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19 THOUGHT LEADERSHIP Listen up, residents and fellows: 12 spine surgeons' advice for the next generation By Alan Condon T he next generation of spine surgeons graduating residency and fellowship programs will soon be making many important decisions, including choosing their career path, the surgical skills and techniques they wish to hone, and where and with whom they wish to work. ere are many challenges, but also many exciting opportunities. With this in mind, 12 spine leaders look back on their careers and share their best advice for emerging spine surgeons. Editor's note: Responses were lightly edited for clarity and length. Question: What advice do you have for spine surgeons graduating from residencies and fellowships next year? Alex Vaccaro, MD, PhD. Rothman Orthopaedics (Philadelphia): To the graduating residents, if you have chosen to pursue fellowship training, congratulations on your match and begin to determine whether you would envision practicing in an academic or a private setting. If academics is in your future, identify research mentors early and consider feasible projects that you can complete within the academic year, as most fellowships are only one year long and it will be difficult to create prospective projects or build data sets with your limited time while being busy with clinical duties and training in fellowship. Continue to engage in academic activities such as presenting at research conferences or joining educational committees. If you are interested in private practice, think about the types of procedures you would like your future practice to encompass and focus on maximizing efficiency and repetition in these areas to gain as much exposure and comfort as possible. In both academics and private practice, focus on networking with others in your field as job opportunities aer fellowship (as well as your future professional relationships) begin to develop during this time. For the graduating fellows, do not underestimate the importance of the clinic. While many fellows head into fellowship with the mindset that they should maximize every opportunity to be in the operating room, it is in clinic where you hone your examination skills and decision-making important for surgical indications, cultivate patient- physician relationships and gain experience in practice management. In addition, your goal as a fellow is to be prepared to transition to independent practice at the end of the year, and it is important that you maximize your time as a fellow to develop into an independent surgeon — take note of things that your mentors do that work well for you, and things that you would do differently. Pay attention to the complications and suboptimal outcomes that you see during fellowship, and identify how your mentors deal with these. Finally, identify mentors who you can trust and continue to speak to over the course of your career — you will continue to need and rely on their advice and input in your practice whether you choose private practice or academics, particularly in early practice when you encounter difficult or complex cases. Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): Giving life advice to a physician yet alone a subspecialist seems imprudent and inconsequential, unless of course the audience possesses a smattering of self-awareness and humility. Describing oneself upon graduation aside, the advice would be open mindedness and observation. So many have trained before us and accomplished so many good things. Patients trust our judgments and experience; they are the recipients of our good fortune. And lastly, avoid the griers in all walks of life. Robert Bray Jr., MD. DISC Sports & Spine Center (Newport Beach, Calif.): Consider the area you wish to live for lifestyle and your family as a primary choice of where to start. Do not expect that the first spot you choose will necessarily be your career. I have told people that I am now on my fih career, from the U.S. Air Force through academia to private practice and now outpatient. Make sure that you are building "you." It takes several years to develop your name, reputation and business skills. Avoid falling into what I consider pigeon holes (workers' comp and personal injury), unless you have decided carefully that is the path you wish to take. Focus on quality and patient relationships, with good decision-making put above the rest. Carefully use new technology. ere are many advances that are happening, but nothing replaces cost-efficient, quality outcomes and keeping patients happy for building your name and reputation. Emeka Nwodim, MD. e Centers for Advanced Orthopaedics (Bethesda, Md.): My advice to those finishing training in residency and fellowship programs, would be to not only master and refine techniques in all aspects of patient care but to also grow in their understanding of the business of medicine. Brian Gantwerker, MD. e Craniospinal Center of Los Angeles: I am now about 15 years out of residency. Many hard lessons have been learned, and had I had a mentor or someone senior to me, I would have had an easier time getting to where I am. But if I was able to give some advice to a younger me, or a colleague, I would advise three important things: First, be firm in your ethics and do not let any supervising partner, entity or bean counter talk you into being dishonest in your billing or coding. It is not worth your career. Second, do not be so full of hubris to ask for a colleague to have a second look at one of your hard cases. You will inevitably learn some things you never did or experienced in training. Lastly, know your worth. Do not ever let someone — especially from administration or an insurance company — devalue what you do. You heal patients and sacrificed so much to get where you are. Your ethics and hard work should never be a liability. Harel Deutsch, MD. Midwest Orthopaedics at Rush (Chicago): I think medicine and physicians are increasingly employed, but it's important for physicians to maintain excellence and strive to better their brand and value. Albert Wong, MD. DOCS Spine Orthopedics (Los Angeles): Residents and fellows should have an honest evaluation of their weaknesses and their skill set. ey should get as much experience as possible to strengthen their weaknesses before the responsibility is truly on them. Find the attendings, surgeries or fellowships that will provide you more experience to strengthen your weaknesses so that you are prepared for the real world on your own. ere are many solutions to solving a single problem and some are better than others. You should have multiple tools in your bag to avoid becoming a one-trick pony.