'Robots do not make surgeons better': What we heard in August

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Spine and orthopedic experts and leaders in August spoke with Becker's Spine Review on topics from private equity to total disc replacements.

1. "What we found is that private equity doesn't know the business better than you do. I have numerous examples of colleagues of mine that went into private equity, and some of their practices don't exist today. You have to be able to assess these opportunities with private equity and look at them closely. But overall, nobody knows the practice or runs the practice better than you do. You have to have your strong team in place, and that will allow you to make the best decision for you. We have found that currently our best decision has been to stay independent." —Eric Freeman, DO, of Union, N.J.-based Redefine Healthcare, on why he has not taken private equity investment.

2. "The key to success with total disc replacement, as with many procedures in spine surgery, is patient selection. Patient selection is so vital, especially since anterior cervical discectomy and fusion is still an excellent alternative in patients with contraindications and helps to ensure good outcomes with surgery. The next step with TDR will be to integrate sensors in the implant that can communicate motion, wear and possible loosening. This information will help alert the patient and the surgeon at an early stage when there may be a problem that warrants a visit to the surgeon." —Michael Goldsmith, MD, of The Centers for Advanced Orthopaedics in Bethesda, Md., on changes he wants to see in total disc replacements.

3. "Private equity has successful roots in healthcare. Private equity in orthopedics is in an early stage, and it will certainly continue to evolve and mature. But the core principles of physicians maintaining leadership, decision authority and equity ownership are sound. As these markets continue to consolidate amongst hospitals, healthcare systems and managed care organizations, it is essential that patients seeking high-quality, cost-effective care, and physicians striving to practice medicine in an independent, private practice setting have choices." —Raj Bhole, MD, chair of Atlanta-based Resurgens Orthopedics, on his outlook for private equity.

4. "My biggest industry worry is physician access to innovative and beneficial treatments for patients. Some large health systems and hospitals have consolidated their spine implant purchasing, with physicians only able to use implants offered by a few large companies. While this simplifies purchasing to some degree, in these arrangements it limits surgeon access to new and innovative products from smaller companies, which is frequently where we see novel treatments emerge. It also has the potential to limit surgeon access to the implants with which they feel most comfortable and most beneficial for their patients." —Stephen Tolhurst, MD, of  Plano-based Texas Back Institute, on his top industry concern.

5. "Robots do not make surgeons better, but robots can help good surgeons execute plans they have otherwise been unable to do with traditional analog instruments. For early-career surgeons it is paramount that they learn to operate without the assistance of technology first to hone their skill, perfect basic principles. In real life, surgeons may not necessarily have a robot for every case. What if the robot is not functioning? Surgeons cannot be entirely reliant on technology." —Nader Nassif, MD, of Irvine, Calif.-based Hoag Orthopedic Institute, on how surgeons can avoid overreliance on robots.

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