Op-Med is a collection of original articles contributed by Doximity members.
Education: Yale University School of Medicine, UCLA Medical Center
Areas of Expertise: Neurosurgical oncology, Spine surgery
Current Position(s): Principal Surgeon at Atlantic Brain & Spine, Assistant Clinical Professor of Neurosurgery at Virginia Commonwealth University School of Medicine, Chief of Neurosurgery Trauma at the Reston Hospital Center.
1. How do you prepare for your workday?
I prepare for my workday much like anyone else. I grab a cup of coffee and spend some time in the morning looking over my agenda for the day (surgeries scheduled, meetings, consultations, etc.) and then I simply jump in.
I see so many patients throughout the day, it’s hard to find any time to take a breath. Thus, it’s nice to have a few moments of peace with my wife in the morning before the craziness of the day.
2. What is the most challenging part about being in Neurosurgery?
Surprisingly, the most difficult part of my job isn’t actually surgery. While being the head of Trauma and Neurosurgery at Reston Hospital does provide me with many challenging cases, I find that the non-clinical aspects of my job are the most difficult.
Specifically, dealing with legal departments and insurance agencies is becoming an increasing burden to me and other clinicians in my field. But it’s all just part of the job.
3. What are some exciting new developments or technologies in your field?
Over the past couple of years, we have seen some very exciting developments in the field of spinal technology; specifically in the area of minimally invasive surgery.
Tools like robotic guidance systems have allowed me to increase my accuracy around the critical areas of the spine which, in turn, makes surgeries safer, faster and more effective.
Additionally, I think 3D Printing is a technology that is quickly becoming a possibility in the near future. I think that within 10 years, hospitals will have 3D printers on site that will allow physicians to create spinal implants that are specifically tailored to the patient’s spine.
4. What area of your specialty is changing most rapidly?
Over the next couple of years, due to insurance and financial burdens, I think there are going to be increasing pressures to do fewer spine surgeries. Meaning that patients will choose to only do surgeries that are absolutely necessary and minimize the ones that aren’t going to be helpful.
That’s a great thing.
Thus, from a doctor’s standpoint, I believe there are going to be increasing pressures for us to ensure that our surgeries are better, faster, and safer.
5. What is the last journal article or piece of research that significantly changed your practice?
Two pieces of research have really changed the way that I practice spine surgery.
First, there are a lot of papers coming out right now on robotic guidance and their accuracy. According to much of the research, robotic guidance can actually increase the accuracy of implant placement by up to 9% when compared to the human hand. Now this may not seem like a dramatic change but, think about a surgery that places 10 screws into the spine and imagine that one of those screws is a few millimeters off its intended location. This misplaced screw could cause damage to the spine and force another surgery. Thus, the increased accuracy with robotic guidance can really make a huge impact in surgery.
Second, we’re seeing that patients who undergo cervical total disc replacement see much better outcomes when compared to patients who opt for fusions. The research shows that these patients have 7x less risk of having the discs wear out and have quicker recovery times.
6. What research are you working on?
Right now I’m actively involved in a national study on the outcomes and accuracy of robotic guidance spine surgery.
7. Outside of your daily practice, do you have any personal or professional projects that you’re passionate about? Please explain in detail.
I love to play golf, my staff knows it and many of my patients know it too. One of the things I’m really passionate about is making sure that people don’t hurt themselves while playing this incredible sport. Research has shown that about 30% of golfers end up experiencing back pain. This being the case, I’ve put together some insights on my website to help golfers, like myself, ensure that they don’t experience pain when they’re out on the green.
8. What is a common misconception that other clinicians have about your specialty?
One thing that many people confuse, even people within the medical field, is the difference between a neurosurgeon and an orthopedic surgeon. When people hear the title “Neurosurgeon” they often think of brain surgery and, while this is completely true, it’s not the only thing we specialize in. Problems with the spine are much more common, thus neurosurgeons end up doing many more spine surgeries than brain surgeries.
In terms of the difference between neurosurgeons and orthopedic surgeons, they both do spine surgeries, but the training is a bit different. Orthopedic spine surgeons typically spend 5 years in residency doing surgeries on the spine, shoulders, knees and other areas in conjunction with a year long fellowship. Neurosurgeons, on the other hand, spend 7 years doing both brain and spine surgery and many, including myself, go on to do a fellowship to specialize in a specific area of spine surgery.
The bottom line is that orthopedic and neurosurgeons’ focuses are different. Orthopedic surgeons often focus on the basic cases of spine surgery as well as other areas throughout the body, while neurosurgeons specialize purely on the spine often focus on complicated micro surgery and minimally invasive surgery.
9. Who are your mentors?
Honestly, it’s hard to just pick one person. Throughout college, medical school, residency and my fellowship I’ve had dozens of people who have made a dramatic impact on my life and who I am today. That said, I think that I have been most impacted by visiting and speaking to other neurosurgeons around the world.
I travel quite a bit and have many opportunities to speak to surgeons at international conferences and meetings. Surgeons in Asia and Europe have access to and are actively using technology that hasn’t been approved in the United States yet. Thus, they have a lot of insight into what is changing in the field.
Additionally, there are many neurosurgeons outside of the United States. This being the case, these surgeons are forced to specialize in one hyper-specific area of the brain or spine. As a result, I’ve been able to gain a certain perspective and see expertise that is simply too much to obtain when you specialize in the entire spine.
10. What’s the best advice you’ve ever received?
The best advice I ever received was in my second year of medical school. I was learning the basics of patient care and my professor said to me, “You don’t have to be super bright or clever to be a good doctor, that’ll come. What separates a great doctor from an average doctor is being thorough.” That advice is something I take into the operating room every day.
11. What has been your most gratifying moment of being a physician?
Throughout my career, I’ve had so many powerful moments that I can’t pick out just one specifically. But what brings me the most joy is knowing that I have made a difference in a patient’s life. It could be anything from taking out a brain tumor and, literally, saving a life, to helping someone who is in severe pain from a ruptured disc.
Big or small, for me making an impact in people’s’ lives is the reason I got into medicine.
At Atlantic Brain and Spine, we love the DocNews tool that Doximity provides. I’m a big proponent of continuing to learn long after you graduate from school and DocNews makes it easy for me to stay on top of what’s happening in my field and allows me to ensure that I’m providing the best care and technologies for my patients.