Latest / Becker’s Healthcare Podcast / Aqib Zehri, MD, Neurosurgeon at The Oregon Clinic

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Aqib Zehri, MD, Neurosurgeon at The Oregon Clinic · Becker’s Healthcare Podcast

0:00
Hi, everyone, and welcome to the Becker's Spine
0:03
and Orthopedic podcast.
0:05
I'm Sophie Ades, a writer with Becker's Healthcare.
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And today, I'm joined by doctor Aqib Zeri,
0:12
a neurosurgeon at the Oregon Clinic who specializes
0:16
in spine care, including complex cases like spinal
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deformity surgery.
0:21
Doctor Zairey is known for his patient centered
0:24
approach with a strong focus on personalized treatment
0:26
plans
0:27
and thoughtful decision making around
0:29
when surgery is truly necessary to achieve the
0:32
best outcomes.
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In this episode, we'll explore how that philosophy
0:37
shapes decision making in spine care today, particularly
0:40
when it comes to quality, safety,
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and cost.
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So, doctor Zaire, so so glad to have
0:47
you.
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To start, I guess, can you just share
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a little bit about your current practice and
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what you're most focused on building or improving
0:56
right now?
0:59
Yeah. Thanks for having me. I appreciate the
1:00
opportunity, Sophie.
1:02
Like you mentioned, I'm Akib Zaire. I'm a
1:04
spine focused neurosurgeon with the Oregon Clinic in,
1:07
Portland, Oregon. I did my residency at Wake
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Forest University, and I completed my spine fellowship
1:13
at the Baronylological
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Institute.
1:15
So my practice covers the full spectrum of
1:17
spine care from minimally invasive spine and endoscopic
1:20
techniques to complex deformity,
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spinal oncology and revision surgery. I use robotic
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guided surgery when appropriate,
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and I've particularly been focused on,
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doing higher acute cases
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and building a program,
1:37
that functions at a tertiary, primary level level
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of care.
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And so most of my surgeries are done
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at Providence Inconset Hospital.
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And so that's where I'm building this program.
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So
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beyond the surgical stuff itself, I'm interested in
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how to structure and grow a spine service
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line service line that runs efficiently and also
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supports
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my level of care.
2:00
Amazing.
2:02
I guess just to get into that a
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little more,
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what I wanted to ask is just how
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are you thinking about access and referral patterns
2:11
today,
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especially as more complex spine cases are being
2:15
funneled
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to specialists like yourself?
2:20
Yeah. So
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so part of that has to do with
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access to to a neurosurgeon
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and to a spine surgeon.
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So that involves
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having
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a good triage system,
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that identifies patients who need urgent
2:37
spine care
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and getting them to see neurosurgeons
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or spine surgeons in a timely fashion.
2:45
So during my clinic days, I have templated
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urgent spine visits,
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so that patients who
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are referred to us who have
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serious neurological conditions such as, we're gonna say,
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weakness, numbness,
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bowel, bladder incontinence,
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they can be seen in an urgent fashion.
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And, and we can also triage patients who
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may need to be seen in an acute
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care setting as well.
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So I think that
3:12
first having access to
3:14
spine care is the most important,
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point that I wanna make about, improving,
3:20
spine care overall. Mhmm. Yeah. Absolutely.
3:24
And as I kinda mentioned too at the
3:27
beginning, I know that you emphasized exhausting nonsurgical
3:30
options,
3:31
before operating.
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Can you explain a little bit how that
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philosophy
3:36
shapes your approach to quality and cost in
3:40
spine care, especially
3:42
in an environment where procedural volume often drives
3:45
revenue?
3:48
Yes. So
3:50
with our triage
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system that we've developed
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with our practice,
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patients,
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are asked a series of questions by an
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AI agent Mhmm. That goes through
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various non operative treatments that they may or
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may have not done.
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That includes physical therapy, chiropractic care,
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pain injections.
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They passed them specifically,
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have they completed their treatment plan? Have they
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received any benefit?
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Regarding injections, we document through our AI agent,
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how many numbers of injection they got, whether
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they got improvement.
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And so we can easily screen patients who
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have done nonoperative treatments,
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and,
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then they can be adequately triaged to see
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us in clinic,
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or they can be referred back to their
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primary care doctor
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to,
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to to do the nonoperative treatments, like physical
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therapy, chiropractic care injections.
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We also,
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identify their BMI.
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We identify their smoking status.
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So those are additional,
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optimization that should be done by the referring
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provider,
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to help with weight loss,
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to help with smoking cessation,
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so that when they come to our clinic,
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to see a neurosurgeon,
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they're already optimized.
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And so that our time is spent dealing
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with patients who need our care the most,
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and it also holds the referring provider accountable,
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so that they are doing their part as
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well,
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in ensuring that, these patients'
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overall health, is looked at and supported.
5:28
Mhmm.
5:29
Yeah.
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That was a great explanation of that, and
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I think it's so important, especially
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as we're sort of seeing the shift,
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from fee, you know, fee for service to
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value based care.
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I think that, you know, approaches like yours
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are definitely gonna be sort of the future
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of, you know, what what is happening in
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in spine care. I guess if you wanted
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to talk, you know, too a little bit
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more about,
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you know, value based care or anything like
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that, I would love to sort of hear
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your perspective on that and just how you're
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sort of working, you know, your,
6:04
I guess, philosophy
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into that.
6:08
Yeah. So there's a few areas that I've
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been focused on to improve quality. Mhmm. Like
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I mentioned, I helped develop a more structured
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spine intake workflow to improve Triage and identify
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higher acuity patients. Yeah. So that has definitely
6:21
improved,
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quality,
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for us in, in ensuring patients come to
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us already
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optimized for potential surgery if needed. Right. So
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that the way to build something like that
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involves,
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building strong relationships with primary care providers, physical
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therapists, chiropractors.
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And for me, it's other spine surgeon, neurosurgeon
6:43
areas,
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to create a consistent pipeline of appropriate patients.
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And, it also involves,
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improving communication
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between our clinic staff and hospital teams, especially
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the preoperative clinic,
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from the,
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in the preoperative period as well. That's really,
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really, really crucial to ensure that patients,
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are set up for the most success for
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for spine surgeries,
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and also that they have the appropriate postoperative
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care arranged
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by coordinating care with
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a medicine team or the
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ICU team, the anesthesia team.
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So
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it's important to have collaboration across multiple
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disciplines, to improve,
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safety and ensure better outcomes.
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100%.
7:32
Yeah. I think that sort of alignment is
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incredibly important, especially
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with those more complex, you know, cases too.
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And I'm wondering just as spine cases become
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more complex,
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what are some of the biggest challenges that
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you're seeing right now?
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So the biggest challenges,
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I'm seeing is
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balancing
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timely access with increasing place complexity.
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So as you improve access, take on more
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referrals, especially from other surgeons or other spine
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programs,
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there's you naturally see more higher duty patients.
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So these cases require more time, more resources,
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and it's important to have a system that
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can support them.
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At the same time, there needs to be
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a system in place where you can, evaluate
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patient
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efficiently while still being thorough in how we
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approach their care. So a lot of that
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focus has been building on standardizing
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processes that allows patients to move through the
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system efficiently from our clinic to the preoperative
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clinic,
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surgery, postoperative care,
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and the initial,
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three month period after their surgery.
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And the goal is to do this efficiently
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without compromising quality of care and also,
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being cautious of the cost to the system
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as well so that we can make
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spine programs sustainable long term. Mhmm.
8:59
Yeah. And I know at at the beginning
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of the conversation, you sort of, touched on
9:04
minimally invasive,
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spine techniques.
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But I'm wondering just where do you think
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that conversation
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around, I guess, minimally invasive,
9:14
techniques sometimes diverges from
9:17
reality in in day to day practice?
9:22
Yeah. So
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my practice philosophy
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is that,
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first, exhausting all nonoperative treatment plans. If a
9:31
patient does need surgical treatment, make sure that
9:33
making sure that they're optimized for surgery.
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The next step is is to look at
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the pathology,
9:39
on their imaging and make sure that it
9:41
matches their symptoms so you're doing the right
9:43
surgery for the right patient at the right
9:45
time. Also, doing the right amount of surgery,
9:48
not too not too much, not too little.
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K?
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And so that's where, minimal invasive spine comes
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into play,
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is doing surgery the right amount of surgery.
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And so it's I believe it's important to
10:02
have,
10:03
minimally invasive skill sets, in a spine practice
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so that,
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you can do approaches,
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that minimize the loss, minimizes pain,
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shortens operative time during the case.
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This will overall decrease cost of the system.
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You'll also have a patient to recover faster,
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and go home the same day. That also
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decreases cost of the system.
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So it's not necessarily about the surgical technique.
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It's all about how to improve outcomes,
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how to make a spine program sustainable.
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Obviously, when you
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employ minimally basic techniques, you need to have,
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equipment,
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available to do these types of surgeries.
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There is a push to do more endoscopic
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spine surgery. However, some endoscopic approaches do require,
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large capital cost,
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and,
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just cost overall to the cases.
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So there just needs to be a fine
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balance,
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when choosing minimally invasive surgeries that we balance,
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what's most effective in terms of treating the
11:06
patient, but also not putting every patient in
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a single category that, yes, they all these
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all these patients need minimally invasive spine surgery
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and that
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then increases the cost of system or it
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sets up a sets the patient up for
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another unnecessary spine surgery because the initial surgery
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was not,
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done in the appropriate approach. So Right. That's
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my thoughts on that. Yeah. Yeah. And I
11:30
appreciate that, and I think, you know, you're
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very intentional
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about that. And I think just as sort
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of these
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minimally invasive, I guess, techniques
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and whatnot come out, I mean, it's gonna
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be incredibly important, and I've had many conversations
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about this just,
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you know, deciphering between
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what's
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just type versus what's actually working. And, obviously,
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more data is coming out every day.
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But I appreciate, you know, what you said
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just about, you know, sort of being intentional
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and will this actually be, you know, the
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best option for this patient.
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So that's great.
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Looking ahead,
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where do you see the biggest opportunity
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to improve spine care delivery?
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You know, whether that's clinical,
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operational,
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or cultural to to drive both better patient
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outcomes and more efficient care.
12:28
Yeah. So I think thoughtful planning is
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one area where we can improve as spine
12:34
surgeons. Mhmm. That includes,
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understanding,
12:39
the patient's pathology better,
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understanding their global alignment,
12:44
segmental alignment,
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understanding,
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spinal pathology better is one area. Preoperative planning
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is very important.
12:53
Mhmm. And,
12:55
rather than going in and not knowing the
12:58
types of implants or the size of implants
12:59
you wanna put in, I think we're we're
13:01
beyond that. I think we need to go
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in having a,
13:05
understanding of the types of implants we're gonna
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put in, the biologics we're gonna put in,
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and making sure that's all,
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cost,
13:13
cost friendly as well to the system. Mhmm.
13:15
And so we don't wanna
13:17
be putting in implants or,
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or or using biologics
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that leaves the system dry,
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because that won't allow the program to be
13:26
sustainable long term. So I think, thoughtful,
13:31
preplanning of surgeries is is crucial.
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That also applies to minimum invasive cases where
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there's
13:38
fusions not involved,
13:40
but also even one or two level deep
13:42
dent and especially more complex blind cases. We
13:44
need to be just more thoughtful,
13:46
about how we proceed with these surgeries.
13:49
Absolutely.
13:50
Yeah. I feel like that's the theme of
13:52
this conversation. Right? It's just
13:54
being thoughtful and being intentional,
13:56
that it truly is so important.
13:59
I guess, is there anything else that we
14:01
didn't cover that you wanted to, you know,
14:04
make sure that we we did?
14:08
Yeah. So,
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I think I what I wanna mention is
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that,
14:13
I'm very optimistic about the future of spine
14:16
surgery and where it's headed.
14:18
There are a lot of challenges in health
14:19
care right now. The need for spine care
14:21
isn't going anywhere. Patients are living longer. They're
14:24
staying active. They're expecting a higher quality of
14:27
life.
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And at the same time, our field is
14:30
quickly evolving technically in terms of how we
14:33
wanna deliver this type this the spine care.
14:35
So I think the opportunity
14:38
moving forward is,
14:39
is gonna involve continuing to improve access,
14:42
consistency,
14:43
efficiency, and how we manage these patients,
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while also maintaining,
14:48
a high standard of care.
14:51
Amazing. Way way to wrap it up and
14:53
and tie it all in a nice bow.
14:56
Yes. Definitely. Yeah. Well, thank you so much,
14:58
doctor Zaire. This has been an incredible conversation,
15:02
and thank you for sharing your insights with
15:04
us.
15:05
That is all for today's episode of the
15:08
Becker Spine and Orthopedic podcast.
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Thank you to doctor Aqibzari of the Oregon
15:14
Clinic for joining us, and thank you to
15:16
our listeners for tuning in.
15:19
We'll see you next time.