1 00:00:00,240 --> 00:00:03,220 Imagine this, you're at the Hyatt Regency Chicago 2 00:00:03,520 --> 00:00:05,859 surrounded by the top minds in the ambulatory 3 00:00:06,160 --> 00:00:07,540 surgery center industry. 4 00:00:07,919 --> 00:00:10,960 Welcome to the Becker's 30th annual meeting, the 5 00:00:10,960 --> 00:00:14,259 business and operations of ASCs from October 30th 6 00:00:14,400 --> 00:00:15,705 to November second, 7 00:00:16,324 --> 00:00:19,285 2024. Picture the excitement as you collect business 8 00:00:19,285 --> 00:00:22,184 cards from over a 1000 executive level attendees 9 00:00:22,404 --> 00:00:23,945 forging priceless connections. 10 00:00:24,484 --> 00:00:25,864 Feel the buzz of conversations 11 00:00:26,164 --> 00:00:28,984 as you participate in more than 60 sessions 12 00:00:29,045 --> 00:00:29,969 led by over 13 00:00:30,849 --> 00:00:33,030 225 elite ASC speakers. 14 00:00:33,649 --> 00:00:37,090 Envision yourself gaining actionable insights on topics like 15 00:00:37,090 --> 00:00:38,390 private equity strategies, 16 00:00:38,929 --> 00:00:43,030 ASC business growth, and innovations in spine, orthopedics, 17 00:00:43,635 --> 00:00:45,734 GI, ophthalmology, and cardiology. 18 00:00:46,354 --> 00:00:49,954 Now imagine yourself listening to inspiring keynotes from 19 00:00:49,954 --> 00:00:53,094 Hall of Fame boxing world champion, Lila Ali, 20 00:00:53,155 --> 00:00:56,879 and professional basketball player, Caitlin Clark. Their stories 21 00:00:56,879 --> 00:00:59,199 will motivate you to take your business to 22 00:00:59,199 --> 00:01:01,600 new heights. You'll leave with a wealth of 23 00:01:01,600 --> 00:01:03,920 knowledge and a network of connections to help 24 00:01:03,920 --> 00:01:06,719 lead your ASC into the next year. Don't 25 00:01:06,719 --> 00:01:09,619 miss out. Get registered today. Visit beckershospitalreviewdot 26 00:01:10,834 --> 00:01:12,754 com and click on the events page to 27 00:01:12,754 --> 00:01:15,094 find the conference website. That's the beckershospitalreview.com 28 00:01:17,075 --> 00:01:19,094 events page. See you in Chicago. 29 00:01:20,354 --> 00:01:22,354 This is Laura Dirda with the Becker Spine 30 00:01:22,354 --> 00:01:23,575 and Orthopedic podcast. 31 00:01:24,010 --> 00:01:25,689 I'm thrilled today to be joined by doctor 32 00:01:25,689 --> 00:01:28,430 Arthur Jenkins the 3rd, board certified neurosurgeon 33 00:01:28,810 --> 00:01:31,290 and an expert in complex and minimally invasive 34 00:01:31,290 --> 00:01:34,009 spine and neurological surgery. Doctor Jenkins, it's a 35 00:01:34,009 --> 00:01:35,869 pleasure to have you on the podcast today. 36 00:01:36,814 --> 00:01:38,895 Thank you very much, Lloyd. It's a pleasure 37 00:01:38,895 --> 00:01:40,674 to be here. Always happy to, 38 00:01:41,615 --> 00:01:44,814 to join any interested colleagues in discussing the 39 00:01:44,814 --> 00:01:47,234 the present and future of spine surgery. 40 00:01:48,174 --> 00:01:49,859 Oh, excellent. I think this will be a 41 00:01:49,859 --> 00:01:51,780 really fun conversation. I know we've got a 42 00:01:51,780 --> 00:01:53,479 lot of ground to cover and certainly, 43 00:01:54,099 --> 00:01:56,099 fascinating time to be in spine, and so 44 00:01:56,099 --> 00:01:58,119 I'm excited to hear more about your perspective. 45 00:01:58,180 --> 00:02:00,819 But before we dig into my questions here, 46 00:02:00,819 --> 00:02:02,340 I was wondering, could you tell us a 47 00:02:02,340 --> 00:02:04,439 little bit more about yourself and your background? 48 00:02:05,594 --> 00:02:07,295 Sure. So I am a, 49 00:02:07,835 --> 00:02:10,974 board certified fellowship trained spinal neurosurgeon. 50 00:02:11,355 --> 00:02:13,435 I did my fellowship training at the Brigham 51 00:02:13,435 --> 00:02:14,655 in at in Boston. 52 00:02:15,034 --> 00:02:17,275 I did my residency at Mount Sinai. I 53 00:02:17,275 --> 00:02:20,060 went back as after fellowship and was full 54 00:02:20,060 --> 00:02:22,080 time faculty for 17 years 55 00:02:22,460 --> 00:02:25,580 doing research on everything from minimally invasive techniques 56 00:02:25,580 --> 00:02:26,960 to spinal cord injury, 57 00:02:27,580 --> 00:02:31,340 and including brain computer interface type research on 58 00:02:31,340 --> 00:02:32,319 spinal cord 59 00:02:33,194 --> 00:02:33,935 functional regeneration. 60 00:02:35,675 --> 00:02:36,175 And 61 00:02:36,715 --> 00:02:39,435 it was a great experience for me. But 62 00:02:39,435 --> 00:02:39,935 after, 63 00:02:40,314 --> 00:02:42,875 oh, 17 years or so, it seemed like 64 00:02:42,875 --> 00:02:44,074 it was time for me to go in 65 00:02:44,074 --> 00:02:45,995 my own path. So I went into private 66 00:02:45,995 --> 00:02:46,495 practice, 67 00:02:47,400 --> 00:02:49,259 and really just have enjoyed 68 00:02:49,800 --> 00:02:50,620 the challenges 69 00:02:51,080 --> 00:02:53,560 as well as the the, the joys of 70 00:02:53,560 --> 00:02:55,340 being a my own boss, 71 00:02:55,639 --> 00:02:57,419 for the last six and a half years. 72 00:02:58,439 --> 00:03:01,979 And so it's, it's been an interesting time. 73 00:03:02,454 --> 00:03:04,935 It's an old curse, although nobody can agree 74 00:03:04,935 --> 00:03:07,734 upon how old this curse is that may 75 00:03:07,734 --> 00:03:09,995 you live in interesting times. 76 00:03:10,375 --> 00:03:11,594 And these are certainly 77 00:03:11,974 --> 00:03:13,034 interesting times. 78 00:03:15,000 --> 00:03:16,939 Indeed. It's just fascinating, 79 00:03:17,319 --> 00:03:19,079 to think about it and, you know, really, 80 00:03:19,079 --> 00:03:20,680 really, truly, I I feel like over the 81 00:03:20,680 --> 00:03:22,439 last couple years, the number of times I've 82 00:03:22,439 --> 00:03:23,500 heard unprecedented, 83 00:03:24,199 --> 00:03:26,039 connected to something happening in the health care 84 00:03:26,039 --> 00:03:28,699 space is, you know, just really, 85 00:03:29,724 --> 00:03:32,284 kind of serves as a great litmus test 86 00:03:32,284 --> 00:03:32,925 of how much, 87 00:03:33,485 --> 00:03:35,884 how many revolutionary things are happening right now. 88 00:03:35,884 --> 00:03:36,384 So 89 00:03:36,685 --> 00:03:38,844 given the, you know, the times we live 90 00:03:38,844 --> 00:03:40,224 in as well as, 91 00:03:40,685 --> 00:03:41,745 your role, obviously, 92 00:03:42,219 --> 00:03:44,419 experience at a health system and really a 93 00:03:44,419 --> 00:03:44,860 a big, 94 00:03:45,819 --> 00:03:48,219 institution and now being a private practice. What 95 00:03:48,219 --> 00:03:50,139 are some of the big trends and headwinds 96 00:03:50,139 --> 00:03:51,020 that you're following? 97 00:03:51,419 --> 00:03:52,939 What is really top of mind for you 98 00:03:52,939 --> 00:03:53,599 right now? 99 00:03:54,814 --> 00:03:56,435 Well, I I think the biggest 100 00:03:56,814 --> 00:03:58,754 trend and and headwind 101 00:03:59,534 --> 00:04:00,835 is the massive 102 00:04:01,135 --> 00:04:01,635 consolidation 103 00:04:02,814 --> 00:04:04,915 of physicians and specifically 104 00:04:05,215 --> 00:04:06,115 spine surgeons 105 00:04:06,599 --> 00:04:07,340 as employed 106 00:04:07,639 --> 00:04:08,139 physicians 107 00:04:08,520 --> 00:04:10,139 in in the as a market, 108 00:04:10,599 --> 00:04:11,740 broad market thing. 109 00:04:12,120 --> 00:04:12,860 It is, 110 00:04:13,719 --> 00:04:16,519 more spine surgeons than ever have and a 111 00:04:16,519 --> 00:04:19,560 larger percentage of the active spine surgeons are 112 00:04:19,560 --> 00:04:21,420 currently working either for 113 00:04:21,904 --> 00:04:24,644 a a large hospital chain, a large hospital 114 00:04:24,785 --> 00:04:26,884 in the in an in a particular market, 115 00:04:27,584 --> 00:04:29,604 a private equity owned 116 00:04:29,904 --> 00:04:31,764 group of surgeons or doctors, 117 00:04:32,544 --> 00:04:33,524 and ultimately, 118 00:04:34,730 --> 00:04:37,210 more than ever are not their own boss 119 00:04:37,210 --> 00:04:38,189 or are not 120 00:04:38,490 --> 00:04:40,889 even within a small group able to call 121 00:04:40,889 --> 00:04:42,910 their own shots. So these 122 00:04:43,449 --> 00:04:44,189 are typically 123 00:04:45,290 --> 00:04:45,790 driven 124 00:04:46,170 --> 00:04:48,569 on an incentive basis, assuming they even have 125 00:04:48,569 --> 00:04:49,790 an incentive basis. 126 00:04:50,224 --> 00:04:52,785 Their incentive basis is usually purely upon the 127 00:04:52,785 --> 00:04:54,564 volume of cases they do 128 00:04:54,944 --> 00:04:55,845 knowing that 129 00:04:56,224 --> 00:04:59,745 the system has been set up that the 130 00:04:59,745 --> 00:05:02,305 boss, whether it's the hospital, the hospital chain 131 00:05:02,305 --> 00:05:04,660 or the private equity group, makes the most 132 00:05:04,660 --> 00:05:06,199 money off of the clinician 133 00:05:06,980 --> 00:05:08,680 doing the most volume. 134 00:05:09,060 --> 00:05:11,460 And the only way spine surgeons can do 135 00:05:11,460 --> 00:05:12,680 a large volume 136 00:05:13,220 --> 00:05:16,360 is by seeing many patients quickly 137 00:05:16,824 --> 00:05:18,205 in their office hours 138 00:05:18,585 --> 00:05:19,404 and operating 139 00:05:19,865 --> 00:05:22,425 regularly on the same case over and over 140 00:05:22,425 --> 00:05:24,365 so they can be done quickly and efficiently, 141 00:05:24,824 --> 00:05:27,384 frequently in a surgery center that the physician 142 00:05:27,384 --> 00:05:29,944 may have an ownership stake in or the 143 00:05:29,944 --> 00:05:32,285 practice may have an ownership stake in. 144 00:05:33,279 --> 00:05:34,579 This has created, 145 00:05:35,439 --> 00:05:36,339 a number of 146 00:05:37,600 --> 00:05:38,100 potentially 147 00:05:38,639 --> 00:05:39,139 misaligned 148 00:05:40,160 --> 00:05:40,660 incentivizations 149 00:05:41,759 --> 00:05:44,319 where the surgeon wants to get through as 150 00:05:44,319 --> 00:05:46,240 many patients as possible. The only way to 151 00:05:46,240 --> 00:05:47,779 do that is to do so quickly 152 00:05:48,935 --> 00:05:51,595 or refer the patient to somebody else or 153 00:05:51,895 --> 00:05:53,735 more likely than not because they don't want 154 00:05:53,735 --> 00:05:55,895 to admit that this isn't either in their 155 00:05:55,895 --> 00:05:56,395 wheelhouse 156 00:05:56,855 --> 00:05:58,694 or that they just don't wanna deal with 157 00:05:58,694 --> 00:06:00,314 the complexity of the situation. 158 00:06:01,139 --> 00:06:02,899 Many of these patients are being told, well, 159 00:06:02,899 --> 00:06:04,360 there's nothing that can be done 160 00:06:04,819 --> 00:06:06,899 for you. So go to pain management. Go 161 00:06:06,899 --> 00:06:09,860 to see a psychologist. Go see somebody other 162 00:06:09,860 --> 00:06:11,079 than a surgeon 163 00:06:11,539 --> 00:06:13,560 to manage these complex patients. 164 00:06:14,185 --> 00:06:17,165 Now as you can imagine with interesting times, 165 00:06:17,704 --> 00:06:20,104 that as we are our body of knowledge 166 00:06:20,104 --> 00:06:20,845 is growing 167 00:06:21,305 --> 00:06:22,604 and then the complexity 168 00:06:22,904 --> 00:06:25,084 of some of the patients we're dealing with, 169 00:06:25,225 --> 00:06:27,464 there are more and more patients who are 170 00:06:27,464 --> 00:06:29,964 basically being shunted out of 171 00:06:30,319 --> 00:06:31,860 the high volume clinics 172 00:06:32,480 --> 00:06:33,139 and being 173 00:06:34,000 --> 00:06:37,839 essentially medically gaslit by their patient by their 174 00:06:37,839 --> 00:06:38,899 by their practitioners. 175 00:06:39,920 --> 00:06:42,399 The other side the other big headwind we're 176 00:06:42,399 --> 00:06:42,899 facing, 177 00:06:43,605 --> 00:06:46,004 and this is also driving many of those 178 00:06:46,004 --> 00:06:46,504 same, 179 00:06:47,365 --> 00:06:48,185 high volume, 180 00:06:49,204 --> 00:06:51,225 issues, is the insurance companies 181 00:06:51,925 --> 00:06:55,045 are cutting back more and more on what 182 00:06:55,045 --> 00:06:56,425 they pay the physicians. 183 00:06:57,060 --> 00:06:59,080 So the hospitals are subsidizing 184 00:06:59,540 --> 00:07:02,339 through what's called an RVU based model or 185 00:07:02,339 --> 00:07:04,439 resource value unit based model. 186 00:07:04,740 --> 00:07:07,860 They're back subsidizing those surgeons since they're not 187 00:07:07,860 --> 00:07:10,199 making as much on the on the insurance 188 00:07:10,259 --> 00:07:12,040 company payment for their services, 189 00:07:12,805 --> 00:07:15,545 But the hospital is making so much more 190 00:07:16,084 --> 00:07:19,285 on the inpatient stay that they can afford 191 00:07:19,285 --> 00:07:20,904 to subsidize the physicians 192 00:07:21,285 --> 00:07:23,144 to the standard of care that they 193 00:07:23,444 --> 00:07:26,024 rightfully so believe that they're entitled to. 194 00:07:27,310 --> 00:07:30,350 And so the insurance companies at a time 195 00:07:30,350 --> 00:07:32,610 when they are reporting record profits, 196 00:07:33,790 --> 00:07:37,329 for their themselves and for their their shareholders 197 00:07:37,629 --> 00:07:40,610 and payments to their their board members 198 00:07:40,985 --> 00:07:42,125 are paying out 199 00:07:42,504 --> 00:07:45,245 less and less to the physicians and especially 200 00:07:45,384 --> 00:07:47,324 physicians like me in private practice. 201 00:07:48,264 --> 00:07:49,245 Now this is 202 00:07:50,745 --> 00:07:52,524 part of the headwind because 203 00:07:53,459 --> 00:07:56,839 if there are fewer doctors in private practice, 204 00:07:57,540 --> 00:07:58,759 those same physicians 205 00:07:59,300 --> 00:08:02,500 are going to be less inclined to say 206 00:08:02,500 --> 00:08:04,339 to their boss, well, I could go into 207 00:08:04,339 --> 00:08:05,319 private practice. 208 00:08:06,285 --> 00:08:09,004 Therefore, I don't accept this lowball offer of 209 00:08:09,004 --> 00:08:09,504 salary. 210 00:08:09,884 --> 00:08:12,764 And so the fewer the fewer opportunities in 211 00:08:12,764 --> 00:08:13,665 private practice, 212 00:08:13,965 --> 00:08:16,705 the less that those doctors can push back. 213 00:08:16,845 --> 00:08:19,485 And so their salaries are actually, on an 214 00:08:19,485 --> 00:08:21,824 inflation basis, starting to drop. 215 00:08:22,949 --> 00:08:25,589 So it's getting harder and harder for a 216 00:08:25,589 --> 00:08:27,050 spine surgeon to 217 00:08:28,389 --> 00:08:29,930 do well and get ahead 218 00:08:30,389 --> 00:08:32,789 in an environment where the insurance companies are 219 00:08:32,789 --> 00:08:35,509 paying less. And the hospitals know they have 220 00:08:35,509 --> 00:08:38,365 a greater market share, essentially becoming what's known 221 00:08:38,365 --> 00:08:39,264 as a monopsony 222 00:08:39,965 --> 00:08:41,904 or a monopoly of employment. 223 00:08:42,925 --> 00:08:45,165 And the doctors really are the ones stuck 224 00:08:45,165 --> 00:08:45,904 in the middle. 225 00:08:46,524 --> 00:08:48,445 So I think those are the 2 biggest 226 00:08:48,445 --> 00:08:48,945 headwinds. 227 00:08:49,565 --> 00:08:51,024 1 is the 228 00:08:51,379 --> 00:08:52,200 the marginalization 229 00:08:52,820 --> 00:08:54,759 of the more complex patients 230 00:08:55,379 --> 00:08:57,860 and the second is the marginalization of the 231 00:08:57,860 --> 00:08:58,759 spine surgeons 232 00:08:59,139 --> 00:09:01,460 as being a cog in a wheel that's 233 00:09:01,460 --> 00:09:03,559 controlled by somebody other than 234 00:09:03,940 --> 00:09:05,720 other spine surgeons or themselves. 235 00:09:07,485 --> 00:09:10,044 That's really fascinating to hear. And, certainly, you 236 00:09:10,044 --> 00:09:11,404 know, I I can see where all of 237 00:09:11,404 --> 00:09:13,264 those trends tie together 238 00:09:13,804 --> 00:09:16,845 in looking at, you know, how health care 239 00:09:16,845 --> 00:09:19,404 has evolved and really the the pressures, like 240 00:09:19,404 --> 00:09:20,544 you mentioned, from 241 00:09:21,610 --> 00:09:24,169 the insurance company in in the hospital and 242 00:09:24,169 --> 00:09:27,049 and, just from, you know, the surgeon's perspective, 243 00:09:27,049 --> 00:09:29,149 trying to figure out how to navigate 244 00:09:29,769 --> 00:09:31,470 all these areas and spaces, 245 00:09:32,250 --> 00:09:34,654 it just really, you know, is a challenge. 246 00:09:34,654 --> 00:09:36,335 So for you, it seems like you've gone 247 00:09:36,335 --> 00:09:38,735 in the opposite direction instead of joining in 248 00:09:38,735 --> 00:09:40,035 with the hospital or 249 00:09:40,415 --> 00:09:40,915 consolidating, 250 00:09:41,695 --> 00:09:43,455 you know, striking out and doing your own 251 00:09:43,455 --> 00:09:45,394 private practice for the last few years. 252 00:09:45,809 --> 00:09:47,350 You know, do you see, 253 00:09:48,129 --> 00:09:50,370 that being a space that'll be possible in 254 00:09:50,370 --> 00:09:51,889 the future? Do you see, you know, kind 255 00:09:51,889 --> 00:09:53,970 of this bubble bursting at some point? Or 256 00:09:53,970 --> 00:09:56,210 what's in store, do you think, for spine 257 00:09:56,210 --> 00:09:58,370 surgeons in the next 6 to 10 years 258 00:09:58,370 --> 00:09:59,190 down the line? 259 00:10:00,365 --> 00:10:02,845 Well, I think that the biggest opportunity for 260 00:10:02,845 --> 00:10:03,585 growth here 261 00:10:03,964 --> 00:10:05,105 is to capitalize 262 00:10:05,644 --> 00:10:07,884 on what you do and how well you 263 00:10:07,884 --> 00:10:08,544 do it. 264 00:10:09,164 --> 00:10:11,804 It's actually many of the hospitals make it 265 00:10:11,804 --> 00:10:14,044 hard for the physicians to find out how 266 00:10:14,044 --> 00:10:15,184 well they're doing. 267 00:10:15,730 --> 00:10:18,549 After all, if the bosses has an negative 268 00:10:18,610 --> 00:10:21,410 incentive about paying your bonus by finding things 269 00:10:21,410 --> 00:10:22,470 you're doing poorly, 270 00:10:22,850 --> 00:10:24,769 those are the metrics you're likely to get 271 00:10:24,769 --> 00:10:27,410 from them. But many of the physicians that 272 00:10:27,410 --> 00:10:29,429 I speak to can't get 273 00:10:29,730 --> 00:10:32,075 the data from their own hospital or the 274 00:10:32,154 --> 00:10:33,455 even their own department 275 00:10:33,835 --> 00:10:36,735 about how much they contribute to the hospital's 276 00:10:36,875 --> 00:10:39,934 bottom line, what's known as the adjusted contribution 277 00:10:39,995 --> 00:10:40,654 to margin. 278 00:10:41,595 --> 00:10:44,154 When physicians know how much they bring to 279 00:10:44,154 --> 00:10:46,735 the table, they tend to have more 280 00:10:48,110 --> 00:10:50,910 marketing power and more negotiation power within their 281 00:10:50,910 --> 00:10:53,149 own institution as well as, you know, being 282 00:10:53,149 --> 00:10:54,289 able to market themselves 283 00:10:54,669 --> 00:10:57,870 as a potential transfer to another place of 284 00:10:57,870 --> 00:10:58,370 business. 285 00:10:59,149 --> 00:11:01,230 But I think also even within their own 286 00:11:01,230 --> 00:11:02,190 practice, they can 287 00:11:02,804 --> 00:11:05,225 by tracking their own data more 288 00:11:05,684 --> 00:11:08,884 and their patient outcomes more and even looking 289 00:11:08,884 --> 00:11:11,924 at long term outcomes more, they can show 290 00:11:11,924 --> 00:11:14,024 that what they're doing provides value 291 00:11:14,404 --> 00:11:17,360 and then that's an opportunity both to let 292 00:11:17,360 --> 00:11:19,679 the world know how well you're doing what 293 00:11:19,679 --> 00:11:20,339 you do, 294 00:11:20,799 --> 00:11:23,839 but also let your employer know how well 295 00:11:23,839 --> 00:11:26,000 you're doing and that if you're doing better 296 00:11:26,000 --> 00:11:27,620 than your than your peers, 297 00:11:28,000 --> 00:11:30,980 then that's an opportunity for you to negotiate 298 00:11:31,039 --> 00:11:33,404 a better deal for yourself, as well as, 299 00:11:33,404 --> 00:11:35,904 you know, potentially, if we could get together 300 00:11:35,965 --> 00:11:37,804 as a group of physicians and get the 301 00:11:37,804 --> 00:11:38,785 insurance companies 302 00:11:39,325 --> 00:11:40,225 to reimburse 303 00:11:40,605 --> 00:11:41,105 physicians 304 00:11:41,485 --> 00:11:43,024 better for better care, 305 00:11:43,485 --> 00:11:45,264 which right now, there is no 306 00:11:46,019 --> 00:11:46,519 bonus 307 00:11:46,980 --> 00:11:49,800 for a physician who provides great care versus 308 00:11:49,860 --> 00:11:53,639 good care or even good care versus mediocre 309 00:11:53,779 --> 00:11:56,100 care. I mean, as long as you're above 310 00:11:56,100 --> 00:11:57,320 the level of malpractice 311 00:11:57,700 --> 00:12:00,065 care, you get paid the same by the 312 00:12:00,065 --> 00:12:02,225 most for the most part by all of 313 00:12:02,225 --> 00:12:04,565 the insurance carriers and even the government. 314 00:12:05,184 --> 00:12:08,164 So that what we really need to do 315 00:12:08,304 --> 00:12:10,245 and is to at least leverage 316 00:12:10,865 --> 00:12:12,404 your ability to provide 317 00:12:13,129 --> 00:12:14,350 good to great care, 318 00:12:14,809 --> 00:12:18,809 incentivize people to provide better care, and then 319 00:12:18,809 --> 00:12:21,950 the marketing on that will follow itself and 320 00:12:22,090 --> 00:12:23,450 be the path you know, people will be 321 00:12:23,450 --> 00:12:24,669 the path to your door. 322 00:12:26,514 --> 00:12:27,794 That makes a lot of sense, and, you 323 00:12:27,794 --> 00:12:29,875 know, it's just a fascinating way to think 324 00:12:29,875 --> 00:12:31,495 about it, you know, a 100% 325 00:12:31,875 --> 00:12:33,475 in in you're right, 326 00:12:33,955 --> 00:12:36,355 in looking at you know? Again, as long 327 00:12:36,355 --> 00:12:38,115 as you're above malpractice, you get paid at 328 00:12:38,115 --> 00:12:38,834 the same rate, which, 329 00:12:39,679 --> 00:12:41,279 doesn't make a lot of sense or doesn't 330 00:12:41,279 --> 00:12:43,839 translate to most other industries. And so having 331 00:12:43,839 --> 00:12:44,579 that incentive 332 00:12:44,879 --> 00:12:47,279 to really be great, produce those outcomes, and 333 00:12:47,279 --> 00:12:48,579 do what you need to do, 334 00:12:49,039 --> 00:12:50,179 could really be beneficial. 335 00:12:51,039 --> 00:12:52,019 From your perspective, 336 00:12:52,480 --> 00:12:54,159 I I guess, are there any other ways 337 00:12:54,159 --> 00:12:56,514 that you see spine and orthopedics evolving over 338 00:12:56,514 --> 00:12:58,134 the next 2 to 3 years or so? 339 00:12:58,595 --> 00:13:01,475 What do you see as realistically being ways 340 00:13:01,475 --> 00:13:04,195 that, you expect the industry to change, both 341 00:13:04,195 --> 00:13:05,954 either from the business side or the clinical 342 00:13:05,954 --> 00:13:07,409 side? I know you do a lot of 343 00:13:07,970 --> 00:13:08,470 innovation, 344 00:13:09,089 --> 00:13:09,589 within 345 00:13:10,370 --> 00:13:12,789 complex surgery as well as minimally invasive procedures. 346 00:13:14,370 --> 00:13:16,690 I I think that that is certainly one 347 00:13:16,690 --> 00:13:19,509 way that it's been evolving and will continue 348 00:13:19,649 --> 00:13:20,389 to evolve. 349 00:13:20,929 --> 00:13:24,174 There the The use of AI is probably, 350 00:13:24,174 --> 00:13:26,814 you know, the widespread use of AI is 351 00:13:26,814 --> 00:13:27,314 probably 352 00:13:28,095 --> 00:13:29,954 a 3 to 10 year horizon 353 00:13:30,574 --> 00:13:32,254 and there are a number of ways that 354 00:13:32,254 --> 00:13:33,554 that can help practitioners 355 00:13:34,014 --> 00:13:34,514 to 356 00:13:35,699 --> 00:13:39,720 improve their process, but not necessarily completely eliminate 357 00:13:39,860 --> 00:13:40,679 certain steps. 358 00:13:41,539 --> 00:13:43,480 For example, I personally, 359 00:13:44,579 --> 00:13:45,079 use, 360 00:13:45,459 --> 00:13:47,240 an AI digital scribe, 361 00:13:48,545 --> 00:13:50,225 and I have used a couple of different 362 00:13:50,225 --> 00:13:51,365 one over the years. 363 00:13:52,024 --> 00:13:52,524 The, 364 00:13:53,585 --> 00:13:56,144 shout out playback health is is currently my 365 00:13:56,144 --> 00:13:58,225 AI digital scribe, but even that is not 366 00:13:58,225 --> 00:14:00,865 perfect. I still have a human scribe who 367 00:14:00,865 --> 00:14:03,264 helps to take what the digital scribe has 368 00:14:03,264 --> 00:14:03,764 done 369 00:14:04,279 --> 00:14:06,759 to, and put it into my final note 370 00:14:06,759 --> 00:14:07,259 format 371 00:14:07,639 --> 00:14:09,559 because there are things that a digital scribe 372 00:14:09,559 --> 00:14:12,200 from a particular office visit doesn't have access 373 00:14:12,200 --> 00:14:14,379 to that my human scribe does. For example, 374 00:14:14,679 --> 00:14:17,160 going back and looking at prior visits for 375 00:14:17,160 --> 00:14:17,660 comparisons. 376 00:14:18,195 --> 00:14:20,274 You know, if I'm checking grip strength on 377 00:14:20,274 --> 00:14:20,855 a patient 378 00:14:21,154 --> 00:14:23,634 who's had surgery that impacts on their hand 379 00:14:23,634 --> 00:14:24,134 strength, 380 00:14:24,754 --> 00:14:27,075 I may be tracking that over time and 381 00:14:27,075 --> 00:14:29,475 my and we can add that data in. 382 00:14:29,475 --> 00:14:30,934 It's harder to do 383 00:14:31,409 --> 00:14:33,809 from a just a a current the current 384 00:14:33,809 --> 00:14:35,429 generation of AI scribes. 385 00:14:35,809 --> 00:14:38,769 But the next generation may actually allow you 386 00:14:38,769 --> 00:14:41,570 to dig into those outcome measures we talked 387 00:14:41,570 --> 00:14:42,389 about earlier 388 00:14:42,769 --> 00:14:46,549 and track the patient's progress through their recovery, 389 00:14:47,425 --> 00:14:49,045 and be able to put that data 390 00:14:49,665 --> 00:14:51,524 right front and center in the note. 391 00:14:52,625 --> 00:14:53,845 I think it's also 392 00:14:54,305 --> 00:14:56,065 the one of the ways that I'm hoping 393 00:14:56,065 --> 00:14:58,884 the industry goes is away from the 394 00:15:00,559 --> 00:15:01,059 hospital 395 00:15:01,679 --> 00:15:02,179 generated 396 00:15:03,279 --> 00:15:07,039 7 page progress note that dumps 6 and 397 00:15:07,039 --> 00:15:09,759 a half pages of old data into the 398 00:15:09,759 --> 00:15:10,899 note to document 399 00:15:11,519 --> 00:15:13,860 a higher complexity of the evaluation 400 00:15:14,845 --> 00:15:16,785 more than actually improve the 401 00:15:17,884 --> 00:15:19,664 insight of the note itself, 402 00:15:20,044 --> 00:15:21,884 but then they turn around and they bill 403 00:15:21,884 --> 00:15:24,285 more back to the insurance carrier for that 404 00:15:24,285 --> 00:15:25,264 level of service 405 00:15:25,725 --> 00:15:27,899 that was provided. But that creates 406 00:15:28,919 --> 00:15:30,540 a mess of a note, 407 00:15:31,000 --> 00:15:33,639 literally 7 pages sometimes I have to wade 408 00:15:33,639 --> 00:15:36,460 through to find the 2 or 3 sentences 409 00:15:36,919 --> 00:15:39,160 that actually mean something for how the patient 410 00:15:39,160 --> 00:15:42,634 was doing that particular day. Having MRI reports 411 00:15:42,634 --> 00:15:43,934 from 3 days ago 412 00:15:44,475 --> 00:15:45,855 in the note as 413 00:15:46,955 --> 00:15:48,095 transcribed verbatim 414 00:15:49,514 --> 00:15:51,914 and then having to find where on that 415 00:15:51,914 --> 00:15:52,414 note 416 00:15:53,115 --> 00:15:56,975 the physician's actual impression was, it's just tedious. 417 00:15:57,250 --> 00:16:00,050 And so I'm hoping that many people do 418 00:16:00,050 --> 00:16:02,050 what I do, which is put on the 419 00:16:02,050 --> 00:16:03,190 very first line 420 00:16:04,129 --> 00:16:04,950 the impression, 421 00:16:05,330 --> 00:16:07,029 what they're there for with impression 422 00:16:07,809 --> 00:16:10,455 and have that be first and then any 423 00:16:10,514 --> 00:16:12,934 ancillary data that supports that conclusion 424 00:16:13,554 --> 00:16:14,855 be down afterwards. 425 00:16:15,634 --> 00:16:17,575 Let's just communicate better, guys. 426 00:16:18,914 --> 00:16:21,394 Absolutely. Wouldn't that be, you know, the the 427 00:16:21,394 --> 00:16:23,920 goal in so many different connections or relationships 428 00:16:23,920 --> 00:16:26,100 is just having that communication aspect, 429 00:16:27,200 --> 00:16:29,920 easier, more streamlined, and and a a better 430 00:16:29,920 --> 00:16:31,059 understanding overall? 431 00:16:31,840 --> 00:16:34,800 Absolutely. Well, you know, I I've appreciated a 432 00:16:34,800 --> 00:16:36,800 lot of your perspective here, and I I 433 00:16:36,800 --> 00:16:38,615 know we're running out of time. But before 434 00:16:38,615 --> 00:16:40,455 we go, I was wondering where do you 435 00:16:40,455 --> 00:16:42,455 see some of the best opportunities for continued 436 00:16:42,455 --> 00:16:44,534 to grow growth and development in the field 437 00:16:44,534 --> 00:16:45,835 as well as in your practice? 438 00:16:47,174 --> 00:16:49,575 Well, I certainly think that from from my 439 00:16:49,575 --> 00:16:50,875 perspective, I've been, 440 00:16:51,419 --> 00:16:55,259 just learning more about the different areas that 441 00:16:55,259 --> 00:16:57,419 I just didn't understand. I mean, I've learned 442 00:16:57,419 --> 00:16:59,360 more in the last 5 years about 443 00:16:59,899 --> 00:17:00,399 autonomic 444 00:17:01,019 --> 00:17:05,214 dysfunction and the spine and peripheral nervous system's 445 00:17:05,355 --> 00:17:07,375 impact upon patients who are 446 00:17:07,755 --> 00:17:08,255 hypermobile 447 00:17:08,875 --> 00:17:11,455 or had an injury that has made their 448 00:17:12,075 --> 00:17:12,575 body 449 00:17:13,035 --> 00:17:14,335 kink and pinch 450 00:17:14,634 --> 00:17:17,695 the autonomic nerves and cause severe problems 451 00:17:18,089 --> 00:17:20,329 that we can treat if we understand the 452 00:17:20,329 --> 00:17:20,829 biomechanics 453 00:17:21,130 --> 00:17:22,429 and then the neurobiology 454 00:17:22,970 --> 00:17:25,929 of this. And it's just not taught widely 455 00:17:25,929 --> 00:17:26,589 in neurosurgical 456 00:17:26,890 --> 00:17:28,410 training, so I had to learn all of 457 00:17:28,410 --> 00:17:30,410 this on my own. But as I learn 458 00:17:30,410 --> 00:17:31,934 it and I realize there are a whole 459 00:17:32,255 --> 00:17:35,055 population of patients out there who are un- 460 00:17:35,055 --> 00:17:36,115 or under treated 461 00:17:36,654 --> 00:17:39,055 for these conditions, and that's an opportunity to 462 00:17:39,055 --> 00:17:41,775 figure out how can you meet the needs 463 00:17:41,775 --> 00:17:43,615 of the patients who are coming in to 464 00:17:43,615 --> 00:17:44,515 see you better. 465 00:17:45,559 --> 00:17:48,140 And so I've learned to work with vascular 466 00:17:48,279 --> 00:17:50,059 surgeons and I've actually added 467 00:17:50,519 --> 00:17:53,640 surgical treatments for thoracic outlet syndrome to my 468 00:17:53,640 --> 00:17:54,619 clinical practice, 469 00:17:54,920 --> 00:17:57,079 once again, something I was not taught during 470 00:17:57,079 --> 00:17:59,500 residency, but after working with others 471 00:18:00,134 --> 00:18:01,815 and and coming up with a better way 472 00:18:01,815 --> 00:18:03,894 of doing it, it's really, it's been very 473 00:18:03,894 --> 00:18:04,394 gratifying. 474 00:18:05,734 --> 00:18:08,154 And then other areas are are clearly, 475 00:18:08,455 --> 00:18:09,434 you know, finding 476 00:18:09,894 --> 00:18:12,715 better ways to provide care to people 477 00:18:13,140 --> 00:18:16,519 through minimally invasive approaches that maybe they were, 478 00:18:16,740 --> 00:18:19,380 like for cancer patients, maybe they weren't healthy 479 00:18:19,380 --> 00:18:22,599 enough for the big old school classic operation, 480 00:18:23,059 --> 00:18:26,180 but a minimally invasive procedure that may have 481 00:18:26,180 --> 00:18:27,880 minimal downtime and recovery 482 00:18:28,515 --> 00:18:31,234 but give them better quality of life and 483 00:18:31,234 --> 00:18:32,934 potentially even longer life, 484 00:18:33,795 --> 00:18:36,615 that's an opportunity to treat people, once again, 485 00:18:36,674 --> 00:18:38,595 who may have been told there's nothing more 486 00:18:38,595 --> 00:18:39,734 we can do for you, 487 00:18:40,195 --> 00:18:42,214 when that's actually not true. So 488 00:18:42,569 --> 00:18:45,049 finding new, better ways to treat the people 489 00:18:45,049 --> 00:18:47,450 who haven't been treated, that's an opportunity for 490 00:18:47,450 --> 00:18:47,950 growth. 491 00:18:48,649 --> 00:18:51,690 And then just finding better ways of doing 492 00:18:51,690 --> 00:18:53,309 the things we're currently doing 493 00:18:53,769 --> 00:18:56,329 and maybe even finding ways to deliver stem 494 00:18:56,329 --> 00:18:56,829 cells, 495 00:18:57,265 --> 00:18:58,565 not just percutaneously 496 00:18:58,865 --> 00:19:01,744 with needles, but in a more targeted fashion 497 00:19:01,744 --> 00:19:02,565 through surgery, 498 00:19:03,424 --> 00:19:04,964 into target areas. 499 00:19:05,345 --> 00:19:08,865 As the biology and and technology of stem 500 00:19:08,865 --> 00:19:11,984 cells evolves, we may find even better ways 501 00:19:11,984 --> 00:19:12,884 to use them. 502 00:19:13,960 --> 00:19:16,519 That's really encouraging to hear. Doctor Jenkin, thank 503 00:19:16,519 --> 00:19:17,799 you so much for joining us on the 504 00:19:17,799 --> 00:19:20,200 podcast today. This has been a fascinating discussion, 505 00:19:20,200 --> 00:19:21,720 and I look forward to connecting with you 506 00:19:21,720 --> 00:19:22,506 again soon. 507 00:19:23,306 --> 00:19:25,146 Great. Well, thank you very much for, for 508 00:19:25,146 --> 00:19:26,906 the opportunity. Have a great day, and, 509 00:19:27,386 --> 00:19:29,546 say hello to all your your, listeners out 510 00:19:29,546 --> 00:19:30,046 there.