Spine Surgery, discusses eight changes for a more positive spine and healthcare environment in the future. 1. Consider other spine surgeons as partners instead of competitors. Physicians tend to see each other as competitors, which is one reason why they have trouble uniting behind one cause. During medical school, students are often pitted against each other to achieve the highest grades and top residency spots. In the field of orthopedics and spine, this is especially true for young surgeons who must achieve highly in their program just to warrant consideration for fellowships. Once surgeons are out of training, they compete with each other for patient volume. “In medical school, the students who know most of the answers move up and the other guys switch to other programs; you go through your entire training like that,” says Dr. Hochschuler. “At some institutions, they tell students a third of their classmates won’t make it through the program at the very beginning. They are competing all the way through to their private practices, so there is no way they are going to win.” Uniting behind mutually beneficial causes is extremely crucial for physicians to hold influence over the future of the healthcare industry, but it will take a major cultural shift within the medical community. 2. Increase physician participation business and legislation. Traditionally, spine surgeons and other medical professionals have focused on the healthcare delivery aspects of their practice instead of the business side. They have also failed to garner influence among legislators in Washington, D.C. Other professionals, such as lawyers, have become much more proficient at running a successful business and lobbying lawmakers than medical professionals. “Trial lawyers, hospital associations and insurance companies all have lobbyists and lobbyists have tremendous influence on what goes on in Washington,” says Dr. Hochschuler. “Surgeons, in a sense, never got out of medical school; they never had to face the economics of their situation because they left that up to the people who were running their offices. Physicians never paid attention to cash flow and didn’t learn how to run a business. When you don’t have a strong lobby and don’t know about economics, you are targeted.” While the American Medical Association and, more recently, the North American Spine Society, have engaged in advocacy at the national level, their efforts are handicapped by lack of donations and experience. “Other organizations might have 100 lobbyists and make huge donations to political campaigns while we have few lobbyists and don’t know how to play the political game,” says Dr. Hochschuler. “NASS is doing a good job, but we continue to be a day late and a dollar short.” 3. Surgeons must maintain their independence. Due to the rising costs and uncertainty of the future healthcare environment, many spine surgeons are beginning to sell their practices and become employed by
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