After 15 years at Pittsburgh-based UPMC, Adam Kanter, MD, left the 40-hospital academic health system, where he was chief of spine surgery and a tenured professor, to become associate executive medical director of the Hoag Pickup Family Neurosciences Institute in Orange, Calif.
Dr. Kanter is a central figure in several spine societies, including the chair of the spine section for the American Association and College of Neurological Surgeons and immediate past president of the Society for Minimally Invasive Spine Surgery. He is also enrolled in the executive master of business administration program at UCLA.
Dr. Kanter spoke with Becker's Spine Review about what prompted this change, the different challenges and opportunities he faces at Hoag and what most excites him about the future of spine surgery.
Note: Responses were lightly edited for length and clarity.
Question: How are you settling into your new role?
Dr. Adam Kanter: It's going very well. I had never worked outside of a university health system before, so there is definitely a learning curve. You do all the research to try and minimize the surprises when you make a switch like this, because it's a completely different way of operating. I do miss training the residents but there is a great camaraderie that exists in the private sector with colleagues, staff and the community that I am very much enjoying.
Q: What drew you to your new role at Hoag?
AK: Over the last several years, the pandemic made us all take pause and really think about what we wanted for our future. I spent 15 years at a major academic center in Pittsburgh and had to decide if I wanted to spend 15 more dealing with the same administrative and leadership politics and bureaucracy. I put some feelers out and considered a change to another university system but also wanted to consider options that were more empowering for true physician leadership. What drew me to Hoag was not just their earnest desire to listen but their commitment to take action. So many university appointments are filled with commanding titles, chairmanships and directorships, but these titles are often meaningless if they don’t fall in line with the administration’s agenda. I came to Hoag because when I asked the CEO pointed questions about hospital care policies and direction, he looked me in the eyes and said, "Let's just do what's right." We shook hands and I've never looked back.
Q: How does an academic health system differ from an organization such as Hoag?
AK: Hoag represented something different and unique to me. A mentor I trained under at the University of Virginia, John Jane, MD, always said, "Never micromanage your leaders, recruit them and get out of their way." In my academic role as chief of spine services, every initiative required a dozen approvals from non-clinicians or others that knew very little about how to treat patients with spine disease. I felt the leadership at Hoag valued the insights and opinions of its physicians, and the titles weren't just for fancy wall plaques; they were issued to fulfill Hoag's mission to empower our patients, our colleagues and our communities, and change the way healthcare is delivered.
Q: What is the biggest challenge in your new role?
AK: My greatest challenge is simply corralling the time to listen and learn from this prominent group of visionary neuroscientists I'm surrounded by at Hoag. There's a tremendous desire for synergy and collaboration that was really inspirational and revitalizing when I was on the interview trail. That's exactly what I needed for this second half of my career and why I landed here at Hoag.
Q: What innovative changes is Hoag looking to implement in spine and neurosurgery? What are the two most interesting trends you're following in healthcare today?
AK: A couple trends are worth noting, but there are a few I also think are important to scrutinize as we move toward them, and that's this dramatic growth and expansion of virtual healthcare. The silver lining of the pandemic was our impetus to evolve and adapt to provide care through telehealth platforms. Healthcare has thus become more accessible and efficient, but we have to remain conscious as it's getting easier to devalue the benefits of a physical presence in our care pathways. Physicians gain valuable information from being able to see and touch our patients, and we have to be careful not to minimize that, otherwise we are no better than the insurers that approve or deny our requests for treatment based solely upon the latest radiology report. There's truly no substitute for the physician-patient relationship, especially when it's in person. During COVID, as providers became more reliant on telehealth, it became clear when they were meeting patients that certain things were being missed or not fully understood until the physical appointment.
Another hot topic is value-based healthcare. We all aim to provide the best care at the lowest cost. We're developing tools and analysis programs as we evaluate new technologies — such as robotics, augmented reality, bone growth supplements, etc., but the challenge is to be able to do this and still pioneer the innovations that often come at a cost without clear and immediate return. That's also one of the things that attracted me about Hoag; they recognize the need to support innovative minds and invest in the treatments, people, and ideas that may not initially provide the biggest bang for their buck. To this end, Hoag leadership was supportive of my interest in obtaining an executive MBA so that I can better negotiate the business of medicine with its practice – I started the program at UCLA last July.
Q: What surgical technologies most excite you in spine surgery?
AK: I'm fascinated with the concept of integrating augmented reality and virtual reality into clinical training models and practice. The millennial generation of surgeons are growing up with these super thumbs — they think differently, they act and interact differently. In our profession, it just might be time we stopped harping on our trainees to put down their devices and enter the real world, and it's time for us to enter theirs.
Training and cadaver labs are constrained by incredible time, expense and travel, and the current augmented reality virtual simulators are becoming more technically advanced by the day. We are increasingly incorporating them into our ORs to improve our accuracy and surgical precision. At Hoag, we can utilize AR technology and see a patient's pathology in three dimensions while navigating through the brain or spine like we're on a magic carpet. The technology can also help you connect in a totally unique way with our patients. It makes it so visually understandable so that our patients can be more involved in the decision-making process.
Q: How do you compare spine robots and AR systems in their current states?
AK: Robots cost about a million dollars and AR systems cost a couple hundred. But it really depends on what you're trying to do. When I hear "robot," I think about something that is automated and learns itself through artificial intelligence and experience, just like the human brain. It learns through data acquisition over time. To me, that's a robot. But current robots are basically navigation assistance; they still require humans to set up and move everything, oftentimes ironically slowing us down. AR technology enables us to plan things out virtually and then navigate during surgery, but it does so at a vastly different price point. I anticipate in the years ahead that AR/VR and robots will be far more utilized and drastically improve our efficiency and safety in the OR, but at the moment, humans remain essential in nearly all aspects of surgical planning and execution.
Q: How do you think spine care delivery will evolve in the next five years?
AK: Spine care delivery will likely eradicate single specialty silos. Patients are increasingly going to be treated at multidisciplinary centers that work more efficiently with providers to deliver expeditious care without all the excess time between evaluations, diagnostics and treatment. This means that insurers will also need to partner up so we can break down the walls between all stakeholders. We have to move more seamlessly through a comprehensive care algorithm that follows evidence-based pathways, so we can methodically determine what diagnostics are necessary, what medicines are most helpful and what treatments work best.