What keeps 4 surgeons up at night

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Economic challenges, evolving technology and surgical outcomes are some of the many stressors surgeons face during their careers.

Four surgeons in the orthopedic and spine surgery fields recently spoke with Becker's about the issues that keep them up at night.

Editor's note: These responses were lightly edited for clarity and length.

Question: What keeps you up at night as a surgeon?

Adam Bitterman, DO. Chair of the Department of Orthopaedic Surgery at Huntington (N.Y.) Hospital and Assistant Professor at Zucker School of Medicine at Hofstra/Northwell (Hempstead, N.Y.): As an orthopedic surgeon, many things keep me up at night. Within any surgical specialty, fear of complications is a major cause of lost sleep. While every effort is made to minimize risk, there is no such thing as a guaranteed outcome. I lose more sleep before an OR day than an office day for certain. Other things that worry me are patient non-compliance and re-injury. My initial surgical job is done, but I cannot be with the patient monitoring their compliance and efforts in the recovery process. I try to put significant effort into ensuring the patient understands the clinical scenario before and after the surgical procedure, as well as the full recovery timeline.

Alexander Ghanayem, MD. Chief Medical Officer at Loyola Medicine, Professor and Chair of the Department of Orthopedic Surgery and Rehabilitation at the Loyola University Chicago Stritch School of Medicine: The loss of fiscal autonomy and margin are day-to-day stressors that need to be addressed, but their effect on marginalizing the value-added educational benefits we provide residents and fellows is a loss we can't afford for the future of our specialty. How well will our trainees be prepared for the future when nobody wants to pay for their education? That keeps me up at night.

Michael McKee, MD. Professor and Chair of the Department of Orthopaedic Surgery at the University of Arizona College of Medicine (Phoenix): As the chairman of an academic orthopedic program, my biggest concern is the financial viability of my institution in general and my department in particular. It seems that we are embedded in a relentless monetary squeeze as reimbursements decline, costs increase and hospitals around the country are shuttered for economic reasons. My institution has been similarly affected, which has (reasonably) led to a focus on revenue production. It is difficult to maintain the academic mission in this setting.

Wilson Ray, MD. Professor of Neurosurgery, Executive Vice Chair of Neurological Surgery and Chief of Spine Surgery at the Washington University School of Medicine (St. Louis, Mo.): Probably a lot of things depending on the day and the caseload. From a general sense, probably two major things: patient outcomes and evolving technologies/techniques. In regards to patient outcomes — we are increasingly relying on large datasets and registries to help guide our decision-making and risk stratification for both patients and procedures. Artificial intelligence is likely to be a bigger player in the space, [so] knowing how to integrate this wealth of information into patient selection and surgery selection. Regarding evolving technologies, we are constantly faced with the adoption of new technologies and techniques. It is a challenge for spine surgeons to integrate these evolving technologies and tools into their practice in a responsible fashion while ensuring we are providing the most cutting-edge technologies to our patients. This is a balance I think about frequently.

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