Latest / Becker’s Healthcare Podcast / Dr. Nolan Wessell, Assistant Professor and Well-being Co-Director, Department of Orthopedic Surgery, Division of Spine Surgery, University of Colorado School of Medicine

Transcript

Dr. Nolan Wessell, Assistant Professor and Well-being Co-Director, Department of Orthopedic Surgery, Division of Spine Surgery, University of Colorado School of Medicine · Becker’s Healthcare Podcast

• 0:00
  This is Carly Beam with the Becker Spine
• 0:02
  and Orthopedics podcast, and I'm thrilled to be
• 0:04
  joined today by doctor Nolan Wessel with the
• 0:07
  University of Colorado School of Medicine. Doctor Wessel,
• 0:10
  thank you so much for being here today.
• 0:13
  Yeah. Thanks you thank you so much for
• 0:15
  having me on board.
• 0:16
  Yeah. Absolutely. And before we dive into our
• 0:18
  discussion, I'd love to if you could just
• 0:21
  introduce yourself and tell us a bit about
• 0:22
  your background. Sure. So,
• 0:25
  as you already mentioned, I currently work at
• 0:27
  the University of Colorado Department of Orthopedics, but,
• 0:31
  I was born and raised in North Central
• 0:32
  Wisconsin,
• 0:33
  did my undergraduate,
• 0:35
  studies at the University of Wisconsin. And then
• 0:39
  after graduation, I worked very briefly in medical
• 0:41
  research for the Howard Hughes Medical Institute
• 0:44
  before
• 0:45
  moving on to medical school at Wayne State
• 0:47
  University in Detroit.
• 0:49
  I stayed in Detroit
• 0:52
  for my residency at the Henry Ford Health
• 0:54
  System
• 0:55
  and then moved out to Colorado in 2017
• 0:58
  to do my fellowship in adult spine surgery
• 1:01
  at the University of Colorado.
• 1:03
  So since 2018, I've been on faculty at
• 1:06
  the university.
• 1:07
  Currently, the majority of my practice is spent
• 1:11
  on the South Side Of Metro Denver in
• 1:13
  the Highlands Ranch community, but I still
• 1:16
  maintain a small portion of my practice at
• 1:18
  the main university campus.
• 1:21
  Right. And, yeah, an interesting
• 1:23
  aspect of your title is reading about you
• 1:26
  earlier, well-being co director. Can you talk more
• 1:29
  about that? Sure.
• 1:30
  You know, it's,
• 1:33
  it's probably no secret to anybody that works
• 1:35
  in health care or has friends or family
• 1:37
  that work in health care that
• 1:39
  burnout, especially on the heels of the COVID
• 1:42
  pandemic a few years ago,
• 1:45
  has run rampant throughout the system. And that's
• 1:47
  not just isolated to orthopedic surgeons. But what
• 1:51
  I can tell you is that,
• 1:53
  currently
• 1:55
  about forty percent of active orthopedic surgeons
• 1:59
  endorse symptoms consistent with burnout and depression,
• 2:03
  and over the course of an orthopedic surgeon's
• 2:06
  career upwards of sixty to sixty five percent
• 2:08
  of individuals
• 2:09
  may suffer from symptoms of
• 2:12
  burnout and depression.
• 2:14
  And, in a system that's already very strained,
• 2:17
  this can lead to,
• 2:20
  early attrition,
• 2:21
  which we certainly don't need because as the
• 2:23
  baby boomers age into those years where they
• 2:26
  demand more care,
• 2:28
  Orthopedic care is a major part of that.
• 2:32
  And we really just wanna make sure that
• 2:34
  we're taking care of not just our patients,
• 2:36
  but ourselves. Right? We we can't be
• 2:39
  expected to care for other people if we
• 2:42
  ourselves are not in good physical and mental
• 2:44
  condition. So the University of Colorado, like many
• 2:48
  large institutions,
• 2:49
  has,
• 2:50
  done its best to prioritize wellness, and myself
• 2:54
  and one of my,
• 2:56
  colleagues from the Children's Hospital of Colorado, doctor
• 2:58
  Sarah Sibyl,
• 3:00
  serve as the co directors for well-being for
• 3:02
  our department.
• 3:03
  So it's a it's an interesting role that's
• 3:05
  kind of always evolving.
• 3:08
  Yeah. I was about to say
• 3:10
  and, I mean, obviously, it's burnout being so
• 3:12
  rampant. And I know there are a lot
• 3:13
  of different headwinds facing spine surgeons. And I'm
• 3:17
  wondering, you know, how are you
• 3:20
  tackling those? How are you training,
• 3:23
  you know, your your students, your residents in
• 3:26
  spine and orthopedics
• 3:27
  to to face these headwinds, you know, without
• 3:31
  completely burning themselves out?
• 3:33
  Sure. I think that's a that's an important
• 3:35
  question, and I don't have all the solutions
• 3:37
  to that.
• 3:40
  Certainly, as you look at
• 3:42
  an older generation
• 3:44
  of surgeons and physicians and health care providers,
• 3:48
  I think we can all agree that the
• 3:50
  work life balance really was not there.
• 3:54
  It was kind of just a mentality of
• 3:57
  work, work,
• 3:58
  work. I'll relax when I retire.
• 4:00
  And then you've got a younger generation. So
• 4:02
  I'm I'm 41,
• 4:05
  or nearly 41.
• 4:06
  And
• 4:08
  kind of starting with my generation and those
• 4:11
  a little bit younger than me,
• 4:13
  I think they are much better suited
• 4:16
  to help maintain that kind of work life
• 4:18
  balance.
• 4:19
  And people in kind of their mid career
• 4:21
  are somewhat caught in between, but more and
• 4:24
  more now, now you see it at the
• 4:26
  university that,
• 4:28
  prioritizing
• 4:29
  that work life balance, especially in a state
• 4:31
  like Colorado where,
• 4:34
  outdoor activities
• 4:35
  are available to you essentially three sixty five
• 4:39
  days a year,
• 4:40
  people really wanna make sure that they're they're
• 4:42
  taking care of their own well-being
• 4:44
  in in conjunction with caring for patients.
• 4:47
  Got it. And I'd love to hear, you
• 4:49
  know, what are some other big trends you're
• 4:52
  following in health care today?
• 4:54
  Yeah. So
• 4:56
  we just had the North American Spine Society
• 4:59
  meeting last weekend.
• 5:01
  It was the forty year anniversary of the
• 5:03
  organization.
• 5:04
  And to my knowledge, the first time that
• 5:06
  they had their annual meeting in Denver. So
• 5:08
  it was kinda nice to not have to
• 5:10
  get on a plane. I just woke up
• 5:12
  You have a little cold. Downtown. Yeah.
• 5:14
  But when you walk through the exhibit floor,
• 5:18
  it's really clear to me that,
• 5:21
  integration of kind of robotics
• 5:23
  and artificial
• 5:25
  intelligence
• 5:26
  and kind of patient specific surgical plans
• 5:29
  is where spine surgery is headed.
• 5:32
  You know, we've seen robotics
• 5:33
  in general surgery for quite a while now.
• 5:36
  You know, we've all heard about the da
• 5:38
  Vinci robot that's probably been around for fifteen
• 5:41
  to twenty years.
• 5:43
  Robotics and spine care is somewhat in its
• 5:46
  infancy,
• 5:48
  but when you start to integrate that with
• 5:51
  preoperative
• 5:52
  planning and using
• 5:54
  large scale database learning and artificial intelligence algorithms
• 5:58
  to help plan
• 6:00
  a patient specific surgery or even custom three
• 6:04
  d printed patient specific implants,
• 6:07
  it really begins to change the game in
• 6:09
  terms of what we can offer patients. And,
• 6:12
  right now the costs
• 6:14
  for some of those technologies
• 6:16
  are quite high,
• 6:17
  but
• 6:18
  as development progresses,
• 6:20
  like anything else, we expect those costs to
• 6:22
  come down,
• 6:24
  and hopefully, that translates to better value and
• 6:26
  better outcomes for patients.
• 6:29
  Definitely. And when you when you think about
• 6:31
  cost, what do you think it will take,
• 6:34
  from these companies without, like, you know, naming
• 6:37
  names? What do you think it'll take
• 6:39
  for these costs come down to make these
• 6:42
  technologies more accessible to any practice setting and
• 6:45
  to patients?
• 6:47
  Yeah. I think cost is at the forefront
• 6:49
  of everything we do in health care right
• 6:52
  now,
• 6:53
  and and we can certainly get into some
• 6:55
  of those issues later in our conversation. But,
• 7:00
  I work fortunately at a at a large
• 7:02
  academic institution.
• 7:04
  And
• 7:05
  when it comes to development of these new
• 7:07
  technologies, I really look at the larger centers
• 7:11
  as the ones that need to lead the
• 7:13
  charge. You know, being a big academic center,
• 7:16
  we have a robust portfolio of research projects
• 7:19
  that are ongoing.
• 7:21
  We have, an easier ability to get,
• 7:25
  large scale federal and and regional grant funding.
• 7:29
  And we need to be smart about how
• 7:31
  we use that money, and I hope that
• 7:33
  a portion of it is invested in advancing
• 7:36
  these types of technologies because,
• 7:39
  ultimately, I think that's gonna gonna benefit
• 7:42
  not just orthopedic patients but the broader healthcare
• 7:45
  system as a whole.
• 7:46
  Right? If we
• 7:47
  have technologies
• 7:49
  that allow us to do
• 7:51
  more or a broader spectrum of surgeries in
• 7:54
  a more ambulatory
• 7:55
  setting with
• 7:57
  smaller incisions and reduced recovery,
• 8:00
  that that's gonna change the game in terms
• 8:03
  of orthopedic care.
• 8:04
  Yeah. And it does it's cool that you
• 8:06
  do have that advantage being, in the academic
• 8:09
  center to really,
• 8:10
  make these changes.
• 8:12
  And then you mentioned, you know,
• 8:13
  government funding for research, for instance. I'm wondering
• 8:17
  how how have you been tracking these
• 8:19
  regular shifts and changes in government policies, whether
• 8:24
  it's with reimbursement
• 8:25
  or,
• 8:26
  this research funding you're talking about. How are
• 8:29
  you tackling those?
• 8:30
  Yeah. I think the one thing that we
• 8:32
  can probably be certain to certain of is
• 8:34
  that
• 8:35
  it's constantly going to change. Right? Hit in
• 8:38
  the American political system,
• 8:40
  it really doesn't matter what side of the
• 8:42
  aisle you sit on.
• 8:43
  We can expect that every two, four, eight
• 8:46
  years, there's gonna be a little bit of
• 8:49
  a shift in terms of which party maintains
• 8:51
  control, and that is gonna result in a
• 8:54
  shift
• 8:55
  in
• 8:56
  various types of funding.
• 8:57
  Mhmm.
• 8:58
  As providers and as academic institutions, you know,
• 9:02
  here at the University of Colorado, we have
• 9:04
  a new dean, Doctor. John Sampson,
• 9:07
  and he is really working hard to
• 9:10
  set up a financial structure that provides more
• 9:14
  stability across the entirety of the med school.
• 9:17
  So
• 9:18
  that if we encounter
• 9:20
  periods of time where federal funding is reduced,
• 9:23
  we have the reserves on hand so that
• 9:26
  we can maintain a robust faculty
• 9:28
  of not only providers but research staff as
• 9:32
  well. So hopefully,
• 9:35
  as, you know, endowments continue to grow,
• 9:39
  as we continue to grow our cash reserves,
• 9:42
  we're well suited to whatever weather, whatever storms
• 9:46
  we might face,
• 9:47
  as as political persuasions fluctuate.
• 9:51
  That's great to hear. And then I wanna
• 9:53
  ask you, how are you thinking about growth
• 9:56
  in the next
• 9:57
  twelve to twenty four months? You know, what's
• 9:59
  really exciting you in that realm? Yeah.
• 10:02
  You know, I
• 10:03
  I already have a robust practice. So when
• 10:06
  people ask me about growth, I think, well,
• 10:08
  gosh, there's only twenty four hours in a
• 10:10
  day. Right? Mhmm. But,
• 10:13
  kinda hearkening the conversation
• 10:15
  back to some of the artificial intelligence,
• 10:20
  the the large language models
• 10:23
  have pretty quickly found their way into health
• 10:25
  care. So one example I like to cite
• 10:28
  is that we now use an AI based,
• 10:32
  passive listening system in the clinic setting.
• 10:35
  And within mere seconds,
• 10:37
  the conversations I have with a patient are
• 10:40
  transcribed into a note.
• 10:42
  And
• 10:43
  like a lot of these systems like ChatGPT
• 10:46
  and others, the more you use it, the
• 10:48
  more it learns about your conversation style.
• 10:51
  And I've been using it now for about
• 10:53
  four or five months, and
• 10:55
  I can leave a patient's room, walk back
• 10:57
  to my workstation,
• 10:59
  and by the time I get there, my
• 11:00
  note is written. I do a quick review
• 11:03
  and boom, the note is signed.
• 11:06
  That has given me back
• 11:08
  upwards of ninety minutes a day, and for
• 11:11
  my nurse practitioner,
• 11:13
  she's getting ninety minutes back on her day
• 11:15
  as well. And
• 11:16
  that can be used a variety of different
• 11:19
  ways. You know, we talked a little bit
• 11:20
  about wellness. Well, you can get some of
• 11:22
  your personal or family time back, which is
• 11:24
  fantastic. Or I see. Yeah. Or, you know,
• 11:28
  based on our clinic schedules,
• 11:29
  that might open up availability for two to
• 11:32
  four patients a week and that that adds
• 11:35
  up quickly, you know, 200 to 300 patients
• 11:37
  a year that otherwise might have to wait
• 11:40
  months to get in to see us
• 11:42
  now can get in to to get their
• 11:44
  care sooner,
• 11:46
  and that's all on the backs of technological
• 11:49
  advancement and artificial intelligence. So when I think
• 11:52
  about growth,
• 11:54
  I think more about efficiency. How can
• 11:57
  I personally better use my time? And then
• 12:00
  how is an entire health care system
• 12:03
  can we better better optimize the time we
• 12:06
  spend with patients and taking care of them?
• 12:08
  Yeah. And I really love that how you're
• 12:10
  describing AI as a tool. Probably, you know,
• 12:12
  the Ambient AI probably helps you stay present
• 12:16
  in visits, gets brings in more access for
• 12:19
  patients. It sounds like a real win win.
• 12:22
  Yep. Absolutely. I mean, in instead of staring
• 12:25
  down at a piece of scratch paper or
• 12:28
  typing notes into a computer,
• 12:30
  I'm really focused on
• 12:32
  what the patient is saying,
• 12:35
  and and can develop that more personalized interaction
• 12:38
  as opposed
• 12:39
  to staring at a computer screen or staring
• 12:41
  at a piece of paper.
• 12:43
  Definitely. And, you know, obviously, AI is, you
• 12:45
  know, one of the biggest disruptors
• 12:48
  to health care and definitely spine surgery.
• 12:51
  Are there any other
• 12:53
  key disruptors that you'll be watching in the
• 12:55
  spine space next year?
• 12:58
  You know,
• 13:01
  conversations about declining reimbursements are not isolated
• 13:06
  to spine surgery. It's across the board.
• 13:11
  A close colleague and friend of mine wrote
• 13:13
  a paper in the journal of arthroplasty
• 13:15
  last year that said, you know, orthopedic surgeons,
• 13:19
  have taken a 31%
• 13:21
  hit,
• 13:22
  on inflation adjusted income over the last quarter
• 13:25
  century.
• 13:27
  And
• 13:28
  nobody really wants to hear an orthopedic surgeon
• 13:30
  complain,
• 13:31
  and I'm not complaining on a personal level,
• 13:33
  but
• 13:34
  what this has led to in other specialties
• 13:37
  are care deserts. So here in Colorado,
• 13:41
  a health care system that covers the Gunnison
• 13:43
  Valley if anybody's ever been to Gunnison, Colorado
• 13:46
  or Crested Butte, we're talking about
• 13:49
  some pristine areas of the state and pristine
• 13:52
  areas of the country.
• 13:54
  But those health care systems, because of declining
• 13:57
  reimbursements,
• 13:58
  have had to shut down their obstetrics and
• 14:00
  gynecology programs,
• 14:02
  and that's leaving countless women
• 14:04
  and their their babies without,
• 14:08
  a place to receive their care.
• 14:10
  And if we're not careful,
• 14:12
  we're gonna see those same trends trickle over
• 14:14
  into other specialties.
• 14:16
  We've seen it in primary care. We're seeing
• 14:18
  it in OBGYN.
• 14:20
  And,
• 14:22
  I I'm concerned that
• 14:25
  not enough red flags are popping up
• 14:27
  amongst the individuals
• 14:29
  and organizations
• 14:31
  that have the ability to influence
• 14:34
  how funding is allocated and how these decisions
• 14:36
  are made. So I'm gonna be watching that
• 14:39
  really closely,
• 14:40
  especially as we learn more about the 2026
• 14:44
  CMS fee schedule and how that might affect,
• 14:48
  practices and and patients' ability to access care.
• 14:52
  Definitely. It sounds like you have a real
• 14:54
  emphasis on just, like, kind of the need
• 14:56
  to speak out and add in for physicians
• 14:58
  to advocate for themselves.
• 15:01
  Yeah. I I think the onus is on
• 15:03
  us to
• 15:05
  try to get a seat at the table.
• 15:06
  Right? You know,
• 15:08
  I've I've mentioned a lot that I work
• 15:10
  at an academic institution, but at the same
• 15:12
  time,
• 15:14
  I'm I'm not that big on on research.
• 15:17
  I like the advocacy side of things.
• 15:21
  I sit on the executive board for the
• 15:23
  Colorado Orthopedic Society, which is
• 15:26
  actually a really fun and rewarding role. You
• 15:28
  know, we're
• 15:29
  always keeping a pulse on what's going on
• 15:32
  within,
• 15:33
  the state of Colorado political scene, but also
• 15:36
  at the national level. And
• 15:38
  there have been numerous instances where I feel
• 15:41
  like we've really made a difference,
• 15:44
  in terms of how health care is regulated
• 15:48
  and,
• 15:50
  distributed within our own state's borders.
• 15:54
  That's very well said. And doctor Wessel, was
• 15:56
  there anything else you wanted to discuss before
• 15:58
  we wrap this podcast?
• 16:01
  You know, not really. I think,
• 16:04
  hopefully, more and more people tune in and
• 16:07
  and subscribe and listen.
• 16:09
  And and I would love to see our
• 16:12
  podcast reach beyond
• 16:14
  other health care providers. Right? I think
• 16:17
  we need to have open and honest discussions
• 16:19
  with our patients
• 16:21
  about what the health care climate is like,
• 16:25
  And
• 16:26
  and if we can bend the ear of
• 16:29
  patients
• 16:31
  hopefully we can bend the ear of
• 16:34
  our politicians
• 16:35
  to
• 16:37
  start to move towards a more sensible
• 16:40
  policy that
• 16:42
  really improves,
• 16:44
  the the value of the care that we
• 16:46
  provide and helps us to improve outcomes for
• 16:48
  our patients.
• 16:49
  Yeah. It's like a real collaborative effort. Absolutely.
• 16:52
  Absolutely. We don't need to be
• 16:55
  pitted against one another,
• 16:57
  one side versus the other.
• 17:00
  You know, the the
• 17:02
  99.9%
• 17:03
  of health care providers I know,
• 17:05
  they they genuinely care about the well-being of
• 17:08
  their patients, and
• 17:10
  they're doing their best, usually far above and
• 17:13
  beyond what patients even realize,
• 17:16
  to to help deliver the best care possible
• 17:18
  and and help people return to a quality
• 17:21
  of life that they want.
• 17:23
  And I think a lot of patients really
• 17:25
  understand that. And the more people who
• 17:29
  intellectualize
• 17:30
  with that concept,
• 17:31
  I think the the better we are all
• 17:34
  going to be served,
• 17:36
  with with adapting and modifying
• 17:39
  our current health care delivery systems.
• 17:42
  It's very well said. Well, thank you so
• 17:44
  much for joining us today, doctor Wessel. It's
• 17:46
  been a pleasure speaking with you, and I
• 17:48
  look forward to connecting again down the line.
• 17:50
  Yeah. Thank you very much. I'm happy to
• 17:52
  join you anytime. This was fun.