Latest / Becker’s Healthcare Podcast / Rachel Bratescu, MD, Orthopaedic Surgeon and member of the GW Spine and Pain Center at George Washington University Hospital,

Transcript

Rachel Bratescu, MD, Orthopaedic Surgeon and member of the GW Spine and Pain Center at George Washington University Hospital, · 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 Rachel Protesco with George
• 0:07
  Washington University Hospital.
• 0:10
  Rachel, thank you so much for being here
• 0:12
  today.
• 0:13
  Thank you. Thanks so much for having me.
• 0:14
  I'm thrilled.
• 0:15
  Absolutely. And before we dive into our discussion,
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  could you introduce yourself and tell us a
• 0:19
  bit about your background?
• 0:21
  Yeah. So my name is Rachel Bortescu.
• 0:23
  I'm an orthopedic spine surgeon in the department
• 0:26
  of orthopedic surgery at George Washington University where
• 0:29
  I'm faculty
• 0:30
  in Washington, DC.
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  And, doctor Botescu, what are your top three
• 0:36
  goals,
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  in your work this year?
• 0:39
  Yeah. I would say great question to kick
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  off the new year. Number one, my number
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  one goal I would say is incorporating endoscopy
• 0:46
  in my practice.
• 0:47
  Mhmm. So if you're not familiar or those
• 0:49
  who are not familiar, spinal endoscopy is a
• 0:51
  technique
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  that a lot of people are more familiar
• 0:54
  with in the context of other joints.
• 0:57
  Right? So the shoulder, the knee, and the
• 0:59
  hip, for example.
• 1:00
  It's the idea of doing the work that
• 1:02
  you need to do as a surgeon through
• 1:04
  one portal while viewing and seeing what you're
• 1:06
  doing in another portal.
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  What's really exciting is that this technique can
• 1:10
  also be translated to spine surgery.
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  This was a technique I trained in, during
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  one of my fellowships in my orthopedic spine
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  fellowship at NYU.
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  I was trained in by portal endoscopy.
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  What makes
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  this unique is that it is essentially
• 1:25
  doing ultra minimally invasive spine surgery.
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  This is incredibly important when we are looking
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  to offer patients
• 1:32
  less invasive forms of surgery that can
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  get them out of surgery with less pain
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  in the acute postoperative period and get them
• 1:39
  back to the things that they love to
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  do.
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  Whether that's working, whether that's spending time with
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  your family, or any other recreational activities that
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  patients wanna get back into, whether that's sports
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  or just staying active throughout your life. So
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  this is a really amazing technique in particular
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  for spinal surgeries such as decompressions and microdiscectomies,
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  but it's also being
• 2:00
  utilized,
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  as well in some fusion surgeries.
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  I'm currently in the process of having this
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  approved at our hospital. I'm hopeful in the
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  next few months that that will be the
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  case and then I can start employing this
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  technique with my patients.
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  That's awesome to hear. And, you know, so
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  sound it sounds like things are looking pretty
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  good. Can you dive into sort of your,
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  I guess, sales pitch to the hospital to,
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  you know, have them thinking about this?
• 2:26
  Yeah. I think
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  when we consider what goes into patients having
• 2:29
  spine surgery, there's a lot of things. There's,
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  not only from a hospital standpoint,
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  think considering things like length of stay, length
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  of surgery,
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  anesthesia,
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  efficiency of surgery, OR time, staffing, and things
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  of that nature.
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  Really doing these surgeries in less invasive manners
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  allows us to be more efficient to help
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  more patients and also consider doing things on
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  more of an outpatient basis or ambulatory surgery.
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  So it's really advantageous
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  from a hospital standpoint,
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  and also from a patient standpoint.
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  And I I think that's one of the
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  the greatest advantages of doing surgery this way.
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  Sounds like an absolute win win. And what
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  were some of your other goals, besides,
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  this? If you wanna say two more?
• 3:13
  Sure. So I I think the next one
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  that I'm really excited about, which is also
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  founded in
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  in my training as a spine surgeon, having
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  done both orthopedic and neurosurgical spine fellowships,
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  is creating a comprehensive
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  spine center at GW.
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  And what that means is merging both the
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  orthopedic and neurosurgery
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  spine departments.
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  I am fortunate that I have a great
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  relationship with the neurosurgeons here, and this is
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  really the future of spine surgery, especially at
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  many large academic centers in The United States
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  and around the world that employ this model.
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  And what that really means is that you
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  have orthopedic
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  and neurosurgeons
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  who are spine surgeons collaborating and working together
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  instead of being two separate departments.
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  You're working under the same department,
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  the Department of Spine Surgery, and a comprehensive
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  spine center isn't just about the surgeons. It's
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  also about everything else that we can offer
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  patients, whether that is pain management,
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  injections,
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  physical therapy.
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  These are other departments and other providers that
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  I work very closely with who take care
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  of my patients, and there's often multiple steps
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  that happen
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  before a patient even goes to surgery in
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  addition to patients
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  for whom surgery is not in their best
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  interest.
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  So it really makes sense to have all
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  of these offerings under the same roof and
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  in the same place.
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  At the same time, this promotes better patient
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  care,
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  better access, streamlining
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  of
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  appointments
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  of staffing,
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  and having everything in one place,
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  both figuratively, but also
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  in many cases under the same roof like
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  sharing clinic space. When you can walk down
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  the hallway and speak to one of your
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  colleagues about a mutual patient or come up
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  with a plan
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  or even see that same patient both in
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  the same
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  day or have their intervention done, whether that's
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  an injection, an ablation, etcetera,
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  and then go check-in and see how they're
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  doing. It's just
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  better involvement in your patient's care and and
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  can also contribute to better patient outcomes. So
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  that makes a a lot of sense. Mhmm.
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  Obviously, these things can take some time,
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  but I'm hopeful that that by the end
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  of this year, that that's another thing that
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  will be on our horizon and both
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  from a neurosurgery and an orthopedic standpoint here
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  at GW,
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  we both agree that that this is the
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  future,
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  and and we look forward to offering this
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  to our patients.
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  Yeah. Absolutely. No. I mean, I've heard from
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  a lot of other spine surgeons and orthopedic
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  surgeons about
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  the importance
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  of having more, interdisciplinary
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  multidisciplinary
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  collaborations.
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  Exactly. Yeah.
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  And so what are some other exciting things
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  going on with, the spine program out here?
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  Obviously, you mentioned this comprehensive spine center you're
• 5:49
  working on, endoscopy
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  spine surgery.
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  But what else is going on?
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  Yeah. I would say that probably the most
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  important thing is is creating the comprehensive spine
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  center.
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  We're also working on collaboration,
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  by educating other providers in our referral base.
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  So that's not just things that are very
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  spine adjacent like
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  pain management,
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  and spine surgeons in general, but this also
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  includes our primary
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  care physicians. This includes other disciplines like endocrinology
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  and rheumatology, people that we work with,
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  very closely as well or have common patients
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  with.
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  And right now, they're
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  in most cases for spine surgery, there's a
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  process by which patients are seen.
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  In many cases, you require six weeks of
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  physical therapy in order to get an MRI.
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  In other cases, we're looking to get patients
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  treated for things like osteoporosis.
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  We're looking to get,
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  before spinal fusions, for example.
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  And just looking to have patients worked up
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  by by other means for other medical conditions
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  to get optimized for surgery.
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  And so
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  really facilitating that communication,
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  educating other providers about how this process works
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  and how we can better take care of
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  our patients,
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  I would say is another thing that's on
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  my list of goals for the upcoming year,
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  but it is an exciting thing that's happening
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  at GW so that we can all work
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  on collaborating and taking better care of patients.
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  Yeah. And I'd love to also pick your
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  brain a bit on, the faculty
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  work you've been doing. What are some of
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  the most important,
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  lessons,
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  themes that you're instilling in,
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  residents, fellows, students, etcetera?
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  I think one of the most important
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  things is mentorship,
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  And that's something that you and I may
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  even have spoken about previously.
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  It's such an important thing
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  as a resident. Not that that was terribly
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  long ago for me, but as a resident,
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  when you think back to the people who
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  influenced your choice in the field you go
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  into and into your sub specialty.
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  And you you think about it like not
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  every orthopedic resident that comes to work with
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  me is gonna be a spine surgeon, but
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  there are people who want to be. So
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  whether I'm serving as a mentor,
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  for somebody who is interested in in the
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  field of spine surgery,
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  from someone from a research standpoint or academics,
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  a medical student who's trying to decide what
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  subspecialty they might want to go into, whether
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  that's orthopedics or not. This is one of
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  the reasons that I really enjoy being in
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  in academic side of things because I do
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  get to to mentor and teach and really
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  guide people and figure out,
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  from both a medical student and a resident
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  standpoint,
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  what makes them happy and what might provide
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  them with a fulfilling career.
• 8:29
  Absolutely.
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  And, you know, what are some of the
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  biggest headwinds you're bracing yourself for in 2026?
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  Yeah. I I would imagine that there are
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  a number of other spine surgeons who have
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  some of the same feelings,
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  on these issues, but one of the main
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  concerns for for me for the upcoming year
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  is really the continued challenges
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  that we have and whether or not insurance
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  companies are going to continue increasing things like
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  denials and peer to peers.
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  The the authorization
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  process, this is goes for imaging, but also
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  surgeries in general has just been incredibly time
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  consuming. It's challenging, and we really noticed a
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  drastic increase
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  in the peer to peers required not just
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  to get things like MRIs done,
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  but also for denials related to surgeries. And
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  a lot of these patients are really well
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  indicated,
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  and really suffering,
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  leading into their spine surgeries. And it's something
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  that we we fight for, and almost every
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  spine surgeon that I know is fighting for
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  on a daily basis.
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  So that's one of the challenges that we
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  kind of brace ourselves as the years progressed
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  for in the upcoming year, but we will
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  continue to fight it for our patients.
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  Yeah. Can you just kind of dive into
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  just kind of your strategy when it comes
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  to dealing with,
• 9:40
  insurers, these peer to peers?
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  I think that one of the most important
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  things, number one, is
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  just the foundation of this indicating your patients
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  well for surgery,
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  doing the right surgery for the right patient
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  at the right time,
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  as well as documenting. I mean, your documentation
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  supports your clinical decision making. You can look
• 10:00
  back at your note or your your office
• 10:03
  visits, and you can say, this is why
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  you know, this is what this patient's symptoms
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  were. This is, from an imaging standpoint, what
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  I believe the pathology is, and this is
• 10:09
  why these are the things that they've tried
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  and why I believe things
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  that they've tried and why I believe they're
• 10:14
  indicated for this specific surgery, and you can
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  demonstrate that that's your logical mode of thinking.
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  I think that's one of the most important
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  things,
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  as well as it being a medical legal
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  document. So I think
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  having really tight and strong indications as well
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  as documenting,
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  in the medical record appropriately
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  and providing very objective evidence for for what
• 10:36
  has been done and why you are recommending
• 10:38
  this are probably the most important things going
• 10:40
  in because then you have a leg to
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  stand on.
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  Yeah. So, like, really having that paper trail
• 10:45
  to back you up. Exactly. Yeah. Yeah. And
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  then, doctor Protesco, the last question I had
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  for you is, how else are you thinking
• 10:52
  about growth in your practice? I know you
• 10:54
  touched on wanting to, you know, expand their
• 10:56
  endoscopy
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  work. But, you know, what are some other
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  areas of growth that you're envisioning?
• 11:02
  Yeah. I think on on the along the
• 11:04
  lines of incorporating less invasive options for patients,
• 11:08
  which we touched on already,
• 11:09
  another thing that is very exciting as far
• 11:12
  as spine surgery goes is the incorporation of
• 11:14
  advanced technology.
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  So these are things like not only robotics,
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  in in navigation, which I use very frequently,
• 11:22
  but,
• 11:23
  additional things in the pipeline like augmented reality.
• 11:26
  I I mean, the the goal is to
• 11:28
  be able to
• 11:29
  do a less invasive spine surgery
• 11:32
  through a microscope
• 11:34
  where you can see an overlay of the
• 11:36
  pathology without actually looking
• 11:38
  at it. Right? There are companies here that
• 11:40
  are working on these technologies and so these
• 11:43
  are these are things that other companies I'm
• 11:45
  talking to, things we're exploring,
• 11:48
  and we're always looking for ways. The bottom
• 11:50
  line is not just that these things are
• 11:51
  cool and exciting, but we are looking for
• 11:53
  ways to make surgery
• 11:55
  safer and incorporate them into our workflow and
• 11:58
  our practice
• 11:59
  so that we can take care of patients
• 12:00
  better and for them to have better outcomes.
• 12:02
  That's the goal. Yeah. And then I just
• 12:04
  had a quick follow-up. I mean, obviously, without,
• 12:06
  like, naming names, but are there any any
• 12:09
  particular,
• 12:10
  types of spine technologies that you think will
• 12:13
  really soar, really develop in the next twelve
• 12:16
  months?
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  I think in in terms of what I
• 12:20
  know is available and what I know is
• 12:22
  out there,
• 12:23
  there
• 12:25
  are navigation systems
• 12:27
  that are
• 12:28
  vendor agnostic, meaning you can use any implants
• 12:31
  that that you would like from any company
• 12:34
  in addition to having
• 12:36
  the accuracy
• 12:38
  that is incredible. Right? So what that means
• 12:40
  is
• 12:41
  submillimeter
• 12:42
  accuracy when you're placing a screw in the
• 12:44
  pedicle of the spine when you're doing a
• 12:46
  spinal fusion, for example, that's very close to
• 12:48
  the nerves or the spinal canal. I mean,
• 12:50
  these are things that are real and that
• 12:52
  are out there and that are gaining in
• 12:54
  popularity.
• 12:55
  So I I wouldn't be surprised, especially
• 12:57
  at the rate that this type of technology
• 13:00
  is developing and being utilized,
• 13:03
  that it doesn't come to a head and
• 13:04
  become even more popular in the next year.
• 13:06
  Yeah. So it sounds like that versatility is
• 13:08
  probably just especially important, I imagine, for,
• 13:11
  spine surgeons.
• 13:13
  Yeah. Well, doctor Portescu, thank you again for
• 13:15
  joining us on today's podcast. I hope you
• 13:17
  enjoy the rest of your evening, and I
• 13:19
  look forward to connecting again in the future.
• 13:21
  Yeah. Likewise. Thank you so much for having
• 13:23
  me. It's been great.