This is Carly Beam with the Becker Spine
and Orthopedics podcast, and I'm thrilled to be
joined today by doctor Nolan Wessel with the
University of Colorado School of Medicine. Doctor Wessel,
thank you so much for being here today.
Yeah. Thanks you thank you so much for
having me on board.
Yeah. Absolutely. And before we dive into our
discussion, I'd love to if you could just
introduce yourself and tell us a bit about
your background. Sure. So,
as you already mentioned, I currently work at
the University of Colorado Department of Orthopedics, but,
I was born and raised in North Central
Wisconsin,
did my undergraduate,
studies at the University of Wisconsin. And then
after graduation, I worked very briefly in medical
research for the Howard Hughes Medical Institute
before
moving on to medical school at Wayne State
University in Detroit.
I stayed in Detroit
for my residency at the Henry Ford Health
System
and then moved out to Colorado in 2017
to do my fellowship in adult spine surgery
at the University of Colorado.
So since 2018, I've been on faculty at
the university.
Currently, the majority of my practice is spent
on the South Side Of Metro Denver in
the Highlands Ranch community, but I still
maintain a small portion of my practice at
the main university campus.
Right. And, yeah, an interesting
aspect of your title is reading about you
earlier, well-being co director. Can you talk more
about that? Sure.
You know, it's,
it's probably no secret to anybody that works
in health care or has friends or family
that work in health care that
burnout, especially on the heels of the COVID
pandemic a few years ago,
has run rampant throughout the system. And that's
not just isolated to orthopedic surgeons. But what
I can tell you is that,
currently
about forty percent of active orthopedic surgeons
endorse symptoms consistent with burnout and depression,
and over the course of an orthopedic surgeon's
career upwards of sixty to sixty five percent
of individuals
may suffer from symptoms of
burnout and depression.
And, in a system that's already very strained,
this can lead to,
early attrition,
which we certainly don't need because as the
baby boomers age into those years where they
demand more care,
Orthopedic care is a major part of that.
And we really just wanna make sure that
we're taking care of not just our patients,
but ourselves. Right? We we can't be
expected to care for other people if we
ourselves are not in good physical and mental
condition. So the University of Colorado, like many
large institutions,
has,
done its best to prioritize wellness, and myself
and one of my,
colleagues from the Children's Hospital of Colorado, doctor
Sarah Sibyl,
serve as the co directors for well-being for
our department.
So it's a it's an interesting role that's
kind of always evolving.
Yeah. I was about to say
and, I mean, obviously, it's burnout being so
rampant. And I know there are a lot
of different headwinds facing spine surgeons. And I'm
wondering, you know, how are you
tackling those? How are you training,
you know, your your students, your residents in
spine and orthopedics
to to face these headwinds, you know, without
completely burning themselves out?
Sure. I think that's a that's an important
question, and I don't have all the solutions
to that.
Certainly, as you look at
an older generation
of surgeons and physicians and health care providers,
I think we can all agree that the
work life balance really was not there.
It was kind of just a mentality of
work, work,
work. I'll relax when I retire.
And then you've got a younger generation. So
I'm I'm 41,
or nearly 41.
And
kind of starting with my generation and those
a little bit younger than me,
I think they are much better suited
to help maintain that kind of work life
balance.
And people in kind of their mid career
are somewhat caught in between, but more and
more now, now you see it at the
university that,
prioritizing
that work life balance, especially in a state
like Colorado where,
outdoor activities
are available to you essentially three sixty five
days a year,
people really wanna make sure that they're they're
taking care of their own well-being
in in conjunction with caring for patients.
Got it. And I'd love to hear, you
know, what are some other big trends you're
following in health care today?
Yeah. So
we just had the North American Spine Society
meeting last weekend.
It was the forty year anniversary of the
organization.
And to my knowledge, the first time that
they had their annual meeting in Denver. So
it was kinda nice to not have to
get on a plane. I just woke up
You have a little cold. Downtown. Yeah.
But when you walk through the exhibit floor,
it's really clear to me that,
integration of kind of robotics
and artificial
intelligence
and kind of patient specific surgical plans
is where spine surgery is headed.
You know, we've seen robotics
in general surgery for quite a while now.
You know, we've all heard about the da
Vinci robot that's probably been around for fifteen
to twenty years.
Robotics and spine care is somewhat in its
infancy,
but when you start to integrate that with
preoperative
planning and using
large scale database learning and artificial intelligence algorithms
to help plan
a patient specific surgery or even custom three
d printed patient specific implants,
it really begins to change the game in
terms of what we can offer patients. And,
right now the costs
for some of those technologies
are quite high,
but
as development progresses,
like anything else, we expect those costs to
come down,
and hopefully, that translates to better value and
better outcomes for patients.
Definitely. And when you when you think about
cost, what do you think it will take,
from these companies without, like, you know, naming
names? What do you think it'll take
for these costs come down to make these
technologies more accessible to any practice setting and
to patients?
Yeah. I think cost is at the forefront
of everything we do in health care right
now,
and and we can certainly get into some
of those issues later in our conversation. But,
I work fortunately at a at a large
academic institution.
And
when it comes to development of these new
technologies, I really look at the larger centers
as the ones that need to lead the
charge. You know, being a big academic center,
we have a robust portfolio of research projects
that are ongoing.
We have, an easier ability to get,
large scale federal and and regional grant funding.
And we need to be smart about how
we use that money, and I hope that
a portion of it is invested in advancing
these types of technologies because,
ultimately, I think that's gonna gonna benefit
not just orthopedic patients but the broader healthcare
system as a whole.
Right? If we
have technologies
that allow us to do
more or a broader spectrum of surgeries in
a more ambulatory
setting with
smaller incisions and reduced recovery,
that that's gonna change the game in terms
of orthopedic care.
Yeah. And it does it's cool that you
do have that advantage being, in the academic
center to really,
make these changes.
And then you mentioned, you know,
government funding for research, for instance. I'm wondering
how how have you been tracking these
regular shifts and changes in government policies, whether
it's with reimbursement
or,
this research funding you're talking about. How are
you tackling those?
Yeah. I think the one thing that we
can probably be certain to certain of is
that
it's constantly going to change. Right? Hit in
the American political system,
it really doesn't matter what side of the
aisle you sit on.
We can expect that every two, four, eight
years, there's gonna be a little bit of
a shift in terms of which party maintains
control, and that is gonna result in a
shift
in
various types of funding.
Mhmm.
As providers and as academic institutions, you know,
here at the University of Colorado, we have
a new dean, Doctor. John Sampson,
and he is really working hard to
set up a financial structure that provides more
stability across the entirety of the med school.
So
that if we encounter
periods of time where federal funding is reduced,
we have the reserves on hand so that
we can maintain a robust faculty
of not only providers but research staff as
well. So hopefully,
as, you know, endowments continue to grow,
as we continue to grow our cash reserves,
we're well suited to whatever weather, whatever storms
we might face,
as as political persuasions fluctuate.
That's great to hear. And then I wanna
ask you, how are you thinking about growth
in the next
twelve to twenty four months? You know, what's
really exciting you in that realm? Yeah.
You know, I
I already have a robust practice. So when
people ask me about growth, I think, well,
gosh, there's only twenty four hours in a
day. Right? Mhmm. But,
kinda hearkening the conversation
back to some of the artificial intelligence,
the the large language models
have pretty quickly found their way into health
care. So one example I like to cite
is that we now use an AI based,
passive listening system in the clinic setting.
And within mere seconds,
the conversations I have with a patient are
transcribed into a note.
And
like a lot of these systems like ChatGPT
and others, the more you use it, the
more it learns about your conversation style.
And I've been using it now for about
four or five months, and
I can leave a patient's room, walk back
to my workstation,
and by the time I get there, my
note is written. I do a quick review
and boom, the note is signed.
That has given me back
upwards of ninety minutes a day, and for
my nurse practitioner,
she's getting ninety minutes back on her day
as well. And
that can be used a variety of different
ways. You know, we talked a little bit
about wellness. Well, you can get some of
your personal or family time back, which is
fantastic. Or I see. Yeah. Or, you know,
based on our clinic schedules,
that might open up availability for two to
four patients a week and that that adds
up quickly, you know, 200 to 300 patients
a year that otherwise might have to wait
months to get in to see us
now can get in to to get their
care sooner,
and that's all on the backs of technological
advancement and artificial intelligence. So when I think
about growth,
I think more about efficiency. How can
I personally better use my time? And then
how is an entire health care system
can we better better optimize the time we
spend with patients and taking care of them?
Yeah. And I really love that how you're
describing AI as a tool. Probably, you know,
the Ambient AI probably helps you stay present
in visits, gets brings in more access for
patients. It sounds like a real win win.
Yep. Absolutely. I mean, in instead of staring
down at a piece of scratch paper or
typing notes into a computer,
I'm really focused on
what the patient is saying,
and and can develop that more personalized interaction
as opposed
to staring at a computer screen or staring
at a piece of paper.
Definitely. And, you know, obviously, AI is, you
know, one of the biggest disruptors
to health care and definitely spine surgery.
Are there any other
key disruptors that you'll be watching in the
spine space next year?
You know,
conversations about declining reimbursements are not isolated
to spine surgery. It's across the board.
A close colleague and friend of mine wrote
a paper in the journal of arthroplasty
last year that said, you know, orthopedic surgeons,
have taken a 31%
hit,
on inflation adjusted income over the last quarter
century.
And
nobody really wants to hear an orthopedic surgeon
complain,
and I'm not complaining on a personal level,
but
what this has led to in other specialties
are care deserts. So here in Colorado,
a health care system that covers the Gunnison
Valley if anybody's ever been to Gunnison, Colorado
or Crested Butte, we're talking about
some pristine areas of the state and pristine
areas of the country.
But those health care systems, because of declining
reimbursements,
have had to shut down their obstetrics and
gynecology programs,
and that's leaving countless women
and their their babies without,
a place to receive their care.
And if we're not careful,
we're gonna see those same trends trickle over
into other specialties.
We've seen it in primary care. We're seeing
it in OBGYN.
And,
I I'm concerned that
not enough red flags are popping up
amongst the individuals
and organizations
that have the ability to influence
how funding is allocated and how these decisions
are made. So I'm gonna be watching that
really closely,
especially as we learn more about the 2026
CMS fee schedule and how that might affect,
practices and and patients' ability to access care.
Definitely. It sounds like you have a real
emphasis on just, like, kind of the need
to speak out and add in for physicians
to advocate for themselves.
Yeah. I I think the onus is on
us to
try to get a seat at the table.
Right? You know,
I've I've mentioned a lot that I work
at an academic institution, but at the same
time,
I'm I'm not that big on on research.
I like the advocacy side of things.
I sit on the executive board for the
Colorado Orthopedic Society, which is
actually a really fun and rewarding role. You
know, we're
always keeping a pulse on what's going on
within,
the state of Colorado political scene, but also
at the national level. And
there have been numerous instances where I feel
like we've really made a difference,
in terms of how health care is regulated
and,
distributed within our own state's borders.
That's very well said. And doctor Wessel, was
there anything else you wanted to discuss before
we wrap this podcast?
You know, not really. I think,
hopefully, more and more people tune in and
and subscribe and listen.
And and I would love to see our
podcast reach beyond
other health care providers. Right? I think
we need to have open and honest discussions
with our patients
about what the health care climate is like,
And
and if we can bend the ear of
patients
hopefully we can bend the ear of
our politicians
to
start to move towards a more sensible
policy that
really improves,
the the value of the care that we
provide and helps us to improve outcomes for
our patients.
Yeah. It's like a real collaborative effort. Absolutely.
Absolutely. We don't need to be
pitted against one another,
one side versus the other.
You know, the the
99.9%
of health care providers I know,
they they genuinely care about the well-being of
their patients, and
they're doing their best, usually far above and
beyond what patients even realize,
to to help deliver the best care possible
and and help people return to a quality
of life that they want.
And I think a lot of patients really
understand that. And the more people who
intellectualize
with that concept,
I think the the better we are all
going to be served,
with with adapting and modifying
our current health care delivery systems.
It's very well said. Well, thank you so
much for joining us today, doctor Wessel. It's
been a pleasure speaking with you, and I
look forward to connecting again down the line.
Yeah. Thank you very much. I'm happy to
join you anytime. This was fun.