Evalina Burger, MD, is the Robert D'Ambrosia Endowed Chair of Orthopedics at the school of medicine for the University of Colorado Anschutz Medical Campus in Aurora.
She has dedicated her career to spinal medicine and built a robust practice; now she is focused on passing her expertise on to surgeons just starting out, in addition to patient care.
Here, Dr. Evalina talks about her key concerns for the field today and where she sees spine headed.
Question: What is the biggest challenge your practice is facing today and how are you overcoming it?
Dr. Evalina Burger: The most challenging issue for me as an individual in my practice is the metrics; we are held accountable for that we do not control. The patient experience is one example. If a patient has a bad experience in the hospital, and that gets on my report card, it's not something that I can control. We work with the hospital to make sure each patient gets the best individual care, but if you are in a big hospital, every now and then there is a patient that doesn't have the best experience. The patient might have trouble finding the orthopedic floor or doesn't receive the care they expected and it's interesting how these things influence the patient's perception of care.
As the chair of my department, the biggest challenge for me is the changing scenarios in terms of the financial scene. In the past, when you were in the academic center, you were affiliated with the hospital. The surgeon and hospital were joined at the hip. Now the academic medical center is part of a hospital system, and we have to compete in the fair market value world for clinic space. If I want to work for the hospital's freestanding clinic that isn't on the hospital campus, I have to pay rent like a private practice group. In academics, that's very challenging because we don't have the same financial means or ancillary income as private practice physicians.
Q: What are your top one or two goals for your practice over the next three to five years?
EB: We have an amazing practice. I do complex spine and adult deformity, and I am extremely busy. I don't have the space to grow myself anymore; what I do see is growing my group with younger people that are like-minded and skilled so we can deliver to patients the same quality of care across the board. It shouldn't matter who actually performs surgery.
Q: What advice do you have for orthopedic and spine surgeons just entering the field?
EB: We have a number of young surgeons in our group. In the first year, we are helping them with their decision making. You have to have your principals straight for the decision-making process, which is influenced by your knowledge, skills and most of all the support system you work in. You can't go into a practice and do what you did in your fellowship if you don't have the support system in place. Sometimes there are issues that you don't notice in your fellowship because everything runs smoothly. But when you start your own practice, you may not have the same resources.
Also, when you manage patients in a team, you achieve better outcomes. We are teaching surgeons what they need beside surgical skills to have successful outcomes. It is also important to build great programs in spine with non-surgical specialists, physical medicine and rehabilitation specialists, social workers and more.
The third thing we are doing is making sure new surgeons do what is right by the patient. We tell them to 'do unto the patient what you would want done unto yourself.' If we can instill these values in the new faculty, set an infrastructure around them and instill good ethics, the surgeons will be great.
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