Five spine surgeon leaders at hospitals and health systems discuss how their roles have changed over the past few years.
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Q: How has your role as a spine department leader evolved over the past two to three years? How have your responsibilities changed?
Michael Steinmetz, MD. Chairman of the Department of Neurosurgery at Cleveland Clinic: If you consider the past few years, it was easier to take your practice for granted. You could turn your lights on and patients would show up. Things were easier. Competition has grown substantially. Insurance contracting has narrowed the market, driving patients to one institution over another. Surgeons are doing more complex surgeries and we are seeing much more regulation from the payer end, and even institutional changes with regards to implant use have made it harder to practice the way we did in the past.
We're moving rapidly into an idea of outcomes-based clinical care as opposed to outcomes -based research. We've had to evolve and as a leader I had to help lead that change. We have had to be much more creative in the marketing space, which is something that I wasn't involved in until recently. We are now focusing more on “customer” service than we did a decade ago.
William Welch, MD. Chair of the Neurosurgery Department at Pennsylvania Hospital (Philadelphia): There has definitely been more economic pressure over the years. There is a pressure from below and above now. The pressure from below is the health system; we have to keep trying to control costs as reimbursements decrease. There is a pressure from above; we put pressure on vendors to lower costs, and frankly now we look at just about everything we do in a scientific and rigorous way to make sure patient care isn't compromised and we reduce the variation in an appropriate and scientific way.
At Penn Medicine, we have really placed increased emphasis on quality and the quality-value equation. That has been a tradition at Penn, one of the nation's first hospitals. For the past 250 years, the hospital has based its reputation on the delivery of quality surgeons, and now we take on the value equation of delivering the highest quality care at the most reasonable cost.
Andrew Gitkind, MD. Vice Chairman and Medical Director of Montefiore Spine Center (New York City): As medical director of the Montefiore Spine Center, my initial responsibilities predominantly revolved around developing a plan which would bring together spine practitioners from four different departments — interventional pain management, neurological surgery, orthopedic surgery and rehabilitation medicine — leveraging the strengths of each provider and their background while ensuring a cohesive work environment amongst practitioners who had not previously worked together. My early responsibilities focused mostly on planning and development. Since the center opened two years ago, my responsibilities have shifted to focusing more on growth, of the center itself and of supporting the professional and academic growth of the staff.
John Bendo, MD. Interim Chief of the Division of Spine Surgery and Department of Orthopedic Surgery and Co-Director of the Spine Center at NYU Langone Health (New York City): One of the biggest changes to my responsibilities has entailed developing new ways to address the massive expansion in the division of spine surgery within the past five to 10 years, to where we now have 18 orthopedic spine surgeons at NYU Langone's Spine Center. The growth of our program has brought with it additional administrative, clinical, research and educational responsibilities and as a division chief, it is my role to ensure care continues to be standardized regardless of who a patient sees, in order to ensure optimal outcomes.
To address our expansion, I recently created an executive committee that contains eight of our spine surgeons who all hold different director roles in the division — including directors of innovation and technology, quality and safety, research, etc. — where we will meet on a regular basis and get everyone involved in the decision-making process in order to maximize efficiencies in our spine service. The intention is to create a "team approach" to ensure unified decisions are made in order to benefit patients and [to] move the division of spine surgery forward.
Additionally, I have applied this team collaboration model to treating our most high-risk, complex cases. We have developed a set of clinical and/or radiographic criteria to determine a 'high-risk' surgical patient, and if a patient meets them, the case gets presented before a multidisciplinary group of spine specialists at a weekly case conference, and appropriate recommendations are then made. These efforts are part of our division's underlying goal to standardize care and maximize outcomes.
Jason Lowenstein, MD. Director of the Scoliosis and Spinal Deformity Center at Atlantic Health System (Morristown, N.J.): We have grown our scoliosis and spinal deformity program over the past two to three years at both our primary hospital, Morristown Medical Center, and across Atlantic Health System, and have continued to develop a comprehensive approach to offer care across our healthcare system.