Latest / Becker’s Healthcare Podcast / Dr. Steven Cyr on Complex Spine Surgery, Independent Practice, and Innovation

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Dr. Steven Cyr on Complex Spine Surgery, Independent Practice, and Innovation · Becker’s Healthcare Podcast

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  - Join us November second through the fifth in
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  - Chicago.
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  - For the agenda and event details,
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  - visit beckershospitalreview.com
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  - and click on the events tab in the
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  - upper right.
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  - This is Scott Becker with the Becker's Healthcare
• 0:53
  - Podcast.
• 0:54
  - We're thrilled today to be joined by a
• 0:56
  - brilliant spine surgeon and physician leader,
• 1:00
  - doctor Steven Cyr. And doctor Cyr is gonna
• 1:02
  - talk about his practice,
• 1:04
  - some of the things he's most focused on,
• 1:06
  - some initiatives, and a lot more.
• 1:08
  - Doctor Cyr, can you take a moment and
• 1:10
  - introduce yourself
• 1:12
  - and tell us about you and some of
• 1:13
  - the endeavors you're focused on?
• 1:15
  - Sure. Well, my name is doctor Steven Cyr.
• 1:17
  - I am based in Houston and San Antonio.
• 1:20
  - I'm a dual board certified orthopedic spine surgeon
• 1:23
  - and also a cosmetic surgeon, one of the
• 1:25
  - first ever.
• 1:27
  - And after fourteen years being on active duty
• 1:29
  - in the military and my fellowship training in
• 1:31
  - in the Mayo at the Mayo Clinic,
• 1:33
  - I developed a practice that focuses primarily on
• 1:36
  - complex revision spine surgery, deformity, multilevel fusions,
• 1:40
  - instability,
• 1:41
  - failed surgeries,
• 1:42
  - and things like that. That's my that's my
• 1:44
  - background. And and and talk a little bit
• 1:46
  - about I don't even know where to start
• 1:47
  - because there's so much there.
• 1:49
  - Plastics
• 1:50
  - and spine surgery?
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  - Yeah. You know, I I have always had
• 1:55
  - an artistic side. You know? And as an
• 1:57
  - orthopedic surgeon, I get to explore the the
• 2:00
  - analytical side, the mechanical side of my of
• 2:03
  - my talents and my interests,
• 2:05
  - and I've really loved that. And I and
• 2:06
  - my first passion and my primary passion will
• 2:09
  - always be spine surgery.
• 2:10
  - But over the course of the twenty two
• 2:12
  - years that I've been a spine surgeon, I've
• 2:13
  - had many, many patients ask me
• 2:16
  - about, you know, just funny in in a
• 2:18
  - kind of a funny way. Hey. While you're
• 2:19
  - in there, why don't you take a little
• 2:20
  - bit of fat here, a little skin here?
• 2:22
  - And there actually is a functional benefit to
• 2:24
  - some patients who have excessive abdominal tissue, especially
• 2:28
  - people that have a panus
• 2:30
  - that has that hangs down. We have a
• 2:32
  - hard time bracing them, of course, soft tissue
• 2:34
  - breakdown. There's a lot of potential complications if
• 2:37
  - people have an an additional skin envelope
• 2:40
  - to work through. So in addition to causing
• 2:43
  - strain on the back,
• 2:44
  - it also creates a problem postoperatively with bracing.
• 2:47
  - And so I started to really think about
• 2:49
  - if that was something that I was interested
• 2:51
  - in doing because there was a time in
• 2:52
  - my residency where I considered
• 2:54
  - doing plastic surgery instead of orthopedic surgery until
• 2:57
  - I found spine.
• 2:59
  - And so I fell into spine, and I've
• 3:01
  - loved it ever since. And there was a
• 3:02
  - time in my life about, you know, about
• 3:05
  - six years ago where I thought, you know
• 3:07
  - what? If I ever wanna do anything in
• 3:08
  - the cosmetic surgery world, I'm young enough to
• 3:10
  - do another fellowship now.
• 3:12
  - So I did a two year fellowship in
• 3:14
  - cosmetic surgery with the American Academy of Cosmetic
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  - Surgeons under the president
• 3:18
  - at the time of the American Board of
• 3:20
  - Cosmetic Surgery, Wilbur Hall. And I spent two
• 3:23
  - years learning cosmetic surgery, and and I've kind
• 3:25
  - of incorporated that into my practice. It still
• 3:28
  - comprises only about 10 to 20% of what
• 3:30
  - I do because I'm in in such a
• 3:32
  - I have such a busy practice when it
• 3:34
  - comes to spine surgery, and the length of
• 3:35
  - the surgeries I do is pretty extensive. So
• 3:38
  - I only do
• 3:40
  - that one day every week or two, and
• 3:42
  - but my primary focus is still spine. But
• 3:44
  - I do everything cosmetic. I do anything and
• 3:47
  - everything except rhinoplasty. I do facial surgeries, cosmetic,
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  - breast augmentation, tummy tucks.
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  - I do what we call orthoscope. I develop
• 3:56
  - techniques based on my orthopedic knowledge of the
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  - musculoskeletal
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  - anatomy
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  - to highlight the muscles in a way that
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  - looks anatomic
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  - and to get people to have a more,
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  - you know, aesthetic physique.
• 4:08
  - Well, I'm gonna play Jeopardy for a second.
• 4:10
  - Do you know how the game Jeopardy is
• 4:12
  - played? Where somebody says something, and then you
• 4:14
  - have to answer in the form of a
• 4:16
  - question. Okay. I'm gonna try. So so I'm
• 4:18
  - I'm gonna play Jeopardy. So
• 4:20
  - I'm gonna give you five
• 4:22
  - things, and you tell me what I'm talking
• 4:25
  - about. Okay?
• 4:27
  - So so here's the deal.
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  - Played college football,
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  - was in the Air Force,
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  - Mayo Clinic,
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  - spine surgeon,
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  - plastic surgeon,
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  - valedictorian.
• 4:42
  - What is Steve Cyr? I
• 4:44
  - Yes. Yes. Who is Steve Cyr? I'll give
• 4:46
  - you credit for the answer. Who is Steve
• 4:48
  - Cyr? Yes. Yes. So that is that is
• 4:50
  - magnificent. And for those that are not, you
• 4:52
  - know, this is an audio, not video.
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  - I'm on audio because I have that face
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  - for radio. Doctor Cyr looks like your typical
• 5:01
  - Air Force football player, Mayo Clinic, has it
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  - all going on. He's on video. I wish
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  - everybody could see it. But but, doctor Cyr,
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  - let me ask you a question. That type
• 5:10
  - of energy drive motivation,
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  - where does that come from? What do you
• 5:14
  - credit for that drive and energy?
• 5:18
  - What motivates you? It it it is sort
• 5:21
  - of the next question.
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  - I think it all probably stems, obviously, from
• 5:25
  - my childhood. I had a father who was
• 5:26
  - a very motivated guy.
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  - He was a a PA and an RN,
• 5:31
  - had three master's degrees.
• 5:33
  - He was a psychologist. He had a clinical
• 5:35
  - psychology PhD and another PhD in counseling psychology.
• 5:39
  - He worked for a long time in the
• 5:40
  - air force. He was active duty for twenty
• 5:41
  - seven years, and he always
• 5:44
  - pushed us to maximize our academics.
• 5:47
  - So his focus was academics. My love was
• 5:49
  - always football and academics.
• 5:52
  - And so I wanted to make sure that
• 5:53
  - I explored both of those interests and passions.
• 5:56
  - And watching my dad work my dad worked
• 5:58
  - full time in the military, but he also
• 6:00
  - taught,
• 6:01
  - college. He was a college professor. He also
• 6:03
  - had a counseling,
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  - job on the side. He he was always
• 6:07
  - doing extra things. And then when he left
• 6:09
  - the military, he opened his own practice. And
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  - so I've always watched my dad. His work
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  - ethic was unbelievable.
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  - His focus and drive when it came to
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  - academic
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  - accomplishments was
• 6:19
  - second almost to none.
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  - And that coupled with the fact that my
• 6:23
  - mom instilled in me the idea that the
• 6:26
  - passions that you're given and the gifts you
• 6:27
  - have are really not for you. They're for
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  - other people, and that your life should be
• 6:30
  - devoted to maximizing your potential
• 6:33
  - so you can make a difference. And so
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  - I've really, really, from both my parents,
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  - learned things that I thought were really vital
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  - to pushing myself to be,
• 6:42
  - excellent in everything I could be and to
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  - and to push myself academically and athletically and
• 6:46
  - everywhere in between. And then, of course, I
• 6:48
  - am now a father of four. I have
• 6:49
  - four kids, and I want them to see
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  - that role to be a role model for
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  - them, to model
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  - that servant mentality that your your skills and
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  - your gifts are for other people.
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  - And and I have to provide for them
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  - in a way that helps them to live
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  - a comfortable life. I've been trying to educate
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  - my kids at some of the best schools
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  - in the in the world, and my oldest
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  - daughter's in law school at Vanderbilt.
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  - My second,
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  - my son, my oldest son is in Vanderbilt
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  - as well. He's going in investment banking, and
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  - I still have a 15 year old and
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  - an 11 year old at home. So, you
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  - know, I I balance life really well because
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  - when I'm not working and with my family.
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  - But I think that it all stems back
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  - from my childhood, really, watching my parents
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  - and learning from them. You have a lot
• 7:30
  - of different endeavors, and and I and I
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  - love that, the role model that had that
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  - kind of energy and instilled that in you
• 7:37
  - folks.
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  - Take a second, doctor Cyr, on
• 7:40
  - you've got a number of different endeavors.
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  - What are the couple things that you're most
• 7:45
  - focused on today?
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  - Obviously, being great spine surgeon doing fantastic work.
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  - But but what gets you up in the
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  - morning and says, this is what I'm focused
• 7:54
  - on the next six months, the next year.
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  - Here's what I'm trying to do.
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  - Well, like I said earlier, I've been a
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  - spine surgeon for twenty two years. I've been
• 8:01
  - a physician for thirty.
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  - I have learned in in the course of
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  - being academic and then being in the military
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  - and then starting my own practice, you know,
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  - from scratch with my wife. We really had
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  - no no know how and no money to
• 8:15
  - back it up. And we started it from
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  - scratch, and we built it into a really
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  - big practice. And then eventually, one day, we
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  - we combed it all back down and focused
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  - on spine.
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  - And we've learned some hard lessons. You know?
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  - We've learned that sometimes people
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  - in this world of of medicine
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  - aren't in it for the same reason as
• 8:32
  - us. And as a physician trying to be
• 8:35
  - a businessman, it's really challenging, and we've we've
• 8:38
  - been burned a lot. So
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  - I've learned that if I really wanna make
• 8:42
  - things work, I have to really focus on
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  - building my own practice and
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  - and trying to battle for my patients every
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  - day. And what we've learned in the practice
• 8:51
  - of medicine
• 8:52
  - lately is that we we feel like we
• 8:54
  - had really no control
• 8:56
  - in the in network model. And I was
• 8:57
  - in network for twenty two years, but we
• 9:00
  - finally made a transition just recently to out
• 9:03
  - of network. We've left the networks. We're we're
• 9:06
  - gonna continue to battle for our patients to
• 9:07
  - get efficient care.
• 9:09
  - And so this next six to eighteen months,
• 9:12
  - our focus is on creating a practice where
• 9:14
  - patients have access,
• 9:16
  - where we can decrease our administrative burden.
• 9:19
  - We can actually fight for their their needs
• 9:21
  - without having to be, you know, complacent about
• 9:25
  - these
• 9:26
  - arbitrary reimbursements that I think have gotten to
• 9:29
  - the point of absurdity
• 9:31
  - and has driven a lot of doctors out
• 9:33
  - of private solo practice. I'm still fighting the
• 9:35
  - battle, you know, in my own private practice,
• 9:36
  - but I think the only way I can
• 9:38
  - stay
• 9:39
  - in this world of private practice is to
• 9:41
  - do this out of network model. So that's
• 9:43
  - our push. Our focus is on that. We've
• 9:44
  - trained changed our administration recently.
• 9:47
  - So we're focusing on building the practice and
• 9:49
  - making sure that we've we still deliver amazing
• 9:51
  - care,
• 9:52
  - individual, and personalized care to patients without letting
• 9:56
  - the insurance
• 9:57
  - obstacles really affect us anymore, hopefully. So that's
• 10:00
  - that's my current push when it comes to
• 10:02
  - the practice.
• 10:03
  - And and let me ask you a question.
• 10:05
  - In terms of being in
• 10:07
  - independent practice as a spine surgeon, depending on
• 10:11
  - what community, sometimes where the hardest thing to
• 10:13
  - do
• 10:14
  - is find backup help or or recruiting additional
• 10:17
  - spine surgeons. Sometimes it's fighting with the insurance
• 10:19
  - companies. Sometimes it's reimbursement.
• 10:23
  - What and then we see some guys really
• 10:25
  - starting to take off an independent practice again,
• 10:28
  - and congratulations,
• 10:30
  - and you among those.
• 10:32
  - What are the biggest challenges today in independent
• 10:34
  - in independent practice or in practice?
• 10:37
  - Well, I think it's being available for your
• 10:39
  - patients at all times and not not giving
• 10:41
  - your life away to your practice and and
• 10:43
  - compromising your family life. Right? So I think
• 10:46
  - keeping that balance is really important. When you're
• 10:48
  - a solo practitioner,
• 10:50
  - you don't really have the leverage or the
• 10:51
  - bargaining power that the big practices have to
• 10:53
  - negotiate for better contracts. So we have always
• 10:56
  - had what I would consider really bad contracts.
• 10:59
  - And I've you know, I I was in
• 11:00
  - the military for a long time. I was
• 11:02
  - fourteen years active duty. So the monetary side
• 11:05
  - of it has never really been a push
• 11:07
  - for me, so I didn't really fight it
• 11:08
  - too hard. But you get to a point
• 11:10
  - where when you're trying to run a business,
• 11:12
  - you just can't survive anymore, and that's why
• 11:14
  - 80% of us are now employed by hospitals.
• 11:17
  - But I think the only way to stay
• 11:19
  - out of, out of that
• 11:21
  - situation and where you're the
• 11:23
  - the employee, basically, of a hospital administrator
• 11:26
  - is to do what we're doing, is to
• 11:27
  - get creative about delivering care, to rely heavily
• 11:30
  - on mid level providers, which I do. I
• 11:32
  - have three amazing physician assistants who help me
• 11:36
  - get through my patients, triage the patients, order
• 11:38
  - all of the conservative treatment,
• 11:40
  - and just practicing. I still practice like I'm
• 11:43
  - in academic medicine. I do everything
• 11:45
  - by the book based on how I was
• 11:47
  - trained,
• 11:48
  - and I feel very comfortable about the surgeries
• 11:51
  - that I do. I've been really blessed to
• 11:52
  - have great outcomes.
• 11:53
  - So I think the biggest challenges are making
• 11:56
  - sure you're available to your patients
• 11:58
  - and making sure that you never give in
• 12:00
  - to the system. I think it's real easy
• 12:02
  - just to give in and say, you know
• 12:03
  - what? I'm just gonna join a hospital.
• 12:05
  - But I just I just don't feel like
• 12:07
  - that's the best way to deliver amazing care.
• 12:11
  - Amazing. And talk about the evolution of working
• 12:14
  - with PAs over the years.
• 12:16
  - What does that look like today versus twenty
• 12:18
  - years ago, and how has that evolved?
• 12:20
  - Well, twenty years ago, I would say they
• 12:22
  - were just they were just on your hip.
• 12:23
  - Right? They would follow you everywhere you went,
• 12:25
  - almost like a medical student. They would see
• 12:27
  - the patients. They'd work them up, and they
• 12:29
  - they come present them to you.
• 12:31
  - And then you would tell them exactly what
• 12:32
  - to do. You'd go back in the room
• 12:34
  - with them, and you'd walk them through the
• 12:36
  - steps. Right? There was a lot less autonomy.
• 12:38
  - And I think that we have, as physicians
• 12:40
  - out of necessity, but also out of a
• 12:42
  - realization that mid level pro providers can really
• 12:45
  - be an asset to our practice.
• 12:47
  - We've realized that they can have a lot
• 12:48
  - more autonomy as long as we guide them
• 12:50
  - and train them properly. So I spent a
• 12:52
  - lot of time with my PAs.
• 12:54
  - I've had mid level providers from the very
• 12:56
  - beginning. You know, in the military, we rely
• 12:58
  - heavily on PAs,
• 12:59
  - not as much on nurse practitioners, at least
• 13:01
  - in orthopedics, but my dad was also a
• 13:03
  - PA. So I've always respected the profession,
• 13:06
  - and I've always respected mid level providers. And
• 13:08
  - I've always used them as an adjunct
• 13:11
  - to facilitating care, especially when it comes to
• 13:13
  - the conservative treatment because my focus is always
• 13:16
  - on conservative treatment first. I don't wanna talk
• 13:18
  - to patients about surgery until they failed everything
• 13:21
  - else. And so the mid level providers have
• 13:23
  - really helped me to see more patients more
• 13:25
  - efficiently
• 13:26
  - to make sure that they get the right
• 13:28
  - nonoperative treatment they need and that acts access
• 13:31
  - to that is a lot easier through them
• 13:33
  - because
• 13:34
  - I'm one person and I'm in the Operating
• 13:36
  - Room. I can have really well trained PAs
• 13:38
  - and mid level mid level providers seeing patients
• 13:41
  - for me, triaging them, doing follow ups. And
• 13:44
  - as long as they're well trained and and
• 13:46
  - talented,
• 13:47
  - patients get amazing care without any compromise in
• 13:49
  - their in their outcomes.
• 13:52
  - Amazing.
• 13:52
  - When you look at health care today,
• 13:55
  - supply and demand
• 13:57
  - of spine surgeons versus the population
• 14:00
  - or in other areas?
• 14:02
  - Where do you see supply versus demand today
• 14:06
  - in in health care? And I know in
• 14:08
  - some areas, far more acute than others. Where
• 14:10
  - do you see it in spine?
• 14:12
  - Well, I think there's there's a a higher
• 14:14
  - number of patients. I think we're we're seeing
• 14:16
  - more and more patients now,
• 14:18
  - and and I think the quality of of
• 14:20
  - spine surgery is not necessarily increasing to meet
• 14:23
  - that demand.
• 14:24
  - And I and I know for sure there's
• 14:26
  - gonna be a massive physician shortage just overall,
• 14:28
  - a general shortage
• 14:30
  - of physicians that I think we're all nervous
• 14:32
  - about as potential future patients, right, not just
• 14:35
  - doctors, but I think the writing is on
• 14:37
  - the wall where people are leaving medicine, talented
• 14:39
  - people's children are not going into medicine
• 14:42
  - because they see how challenging it is.
• 14:45
  - And so I think that there's there's gonna
• 14:46
  - be a shortage. There's already a little bit
• 14:48
  - there's kind of a shortage now. I have
• 14:49
  - people that reach out to me from every
• 14:51
  - state in the country.
• 14:53
  - I have people that reach out to me
• 14:54
  - from overseas, and these are people who have
• 14:55
  - already sought spot on care, who have already
• 14:57
  - had surgery many times, who have been told
• 14:59
  - there's no hope for them. There's nothing that
• 15:01
  - can be done for them. And so I
• 15:03
  - think the the number of surgeons out there
• 15:05
  - that are willing to tackle complex
• 15:08
  - conditions like revision surgeries or deformities or multilevel
• 15:13
  - fusions, I think the number of those is
• 15:14
  - getting smaller and smaller. Most of them are
• 15:17
  - isolated in the big academic centers like Mayo
• 15:20
  - and the Hopkins and the Harvards of the
• 15:22
  - world, but patients don't have access to those
• 15:25
  - big facilities. So one of the things that
• 15:26
  - I sought to do in the be very
• 15:28
  - beginning when I left the military and left
• 15:30
  - that academic world
• 15:32
  - was to try to provide that level of
• 15:33
  - care in the private community.
• 15:36
  - And and I think that that that has
• 15:38
  - made a difference, and and I think that
• 15:39
  - resonates with people that
• 15:41
  - that come to see me. I think they
• 15:42
  - see a difference in my approach. You know?
• 15:44
  - It's not one based on
• 15:46
  - numbers or speed or
• 15:48
  - volume. It's really based on delivering quality care
• 15:51
  - and doing doing something I'm proud of. And
• 15:53
  - I I think that I've been able to
• 15:55
  - deliver that pretty well, but I think that
• 15:56
  - that's becoming less and less. You know? And
• 15:58
  - and you mentioned earlier about how hard is
• 16:00
  - it to find other surgeons to help you.
• 16:02
  - And I I've looked. I I have looked,
• 16:04
  - and I'm still looking for someone that I
• 16:07
  - feel I can deliver the same quality and
• 16:08
  - the same
• 16:09
  - more than that, just compassion and care and
• 16:12
  - and talent all wrapped into one. You know?
• 16:14
  - And it's hard to find that, but I'm
• 16:16
  - looking. So hope if if you're out there,
• 16:17
  - let me know. So I'm looking No. It's
• 16:19
  - fantastic. Because I I know of a physician,
• 16:21
  - for example, in Arizona. And, essentially, at some
• 16:24
  - point, he had to go to the hospital
• 16:25
  - because he just couldn't find additional partners or
• 16:28
  - colleagues
• 16:29
  - in his practice where he was and at
• 16:31
  - some point just became impossible
• 16:33
  - to deal with call and deal with other
• 16:35
  - problems and deal with just a chance to
• 16:37
  - take a break because just couldn't, you know,
• 16:39
  - couldn't couldn't do it. So no.
• 16:42
  - Fascinating.
• 16:43
  - I'm I'm gonna ask you about football. And
• 16:45
  - and where are you at on having I
• 16:48
  - don't know if you have sons or daughters
• 16:50
  - or you have children.
• 16:51
  - You're in Texas. The the you know, Texas,
• 16:54
  - Ohio, a few other places, the heart of
• 16:56
  - football in America.
• 16:57
  - Where is your thought on the kids playing
• 16:59
  - high school football, playing Pop Warner football, playing
• 17:02
  - college football
• 17:04
  - versus longevity and injuries? What's your any take
• 17:07
  - on that?
• 17:08
  - Oh, my gosh. I mean, I loved there's
• 17:10
  - nothing that anyone could have said to me,
• 17:12
  - including my parents, because trust me, they tried,
• 17:15
  - that would have stopped me from playing football.
• 17:17
  - Nothing.
• 17:18
  - The only thing that would have stopped me
• 17:19
  - is an injury or not getting to the
• 17:22
  - next level. That's the only thing. And when
• 17:23
  - you love something like that and you have
• 17:25
  - that passion for it,
• 17:27
  - you have to explore it. You have to.
• 17:28
  - And as a parent, you know, I have
• 17:30
  - I have kids that are athletic,
• 17:33
  - but academic. And my my thought is if
• 17:36
  - you love it and that's your skill and
• 17:38
  - that's your god given gift, you have to
• 17:39
  - do it. You have to pursue it.
• 17:41
  - But you have to also be realistic about
• 17:43
  - it. And then as a parent, I warned
• 17:44
  - all my kids about football. You know, my
• 17:46
  - my I have two boys, and I I
• 17:47
  - warned both of them about the potential
• 17:49
  - downsides to football, the the repetitive injuries,
• 17:52
  - the long term problems, you know, that I
• 17:54
  - have multiple discs that are not in health
• 17:57
  - not in good shape. I have three herniated
• 17:59
  - discs in my neck and in my lower
• 18:00
  - back. I've had four ACL reconstructions,
• 18:03
  - all from football. And, you know,
• 18:06
  - I'm paying a little bit of the price
• 18:07
  - for that, but I had surgery, and I'm
• 18:09
  - doing relatively well. I had it four times,
• 18:10
  - unfortunately. But
• 18:12
  - I I warned my kids about football. I
• 18:13
  - tried to steer them honestly away from football.
• 18:15
  - I had my oldest son playing basketball.
• 18:18
  - My youngest son is just built for football,
• 18:20
  - so he had to play, but he lost
• 18:22
  - his interest in it. But I'm not totally
• 18:25
  - opposed to it, but you have to be
• 18:27
  - aware that
• 18:28
  - long term
• 18:29
  - injuries can occur. And, you know, especially with
• 18:32
  - CTE, now people are more aware of that.
• 18:34
  - I think that that's a problem you have
• 18:37
  - to be aware of. Hopefully, they improve. I
• 18:39
  - was at one point, I was looking at
• 18:40
  - trying to improve the neck support for football
• 18:43
  - players because there's really no neck support.
• 18:45
  - And, you know, the you look at race
• 18:47
  - car drivers, they have these amazing neck braces
• 18:49
  - that protect them from an accident,
• 18:51
  - from becoming injured,
• 18:53
  - And we don't have anything like that in
• 18:54
  - football that allows motion so you can still
• 18:56
  - play. So that's something that I think needs
• 18:58
  - to be developed. I think the head injury
• 19:00
  - risk needs to be, you know, continued to
• 19:02
  - look at, and they need to continue to
• 19:03
  - improve the the the mechanics of the helmets.
• 19:06
  - But, yeah, you can't really protect from the
• 19:08
  - injuries
• 19:09
  - completely. And we're seeing more and more ligamentous
• 19:12
  - injuries from the turf, and it's become
• 19:14
  - almost every
• 19:16
  - stadium is now turf.
• 19:17
  - So I I don't know that there's a
• 19:19
  - way around it, but it's it's one of
• 19:20
  - those things where if you have a love
• 19:21
  - for something, it's really hard to talk somebody
• 19:24
  - out of it. And and so many
• 19:26
  - people are entertained by watching it and entertained
• 19:28
  - by playing. So I'm it's it's hard for
• 19:30
  - me. It's I'm I'm kinda torn. As a
• 19:31
  - parent, I'm not really a fan, but as
• 19:33
  - a as as a player, of course, I
• 19:35
  - loved it. Alright. You're in San Antonio. Correct?
• 19:38
  - You're in San Antonio? I'm in Houston now.
• 19:39
  - I'm in Houston. That's right. That's right. That's
• 19:41
  - right. Okay. Houston primarily. Yeah. Okay. Got it.
• 19:43
  - Got it. Got it. Okay. Do you have
• 19:46
  - a favorite football player of all time? Who's
• 19:48
  - in your top list? Is football your favorite
• 19:50
  - sport? And I guess, do you have a
• 19:52
  - favorite? Well, by far, my favorite sport, of
• 19:54
  - course, is football because I was a player
• 19:56
  - in college. But my favorite of all I
• 19:58
  - was a running back, by the way. So
• 19:59
  - my favorite player of all time is Barry
• 20:02
  - Sanders, and I think he was unbelievable.
• 20:05
  - And so Barry is a fantastic example for
• 20:07
  - the discussion we're having.
• 20:09
  - Barry, you know, a lot of people are
• 20:11
  - not as familiar with Barry Sanders, particularly the
• 20:13
  - younger generation,
• 20:14
  - but nine years in NFL,
• 20:16
  - left before he was beat up too bad.
• 20:19
  - I think never regrets having left,
• 20:22
  - but so few guys have the ability to
• 20:24
  - make that choice or choose to make that
• 20:27
  - choice.
• 20:27
  - And and Barry Sanders with Earl Campbell, Walter
• 20:30
  - Payton, a handful of others, you know, some
• 20:33
  - of the great running backs of all time.
• 20:35
  - And Barry Sanders is right up there towards
• 20:36
  - the top.
• 20:37
  - How much respect do you have for Barry
• 20:39
  - Sanders for making that choice less than ten
• 20:41
  - years in, but still in his prime
• 20:43
  - and choosing didn't want to live in his
• 20:46
  - seventies that beat up?
• 20:48
  - Yeah. I think that was a real smart
• 20:49
  - decision on his part. Nobody understood the financial
• 20:52
  - and all of his fan you know, but
• 20:53
  - reason behind it, but all of his fan
• 20:55
  - base was really upset, obviously,
• 20:57
  - because he was so dynamic to watch. But
• 21:00
  - there's no way he could've lasted, you know,
• 21:02
  - much longer. You know, he was gonna develop
• 21:04
  - some type of overuse injury at the very
• 21:06
  - minimum, if not an ACL or an Achilles
• 21:09
  - tear or something. But, yeah, I mean, gosh,
• 21:10
  - I loved watching him run. I didn't run
• 21:12
  - quite like him. Nobody really did, but I
• 21:15
  - loved watching him him play. But I think
• 21:17
  - it was a smart decision. You know? I
• 21:19
  - I think a lot of guys don't have
• 21:20
  - the luxury of walking away. You know, most
• 21:22
  - guys last a couple years, and their time
• 21:25
  - is up. They've been replaced by someone new.
• 21:27
  - But
• 21:28
  - they're they're And we think of you more
• 21:29
  - as, like, the Craig James,
• 21:32
  - Roger Craig
• 21:34
  - with Daneland Tomlinson running back versus Barry Sanders.
• 21:37
  - What was the yeah. Roger Craig was the
• 21:40
  - guy that I modeled my running after. I
• 21:41
  - love the way he ran. Yeah. Roger Craig.
• 21:43
  - I ran just like Roger Craig.
• 21:46
  - Love it. Love it. So I I guess,
• 21:49
  - to to take you back there, the the
• 21:51
  - the thing you're most focused on the next
• 21:53
  - year is building the practice out.
• 21:55
  - What else do you watch in health care
• 21:58
  - that you find particularly interesting that you keep
• 22:00
  - your eyes on? Well, I'm watching all of
• 22:02
  - the new technologies. You know, of course, AI,
• 22:04
  - I think it's it's pretty basic.
• 22:05
  - AI is gonna be something that I help
• 22:07
  - I think helps expedite
• 22:09
  - getting answers,
• 22:11
  - appropriate answers, getting research, you know, kind of
• 22:14
  - information more quickly.
• 22:16
  - I think the things that are that are
• 22:18
  - being looked at for spinal cord injury, of
• 22:20
  - course, will always be at the top of
• 22:22
  - everybody's, you know, interest list.
• 22:24
  - For me, there's a lot of promising things
• 22:26
  - happening in Brazil and Japan and China.
• 22:29
  - I think stem cells are gonna probably continue
• 22:32
  - to grow an interest in potential
• 22:35
  - in reversing those things. There's hydrogels.
• 22:37
  - There's a lot of stuff that I think
• 22:39
  - is cool, injections of of materials into the
• 22:41
  - disc to regenerate the disc again.
• 22:43
  - We've been trying that with growth factors. I
• 22:46
  - think there's gonna be better stuff on the
• 22:47
  - horizon for that. I think those things are
• 22:50
  - really promising. People are always pushing the idea
• 22:52
  - of robotic surgery and minimally invasive. But the
• 22:56
  - truth is, you know, after twenty two years
• 22:59
  - of being a spine surgeon and and doing
• 23:01
  - complex revision surgeries,
• 23:03
  - I really I'm still a huge fan of
• 23:06
  - doing an open surgery. I think that the
• 23:08
  - amount of bone graft you're allowed to put
• 23:10
  - place when you're doing those surgeries,
• 23:12
  - the thoroughness of your of your surgeries,
• 23:14
  - and the ability to expose the bone
• 23:18
  - appropriately, decompress the nerves appropriately. I think that
• 23:21
  - there's still a focus has to be made
• 23:23
  - on getting the bone to heal first in
• 23:25
  - a fusion
• 23:26
  - instead of protecting the muscle first. I and
• 23:28
  - I think there's kind of a backwards philosophy,
• 23:30
  - unfortunately,
• 23:32
  - when it comes to muscle preservation instead of
• 23:34
  - bony healing
• 23:35
  - as a priority.
• 23:37
  - So I'm I I I believe you know,
• 23:39
  - as far as technology goes, I'm a navigation
• 23:40
  - guy. I like the stereotactic navigation tools,
• 23:43
  - but I'm still primarily an open surgeon. So
• 23:45
  - I'm watching the things. I don't jump on
• 23:47
  - the bandwagon with the new technologies a lot
• 23:49
  - of times. I wanna see them prove themselves
• 23:51
  - a little bit. So I'm still watching all
• 23:52
  - that stuff.
• 23:54
  - Thank you.
• 23:55
  - One more question, and you could choose to
• 23:57
  - answer this, not answer this.
• 23:59
  - Any particular
• 24:01
  - other spine surgeons,
• 24:02
  - mentors that you admire, that you look up
• 24:05
  - to, that you do that you refer with,
• 24:08
  - that you particularly think of as, you know,
• 24:10
  - hey. This is someone I really respect greatly.
• 24:15
  - And you can't talk about anybody you think
• 24:16
  - is horrible because we don't wanna get sued.
• 24:18
  - Oh, I would never If you do have
• 24:19
  - mentors, you know, I I would never do
• 24:21
  - that. You know what? We have a terrible
• 24:23
  - we have a terrible track record in in,
• 24:26
  - medicine recently of bashing each other. I would
• 24:29
  - never do that. But And I say that
• 24:30
  - joke, and I say that joke. Yeah. Literally.
• 24:32
  - But but but the point being, are there
• 24:35
  - a couple people that you tremendously respect or
• 24:37
  - that have been great mentors to you that
• 24:38
  - you'd like to shout out to? Yeah. I've
• 24:40
  - had I have a three really amazing mentors
• 24:43
  - who trained me when I was at the
• 24:44
  - Mayo Clinic, and everything I am as a
• 24:46
  - spine surgeon began with that training with those
• 24:48
  - three.
• 24:49
  - And the youngest of of those guys is
• 24:51
  - a guy named Paul Huddleston. He's at the
• 24:53
  - Mayo Clinic now. He's still there. He's a
• 24:55
  - professor of spine surgery there.
• 24:58
  - Brad Currier
• 24:59
  - was the head of the spine fellowship,
• 25:01
  - which I was a fellow at. And then
• 25:03
  - Mike Yaczynski, who actually was my lifelong mentor
• 25:06
  - starting from medical school through the air force
• 25:08
  - into the Mayo Clinic fellowship,
• 25:11
  - my life just sorta ended up following his
• 25:13
  - his pathway through medicine and spine. And I,
• 25:17
  - man, I I I owe the world to
• 25:18
  - those guys because they train me in a
• 25:20
  - way that I think I couldn't have been
• 25:22
  - trained anywhere else.
• 25:24
  - And it helped me to make a difference
• 25:26
  - in the world in a way that that
• 25:28
  - will be hopefully lifelong and everlasting. So those
• 25:31
  - three,
• 25:32
  - contemporary spine surgeons that are not in the
• 25:34
  - academic world at the Mayo Clinic.
• 25:37
  - There's a guy named Chol Kim who was
• 25:38
  - the fellow when I was a a resident
• 25:42
  - interviewing for my fellowship, Chol Kim,
• 25:44
  - and he is in San Diego doing private
• 25:47
  - practice. He's primarily a minimally invasive spine surgeon.
• 25:50
  - But if I ever needed to send someone
• 25:52
  - to a surgeon in California, it would be
• 25:54
  - Joel Kim. I really respect him. He's even
• 25:57
  - though his focus is minimally invasive,
• 25:59
  - he does great work. He's a brilliant guy.
• 26:01
  - He's conscientious.
• 26:03
  - And so he is one of my contemporaries
• 26:05
  - that I really, really look up to and
• 26:06
  - respect
• 26:07
  - as a surgeon. He's And and doctor Kim,
• 26:09
  - I just saw at a I think I
• 26:10
  - just saw him at a spine surgery meeting
• 26:12
  - in Cabo
• 26:13
  - and and a really, really exceptional leader and
• 26:16
  - physician. I haven't talked to him over the
• 26:17
  - years. But but what a great group. Yeah.
• 26:19
  - And then the other one is Archie Perry.
• 26:21
  - Archie Perry is a is a good friend
• 26:23
  - of mine who trained at Twin Cities,
• 26:25
  - and he was at Mayo for his residency.
• 26:27
  - So we met each other on the interview
• 26:29
  - trail. But Archie Perry is in in, Nevada,
• 26:32
  - and he does amazing work too. He's a
• 26:34
  - he's a contemporary and a friend of mine.
• 26:36
  - And so if I ever have have anybody
• 26:38
  - in that part of the world, I always
• 26:39
  - refer to those two guys. I think they're
• 26:40
  - tremendous people and tremendous surgeons as well.
• 26:44
  - Doctor Sheer, what a pleasure to visit with
• 26:46
  - you. Anytime you'd like to be back on
• 26:48
  - to talk about what you're doing and developments
• 26:50
  - you're seeing, we'd love to hear them. You're
• 26:52
  - you're literally the Roger Craig of spine surgery.
• 26:56
  - Thank you for joining us today on the
• 26:57
  - Becker Southgate podcast. I really enjoyed it. Thank
• 26:59
  - you so much. Very much. I appreciate it.