Generally speaking there are two entry points to a spine practice. A practice is either looking to expand and increase patient load or it is looking for a surgeon to fill a specific subspecialty niche, such as a surgeon trained in spinal deformity. New surgeons can expand the range of options the practice offers and help handle an increased patient volume.
Here, three spine surgeons share the reasons they joined their respective practices and tips for surgeons seeking to join a practice.
![Dr. Roger Hartl]( "Dr. Roger Hartl Choosing a Practice")
1. Choose the practice setting most fitting for you. Roger Härtl, MD, is the chief of spinal surgery and neurotrauma at Weill Cornell Brain and Spine Center. He also serves as an associate professor of neurological surgery at Weill Cornell Medical College.
When Dr. Härtl first began weighing his options he had to ask himself if he was interested in entering private practice or an academic setting. He decided, "I was really interested in the freedom and support to pursue other interests that an academic environment could offer."
Dr. Härtl finds the most appealing aspect of his day to day practice to be the large amount of freedom he is afforded. He has a great deal of autonomy when it comes to organizing his schedule. He generally sees patients in the office for 1.5 days a week, performs surgeries three days of the week and spends half a day on administrative tasks. He is able to fit in time for his research between all of his other activities.
2. Select a focused area of interest. Kris Radcliff, MD, an assistant professor of orthopedic surgery at Rothman Institute, Thomas Jefferson University, identifies the first step of choosing a practice as selecting a particular geographic area of interest. From there surgeons can begin to look for practices that fit their individual needs. He points out that, after having settled on a particular geographic region, spine surgeons seek other interests, such as an environment where they can teach and spend time on scholarly pursuits.
3. Make sure the group is in good ethical standing. Stephen T. Onesti, MD, is a partner of Neurological Surgery PC of Long Island and director of neurosurgery at South Nassau Communities Hospital in Oceanside, N.Y. "When I joined this group what was important to me was its ethical standing and that I would respect the people I was working with," said Dr. Onesti. He values working in a collaborative environment with colleagues he trusts.
Dr. Onesti suggests that spine surgeons seeking to join a new practice should always look for a group that has a longstanding reputation. It is wise to question a group that has a single member or very few members. "Issues that lead to surgical partners leaving a group are a tremendous red flag," he said. Other practices to be cautious about before joining include single specialty groups, such as workman compensation and personal injury focused groups.
4. Research the practice to make sure future volume will sustain you. Spine surgeons should consider the procedure volume of a practice before joining. Dr. Radcliff recommends that surgeons ask how busy any current spine surgeons are. It is critical that the practice have a clear explanation of why they are recruiting another spine surgeon. One good way to quantify practice volume is the number of cases that they book per week, the length of time to obtain a new patient appointment, and the length of time needed to schedule an elective surgery. When practices think about adding their first spine surgeon, they should consider the number of spine patients they refer to a different location each month. If they take on these cases will there enough to keep a spine surgeon busy? Will there be too many for just one spine surgeon to handle?
![Dr. Stephen Onesti]( "Dr. Stephen Onesti Choosing a Practice")
5. Find partners and a culture that fits your personality. In Dr. Onesti's opinion the ability to work with both neurosurgeons and orthopedic surgeons facilitates the best patient experience. He is able to learn from surgeons in both specialties and patients receive the benefit of the collaboration between the two types of surgeons. He also points out that he is able to work with both senior and younger surgeons, who bring a fresh perspective to the table.
Dr. Härtl points out that personalities play a huge role in career satisfaction for spine surgeons. Spine surgery is a demanding profession and personalities can easily clash. "The most important thing is that you like the people you work with," he said. He trained at Weill Cornell and found it to be a very comfortable environment. He cautions that switching practices always constitutes the risk of finding yourself working with people who don't have personalities that complement your own.
Dr. Radcliff also agrees that a collaborative, center of excellence environment is a tremendous asset for any practice. At Jefferson the orthopedic and neurosurgery departments have collaborated for decades on surgical indications, co-surgery, research, and training surgeons with skill sets from both respective disciplines. "I have always enjoyed the collegial relationship with Jefferson neurosurgery," says Dr. Radcliff. "This environment enables the spine surgeons at Jefferson to advocate with a unified voice for resources to benefit patient care. "
6. Pick colleagues who are supportive of your desires. Though Dr. Härtl warns that some surgeons may not want to take on a high level of multitasking, he has found that is practice has provided a great deal of support. His colleagues are understanding and needed administrative support is available. He also has access to research fellows who shoulder a great deal of the leg work for his projects, along with research coordinators.
7. Ensure there will be enough space and staff available. Consider the amount of space and staff available for you when joining a practice. Dr. Onesti said surgeons need to ask, "Are there enough resources to run an efficient, busy practice?" The staff of spine practice is essential to getting patients in on time and managing paperwork. There need to be enough physician assistants and staff members to provide a streamlined, efficient environment. Patients will lose confidence in a practice if they feel they are not receiving enough individual attention.
8. Understand how the local hospitals work. Dr. Onesti says spine surgeons should also investigate processes at the local hospitals where they'll be performing surgical cases. Consider operating room and anesthesia availability and turnaround times. Talk with current spine surgeons at these institutions. Also consider whether they'll have the instrumentation you need for your procedures; most large to medium sized hospitals will already have the equipment necessary for spine surgery. "Much of spine surgery involves elective procedures in relatively healthy and younger patients. There is motivation to maintain a state of the art facility," said Dr. Onesti.
9. Become a team player. When it comes for spine practices to add surgeons, Dr. Härtl stresses the importance of finding surgeons that are willing to be team players. "Everyone is so specialized," he said. Specialization can be a benefit, but practice members need to be willing to work together. Make sure that someone at the practice doesn't already cover your particular focus, and if they do, speak with the current partners before committing to make sure there will be enough patient volume for you to pursue your interests as well. Each surgeon can focus on a specific area of interest, while keeping in mind practicing as a team.
Dr. Radcliff finds the large range of specialties his colleagues have to be a major benefit of his current practice. "I really like to practice within a multispecialty group in which I have a tremendous amount of trust in my partners," he said. Dr. Radcliff is confident that he can refer a patient to any of the many surgeons in his practice. If patients are happy with all of the surgeons they have met with, it is likely they will return to the practice.
![Dr. Kris Radcliff]( "Dr. Kris Radcliff Choosing a Practice")
10. Find a senior surgeon within the group as a mentor. Spine practices within an academic setting will have access to trainees and select surgeons to join the practice from the training pool. However, young spine surgeons will often cold call practices they are interested in. Dr. Radcliff said that Rothman Institute welcomes both methods of adding surgeons.
He was a fellow at Rothman and found he was able to get to know his mentors and build a great working relationship. "The ability to have professional mentorship and have a good relationship with senior partners is invaluable for a spine surgeon," said Dr. Radcliff. Performing complex surgeries with mentors early on in training improves patient outcomes in any field, but Dr. Radcliff finds this to be especially key in practicing spine.
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9 Surgeons on Adopting Minimally Invasive Spine Techniques
1. Choose the practice setting most fitting for you. Roger Härtl, MD, is the chief of spinal surgery and neurotrauma at Weill Cornell Brain and Spine Center. He also serves as an associate professor of neurological surgery at Weill Cornell Medical College. When Dr. Härtl first began weighing his options he had to ask himself if he was interested in entering private practice or an academic setting. He decided, "I was really interested in the freedom and support to pursue other interests that an academic environment could offer."
Dr. Härtl finds the most appealing aspect of his day to day practice to be the large amount of freedom he is afforded. He has a great deal of autonomy when it comes to organizing his schedule. He generally sees patients in the office for 1.5 days a week, performs surgeries three days of the week and spends half a day on administrative tasks. He is able to fit in time for his research between all of his other activities.
2. Select a focused area of interest. Kris Radcliff, MD, an assistant professor of orthopedic surgery at Rothman Institute, Thomas Jefferson University, identifies the first step of choosing a practice as selecting a particular geographic area of interest. From there surgeons can begin to look for practices that fit their individual needs. He points out that, after having settled on a particular geographic region, spine surgeons seek other interests, such as an environment where they can teach and spend time on scholarly pursuits.
3. Make sure the group is in good ethical standing. Stephen T. Onesti, MD, is a partner of Neurological Surgery PC of Long Island and director of neurosurgery at South Nassau Communities Hospital in Oceanside, N.Y. "When I joined this group what was important to me was its ethical standing and that I would respect the people I was working with," said Dr. Onesti. He values working in a collaborative environment with colleagues he trusts.
Dr. Onesti suggests that spine surgeons seeking to join a new practice should always look for a group that has a longstanding reputation. It is wise to question a group that has a single member or very few members. "Issues that lead to surgical partners leaving a group are a tremendous red flag," he said. Other practices to be cautious about before joining include single specialty groups, such as workman compensation and personal injury focused groups.
4. Research the practice to make sure future volume will sustain you. Spine surgeons should consider the procedure volume of a practice before joining. Dr. Radcliff recommends that surgeons ask how busy any current spine surgeons are. It is critical that the practice have a clear explanation of why they are recruiting another spine surgeon. One good way to quantify practice volume is the number of cases that they book per week, the length of time to obtain a new patient appointment, and the length of time needed to schedule an elective surgery. When practices think about adding their first spine surgeon, they should consider the number of spine patients they refer to a different location each month. If they take on these cases will there enough to keep a spine surgeon busy? Will there be too many for just one spine surgeon to handle?
5. Find partners and a culture that fits your personality. In Dr. Onesti's opinion the ability to work with both neurosurgeons and orthopedic surgeons facilitates the best patient experience. He is able to learn from surgeons in both specialties and patients receive the benefit of the collaboration between the two types of surgeons. He also points out that he is able to work with both senior and younger surgeons, who bring a fresh perspective to the table. Dr. Härtl points out that personalities play a huge role in career satisfaction for spine surgeons. Spine surgery is a demanding profession and personalities can easily clash. "The most important thing is that you like the people you work with," he said. He trained at Weill Cornell and found it to be a very comfortable environment. He cautions that switching practices always constitutes the risk of finding yourself working with people who don't have personalities that complement your own.
Dr. Radcliff also agrees that a collaborative, center of excellence environment is a tremendous asset for any practice. At Jefferson the orthopedic and neurosurgery departments have collaborated for decades on surgical indications, co-surgery, research, and training surgeons with skill sets from both respective disciplines. "I have always enjoyed the collegial relationship with Jefferson neurosurgery," says Dr. Radcliff. "This environment enables the spine surgeons at Jefferson to advocate with a unified voice for resources to benefit patient care. "
6. Pick colleagues who are supportive of your desires. Though Dr. Härtl warns that some surgeons may not want to take on a high level of multitasking, he has found that is practice has provided a great deal of support. His colleagues are understanding and needed administrative support is available. He also has access to research fellows who shoulder a great deal of the leg work for his projects, along with research coordinators.
7. Ensure there will be enough space and staff available. Consider the amount of space and staff available for you when joining a practice. Dr. Onesti said surgeons need to ask, "Are there enough resources to run an efficient, busy practice?" The staff of spine practice is essential to getting patients in on time and managing paperwork. There need to be enough physician assistants and staff members to provide a streamlined, efficient environment. Patients will lose confidence in a practice if they feel they are not receiving enough individual attention.
8. Understand how the local hospitals work. Dr. Onesti says spine surgeons should also investigate processes at the local hospitals where they'll be performing surgical cases. Consider operating room and anesthesia availability and turnaround times. Talk with current spine surgeons at these institutions. Also consider whether they'll have the instrumentation you need for your procedures; most large to medium sized hospitals will already have the equipment necessary for spine surgery. "Much of spine surgery involves elective procedures in relatively healthy and younger patients. There is motivation to maintain a state of the art facility," said Dr. Onesti.
9. Become a team player. When it comes for spine practices to add surgeons, Dr. Härtl stresses the importance of finding surgeons that are willing to be team players. "Everyone is so specialized," he said. Specialization can be a benefit, but practice members need to be willing to work together. Make sure that someone at the practice doesn't already cover your particular focus, and if they do, speak with the current partners before committing to make sure there will be enough patient volume for you to pursue your interests as well. Each surgeon can focus on a specific area of interest, while keeping in mind practicing as a team.
Dr. Radcliff finds the large range of specialties his colleagues have to be a major benefit of his current practice. "I really like to practice within a multispecialty group in which I have a tremendous amount of trust in my partners," he said. Dr. Radcliff is confident that he can refer a patient to any of the many surgeons in his practice. If patients are happy with all of the surgeons they have met with, it is likely they will return to the practice.
10. Find a senior surgeon within the group as a mentor. Spine practices within an academic setting will have access to trainees and select surgeons to join the practice from the training pool. However, young spine surgeons will often cold call practices they are interested in. Dr. Radcliff said that Rothman Institute welcomes both methods of adding surgeons. He was a fellow at Rothman and found he was able to get to know his mentors and build a great working relationship. "The ability to have professional mentorship and have a good relationship with senior partners is invaluable for a spine surgeon," said Dr. Radcliff. Performing complex surgeries with mentors early on in training improves patient outcomes in any field, but Dr. Radcliff finds this to be especially key in practicing spine.
More Articles on Spine:
5 Steps for Spine Surgeons to Run Top OR Teams
7 Things for Spine Surgeons to Know for Thursday
9 Surgeons on Adopting Minimally Invasive Spine Techniques