At miiSpine, we’re determined to redefine what it means to be a spine surgeon and the stereotypes that follow spine surgery around. Our approach deviates from the traditional path of surgery to pain doctors, or pain doctors to more pain doctors to surgery and so on and so forth. We pride ourselves on the hybridity of our services – on a comprehensive answer to your back pain, not just a step in the direction of relief.
How Are Spine Surgeons and Pain Doctors Different?
Now, all spine surgeons complete either a neurosurgery or an orthopedic residency, followed by a one-year fellowship in spine surgery. This means that after four years of medical school, it takes another 6-8 years to be a spine surgeon. In the residency years, aspiring spine surgeons learn all aspects of orthopedics or neurosurgery - including spine – and then, in the one-year fellowship, they hone their skills, focusing only on spine surgery.
Pain doctors, alternatively, are almost always trained in anesthesia (although some are trained in Physical Medicine and Rehabilitation).They complete an intern year, usually in general surgery, followed by three years of anesthesia. After a one-year pain fellowship, where they learn about spinal injections, amongst other things, they begin practice. But in the scheme of things, very little of their 5 years of clinical training is spent diagnosing and treating spine patients. This is why it’s always important to see a specialist first, when it comes to back pain – treating the problem early at the source instead of putting a band aid over the pain can save you a lot oftime, pain, and money in the long-run.
The traditional practice in the US includes spine doctors and pain doctors referring patients to each other – except, the referrals tend to skew one way, with more patients ending up at the practices of pain doctors without consulting a spine specialist. A big reason, I believe, is that the majority of patients are avoiding surgery. This is quite understandable, especially given how many misconceptions about spine surgery exist.
The problem is, though, that pain doctors may not be able to treat back pain effectively, especially if the problem lies deeper than just muscle or superficial pain. There is always a risk of over-prescribing injections and medications when they are ineffective or only effective for a short period of time before the pain returns. Sometimes, a surgery or a non-operative approach conducted by a spine specialist is the better, safer way to go.
In a New York Times article from 2018, the rise of interventional pain injections with the opioid epidemic is exposed in this excerpt:
“The victims of our era of aggressive opioid prescribing are being exploited in some cases by interventional pain doctors, who will continue them on opioids in exchange for allowing them to perform expensive procedures that they don’t need,” said Dr. Kolodny, who is also executive director of Physicians for Responsible Opioid Prescribing. "These are not benign procedures. Patients can be harmed and are harmed.” - NYT 2018
There is a huge cost to all this treatment at a time when healthcare costs are in crisis more than ever. The US spends 20% of its GDP on healthcare, which is far and above our rivals, but with no better or worse clinical outcomes.
A Hybrid Spine Surgeon is comfortable, practiced, and licensed to perform interventional spinal injections as well as spine surgery. With a vast knowledge from countless hours operating on spines, Hybrid Spine Surgeons have the added benefit of knowing the the anatomy of the spine much better than pain doctors. Years of seeing and treating patients, of training, and experience with musculoskeletal and spinal conditions make Hybrid Spine Surgeons better diagnosticians when it comes to back pain than a general pain doctor.
What If You Don't Want Surgery?
There will always be bias and negative connotation surrounding anything to do with the spine, as it is an essential part of the body, and bias is human nature. It’s natural to choose what you know over the unknown. If the only tool in your tool box is a hammer, then everything looks like a nail. In the same way, if the only tool you’ve been told is in your tool box is a needle, then every solution looks like an injection. Hybrid Spine Surgeons possess a Craftsman toolbox of needles, kerrisons, ronguers, Cobbs, drills, and other tools besides injection that can safely relieve your pain.
While it is impossible to eliminate bias, Hybrid Spine Surgeons have more options to offer to those who suffer from back pain. Instead of wasting time, resources, and creating additional opportunities for continued pain later, Hybrid Spine Surgeons utilize injections only if they are effective and, if appropriate, can recommend a surgical or potential non-invasive option if the injection’s effectiveness declines. Of course, Hybrid Spine Surgeons will also always encourage spine wellness through diet, exercise, mindfulness, and medications, just like any doctor should before medical action is taken.
There is still a need for pain doctors, however – they’re not devoid of purpose in the medical world. They serve an incredibly important role, treating cancer patients and other chronic pain sufferers, and their expertise regarding pain devices like Spinal Cord Stimulators and Pain Pumps help plenty of people managing chronic pain.
But with healthcare costs rising and improvements in backpain still stagnant and not improving, we can do better. Of all healthcare expenditures in the US, spine care is third, behind diabetes and ischemic heart disease. And at miiSpine, we’re tackling the soaring costs of healthcare as well as he stereotypes surrounding back pain and spinal dysfunctions.
In their book, Big Med, authors David Dranove (Economist at Northwestern University) and Lawton R. Burns (Professor of Healthcare Management at Wharton) chronicle the failure of “Megaproviders”(or “Big Hospital”) to rein in the cost of healthcare. The failure of the legal mechanism to break up these monopolies has caused costs to skyrocket, even after Big Hospital held the promise of lowering costs through vertical integration, which has also failed. As they point out in the book:
“Doctors make decisions that affect roughly 80 to 85 percent of every dollar spent. The most expensive medical technology is not drugs or magnetic resonance imaging(MRI); it is the physician’s pen.”
Nearly 70% of all US doctors are employed by hospitals or corporations; it’s no wonder costs are out of control. The difference in costs at a hospital compared to a private clinic are staggering.
Take an MRI scan, for example, which in Louisville, runs at $450at a private imaging center compared to $1500 at a local hospital. How does this happen? Big Hospital controls the market and the doctors – that’s how.
So how do miiSpine and Hybrid Spine Surgeons save healthcare dollars?
By integrating the pain interventional with spine surgeon, Hybrid Spine Surgeons (and miiSpine) eliminate unnecessary and costly procedures. If the doctor’s pen is the biggest contributor to healthcare spending, then we cut costs by 50% by consolidating two doctors into one. We provide a lower-cost, higher-quality option for spine care. From our Pain Suite to our Ambulatory Surgery Center, our full gamut of spine procedures and surgeries come in at a fraction of Big Hospital’s cost, and with all the pain resolution, as well.
If you are experiencing back or neck pain and are concerned that you may be suffering from a medical condition, you may benefit from finding an innovative spine physician. Dr. Venu Vemuri at miiSpine is an award-winning doctor focused on providing a comprehensive treatment approach towards all types of back conditions and pain. For additional information or to schedule an appointment, call the Louisville, Kentucky miiSpine office today at: (502) 242-6370.