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This is Carly Beam with the Becker Spine

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and Orthopedics podcast, and I'm thrilled to be

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joined today by doctor Sophie Zhou, a neurosurgeon

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at University Hospitals.

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Doctor Zhou, welcome back to the podcast, and

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thank you for being here today.

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Yeah. Of course. Thank you so much for

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having me.

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So before we, get started, can you just

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introduce yourself and share a bit about your

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background?

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Yeah. So I am,

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an assistant professor of spine surgery and neurosurgery

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at University Hospitals in Cleveland.

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I am the associate program director as well.

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So part of my role is to

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help guide new residents and new medical students,

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into the field of neurosurgery.

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It's one of the best parts of my

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job is to, you know, bring in the

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the new people, the new fresh blood into

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our field. It's,

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it's very, very rewarding.

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I bet. And, you know, we're recording this

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in December heading to 2026. And I'm wondering

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what are the most important shifts in spine

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neurosurgery

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education that we need to see?

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I think one of the things that really,

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we all focus on is surgery itself. Right?

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And I think when you go through neurosurgery,

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it's seven years of training. You do thousands

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of cases,

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and

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you come

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out very experienced

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in surgery.

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And you come out very

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nuanced in your,

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in your decision making. And I think that's

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across the field in all of the different

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programs that I've seen

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throughout The US. But I think one of

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the things that we don't have a focus

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on is

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how does that translate

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in the current

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medical

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world. Right? I think we see neurosurgery

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and surgery and any kind of medical practice

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as medicine itself, but it doesn't exist

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alone.

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It exists

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in our

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medical system. So I think there should be

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a broader

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teaching

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of how does that translate with insurance? How

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does that translate in private practice?

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How does that translate in academic medicine? What

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is an RVU?

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I think those are the things that we

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don't focus on as much because, you know,

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at the end of the day, our greatest

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focus is our patients, and that should always

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remain true.

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But I think to be a better

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physician, we should understand where our patients are

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coming from, the financial background.

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What does it mean to take care of

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our patients, not just in their disease process,

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but what does it mean to take care

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of them to

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get them access to care? I think that's

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a really important part

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of medicine nowadays

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that we really should refocus on.

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Definitely. And, I mean, I imagine for

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surgeon surgeons and patients are both navigating very

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different kind of elements of the health care

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system that still may be just equally as

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shifting,

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potential confusion,

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etcetera.

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I'd love if you could, dive a bit

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deeper into what you've been telling

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your own fellows and residents. How are you

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what are you doing in your own work

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to equip them with this,

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full

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spectrum?

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Yeah. So we really encourage our residents

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and our fellows to go out to courses.

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Because I think when you go to these

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national courses,

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there there are always coding courses, and you

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can learn more about, you know, what is

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a code, what does it mean. I think

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there's also,

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courses about health care, and, you know, neurosurgery

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also has advocacy

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programs

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that are involved in different aspects of health

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care.

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You know, we're involved in the Washington Committee

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and things like that. So

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I think,

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really, just looking beyond

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the pure medicine

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and allowing your residents to have that kind

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of focus

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is

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is critical. Because I think

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there's such a lack of focus on it

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in our training

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that just by telling them this is an

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aspect that you should focus on

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is great. For example, when we went to

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the Becker's meeting

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last year in June, there was a real

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drive towards understanding how does insurance work, how

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does,

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access to medicine work, and how do we

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provide care at a sustainable, cost effective way.

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And I think that kind of dialogue

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between not just academic medicine, which really focuses

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on, you know, patient outcomes,

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but with private practice as well,

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which, you know, has this other aspect, other

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dimension of medicine. I think this kind of

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dialogue is really what drives our understanding

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of

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medical care in The United States.

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Definitely. And, hey, thank you for, the kind

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words about our conferences.

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You know, with spine surgery, there's always, you

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know, a lot of new innovations coming out.

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And I'm wondering how are you balancing between

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teaching innovations,

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but also, you know, restraining unnecessary

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interventions?

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Yeah. I think that's, like, such a great

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question. Right? Because you we're always

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at the cusp of the next new thing,

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and you always think that the new thing

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you're trying

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well, you at least you hope the new

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thing you're trying is going to be the

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next biggest and greatest.

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And I think one of the things that

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you have to really

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understand

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when you try a new thing

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is that you have to look at it

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as,

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does it effectively

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change my management of my patients? Does it

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provide

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good quality care?

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And

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it's not just, oh, I have this new

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cool

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thing.

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But really looking at it,

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with some amount of focus on,

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is it beneficial to my patient for the

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cost? And is it beneficial to my patient

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for the effort? Because sometimes

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you can do something, but it may be

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slower. It may cost more. And

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does that time and money cost really,

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really benefit the patient?

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And I think one of the things that

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academic medicine

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does a really good job on

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to try to create that balance

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is that

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we do research projects. Right? We look at

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outcomes.

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And I think really focusing on the outcomes

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being driven by the data

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is how you

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discern what is good and what is just

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flashy.

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Mhmm.

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Yeah. It's a great way to think about

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it. And, you know, obviously, AI, it's just

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it's everywhere in health care. There's always,

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people are always exploring new

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applications,

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new, new tools.

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How should spine surgeons and neurosurgeons be taught

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to evaluate these,

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applications so they don't over rely on, like,

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black box decision support?

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Yeah. I think the good thing about

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our generation

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of,

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surgeons is that we're kinda growing up with

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AI. Right? It's not like AI was something,

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that

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kind of occurred

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twenty, thirty years ago. It's something that we're

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integrating actively now into our practice.

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So

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as a practicing surgeon,

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you are kind of looking at at AI

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as it integrates into practices every day. And

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one of the best examples right now is

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how we use AI in dictations.

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It kind of

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increases our speed

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in

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writing documentation,

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but it doesn't necessarily

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change our decision making. It takes away some

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of the busy work as of right now.

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It helps with scheduling. It helps with some

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aspects of medicine

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that are tedious

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but are very,

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rote. There's also

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AI

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applications in imaging. Right? It helps refine

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some of the reads, but

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would I trust my

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radiology partners over an AI read? 100%.

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Because

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there are just nuances

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of

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patients that

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experience

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teaches you. And that's the part

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about AI that

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will get better. Right? It's about training these

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programs.

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They also rely on experience,

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and I just don't think we're quite there

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yet.

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But the greatest thing about

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being a part of, you know,

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growth in medicine

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is that you start from the beginning. So

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if you're one of those people who waits

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until everything is already said and done, then

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you're behind. But if you integrate as it

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becomes,

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available,

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then you're part of the learning process. And

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I think that's how you avoid the pitfalls

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because you are able to look at it

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from a perspective of

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it's learning with me.

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Yeah. And it's kind of like that approach

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of curiosity and what can this do well,

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where can we refine things.

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Yeah. That curiosity, that's that's such a good

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way of putting it. Because I think if

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you

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just trust it blindly because you're so far

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behind,

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and you're like, well, it must be good,

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well, then you don't realize the pitfalls. But

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subs you know, on the other hand, if

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you're just like, I don't trust it. Nothing

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about it is good, then you're gonna fall

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out of favor. Right? Because the things that

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are good about,

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AI, you're gonna miss. So I think just

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having that balance and knowing that it's a

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tool and it's a tool that you can

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help

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make better,

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I think that is what creates that balance.

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Got it. And I want to pivot a

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little bit. I was wondering, what part of

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surgeon well-being do you think is missing from

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today's education right now?

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Oh my gosh. I think that's such a

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good topic. Right? Because we're all humans at

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the end of the day. And I think

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that is the part we forget. There's so

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much machine learning. There's AI. There's all these

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things that,

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you know,

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are designed to make our practice better, to

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make our patients better, but we forget that

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we're human too at the end of the

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day. And so we talk a lot with

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our residents about,

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you know, you have to focus

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on

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your own well-being.

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And sometimes,

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you know,

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it's just taking a five minute breather

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after a hard case or a hard outcome

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and real realizing and recognizing

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your own humanity.

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And sometimes it's more than that. Right? Five

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minutes may not be enough, but,

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I think

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eating right,

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exercising,

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having

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a friend circle,

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not making

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this job your entire life,

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and

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having outside interests

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are all critical

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towards being a really good doctor.

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Because when I have doctors that I really

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respect that take care of me,

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what I really love about them

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is

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that they're human, and they connect to me

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on an emotional level. Right? And I don't

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think they can do that if they were

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burned out and

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tired and can't even focus on themselves.

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The best doctors I've ever seen have always

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been able to talk to me

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like I'm their friend. They ask me how

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I'm doing,

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how,

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how things are going in my life. And

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that's what I try to emulate

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in my practice.

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I always wanna know personal details about my

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patients because I think it also

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helps me focus

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on

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not just the medicine, but how their back

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pain or how their

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leg pain, how does it

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it how does it translate in their life?

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Because they're not just a spine that I

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need to operate on. They're

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a person who I can help.

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And I think

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if we look at ourselves that way and

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treat ourselves as humans,

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then

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as we train and as we get better

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and as we,

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you know, evolve in our physician practices,

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we're gonna be that much better.

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I like that the way you're framing that

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too. It's like the surgeon

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takes care of themselves, then that

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translates to just

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the positive interactions with the patients, etcetera.

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Yeah. I

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00:13:11,075 --> 00:13:12,914
mean, how many times have you ever had

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a doctor

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where you're like, wow. That guy is a

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00:13:15,714 --> 00:13:17,495
machine, and you think

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he's probably technically really good,

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but

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is he gonna take care of me in

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a moment of

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hardship?

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Like, is he someone I can trust and

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00:13:27,590 --> 00:13:29,289
talk to? I think

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when you

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really reflect on

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the physicians that

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kind

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00:13:36,389 --> 00:13:37,610
of have been great,

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their technical skills

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have to be good,

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but it's their humanity that kind of

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triggers that emotional response. Right? Because when I

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want to take care of someone or when

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I want someone to take care of me,

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I don't want a machine.

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00:13:53,375 --> 00:13:55,235
I want a doctor who understands

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there are nuances to my life. And so,

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I think by embracing the nuances in your

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own life

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through training,

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afterwards, throughout your entire career, and after,

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I think that if you can focus on

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those aspects of your life, you will come

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00:14:11,735 --> 00:14:13,595
out that much better of a doctor.

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00:14:14,294 --> 00:14:17,414
Very well said. And, doctor Jo, last question

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00:14:17,414 --> 00:14:19,654
I have for you. What are the three

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00:14:19,654 --> 00:14:21,654
top trends that you're following in health care

390
00:14:21,654 --> 00:14:24,235
today? You can think broadly, spine specific.

391
00:14:26,129 --> 00:14:28,050
Yeah. I think the things that we really

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00:14:28,050 --> 00:14:29,350
face are

393
00:14:29,970 --> 00:14:31,830
the changes in insurance.

394
00:14:32,370 --> 00:14:34,309
Right? There's just been so many,

395
00:14:36,129 --> 00:14:37,910
issues with insurance companies

396
00:14:38,644 --> 00:14:40,904
with the way that, spine coding

397
00:14:41,285 --> 00:14:41,785
is,

398
00:14:43,045 --> 00:14:45,125
going forward, whether or not we're gonna have

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00:14:45,125 --> 00:14:46,024
bundled care.

400
00:14:46,965 --> 00:14:49,625
And then I think those aspects of medicine,

401
00:14:49,764 --> 00:14:52,264
the financial aspects of medicine are a huge

402
00:14:52,850 --> 00:14:55,350
component of how our patients receive care.

403
00:14:55,889 --> 00:14:57,509
I think medical training

404
00:14:58,049 --> 00:15:01,490
is also a huge trend or not trend,

405
00:15:01,490 --> 00:15:03,350
but medical training and

406
00:15:03,730 --> 00:15:04,789
access to training,

407
00:15:05,250 --> 00:15:06,129
whether or not,

408
00:15:06,615 --> 00:15:07,514
you know, medical students

409
00:15:08,375 --> 00:15:09,274
can afford

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00:15:09,735 --> 00:15:10,394
to train,

411
00:15:10,855 --> 00:15:11,355
and

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00:15:11,815 --> 00:15:13,514
whether or not they pick

413
00:15:14,455 --> 00:15:16,554
specialties based on income

414
00:15:17,575 --> 00:15:19,950
that is going to be huge as in

415
00:15:19,950 --> 00:15:22,850
medicine in general, probably less so in subspecialties

416
00:15:23,470 --> 00:15:25,090
like spine and neurosurgery,

417
00:15:25,470 --> 00:15:27,389
but I think that is a huge player

418
00:15:27,389 --> 00:15:27,889
in

419
00:15:29,550 --> 00:15:31,330
medical education going forward.

420
00:15:31,790 --> 00:15:33,009
And I think that

421
00:15:33,985 --> 00:15:35,044
the biggest trend

422
00:15:35,504 --> 00:15:36,404
in spine

423
00:15:36,785 --> 00:15:38,245
is our embrace of,

424
00:15:38,785 --> 00:15:40,004
you know, technology.

425
00:15:40,465 --> 00:15:42,644
I think there are just so many different

426
00:15:42,785 --> 00:15:43,285
inventions

427
00:15:43,825 --> 00:15:44,565
coming forward

428
00:15:45,424 --> 00:15:47,184
that we just need to be critical in

429
00:15:47,184 --> 00:15:49,199
the way that we assess them. I think

430
00:15:49,199 --> 00:15:50,419
we assess things

431
00:15:51,600 --> 00:15:52,500
with research,

432
00:15:53,199 --> 00:15:53,699
with

433
00:15:54,000 --> 00:15:58,339
outcome studies. And now that large population databases

434
00:15:58,879 --> 00:16:00,339
are so readily available,

435
00:16:00,799 --> 00:16:02,579
I think we just need to be

436
00:16:02,985 --> 00:16:03,804
really keen

437
00:16:04,264 --> 00:16:05,245
on how we

438
00:16:05,865 --> 00:16:08,205
integrate those things into our practice.

439
00:16:08,745 --> 00:16:10,365
I think that we should embrace

440
00:16:11,384 --> 00:16:14,264
change, but we shouldn't just rush into things

441
00:16:14,264 --> 00:16:16,365
like we've always talked about.

442
00:16:17,370 --> 00:16:19,529
Great. Well, doctor Jo, thank you so much

443
00:16:19,529 --> 00:16:21,370
for joining us today. It's been a pleasure

444
00:16:21,370 --> 00:16:23,049
to catch up, and I hope you have

445
00:16:23,049 --> 00:16:23,950
a happy holiday.

446
00:16:24,330 --> 00:16:26,009
You too. Thank you so much for having

447
00:16:26,009 --> 00:16:26,509
me.