Becker's Spine Review

28 Becker's ASC 22nd Annual Meeting - The Business and Operations of ASCs – Call (800) 417-2035 By Anuja Vaidya Question: Would the physician shortage affect spine care? Why? John C. Liu, MD, Co-Director, USC Spine Center, Keck Medicine of USC, Los Angeles: I do not think the anticipated physician shortage will affect spine care. As the healthcare market continues to change, spine care practitioners will need to adapt because patients and payers will demand appropriate, high-quality care no matter what. A movement away from procedural, volume-driven spine care to more preventative and conservative care will likely decrease the number of spine surgeons required in the future. Improve- ments in quality and technical precision in diagnosis and surgery will reduce failed spine surgeries and unnecessary surgical interventions, while much of the current care provided by spine surgeons will likely be supported by other specialists or physician extenders. Richard Kube, MD, Founder, CEO, Prairie Spine & Pain Institute, Peoria, Ill.: e answer is a pretty com- plex economic equation given all of the variables. Obvi- ously, it is really hard to predict exact changes. e sim- plest concept is supply and demand. Fewer doctors and more patients — think baby boomers — would tend to be favorable for physicians. With market forces pushing doctors into employment rather than independence, this force could help to counter or weaken that trend. We do, however, see greater numbers of ancillary providers providing a great- er amount of care. For example, a couple dozen states allow nurse practitio- ners to practice independently from physicians. We could see those individu- als filling the supply/demand gap and changing how and by whom patients are treated. ere can be treatment delays on more complex issues that only the surgeon can address which can lead to different types of patient presen- tations to be treated. Unfortunately, there may be increased stratification of access to care based upon type of payer. One can speculate further about infinite possibilities, but I think it is really just important to follow internal metrics and try to identify trends in payer mix, patient age, referral source, etc., so that your practice can read the tea leaves so to speak and be better prepared for what is to come. ough the shortage is still on the horizon, changes will not happen over night, and you can always count on a few surprise variables. Also, given the time it takes to train a spine surgeon, it will take some time to add the physicians through traditional methods. Hence, hope for higher volume, but don't make it a for- gone conclusion. Be thoughtful and diligent and embrace the need to evolve with the market. Bryan Oh, MD, Neurosurgeon, BASIC Spine, New- port Beach, Calif.: With the continued aging of the baby boomer generation, comes more degenerative healthcare-related issues such as spine degeneration and thus, an increased need for patient access to health- care and spine providers. Any event that limits patient access to those healthcare providers will have a negative impact on the delivery of that healthcare. ere is a projected shortage of physicians throughout all different special- ties, including spine surgery. e anticipated physician shortage, mostly in primary care specialties, will mean fewer patients will have timely access to diagnosis and treatment of their spine conditions. Ultimately, patients be- ing able to access spine specialists via a referral network will be negatively affected. As a result, I do anticipate advanced practice practitioners, such as physician assistants and nurse practitioners, to be more prevalent in the spine world. As with anything, there will be a learning curve for these new providers. In the interim, spine care may be adversely affected, but with better specialty- specific training for these APPs and an expectation that they will be integral to the care of spine patients, I do believe that quality spine care will still be present. Q: Which spine care innovation has had the most impact on the industry in recent years? Kern Singh, MD, Minimally Invasive Spine Institute, Chicago: Without a doubt the three biggest innova- tions in my spinal career over the last 10 years have been bone morphogenetic protein, lateral spine surgery and a tubular retractor. BMP has changed how we ac- complish spinal fusions with much more predictability. Lateral spine surgery has allowed us to address even the most complex cases from an outpatient perspective and a tubular retractor has allowed us uncompromised vi- sualization with minimally invasive surgical procedures. Howard An, MD, Director, Division of Spine Sur- gery, Spine Fellowship Program, Rush University Medical Center, Chicago: e majority of patients who are undergoing fusion surgery prefer not having their iliac crest harvested for a bone gra. erefore, biologic or synthetic bone gra substitutes developed by the industry have had a significant impact on the practice of spine surgery for last several years. Bone morphogenetic protein is one of these innovations available for clinical use, but its indication is narrow, and there is controversy surrounding side effects. Other bone gra substitutes, such as demineralized bone matrix, synthetic ceramics and stem cell products have been intro- duced, but more research is needed to assess their efficacy and indications. Q: What are some short-and long-term goals you've set for your practice? Patrick C. Hsieh, MD, Director, Minimally Invasive Spine Program, USC Spine Center, Keck Medicine of USC, Los Angeles: I started my practice at the Keck School of Medicine of the University of Southern Cali- fornia seven years ago. With the addition of several new spine surgeons in the past two years, we now have a core group of leading academic spine surgeons that can deliver the highest level of care in all facets of spine surgery, including minimally invasive spine, spinal de- formity, spine trauma and spine tumor surgeries. My short-term career goal is to continue to promote growth and expansion of the USC Spine Center's footprint in Southern California. rough a combination of patient care, ed- ucation and research, I believe that we will be the preeminent spine program recognized by our patients, referring physicians and community. We have a tremendous advantage in our program in which both orthopedic surgeons and neurosurgeons truly work closely together on a daily basis to provide patient care and education to our trainees. I ensure that our resi- dents and fellows are exposed to some of the latest techniques and innova- tions in degenerative spine, minimally invasive spine, spinal deformity and Physician Shortage, Spine Innovations & Big Goals for the Future — 6 Spine Surgeons' Key Thoughts

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