Bright Board Blog

Bright Board Blog

How we got here

Author: Allen L. Carl, MD
Sunday, July 30, 2017

We are all engaged in improving spinal health. There are those of us who do this with invasive means and others with less invasive means. Each of us has decided upon strengths and weaknesses of our selection by how we act in delivering our care. The overall complexity of the problem leads to a daunting task. Societal issues, genetics, experiences as well as perceived understanding of the problem makes this an issue that can be addressed with a spectrum of alternatives.

In order to be a part of this spine care community we need to meet expectations that have been drawn by our colleagues that have come before us. This makes for an interesting selection process.

Focusing on just surgeons is a small part of the whole process but it is the group I have selected to attach myself to and have met the criteria that allows me join just as you have. Secondary gain plays a role in everything but is seen as less altruistic when that gain is more focused on a more tangible and variable goal such as economic reimbursement.

Entering the care delivery process requires an acceptance after a certain appeal has attracted us to that specific area of medicine. As goal oriented people we focus on the end result and plot a course. There are multiple paths that can be taken and due to our varied personalities and varied experiences this course may vary.

Once we get credentialed then we seek a position to deliver the skills we have attained. The majority of us have gone into a practice situation that allows great autonomy because those are the values that have been instilled in us and which we have gravitated towards. Others may have selected a less autonomous option in an academic or university setting. There are many reasons to select one or the other.

Our education has directed us to be independent thinkers but we are guided by our mentors. This occasionally makes our relationships in our work community more challenging due to this independence. As a group, we look up to our colleagues who have strived to understand and improve on what we do usually on the basis of our observations and experience.

This process has changed as our discipline has matured and as the economic rewards have changed. The presence of industry to supply us the technology we develop has evolved into a marketing and business process now mostly controlled by the business entities. Originally, the physicians of the past suggested keeping an arms length from industry. Recounting the history, the revolutionary ideas were developed by out of the box thinkers and typically did not find an eager industry partner.

The evolutionary ideas were more closely considered by industry and as the companies and treatment alternatives matured they were the ones directing the development process. This prompted those companies to maximize their exposure by identifying and fostering those doctors who came forth as consensus leaders. This also gave way to scientific advisors who would have a direct hand in contributing their input and experience in a technology development for their industry associate. The successful endeavors resulted in economic reward and patient success typiclally recorded in journals and presented at meetings.

Many times the consensus leaders and scientific advisors may not be the new technology developers.  This makes for a disconnect in the chain of new technology evolution. In the past when the clinicians were comfortable with their reimbursement process, they were not noting concern with industry.

As the landscape has changed and continues to change, this relationship is now moving in a different direction for doctors and alternative ways will evolve based on the yet to be found opportunities possible now with advances in information technology. We need to empower the technology developers with the tools to move their ideas forward independently so that control of their ideas continue with them and get input from others directly involved in the field who are deaing with the same problems and issues.

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