Latest / Becker’s Healthcare Podcast / Advancing Multidisciplinary Spine Care and Innovation with Edward J. Dohring, M.D.

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Advancing Multidisciplinary Spine Care and Innovation with Edward J. Dohring, M.D. · Becker’s Healthcare Podcast

• 0:00
  This is Carly Beam with the Becker Spine
• 0:02
  and Orthopedics podcast. And joining me today is
• 0:05
  doctor Ed Doering, a surgeon with Spine Institute
• 0:07
  of Arizona.
• 0:08
  Doctor Doering, thank you so much for being
• 0:11
  here today. Thank you, Carly, for having me.
• 0:13
  And so before we dive into our questions,
• 0:15
  could you introduce yourself and share more about
• 0:18
  your work?
• 0:19
  Sure. I I probably had a little different
• 0:21
  entryway into the spine world than most. I
• 0:24
  went to Dartmouth College and was a philosophy
• 0:26
  and psychology major,
• 0:28
  went to Yale med school because that was
• 0:30
  the number one psychiatry
• 0:31
  program in The United States.
• 0:33
  But I quickly soured on that and ended
• 0:36
  up to the dismay of my med school
• 0:38
  dean
• 0:39
  doing what,
• 0:40
  was not very common then, but I I
• 0:42
  may have helped to invent the gap year.
• 0:45
  Ended up working on the senate's of committee
• 0:47
  for health and then
• 0:49
  doing some public health work in Ghana and
• 0:51
  assisting in surgeries there, and that's where I
• 0:54
  decided that that I was gonna be a
• 0:55
  surgeon. So when I got back to med
• 0:57
  school, I,
• 0:58
  dove into orthopedics and spine with doctor Wayne
• 1:01
  Southwick, who is the originator of the ACDF
• 1:04
  approach, and it just kind of has gone
• 1:06
  on from there with residency and fellowship. And
• 1:10
  and then,
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  couple years in academics and then creating the
• 1:14
  Spine Institute of Arizona here in in Scottsdale.
• 1:18
  A fascinating path you got to get here.
• 1:21
  And to talk about, you know, your so
• 1:23
  with, Spine Institute of Arizona,
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  what are some of your top priorities in
• 1:27
  spine care right now?
• 1:29
  Well, the priorities in spine care have been
• 1:32
  the same the entire time we've
• 1:34
  had the Spine Institute of Arizona open for
• 1:36
  business, which is patient care. But commensurate with
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  that is really trying to be on top
• 1:41
  of
• 1:42
  those innovations that make sense for patients.
• 1:46
  And so we've been involved in a lot
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  of FDA
• 1:49
  investigational
• 1:50
  device exemption trials,
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  trying to work on a lot of things
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  that had to do with, the first minimally
• 1:57
  invasive type approaches to different procedures,
• 2:00
  the first artificial discs and disc replacement procedures.
• 2:04
  At the same time,
• 2:05
  we are a multidisciplinary
• 2:07
  group, which when we started was very unique
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  and try to work together by having meetings
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  every week where we share ideas so that
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  we're not,
• 2:16
  ensconced in our silos
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  and only thinking that, you know, if I
• 2:20
  have a hammer, everything's a nail kind of
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  the old aphorism.
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  So it's been a patient oriented
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  but also
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  innovation
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  oriented
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  place. And then finally, education. We've the entire
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  time, we've we've been privateemic in nature where
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  we educate nursing students, PA students, medical students,
• 2:39
  residents, and fellows.
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  Yeah. I'd love to hear more about some
• 2:43
  of the multidisciplinary
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  work you're doing and if you have any
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  examples of a lesson you've learned from a
• 2:50
  colleague maybe in, you know, orthopedics
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  or in,
• 2:54
  neurosurgery
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  or any other field.
• 2:57
  Sure. I mean,
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  everybody comes at their patient care perspective
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  from a different background, and some of those
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  backgrounds are ensconced in our training, and some
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  of them are just our own pathway in
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  life.
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  What's been great about, you know, how we
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  started this manuscript is very from the very
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  beginning,
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  including people who are interventional pain, physical therapy,
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  you know, chiropractic,
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  and then surgeons, of course. And that and
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  because we have weekly meetings and talk about
• 3:28
  patients,
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  because we talk about the literature in our
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  own fields, because we talk about what we
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  learned from a conference we went to, we're
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  constantly sharing
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  ideas that we wouldn't be otherwise exposed to.
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  So I may see a patient and think
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  this patient's a pretty good surgical candidate,
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  discuss them at conference, and realize, no. Wait
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  a minute.
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  These colleagues of mine can approach this in
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  a different way that may be better for
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  the patient. Let's let's do that and see
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  what happens. And that way we learn from
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  each other all the time.
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  It's one of the things that led me
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  to be very, very involved in the North
• 4:02
  American Spine Society because
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  the North American Spine Society is one of
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  the few
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  multidisciplinary
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  organizations
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  focused on spine care of patients.
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  And rather than focus only on surgery, only
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  on interventional pain and injections, only on chiropractic
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  or physical therapy,
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  our even though we are surgeon heavy,
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  over 30 of the membership is
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  not nonsurgical
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  and represents all the other fields that take
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  care of spine care. And they have a
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  strong voice at every level from committees to
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  conference education
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  to the board,
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  and that just
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  creates a milieu for better patient care.
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  Yeah. And I really like how sounds like
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  you're you were
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  really kind of hitting the ground running when
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  it comes to just thinking about the role
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  of interventional
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  and pain
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  medicine, spine care. I'd love to hear some
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  of your thoughts on
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  where you think the role of interventional spine
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  physicians, pain management,
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  where you see them growing
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  in, you know, the realm of spine surgery,
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  and if you're, you know, optimistic,
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  nervous.
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  That's a pretty controversial, and I think it's
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  an important topic.
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  Before interventional
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  pain fellowships existed
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  where people really learned how to do different
• 5:21
  kinds of primarily injection approaches to to patients'
• 5:26
  problems.
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  This was done very ad hoc. I mean,
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  occasionally, an anesthesiologist would do it. Occasionally, radiologists
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  do it or a surgeon would do it.
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  So it it definitely increased the quality of
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  care tremendously when it was really about twenty
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  years ago or so that the interventional pain
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  fellowship started becoming more widespread, and people started
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  coming out of this training with a focus
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  on how they could help patients with these
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  minimally invasive
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  procedures that could really help patients.
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  I think as we've gone along, it's morphed
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  into a situation where,
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  some of the interventional pain people are doing
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  procedures
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  that,
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  potentially
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  would be more ideally
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  adopted by those who have more training in
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  anatomy and diagnosis and in the potential complications
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  of these procedures.
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  And,
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  you know, indeed, when I was president of
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  NASS
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  with the concurrence of
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  our PM and R docs and our interventional
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  docs
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  did issue,
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  a statement
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  that we were
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  that we felt that it was most appropriate,
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  especially when we're talking about fusion type surgeries,
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  that patients
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  be treated by those who are neurosurgically
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  trained or orthopedically trained,
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  six to seven years of training in anatomy,
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  diagnosis of spinal conditions,
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  and then surgical procedures, the potential complications,
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  and how to take care of those complications.
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  And they're probably not best in the hands
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  of an in a person with a year
• 6:56
  of interventional pain training.
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  Got it. And then I want to switch
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  gears a little bit. You mentioned, you know,
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  you've been
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  involved in a lot of FDA
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  related IDE trials, and I'd love to hear
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  just if there's anything exciting that you've been,
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  working with right now. Just come what are
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  some of the most exciting innovate innovations in
• 7:18
  Spine that you're watching?
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  It's interesting. I'm, you know, not currently involved
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  in any IDs, but just in the general
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  realm. I've been involved in robotics for a
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  long time since it first came out fifteen
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  years ago. It's kind of a sexy thing.
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  It's kind of a great hot topic.
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  However, I don't
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  really think that that's going to be a
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  significant advantage to day to day surgery until
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  the robots can do a decompression.
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  And that's something that's been worked on for
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  over eight years. I was involved in a
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  project with that about eight years ago. And,
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  at this point, just not safe enough to
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  do, but I think within a few years,
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  a robot will be able to successfully do
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  a laminectomy without injuring nerves or without causing
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  excess bleeding, and that'll be a true revolution.
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  On the other hand, something completely
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  not part of the operating room, but becoming
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  more and more a part of the operating
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  room is just the role of AI. And
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  it's exciting in both positive and negative ways.
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  I mean,
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  positive the negatives are it's being used for
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  prior authorization with no human
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  oversight or intervention unless there's an appeal process,
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  so it creates more barriers to patient care.
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  On the other hand,
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  AI is able to accumulate vast amounts of
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  data. We have 13 spine publications
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  that talk about things and come out every
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  month. It's almost impossible to keep up with
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  what's going on in the research portion of
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  the spine world.
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  AI can bring that together, and eventually,
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  we can apply that data to specific patients
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  to help us make better diagnosis
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  and more patient centric
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  treatment plans. That'll be incredible.
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  Definitely. It sounds like there's both pros and
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  cons. There's having the algorithm involved in your
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  health care and health care research.
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  Absolutely.
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  Yeah. And then I was wondering, I know
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  you you work with HonorHealth's Orthopedic Co management
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  organization.
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  Can you talk about
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  that a bit more and some of the
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  most interesting trends you're seeing in, spine and
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  orthopedic care delivery? I know you touched a
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  bit on prior prior auths and the way
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  AI is being involved with that.
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  Sure. This is a, you know, a co
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  management agreement that's very common amongst hospitals. And
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  in this particular case, it started out with
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  the hospital working with just one orthopedic group.
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  It excluded about half of the orthopedic surgeons
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  in the system. So,
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  it didn't it had suboptimal outcomes the first
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  year or a little bit more than a
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  year, and then I was asked to be
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  involved and help to bring in the rest
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  of the orthopedic,
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  surgeons
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  at on our health. And this then resulted
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  in a much better working group where we
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  can incentivize
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  physicians
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  with monetary
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  reward is really what it is for having
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  better outcomes and for
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  controlling costs when it made sense. So these
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  are, you know, things that
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  obviously permeate all of our
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  systems within health care. It's how can we
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  preserve good outcomes and yet at the same
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  time, potentially
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  either diminish costs or diminish cost related problems
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  like like a complication of surgery or a
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  complication
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  of some other sort. So,
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  I mean, HonorHealth is is one of the
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  systems that's done that well, and it's evolved
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  over the years to go through different iterations
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  with new ones coming up. Goal again, you
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  know, being simply, how do we get the
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  best outcomes at a reasonable cost and,
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  trying different things and seeing what works and
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  what doesn't.
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  Totally.
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  And, you know, HonorHealth, they also gave you
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  an honor recently. HonorHealth's,
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  president's lifetime achievement award. One, you know, congratulations
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  on that. And then, two, can you just
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  talk about what this honor means to you
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  and just your outlook for the next generation
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  of spine leaders like yourself?
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  Well, I really appreciate the recognition, obviously.
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  In some ways,
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  I feel like it validates an approach that's
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  that not I'm not the only one who
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  takes a lot of people
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  take when they get involved in,
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  health care beyond their their
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  their care of their own patients.
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  And a lot of that has to do
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  with the collaboration that we have with other
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  departments at the hospital, with administration,
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  with beyond that, working with legislators at the
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  state level, at the at the federal level
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  in order to have, you know, rules in
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  place and have systems in place that we
• 11:51
  can really take best care of patients. And,
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  obviously, that's what societies do as well, like
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  the North American Spine Society or others, in
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  working with insurance carriers and working with CMS
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  that runs Medicare.
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  I mean, basically, I I have think the
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  next generation of spine leaders, there's already a
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  superb group of people I've seen. Unfortunately, it's
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  usually about 10% of physicians, and I'd love
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  for it to be 40% of physicians
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  that are involved and see the benefits to
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  being involved in this kind
• 12:23
  of extra patient care beyond patient care types
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  of things that
• 12:27
  ultimately
• 12:28
  improve patient care and also
• 12:31
  can improve
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  each physician's, you know, business environment,
• 12:35
  which is important for them to go on
• 12:37
  in their career.
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  I found personally that it's just been so
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  rewarding to work with people all over the
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  country,
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  not just to further these goals, but also
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  you just meet incredible people. And these people
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  are very interesting, and you end up forming
• 12:51
  lifelong friendships.
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  And so to me, it I just
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  the honor from
• 12:57
  HonorHealth
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  was just a validation of sorts of what
• 13:00
  I see a lot of people doing, but
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  I wish more people would do, which is
• 13:04
  get involved
• 13:05
  on behalf of your patients with the greater
• 13:08
  health care world, working with systems, trying to
• 13:11
  improve them, and, and making great friends along
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  the way.
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  Could have said that myself. And I know
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  you've you've absolutely you've absolutely
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  laid some great groundwork for, you know, hopefully,
• 13:22
  that 40% of physicians who wanna follow in
• 13:25
  your footsteps. But, doctor Doreen, thank you so
• 13:28
  much for taking the time to chat. It's
• 13:30
  been a great conversation. I look forward to
• 13:32
  connecting in the future.
• 13:34
  Oh, thank you, Carly. I really appreciate it.