Spine care comes from many sources — standalone practices, partners in group practices, hospital outpatient procedures, specialties in surgery centers — but the future of spine care and surgery is freestanding centers that offer "one-stop shopping," says David Abraham, MD, co-founder of the Reading Neck and Spine Center in Wyomissing, Pa.
"Right now, if you ask typical 68-year-old grandmothers with spinal stenosis what they would change about the healthcare system so they could have a better care package, their No. 1 complaint is that they tend to be bounced around from person to person to person, and no one has really orchestrated or organized their care," Dr. Abraham says.
"If you talk to family doctors, their biggest hassle is that when they send a patient to a surgeon, and the surgeon sends them to pain management, they don't want to see them back," he continues. "They want the surgeon to coordinate that care for the whole musculoskeletal-disease pattern and they are interested in referring that patient to a comprehensive service that's already set up. The days of kind of piecemealing patient care should be, I think, over because we really can't treat patients lik ethat anymore."
The solution to piecemeal care should come in the form of freestanding spine centers, he says. These centers, whether they are in the form of standalone practices, surgery centers or sub-specialties in a group practice, should provide the entire spectrum of treatment and care for patients in need of spine services.
"Yes, this stepping outside of our comfort zone, but if you can get physiatrists, pain management specialists, perhaps physical therapy, MRI … if you can be enough of a business man to organize all of that, you will never have to worry about another referral because everyone in your catch area will know that you provide comprehensive care services which is really what every family doctor wants," Dr. Abraham says.
Dr. Abraham says he frequently speaks to young spine surgeons looking to make their mark in spine but unsure how to do so with so many pressures to take on orthopedic cases.
"Let's focus on a surgeon who's fellowship-trained," he says. "They go and a join an orthopedic group, but they are wondering 'Why haven't I distinguished spine?' and 'How do I develop a spine-exclusive practice?' So many guys I talk to are not 100 percent committed to their fellowship training and that is not where a graduating spine fellow, in my humble opinion, should be. There's so much work out there that needs to be done in only spine surgery and spine care, that all these other distractions of total hips and total knees are really the reason I think spine care is in its infancy."
Dr. Abraham offers the following advice for spine surgeons in orthopedic group practices interested in devoting themselves to spine care.
1. Prepare for a challenge.
"The burden of opening a center that is something different, something new, means that you have to break down barriers between doctors, between specialists, and get orthopedic spine specialists to team up with pain management doctors, and physiatrists, and therapists — you have to want to organize these people in a way that they may have never been aware of or have any of their friends or colleagues be engaged," he says.
The workload will be heavy, but it is the stress and the anxiety of the challenge that will help make sure that business succeeds.
"That way, you don't fall into a comfort zone and become complacent; you tend to be proactive and you tend to add services to your business that you might not find necessary if you're fat, happy and supported by an orthopedic group," Dr. Abraham says.
2. Start by adding a physiatrist.
"Go to your orthopedic group and say 'I am going to bring on a physiatrist who is a musculoskeletal specialist who may have a background in pain management,'" he says. "When you think about pain management today, half are physiatry, half are anesthesia. You could easily sell a physiatrist to an orthopedic group; they will buy into this because even orthopedists want non-operative spine specialists."
3. Add other supportive physicians.
"Bring in an anesthesiologist, rheumatologist, neurologist, and get them to work to support not only the spine but also help the orthopedic group," he says.
"Family doctors are doing sports medicine fellowships — a lot of times these guys are hired to screen all musculoskeletal problems and only refer surgical cases to the surgeons. That's another kind of person who can help develop the specialty of spine care.
"Bringing in non-surgeons is the way to grow the division of spine surgery in a way that other people might not be familiar with," he says. "One of the best ways I think spine guys can really make a difference in the development of their specialty is to team up with podiatrists and pain-management specialists so that they work within the same office, side-by-side, and, more specifically, out of the same office chart. If you're only providing surgical services, you really haven't distinguished yourself from the competition."
4. Make spine a true subdivision.
"A lot of orthopedic group are subdivided — there's the division of sports medicine, spine surgery; and hand surgery," Dr. Abraham says. "I think it's a great idea because then you're giving the individual the autonomy to develop a 'center of excellence' while still remaining part of the tax ID number of the big orthopedic group."
5. Give subdivision its own identity.
While the spine subdivision is part of the orthopedic group, you will find that referrals and patients gain a better understanding of the level of care you are looking to provide if the subdivision truly becomes its own entity, he says. Give the subdivision its own name, promote the leaders within the subdivision as representing the subdivision (and not the orthopedic group), and even develop a unique, independent marketing effort around just the spine component.
6. Reap the rewards.
"When I started my practice, I went to the family doctors and said 'We're providing one-stop shopping,'" he says. "I was surprised that once I defined myself as a spine surgeon, the number of good referrals that I got from many other people was astonishing. It really has allowed my practice to grow. Stop doing ankle fractures, stop doing hip fractures. We've trained enough orthopedic surgeons to take care of those things; now you can really grow your spine business by really just focusing on spine."
7. Don't wait.
"If we private practitioners don't do this work, hospitals will do it for us because their incentive is to control spinal surgeons," Dr. Abraham says. "Their whole [angle] is if we want to grow our local hospital's revenue, we need spine surgeons. The thing that I mention about delaying this process to young guys is if you aren't the leader who does it and puts in the extra time to organize this, your hospital is going to and then you're looked at as simply a cog in the wheel and you're working for the hospital."
Dr. Abraham (abrahamatrnsc@aol.com) is a founder of the Reading Neck and Spine Center. The facility takes a multidisciplinary approach to spine care by offering medication; epidural steroid injections and facet injections of the spine; pain management; minimally invasive spinal surgery; standard spinal surgery; physical medicine and rehabilitation; and spine-specific physical therapy. Learn more about The Reading Neck and Spine Center at www.readingneckandspine.com.