Charles Mick, MD, 2013 President of the North American Spine Society, gave the presidential address at the organization's annual meeting.
Each decade the World Health Organization conducts a study to measure the global impact of burden on disease, and low back pain is the number one cause of global pain; neck pain is number four.
"Spine problems may not be a lethal as cancer or as devastating as blindness, but given their high prevalence and lengthy duration of symptoms the resulting impact on the quality of life is tremendous,” said Dr. Mick. “This is the challenge that each one of us face every day. This is the reason we put up with the day-to-day hassles of electronic medical records; declining reimbursement; increasing overhead; insurance rejections; and an insane liability system."
He then discussed the lessons spine surgeons can learn from baseball, bringing a out a 1956 Brooklyn Dodgers game used ball signed by the entire team as well as a baseball bat. While the baseball is exceptional, the bat is average.
"There are 23 players batting above .300. There are 183 players batting zero. Most are average; in the middle with a few superstars and a few dogs. How good are you batting as a spine care provider. Are you a superstar?" he asked.
Baseball players use statistics and sabermetrics. How can surgeons rate their ability to care for patients?
"Imagine for a minute that we had the ability to rate your care for patients and put your ability on a graph,” Dr. Mick said. “As scientists, we know it would be the classic bell curve. Some are better, some are worst and most are in the middle. Bell curves do have limitations; they aren't as sophisticated as funnel plots for describing this type of information. They don't account for the extremes and variation and they don't determine the appropriate level of care. Insurers at times assume that all care provided above or below an arbitrarily defined limit on the curve is ether good or bad. The media sometimes inflames the public by declaring that half of physicians are below average. If I asked you to place yourself on the graph, where would you be?"
Dr. Mick quoted Malcolm Gladwell's "Outliers," comparing the old adage it's better to be lucky than good. However, Mr. Gladwell argues that practice and training are more important than genetics. The examples in his book passionately practiced their skills for more than 10,000 hours, repeating their skills until they became effortless.
"There is a growing amount of evidence that experienced and high volume providers get better results," Dr. Mick said. Adding up education, residency and fellowship, you have about 8,000 hours said Dr. Mick, and much of that time doesn't meet the rigorous practice Mr. Gladwell described. "Attending NASS meetings and directed practice are still not enough; it's only a start."
In following with the baseball analogy, Dr. Mick discussed how baseball players know whether what they do works and figure out how to maximize resources using data.
"We are starting to measure things in medicine," he said. "They are important but removed from the goals that patients and physicians consider important. Having three hits in a game is fantastic but what if your team loses."
Medicare has an incentive program to measure the performance of physicians. In order to improve practice meaningfully, providers need accurate, timely, transparent and risk-adjusted data, Dr. Mick said. Spine registries, including one NASS plans to launch next year, are becoming more prevalent.
"We need to analyze our delivery of care and learn from our failures," Dr. Mick said. Sometimes this may mean discarding old habits and motivating change. Healthcare reform changes are motivated with penalties and incentives, but comprehensive change or activities that require creativity and innovation are less likely to respond to these motivators.
Daniel Pink, in his book “Drive,” describes a new way to motivate creativity with composed of autonomy, mastery and purpose. “If we wish to survive in the new healthcare paradigm, we need to understand and incorporate these motivators into our work,” Dr. Mick said.
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