How spine surgeons can prepare for physician shortages, growing demand

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Spine surgeons are anticipating large physician shortages in the near future.

By 2025 neurosurgery is expected to be down 1,200 physicians, and orthopedics overall is expected to be down 5,050 physicians.

At the same time, the population of people 65 and older is expected to grow 47% in the U.S. between 2022 and 2050, according to the Population Reference Bureau.

Eight spine surgeons discuss how practices can get ahead of the changing tides.

Note: Responses were lightly edited for clarity.

Question: How should spine practices prepare for the rising aging population and projected physician shortages?

Brian Fiani, DO. Mendelson Kornblum Orthopedic & Spine Specialists (West Bloomfield, Mich.): Spine practices can prepare for the rising aging population and projected physician shortages by implementing telemedicine services to reach a larger patient population, investing in technology to improve efficiency and patient outcomes, and providing comprehensive training programs for existing staff to take on more responsibilities. Additionally, developing partnerships with academic institutions and research organizations can help attract top talent and stay at the forefront of advancements in spine care.

Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: I believe that practices will likely get busier with the aging population. As there are fewer physicians to take care of patients, practices will need to be able to scale up as the volume increases. Smaller practices, like mine, may be able to continue on, running a lean business. Larger groups or multispecialty groups may try to staff up, unnecessarily in the anticipated volume. I would recommend instead of hiring a whole bunch of newly minted office staff, find processes that are major drains on resources. 

Converting to a paperless office saves time and money, and also keeps a digital record of what you do. Time spent on the phone with prior authorization is a major time suck.  Identify those staff members who enjoy the combative nature of these interactions and move them to that position. 

More than anything, never organize based on what will likely be a temporary swell. Instead, solidify your positions and find ways to prepare for the long haul, and get out of the quarterly mentality. Hire good people, pay them a decent wage, train them and work with them to grow your organization in a way that reduces turnover and fosters natural growth.

Osama Kashlan, MD. Weill Cornell Medicine (New York City): With the rising aging population and the specific subtleties in care that are associated with those patients, it will be imperative for spine practices in the future to find the perfect balance between personalization and standardization. 

This is already happening with the emphasis on ERAS (enhanced recovery after surgery), minimally-invasive spine surgery, and the utilization of continuous monitoring with artificial intelligence capability to increase patient involvement/feedback. ERAS streamlines the perioperative experience and helps optimize medical comorbidities including bone density in osteopenic or osteoporotic older patients. The combination of ERAS and MIS techniques decreases length of stay, minimizes complications, and quickly gets patients to their normal levels of activity. This is critical for older patients. 

Continuous monitoring, which could be in the form of personalized mobile applications or smart implants/external sensors, will allow patients to be more involved in their care and will allow treatment teams to make appropriate changes in real time. All three of the interventions above most importantly also decrease the requirements for healthcare resource utilization. This is especially important in the future with the projected physician shortages. In this way, clinic managers and physician extenders can be more involved in the process with less immediate primary involvement needed by the surgeon.  

With these three critical points of emphasis, spine practices can be ready for the future where there will be less surgeons taking care of older and sicker patients. 

Arya Shamie, MD. UCLA Health: To effectively prepare for the challenges of a growing aging population and looming physician shortages, spine practices should adopt a comprehensive strategy. This includes embracing technological advancements such as telehealth services and artificial intelligence to extend the reach of care and streamline patient management. Training and education should be prioritized to expand the pool of specialized spine care professionals.

Efficiency in clinic operations can be achieved through the implementation of electronic health records and patient self-service portals, allowing physicians to focus more on patient care. Preventive care and early intervention should be emphasized to manage spine-related conditions before they escalate. Additionally, developing collaborative care models with interdisciplinary teams, including physiatrists and pain management specialists, can optimize physician workload and patient outcomes. 

Engaging in healthcare policy advocacy is also crucial to address reimbursement, liability and regulatory issues that may hinder the expansion and efficiency of spine care services. By addressing these key areas, spine practices can ensure sustained quality care for patients with spine-related conditions, despite the challenges ahead.

Vladimir Sinkov, MD. Sinkov Spine (Las Vegas): With the aging population all physicians, including spine surgeons, will likely be treating more age-related diseases. For spine surgeons this would include more lumbar spondylosis, instability, stenosis, and degenerative deformities.  Some of these patients will require surgical interventions to address these issues. Older patients are also more likely to be frail and are likely to have more medical comorbidities. Therefore, treating their surgical spine pathology with minimally invasive surgical techniques will become even more important as it lowers the risks of intraoperative and postoperative complications and allows for quicker recovery. 

With the projected physician shortage, the spine surgeons will likely become busier performing surgeries and will have to delegate more non-surgical spine care to other physicians (such as primary care providers, pain management specialists, or physiatrists) as well as to mid-level providers such as physician assistants and nurse practitioners.

William Taylor, MD. University of California San Diego Health: Just as children are not older adults, the same can be said of our aging population. The issues and complications arise when we fail to adequately consider the various medical, social and bone health issues with our aging population.

Timur Urakov, MD. University of Miami (Fla.): Rising aging population and projected physician shortages will drive for improved efficiency in patient access and disposition. Spine practices can implement advanced surgical techniques and robotic-assisted procedures to improve efficiency and outcomes. Further optimize utilization of mid-level providers to expand patient care capacity to address physician shortages. 

Telemedicine has proven to be beneficial in improving patient access and should continue being implemented. It facilitates remote consultations, follow-ups, and monitoring, as well as increasing access to care for elderly and less-abled patients. Community outreach and education is ever more important to promote spinal health and preventive measures among the aging population. Spine practices should strive to develop strong collaboration with primary care providers to streamline referrals and ensure preventative and conservative care for the patients.

Vijay Yanamadala, MD. Hartford (Conn.) HealthCare: The aging population will undoubtedly mean an increase in degenerative spinal conditions which will require interventions and surgeries, but it will also increase the need for non-surgical care, including physical therapy. There is currently no shortage of surgeons, but getting these patients the right non-operative care will indeed be an increasingly difficult challenge. Patient's access to primary care and physical therapy will be essential to getting patients the right care that they need. We need to focus on comprehensive multidisciplinary care that will get every patient the appropriate care.

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