In different practice settings and markets, spine surgeons tackle unique hurdles when it comes to managing costs, maintaining independence and finding their niches.

Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. Becker’s invites all spine surgeon and specialist responses.

Next question: What’s one textbook all spine surgeons should read? Please send responses to Carly Behm at cbehm@beckershealthcare.com by 5 p.m. CST Tuesday, March 4.

Editor’s note: Responses were lightly edited for clarity and length.

Question: What unique challenges does your practice setting face compared to others?

Michael Briseño, MD. North Texas Orthopedics & Spine Center (Grapevine): We are unique in that we are trying to perform two seemingly divergent goals at the same time. Namely, we want to coalesce with other like-minded practices to formulate the broader United Musculoskeletal Partners consortium. At the same time, we want to maintain our identity as the private practice that has garnered the trust of our local community over the past 30 years. We are achieving this by being incredibly selective in which other groups we choose to associate with in UMP and partnering with those who represent our mission and values while not losing sight of who we are historically and focusing our efforts on continuing to provide exceptional patient care and patient experience.

Brian Fiani, DO. Spine Surgeon. (Birmingham, Mich.): A unique challenge my practice faces is also my greatest offering to patients which is multiple geographic territory locations.

Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: As a private practice doctor, there is always the looming shadow of large, well-monied groups coming into the space.  In large markets, if you throw a quarter, you hit a spine surgeon. As the large fish gobble the medium size fish, there will be space and niches to occupy. Finding that niche for some of us has been hard. Others seem to never find it and eventually leave or become part of the collective. I think this and staying on top of new techniques is a challenge as time away from practice is time spent not working. While these are both challenges unique to my practice, I have found ways around and feel good about the year to come.  

Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): The usual and customary operational and cost-related hurdles with newer visualization technologies such as intraoperative CT Spinal Endoscopy. The upfront costs, reimbursement issues and technological retrofitting remain issues including the outcome marginalities and comparisons of these evolving technological assist mechanisms versus standardized microscopic guided decompressive surgery. The other area of concern surrounds the indications and outcomes of minimally invasive lumbar decompression surgery. The imposed self-pay cost, results and satisfaction rates of these procedures, (which are frequently being done by non-surgically trained providers) routinely leave patients/family members dumbstruck and questioning as to validity and recourse.