Name of Practice: University of North Carolina (UNC) Staff structure
UNC Spine Center is a multidisciplinary, hospital-based clinic that is open five days a week. The clinic cares for patients with all types of spinal diseases, from low back pain to spinal cord injuries. We have one fellowship-trained neurosurgeon and one fellowship-trained orthopaedic surgeon, four physiatrists, two anesthesia pain specialists, one rheumatologist, one neuro-psychologist, one nurse practitioner and one physical therapist on staff, all of whom see patients within the Spine Center clinic. Practice philosophy
We practice evidence-based medicine with an emphasis on patient education. We have an extremely conservative approach to the surgical management of back pain and assume responsibility for all patients referred to us for the management of spinal disorders. We attempt to see patients collaboratively and provide “one-stop shopping” for patients with spinal disease.
Standing apart from the rest Our clinic is unique in that we employ disease management models for distinct diagnoses of the spine. We use clinical pathways and monitor our success with outcome measures. More important, we provide education to outlying facilities utilizing the AHEC system. We also have a community-based THINK FIRST prevention program that is implemented from the Spine Center, and are developing a cognitive behavioral program for patients with acute back pain. Most innovative back office management solution
We have organized a template that allows physicians of different disciplines to see patients collaboratively and efficiently. We also have cross-trained our staff so that our front desk staff and nurses aides can substitute for each other, resulting in an efficient staffing model.
Most innovative approach to managing external relationships
We use the telephone. A personal conversation often is critical to getting things done quickly and efficiently. When a neurosurgeon picks up the phone and makes a call, constructive things usually happen. A neurosurgeon can accomplish in minutes what often takes an employee hours or days to get done. We try to use our office time in the most efficient manner. Neurosurgeons need to see patients in the office. Occasionally, however, they need to advocate for a patient or for their practice. The phone works wonders. Biggest investment in the practice in recent years
We recently converted to a five-day-a-week Spine Center clinic with walk-in capability. This represented a substantial institutional commitment. This model is relatively unique within academic medicine and represents a commitment by the physicians to the maintenance of this multidisciplinary clinic, which opened in May of 1995. It also represents a collegial and collaborative approach to patients with spinal disease that allows for better patient integration within the academic health system.
Advice for neurosurgeons starting their own practice
In today’s environment of declining reimbursement there exits a need to increase volume to maintain clinical income. This means that we have to be more efficient in our management of the patients that we service, both from the standpoint of clinical evaluation and diagnosis, as well as surgical outcomes. Disease management and subspecialization, specifically for spinal disease, is a necessity. Having a multidisciplinary approach with colleagues who can help you manage the non-operative component of the spectrum of disease that you see is essential. One must also be open to the challenges posed by third-party payers and government regulations. By providing good quality, cost-effective care, you can remain competitive in the marketplace and provide a service to the patient population.
Future advances in neurosurgery
Neurosurgery will be technology driven, both in the clinical setting for data collection and in patient education. New advances will occur in operating rooms with the emergence of new techniques for instrumentation and bony fusion. Patient’s health status and long-term outcomes from both operative and non-operative treatments for spinal disease are necessary and hopefully will be done by spine surgeons in the future.
Closing thoughts
My partners and I respect and admire each other. We work hard and we share profits equally. We are very happy to be practicing in Oklahoma City.
This is the first in a series of profiles that highlight an AANS member and his or her innovative practice-building techniques.
Location:University of North Carolina (Chapel Hill Campus)
President: Stanley Pelofsky, MD
Number of neurosurgeons: 5
Other physicians: 885 attending physicians and 545 resident physicians
Number of Patients Served each week: 200
Number of medical centers served: One with 684 hospital beds