by Elizabeth Hofheinz, M.P.H., M.Ed., February 5, 2020
Will spine one day turn its back on ortho? At least one spine surgeon hopes so.
“Spine surgery should become its own specialty,” says one veteran spine guru. “It can be a division of its own which reports both to neurosurgery and orthopedic surgery. But the training should be different from those of typical orthopedic and neurosurgeons. Those who are interested in going into spine at the outset of their residency could do one year of neurosurgery and one year of orthopedic surgery followed by three years of spine surgery followed by one year of subspecialty training in some field of spine surgery.”
And why not? Well, follow the money…
“What prevents this from happening in the United States is not that it would be bad for patients. In fact, the opposite is true. This system would produce much better spine surgeons. Instead, it is all about the financial health of the orthopedic and neurosurgery departments. Spine can represent up to 50% of the revenue of an orthopedic surgery department and even a much higher percentage of the revenue for a neurosurgery department. Therefore, having spine secede from those departments would decimate their finances.”
But such a splintering is already afoot, says this surgeon, and isn’t likely to slow down.
“Also, because spine represents such a high percentage of what a typical neurosurgeon in private practice does, it could decimate neurosurgery as a specialty. This can be resolved by having spine be a division of the two departments. Spine can pay a tax to the two departments. New recruits would be hired jointly by the two departments. Such a system already exists at Duke and at the Cleveland Clinic. I believe that this is a trend that is going to continue and that it is essentially unstoppable. Specialization is something that has happened in medicine since the dawn of time and there are inexorable forces that will push this forward.”
