Ask any healthcare professional, and they’ll tell you it’s getting harder to make a living in medicine. Corporate consolidation, post-pandemic burnout, a shortage of nurses—some of whom are going on strike—and hospitals that face unprecedented losses are just a few of the challenges.
At the same time, Americans spend more on healthcare than any other industrialized country, but our health outcomes are dismal compared to almost any other modern nation.
Despite the current climate, Seattle Dr. Venu Nemani is not just surviving; he’s thriving as a renowned spine surgeon, researcher, and teacher. He says the keys to success are to follow your heart, partner with the right people, and never forget why you chose medicine in the first place.
Resources from the episode:
- Learn more about Dr. Nemani and his work here.
- Watch Dr. Nemani and fellow orthopedic spine surgeon Dr. Louie on their YouTube channel, The Athlete Spine. These two spine surgeons LOVE sports. In each episode, they present spine injuries or surgeries in professional (and amateur) sports, and describe the injury, anatomy, and treatments to a general audience in just a few short minutes.
- Connect with Dr. Nemani on LinkedIn.
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Transcript
The following transcript is not certified. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors. The information contained within this document is for general information purposes only.
Speakers: Dr. Venu Nemani, Mark Wright
DR. VENU NEMANI 00:00
All of these things are, are integral to my job and none of them feel like work. I often say, especially doing surgery, I would do surgery for free. You know, I, I, I love what I do. It’s, it’s amazing what I do. Um, some of the, uh, you know, dealing with insurance companies, I think that part certainly feels like working.
MARK WRIGHT 00:22
Oh, you too?
Dr. Venu Nenami 00:22
I can skip that part of my job.
MARK WRIGHT 00:26
This is the BEATS WORKING show. We’re on a mission to redeem work – the word, the place, and the way. I’m your host, Mark Wright. Join us at winning the Game of Work.
MARK WRIGHT 00:40
Welcome to BEATS WORKING. I’m Mark Wright. Ask any healthcare professional and they’ll tell you it’s getting harder to make a living in medicine. Corporate consolidation, post-pandemic burnout, a shortage of nurses, some of whom are going on strike, and hospitals that face unprecedented losses are just a few of the challenges. At the same time, Americans spend more on healthcare than any other industrialized country, but our health outcomes are dismal compared to almost any modern nation. Despite the challenges, my guest today is not only surviving, but thriving in medicine. As a renowned spine surgeon, researcher, and teacher, Virginia Mason doctor Venu Nemani says the keys to success today are following your heart, partnering with the right people, and never forgetting why you chose medicine in the first place. By the way, we also talk about what you can do to avoid back surgery, and some of it’s really simple. And we also talk about Dr. Nemani’s research to study golf-related back injuries, and since he’s a golfer and so am I, yeah, we had to go there. I hope you enjoy our conversation.
MARK WRIGHT 01:52
Dr. Venu Nomani, thanks for joining us on Beats Working. It’s great to have you here.
DR. VENU NEMANI 01:56
Yeah, thanks so much for having me, Mark. I really, uh, I’m really excited for the opportunity to be on this, uh, with you.
MARK WRIGHT 02:02
So, as a reporter, one of my jobs on the podcast is to do a deep dive and find out as much information as I can about our guests and the more that I started digging into your background, oh my goodness, the more I was impressed with your career and the surgical team that you work with. For people who don’t know who you are, give us a, a brief background of your expertise as a doctor.
DR. VENU NEMANI 02:24
Sure. So, I am a cervical spine and scoliosis and spinal deformity surgeon at Virginia Medicine Medical Center in Seattle, Washington. And, uh, while I’m, I’m trained as a spine surgeon and I take care of essentially all disorders related to, to the spine from the skull all the way down to the pelvis, uh, I have a particular interest in expertise in problems related to the cervical spine. So that’s the, basically between the skull and the bottom of your neck, uh, as well as, uh, problems involving spinal malalignment and, uh, lumped into a category, not a spinal deformity. So, the most common one that people know of is something called scoliosis. Uh, but any malalignment of the spine, uh, from the cervical spine down to the pelvis are, are, is a problem that I, uh, that I deal with.
MARK WRIGHT 03:12
So, we’re gonna get into your expertise, uh, on that end in just a little bit. But I wanna go back and talk about your childhood. Were you one of those kids who knew like, from six years old, I wanted to be this when I grow up? Or how did you, how did you end up getting into medicine?
DR. VENU NEMANI 03:26
Yeah, so, I wasn’t really that way. You know, there was no one else that was, uh, a physician in my family at the time, and I, um, liked science. I liked math. Uh, I grew up in Indiana. I liked, I liked, uh, college basketball and so, so for me, and, and my father was an engineer, actually, a mechanical engineer. And so, I was fairly mechanical growing up and I, I went to Duke University for college, and I was an engineering major and I realized within my first couple of years of, of college that engineering itself, at least what I was studying at the time, which was biomedical engineering, uh, uh, and, and a lot of electrical engineering, wasn’t really for me. And I started spending time in a lab and I actually had a lot of interest in, in research and I spent a lot of time with a, a pharmacologist doing biochemistry projects and things like that. But what I didn’t like about the lab was the immense lag time it took to kind of, reach and help people. And so, then I started spending some time in a hospital and shadowing some doctors and I realized that, that the, that that I liked interacting with patients and seeing patients. Um, I had a, uh, unfortunately a traumatic episode. Uh, my, my close friend from high school was in a skiing accident when I was a sophomore in college, and he became paralyzed, basically from the chest down, from that incident. And that, in addition to my experience in the lab, was what spurred me into a career in academic medicine where I not only take care of patients, but, but do research as well.
MARK WRIGHT 05:01
So, what, when was that? Because I remember, just distinctly, when actor Christopher Reeve was paralyzed from the neck down in a horse-riding accident and it must have been ‘95. Tell, tell me more about what happened to your friend and, and that really did spur you, didn’t it, to, to become what you are today?
DR. VENU NEMANI 05:18
Yeah, I actually remember exactly where I was when I, when I learned about that, I was sitting in my hallway my junior year of college and um, I remember getting a phone call from my friend’s family saying that, that he was in a skiing accident, and he was an excellent skier, and he just went off a jump, which he had done countless times before and landed wrong. And he essentially, uh, had a fractured dislocation of his thoracic spine and he was taken to a hospital and had emergency surgery to realign and stabilize his spine. But the problem with the spinal cord itself is that it has a limited capacity to heal. And so, although the surgeons could realign the bones of his spine, his spinal cord itself never regained function, and, and thus he remains, uh, paraplegic. And that was one of those seminal moments in my life where, uh, I, I, I one, uh, you know, realized that this is a problem that would be amazing if we could solve it, uh, in, in, in our lifetimes and if I could play some part, and two, being just amazed at the surgeons that were able to have the technical skill and ability to, to take my friend’s spine and put it back together. So those two things deeply affected me.
MARK WRIGHT 06:33
So, I understand that you got your PhD and your MD at the same time. I’m curious about that. I’m thinking, come on, man. Isn’t just becoming a doctor hard enough?
Dr. VENU NEMANI 06:46
Well, part, part of it is that I just couldn’t make up my mind, you know? So, so I was in college. I knew I liked research. I knew I liked medicine. And, and usually you kind of pick one of those to, to move forward with. And, and I found out about these things, uh, that were combined MD and PhD programs that allowed you to, to do both degrees, albeit in a little bit of a longer time than either one (each) would take. But, uh, yeah, so I spent eight years and, and I did both, and I, I, you know, went to medical school and then I also got a PhD in molecular neuroscience.
MARK WRIGHT 07:18
Oh my gosh. So, you’ve, you’ve got, you’re very steeped in, in research as well as the, uh, the practical side of treating patients, right?
DR. VENU NEMANI 07:25
Well, I like, I like to call it, you know, that I did the remedial track through medical school where it took me eight years instead of four, you know, for everyone else.
MARK WRIGHT 07:32
So, so I want to get back to, um, you know, actor Christopher Reeve, and you know, that was, that was uh, something that really, I think, opened a lot of people’s eyes to, to what spinal cord injuries were and just how kind of depressing it was back in the day. I mean, he was paralyzed in ‘95 and I think he lived for another nine years after that with the help of a ventilator. But take, take me back to that time, like, so from the nineties until today, have we seen a lot of, of growth in, in, in terms of understanding these injuries and treating them?
DR. VENU NEMANI 08:25
You know, I, I wish I could answer that we have advanced a lot, but the fact of the matter is that we actually haven’t, you know? I think that if you were to have today a similar spinal cord injury, uh, or a complete spinal cord injury involving either the cervical or thoracic spinal cord, your outcome today is fairly similar to what it would’ve been in 1995. What we have gotten better at, from a surgical perspective, is we have really, really good instrumentation to be able to realign the spine and to stabilize the spine, but the limited capacity of us to, to actually allow the neurons to regenerate the connections that have been severed as a result of a traumatic episode have not yet gotten there. And it’s the same thing with stroke care, for that matter. You know, uh, strokes are also something that affect the central nervous system, in this case, the brain. And while our EMS system has gotten better at getting patients to the hospital quickly, and in the case of stroke, having timely care to getting blood flowing back to the brain, what we have not developed an ability to do yet is to kind of regenerate brain cells or to regenerate spinal cord cells. And this is something that’s an active area of investigation all around the world to try to figure out strategies to actually do this.
MARK WRIGHT 09:24
Yeah, is that still just a big mystery? I mean, it seems like so many other cells in the body had the ability to regenerate, but when you talk about the central nervous system, it, it’s not the same thing. Um is, is that still a medical mystery?
DR. VENU NEMANI 09:36
It’s, um, it, it, it is in the sense, you know, and I, and I think it is a problem that will be solved, perhaps not in our lifetimes, but perhaps, you know, I, I think certainly in the next, in the next century. And it’s just a matter of figuring out a way to turn back the clock, so to speak, and to utilize, you know, stem cells or some other type of cell that has the ability to regenerate into a neuron and the other types of cells that are present in the brain and central nervous system. And to figure out the precise signals to get those neurons to form the right connections to other neurons and to muscles, and that will allow the, the signals to get from brain to limbs again. So, uh, I’m, I’m certainly hopeful that that’s going to happen. That was something that I, uh, originally wanted to study during my PhD, uh, right after I decided that I wanted to go to medical school and go to UCSF, which is where I did, uh, my, my training. The, the person that I wanted to study with ended up leaving the university to, to go do something else. And so I, my, my, my career path and research path kind of shifted at that point.
MARK WRIGHT 10:41
So, give me an idea of what a typical patient is for you today. I know you work with a team of, of doctors at Virginia Mason, and it sounds like that team is really necessary to work together on these super complicated cases.
DR. VENU NEMANI 10:55
Yeah, so like I said, I take care of, uh, both cervical spine problems, uh, and scoliosis or spinal deformity, but I also see the gamut of spine problems, um, specifically for the spinal deformity population. These are people that often have had multiple prior operations done over the course of many years, typically, and in some cases, they had well done operations that they’ve just had continued disease, or they had smaller operations in the hopes that that would be enough to try to avoid a bigger surgery. But in some cases, we actually see people who have had very badly done operations, that have created new problems that then we have to undo and fix. And often these patients, um, uh, we see patients from all over the country really, uh, that, that come to see us for these types of issues. And they are often from places where there’s not good access to primary care or they have, uh, doctors that are just prescribing them opioid medications and so they’re on high-dose narcotics. And these all create very difficult challenges for us when we have to do a spinal reconstruction. So, we see, um, uh, we see patients that really need the care and expertise of not only surgeons, but also, uh, uh, pain specialists from physical therapists, uh, anesthesiologists, um, uh, psychologists. And these were all people that we utilize in a team manner and, and team-based approach to try to help these patients and figure out a strategy to get them to surgery safely. And, and sometimes the answer is actually no surgery. Sometimes someone has pain that doesn’t have, that doesn’t have a structural correlate, in which case we work very closely with our non-operative spinal specialists, or physiatrists to, to take care of these patients effectively. Cause ultimately our goal is to help someone have improved pain control, improved function, with the least risk possible, and sometimes that means no operation at all.
MARK WRIGHT 12:53
So when, when you say that these are really complicated surgeries, give us an idea of somebody who knows nothing about medicine. Like, what does that mean, like, when you say complicated? Because you know, I did surgeon for a day up at one of the hospitals and, and I got on one of those robotic, um, machines where you can put in sutures with robotic hands. And I was trying to just put a suture into a pig valve, uh, and it was impossible. And I’m thinking, how in the world do people like you do that? So, so tell, I mean, I, I’m blown away at the dexterity that you must have to have developed over the years, but when you say complicated, what does that mean?
DR. VENU NEMANI 13:33
So, specifically for spinal deformity surgery, a lot of our operations, uh, involve basically placing instrumentation into a spine, and these are fixation points. Essentially, we’re trying to get a grip on the different spinal bones, and then we have to fix a malalignment, and so we use the screws to move the bones to a location that’s a more optimal alignment for the patient. Now, sometimes the bones are fixed in position, much like, if your arm was broken and healed crooked. You can’t just put a plate and screws on it and expect it to move, you have to actually loosen the bones up or cut the bone to realign it, to put it back into a better position, and so, our operations involve a combination of placing spinal instrumentation. Those, uh, those screws that we place in the bones, uh, usually they go into bone channels that are no more than, anywhere between three and eight millimeters in size, and so, um, if you miss to one side, you hit the spinal cord and you cause paraplegia. If you miss another way, you might, uh, injure a large blood vessel such as the aorta or the vena cava. And so certainly, uh, with training, this becomes fairly routine to do this, uh, safely. And we have some technology that can, uh, help us in certain situations, uh, increase our accuracy of doing that. Also, it involves, like I said, cutting bone in particular locations to increase the mobility, and also it’s a decompressed nerve. Sometimes arthritis or the malalignment of the spine itself can cause pressure on nerves that can cause either a spinal cord problem or, or a nerve problem that can cause pain, numbness, tingling down a leg or both legs. And so these are all the things that we do to, to realign the spine and to help people have less pain and more function.
MARK WRIGHT 15:17
I’m guessing when people come into your office and you, do you ever mention the story about your friend in college who was paralyzed?
DR. VENU NEMANI 15:23
I do, actually. Yeah. Yeah, you know, cause I, it’s, it’s a question we commonly get. Um, you know, I, I think I’m blessed to be in a field where, sometimes people come in and they’ve had multiple operations and they finally have relief after a corrective procedure, and they ask, gosh, you know, you’re, you’re lucky to be able to do what you do and help people. How’d you get into this in the first place? You know, I always come back to my, my friend because that really was the first introduction that I ever had to spinal surgery at all. And, and, uh, so, so it is a blessing to be able to do what I do and, and to relay that story.
MARK WRIGHT 15:58
And I’ll tell you just from a patient standpoint, my, when my wife was diagnosed with breast cancer about four years ago, we walked into, uh, Seattle Cancer Care Alliance, and, uh, her oncologist, you know, our first meeting he said, you know, why I got into this field is my, my grandmother died from, from breast cancer. And he said, “I vowed to do everything I can to try to, to save people.” And I, I just thought, oh my gosh, this guy has got skin in the game. And I’m glad that you share that story with, with patients because, uh, you know, my wife is fine now and, and just I’m, I’m so grateful for that. But I, I’m so inspired by people who go into medicine for reasons like you have, because it just, it just means so much more for patients when we know how much you care.
DR. VENU NEMANI 16:45
Yeah, certainly, you know, I’m, I’m, I’m happy at least, uh, knock on wood, so far, I myself have not had to deal with a spinal issue or needed spinal surgery. But it is, uh, uh, you know, I, I think that patients can relate when they know that you have had some personal experience with some of the issues that they may be dealing with.
MARK WRIGHT 17:03
As I dug into your background, I was pleasantly surprised that you are a golfer. Um, and you’ve written something like 50 publications, uh, articles, whatnot, scientific articles, but the one that caught my eye had to do with golfing and, uh, golf related spinal injuries and I’d love for you to talk about that cause I’ve followed golf for years and people like Freddy Couples and, and other golfers on the pro golfers tour, some of them really suffer from just really terrible back problems. But I’d love to know what, what prompted you to, to study golf-related spine injuries and, and how to treat them.
DR. VENU NEMANI 17:42
Yeah, so golf is a big passion of mine. You know, I played, I played in high school, and I continue to play when I can, and my seven-year-old daughter is just starting to play, and so I’m, I’m hoping selfishly that she picks up the game because that means that I get to play more golf. And so, it’s, uh, it, it’s a great thing. But, um, you know, golf is certainly, uh, an activity, like you said, that, that can create a lot of spinal problems. And the force that’s generated from a, from a tour professional’s golf swing is similar to that of a football lineman hitting a blocking sled. And, and so that’s actually been studied. So, the amount of force that’s generated on the lumbar disc, uh, is, is tremendous, you know, and, and, and we’ll see that on display here this week at the Masters. You know, uh, the, the tremendous clubhead speeds, uh, you know, upwards of 120 miles an hour that tour pros generate. And, and so, You know, with, with just the number of injuries that happen and, and no one’s more famous than Tiger Woods who has had multiple spinal operations, including a spinal fusion surgery. And, and so the idea, you know, uh, with me and also one of my, uh, uh, partners here, uh, Dr. Phil Louie, uh, is, is, you know, there really has not been a whole lot of research into understanding the, uh, biomechanics of the golf swing as it relates to the spine. Um, and, and how do we actually rehab people back to playing golf if they’ve had a spinal problem? Um, a lot of it is kind of expert opinion, but, but understanding how the biomechanics of the swing change after you’ve had spinal operation or especially a spinal fusion, and can we somehow understand, uh, uh, or by better understanding that can we do a better job rehabbing golfers back to, to playing their sport? Um, as any golfer knows, you know, as soon as you, uh, um, you know, get done with whatever procedure you need, your first question is, when can I get back to playing? And we don’t have great answers as of yet. And so, our hope through some of this research is to better understand that, to give better guidance to our, our, um, uh, golfers that we see as patients.
MARK WRIGHT 19:43
I think probably everyone listening to this podcast probably knows someone who may have had back surgery specifically, um, you know, the fusion surgery. Uh, help us understand exactly what that is and why you have to get to the point of fusing two, two of the vertebra.
DR. VENU NEMANI 20:00
Sure. So, thankfully most spine surgery doesn’t involve a fusion, actually, you know, and so the good news is that most people, the most common surgery is something where you just have a pinched nerve caused by a disc herniation. You can take it out, usually does not need a fusion. There are really only a, a few reasons why someone would need a spinal fusion. And what a spinal fusion is, is joining two bones in the lower back that aren’t meant to be separate, but to, to put them together surgically so that they grow together into one bone. Much like if you were to have a broken arm, a surgeon might put a plate and screws across the fracture to get the bones to unite, but ultimately the bones need to unite. And so, what a spinal fusion is, is putting an instrumentation to link two or more bones together with the hopes that they will eventually surgically grow together to form one bone. Um, spinal fusions importantly, except for very particular instances, are not really done for back pain, actually. Um, now if they’re for a spinal malalignment or a spinal deformity, uh, like the, what we’ve been talking about previously, then a spinal fusion can be beneficial to help back pain. But actually, the most common reason why we do a spinal fusion is for some instability in the lower back, which can often cause pressure on the nerves, which causes leg pain. And pinching of the nerves with some spinal instability is the most common reason why we would do a spinal fusion procedure. And the main goal of that surgery is to relieve pain traveling down a leg from a pinched nerve. There are some other reasons why we would do a spinal fusion. Um, like I mentioned, spinal deformity or malalignment. Also, if someone were to have a spine tumor that was eroding their spine, um, you know, causing instability, we might do a fusion. Um, uh, but, but typically the reasons are instability from arthritic change, that’s pinching a nerve, is the main reason, most common reason why we would do a spinal fusion procedure.
MARK WRIGHT 21:57
When we talked a few weeks ago, you said something that kind of shocked me and I hope, I hope I heard it right. You said that about half of all spine surgeries may be unnecessary. Did I, did I hear that right?
DR. VENU NEMANI 22:12
Yeah, yeah. So, if you, if you think about the number of people in the United States and around the world that have back problems, it’s, it’s immense, you know? In fact, you know, over 80% of the population will have some issue with their back over the course of their lives. So, it’s, it’s pretty much ubiquitous. Now, uh, the vast majority of spinal problems don’t need an operation. They can be very effectively treated with, you know, regular exercise, stretching, physical therapy, medications, or injections. However, if you are a spine surgeon and you are the only one in your area treating a problem and someone comes to you with a problem, you’re going to look at that problem through the lens of surgery. How can I fix this using an operation? Whereas, there may be other ways to treat that problem – the methods that I, that I mentioned that don’t require an operation – and might be as effective to treat that person’s problem and without the risk of an operation. And, and so there was a study that was performed at my institution. I wasn’t, um, uh, here when that, that study happened, that looked at all patients being referred here, uh, by, by a, uh, a particular insurer. And what we found was, and these were all patients that had been recommended to have surgery by another surgeon elsewhere, and what we found was that over 50% of these patients, when reviewed by a multidisciplinary panel here, including surgeons, physical medicine and rehabilitation doctors and pain management specialists, that, that over half did not need an operation and would benefit from some other type of conservative care, whether that was weight loss or physical therapy, or medication adjustment, or injections. And, and, and would’ve done better with that rather than having an operation. Which is a little bit sobering for our own specialty, honestly.
MARK WRIGHT 24:13
Boy, it really is. And when you think that, you know, insurance companies have gotten really good over the years at not spending money where they don’t have to spend money, you’d think that insurance companies would maybe look a little deeper into this to try to figure out how we get those people out of the, the surgery pipeline and maybe into some of these other modalities, right?
DR. VENU NEMANI 24:34
Yeah. Well, I think the, you know, the, the ultimate issue in, in American healthcare is that, uh, most physicians, um, and hospitals are still paid on a fee for service model. Meaning that the more you do, the more you get paid. Which, which ultimately is, is not, not good, you know? Um, the, the way that I hope things will change, uh, for the future is that you get paid to take care of a problem or you get paid for the outcomes that, that you produce. And so, whether or not you treat that person with physical therapy or medications, or injections, or surgery, uh, what you get paid for is taking good care of someone, you know? And as long as there are these incentives that, that may be perverse, that encourage you to do more, than the, then of course people are gonna respond to those incentives and do things that that help their, their, their wallet. It’s, it’s unfortunate, um, I think I’m, I’m very blessed to work in a system where we have really, really good doctors from all of those disciplines, you know, that, that, that take care of spine patients in different ways. And we discuss many of these patients at a conference where whenever someone comes with a problem, in fact, we just had that conference this morning, um, where internal medicine, sorry, not internal medicine, but physical medicine doctors, uh, pain doctors and surgeons all get together and decide what is the optimal way to take care of this patient.
MARK WRIGHT 25:56
Wow. That is, that is just really, really interesting. I guess I would love in, in light of that, I mean, I’ve had back problems before and, and you know, my father-in-law has, and you know, like you said, 80% of the population…help us understand when, I guess, how to be a good consumer, because like when my car breaks down, I have no idea who to take it to, but then I start asking people, hey, do you know a good person to work on this kind of a car? What kind of advice would you give to just the average person who maybe is struggling with some back issues, who, who really can make an informed decision about whether or not to have surgery?
DR. VENU NEMANI 26:33
Yeah, so, so back problems are ubiquitous and, and like you said, you know, it’s hard to know when you’re someone, all you know is your back hurts and, and you don’t know what to do or who to go see, you know? Um, I think any problem that’s lasting more than a couple weeks, that is not getting better, probably should be looked at first by your primary care, uh, uh, provider. And, and usually that involves just a physical exam and perhaps just a simple x-ray of your, of your lower back and the, the, um, as long as the pain is localized to your lower back, usually it is not anything concerning, and all it needs is some anti-inflammatories, if that’s safe for you to take, and time to get better. Um, a lot of back problems these days are related to poor lifestyle, uh, uh, choices, and so being overweight, uh, being sedentary, spending too much time at a desk, um, or smoking cigarettes, these are all things that are not good for your spine. I think people don’t really know, uh, uh, uh, that smoking is so toxic to your spine, but actually the nicotine and cigarette smoke just destroys your discs and the incidence of back pain, uh, or spinal problems and people who use nicotine products is, is very, very high. And so, uh, to anyone listening to this who smokes or uses any nicotine products, please stop. Um, when you need to be concerned is if you start to have pain that’s traveling down a, a, a leg, either one or both legs, or if it is associated with any weakness or numbness, um, or certainly any problems affecting sensation in your groin or bowel and bladder problems. Those are generally more urgent issues and should prompt you to go see a doctor or to an emergency room, uh, more urgently. Anyone who has a medical history of, of cancer or um, uh, uh, or some type of infection that’s, uh, or a problem with their immune system, they can develop some odd spinal conditions, which should also prompt someone to go to a doctor more frequently. But these are kind of the rare situations. Usual, uh, the most typical person that has back pain that is of short duration doesn’t need anything other than just time.
MARK WRIGHT 28:49
One thing that I’ve found really interesting over the years in talking with, uh, physicians that I know is that there’s a business side of being a doctor, and then there’s the treatment side, you know, the calling side of being, being a doctor. And I’d love for you to give some advice to maybe somebody just starting out in their medical career, how do you find a good group to connect with? How do you find a good company? Because it seems like, you know, like every other industry, medicine is being sort of consolidated by big, big companies, but what did you do to find this great group of, of physicians to work with on this team, and what advice would you have?
DR. VENU NEMANI 29:23
Yeah, that’s a great question. So, this was actually, this is actually my second job. And so, I started off, when I, when I finished training, I was interested in taking care of complicated spine problems and the type of job that I was looking for was not readily available, cause there aren’t that many people that do this kind of, uh, job, uh, if, if you look around. And, and so I ended up taking a job, uh, uh, at a private practice and it was a very, very good group, a very highly regarded group, but the focus of the, uh, the spinal care and the, the other surgeons and me were just a little bit different to the, to the extent that it was not quite, um, uh, the type of practice I, I wanted to be in or found myself, uh, fitting in long term. Additionally, we kind of all were driving in parallel lanes, so to speak, rather than having a synergistic focus, and when I came here, one of the big reasons why I chose this group is that we really work synergistically to provide excellent patient care. And because of that approach, we, um, uh, that means that sometimes I’m sending a patient to my partner or to another doctor that hurts my bottom line but is actually best for the patient. And because the culture of my group is such that everyone feels that way and everyone works towards the best interest of the patient, it works really, really well. It’s hard if you are in a group where your partners see differently than you do, and I would advise a young doctor or a young surgeon when they’re applying for jobs to really look around and talk to the other surgeons and ask some of these questions up. You know, if, if there’s a problem that you don’t know how to take care of, who does it get sent to? Or how do you deal with this? Or do you guys ever have conferences to discuss difficult patient problems and how to best treat that? And I think that, uh, having those sorts of collaborations and interactions with your colleagues is really beneficial. I think the other thing that I really enjoy here, which I think is great, is that our focus isn’t solely on clinical care. That is a big part of what we do, but we have a heavy focus on research and academics in our, in our department, and that in, in my sort of institution, you know, I don’t work at a university, it comes at a financial cost to me when I go travel to a conference. I was just in Ireland two weeks ago, uh, giving a talk at a big international spine meeting, and that’s a week where I could have spent here seeing patients or doing surgery and making money. But to me, you know, it’s beneficial to go interact with my colleagues around the world and to help promulgate new knowledge and new information, how to take better care of these patients, which is good for everyone in the long run. And so I, I find a lot of value and joy in that, and I think that a lot of new doctors coming out that, um, you know, they get caught up in the, the business of medicine and just out to see more patients, do more surgery and make more money. But I think that’s a path to burnout. You know, it’s a, it’s a long time and it’s a difficult job, uh, and, and I think if you’re just doing that to, to make money, then it’s not a, not a path to happiness.
MARK WRIGHT 32:52
So you brought up, you know, going to other countries. I read, and I don’t know if this figure is still true, but something like, we spend $10,500 per person a year on healthcare in this country, which is about double most industrialized countries, and yet the World Health Organization ranks us 37th in the world when it comes to healthcare outcomes. I’d love your perspective on that. And I, I think I’d love also just a really, a really honest assessment in terms of what our responsibility is as patients and what the system’s responsibility is, because that’s, that’s just, we’re not getting what we pay for.
DR. VENU NEMANI 33:32
Yeah, yeah. Yeah, so I, I, I think from a, from a system responsibility, I think that there is a lot of wasted healthcare dollars, you know? Um, I think that anyone who, who has a, sees their hospital bill after, uh, a medical stay, can see how much money is wasted and, you know, the $500 charges for Tylenol and things like that. And, and part of it is that we have a pretty convoluted health system with a lot of other people involved other than physician or healthcare provider, uh, and patient, you know, um, and, and some of that is necessary. Certainly no one want, no one can or, or should pay a, uh, five-figure bill for a simple health problem. And, and people just, you know, no one’s able to do that. And so, health insurance is necessary and all of these things, but the system needs to find a better way to decrease the overall cost of care and to decrease the amount of waste that’s in the healthcare system because ultimately, we all pay for that, uh, into Medicare and Medicaid. And, and that leads to inflated charges. I think that on the consumer or patient side, a lot of the healthcare problems in this country are caused by lifestyle choices and, um, lack of activity. I’m a firm believer that exercise is a cure for a lot of the problems that we face, certainly on the, on the spine side. But really, you know, if you think of, if everyone were to quit smoking, if that were not a thing anymore, if, uh, everyone had a BMI of under 30, you know; if everyone got 30 minutes of exercise five to six times a week, as is recommended by, you know, our, our healthcare authorities; if everyone were to eat, you know, a regular balanced diet; a lot of the healthcare problems would go away. Now, there are certainly some systemic barriers to, to all of those things, you know. Many people don’t have a safe place to exercise. Many people don’t have access or the resources to, to, to buy healthy food, you know. But if a lot of our healthcare dollars and resources were spent towards, towards, um, helping people get access to those things and access to really good primary care, um, primary care doctors and, and PAs and, and NPs that could take care of patients on the initial side, then patients wouldn’t develop the problems that I have to take care of. And so, you know, if I was less busy because people were generally healthier, that’s, that’s a good thing. You know, I always tell people who, who meet me and they ask what I do, I say, I’m the kind of doctor you hope to never have to see.
MARK WRIGHT 36:09
I never wanna see you professionally.
DR. VENU NEMANI 36:12
Yes, exactly. So, yeah, we need, I think we need a higher, a higher value placed towards our, our primary care doctors, you know, internal medicine doctors and pediatricians, uh, to, to keep people out of specialist’s offices.
MARK WRIGHT 36:25
Let’s talk about artificial intelligence. Um, I was reading something the other day that talked about how revolutionary artificial intelligence is going to be and already is in diagnosing things like, you know, you, you have a mammogram and finding cancerous cells and, and things like that. Talk a little bit, if you would, about, uh, how you think artificial intelligence is going to change healthcare in America.
DR VENU NEMANI 36:51
Yeah, so I think that certainly, uh, I mean, AI we use for everything, right? The algorithms that drive Google Maps when you’re trying to find your way home, I mean, that’s all driven by AI and, and, and predictive analytics, and in medicine, medicine is no different. It is certainly gonna play a big role. And I think where it has started to, we’ve started to look at it in spine surgery, is trying to predict outcomes of certain types of patient populations that are undergoing or considering spinal surgery. Um, uh, Dr. Chris Ames, uh, who is one of our colleagues at UCSF, has done a lot of work in this area and the idea being that you can have two patients that have what looks like a very similar spinal problem, and you can do what you think is a very similar operation for those two people, but they can have wildly different outcomes and one person can do really well and, and have a great result, and someone else can have complication after complication. And on its face, you may look at these people and say, “You know, those just, those were very similar patients, and they had a similar operation. I don’t understand.” But there are a lot of data inputs that potentially could influence the complication rate and the outcomes between those two patients, whether it’s their zip code, where they live, their demographics, their, their genetics, um, you know, uh, that their environmental risk factors. All of these things could theoretically be put into an algorithm to help you understand and help you put patients into boxes where you could actually at the bedside before surgery, tell a patient, “this is where I’ve treated, you know, or there are 10,000 patients like you in this algorithm, and based on your individual data, this is what we predict your outcome would be.” Now, this is not real time yet. There hasn’t been any data to show that this actually works in our field, um, and, and we really just need a lot more data, I think, uh, for, for that, for that to be the case. Where I have already started to use, um, artificial intelligence and predictive analytics is helping to plan my spinal reconstruction operations, and so, we do have some algorithms that allow us to predict and model what a patient alignment will look like after a particular kind of surgery and allows us to order some custom rods and custom implants that help us to better achieve our pre-operative goals. And this is an algorithm that’s driven by lots of data points and lots of x-rays, uh, and, and using artificial intelligence predicts what that patient’s post-operative alignment will be. And so, this is something that we are using in practice. I think that it will become even more prevalent as time goes on, not only in spine surgery, but in all areas of medicine.
MARK WRIGHT 39:50
That’s really interesting. Um, we’re just coming out of the Covid pandemic. I’m curious, how did Covid, Covid change your practice and, and just medicine in general?
DR. VENU NEMANI 40:04
So when March of 2020, I guess it was, or 2021. I can’t even keep the years straight now. Um, uh, when that, when that happened, you know, we basically had to shut down our operating rooms as did pretty much most of the country at the time. And part of it was due to lack of knowledge of what Covid was going to be like, and so, we stopped doing operations for almost everything to try to preserve hospital beds. And so, there were patients with spine tumors who we were not operating on. There were patients who were losing function from spinal cord compression who we were not doing surgery for because we were told that we had to keep these beds open for, for Covid patients, you know, and as time went on, we kind of figured out what, you know, which patients we could and should proceed with surgery on to treat and which ones that, that could wait. But what it resulted in, I think, in the healthcare system in general, was a massive exodus out of healthcare. And so, at least in Washington state here, we’ve had staffing issues and, um, an inability to run the hospital in the operating room at full capacity, which for us has limited access to care for a lot of patients who are trying to get in to see us. Um, you know, it just led to increased wait times and, and, and inability to take care of things in a timely fashion. And so, I think that’s one of the things that we still struggle with that, that our hospital and many other hospital systems are still, uh, are still working at, is how do we make sure that people have timely access to see us when they have a problem that needs to be taken care of in a, in a prompt manner.
MARK WRIGHT 41:39
Yeah, we saw, certainly saw stories about, you know, traveling nurses making, you know, double and triple what, what regular nurses were making just because there was such a shortage of, of, of nurses. Um, I, I have to ask you about golf. Um, do you have any golf advice for just an average golfer who wants to take their game to the next level?
DR. VENU NEMANI 42:01
Um, get to the course and driving range as much as you can. Work on putting and chipping more than anything. I have, I have tried to, uh, you know, my, I think as I mentioned, my seven-year-old is trying to pick up the game now and, you know, we are working on a lot of chipping and putting in addition to working on the full swing. Uh, and, and if you are able and, and have the means take, take, take a lesson or two, as I think that learning something from a trusted professional, uh, is helpful. I think one of the other things that I’ve benefited from is I bought a, a stand for my iPhone. It’s very easy to videotape yourself, to videotape your swing from multiple angles, and then all you have to do is compare it to a slow-motion analysis of any of your favorite Tour Pro, which you can find on YouTube, and try to work on your swing mechanics yourself.
MARK WRIGHT 42:55
That’s great advice. Um, I interviewed Deepak Chopra earlier in my career, and I knew he was an avid golfer. And as we were walking out of the studio, I said, I said, “Do you have any, do you have any golf advice?” And, uh, he said, “Well, I was golfing with two Catholic priests…” And I thought, oh, seriously? This sounds like a terrible joke. No, but it was true. He’s, they’re on a golf course. They’re on a par three. There’s the tee, and then there’s a big lake, and then the green is on the far side of the lake. And the first priest gets up and he hits his ball right into the water. The second priest does the same thing, and Deepak tees up his ball and hits it over the water, lands right on the green, and they turned and looked at him and said, “How come you didn’t hit it in the water?” And his response was, “What water?” And he said the takeaway to the story is if you focus on the outcome and not the process, you’re not focusing on what you need to execute the shot. And I thought, oh my gosh, that is just brilliant, cause how many times are we up there thinking, don’t hit it in the water, don’t hit it in the water.
DR. VENU NEMANI 42:59
That’s right. That’s right. Yes. Yes, exactly. Well, I would say that, uh, you know, for, for spine surgery, actually, you know, we, as I mentioned before, you know, we put instrumentation or screws next to some very, very vital structures. And so if you are thinking don’t hit that artery, don’t hit the spinal cord, you’re probably not gonna be a very good surgeon. Instead of focusing on, I’m gonna place this exactly where it needs to be.
MARK WRIGHT 44:23
Oh my gosh. That’s fantastic. Well, that, that leads me to, I have to ask you, I look at somebody like Tom Brady, who is like, he’s gotta be 70 years old by now, but he’s, he’s, you know, was able to play for so long in the NFL by stretching and yoga and stretching and strength and, and I’m, I’d love, I mean, is he, is he a classic example of what, what can happen to all of us if we just do the right thing? What’s the best way to avoid seeing you in your office?
DR. VENU NEMANI 44:54
Well, I think that he certainly has the time and resources to do a lot of the right things, right? And so, um, it’s probably not all, environmental or, you know, his own doing. I think he probably is blessed with some amazing genetics, that plays a role in that. Um, but certainly everyone could take a page from him in terms of eating right, getting daily exercise, and spending time working not only on his physical self, but his mental self as well, you know, and, and those things are, are really real, really important for, for staying out of a spine surgeon’s office. I think, you know, keeping your weight in a normal range, getting regular aerobic exercise, hopefully 30 minutes, you know, four or five times a week at minimum, trying to eat as well as you can, and not smoking. These are all the, the key things, I think, to minimizing your risk of spinal problems. Now, some people just have bad genetics and their mom had spine surgery, their dad had spine surgery, their brother had spine surgery. And I commonly see patients like that where I’ve actually, there are some families where I’ve operated on three members of the same family, you know, and so a lot of it is genetic, but you can minimize the additional hit to your system by working out, eating right, eating good food, you know, and, and, and avoiding bad habits.
MARK WRIGHT 46:10
I wanna come back kind of full circle as we wrap things up, doctor, and talk about, was there a day in your practice when you’re driving home, driving home to see your family, and you’re thinking, man, it does not get better than this. This was such a great day. Was, did, do you remember a day like that or can you tell, share a story?
DR. VENU NEMANI 46:32
Well, I think, you know, that doesn’t happen frequently after a surgical day, actually, you know? Um, because while there is, I think one of the reasons why I went into surgery is that there’s a satisfaction in finishing a difficult case and doing a great job. And that I experience on a fairly regular basis where we will, I’ll have a difficult operation, I will have planned it out for months ahead of time, and then I execute it perfectly and I’m really happy with the way it went. That happens, uh, I would say fairly regularly, you know? Um, and, and there is a sense of, of feeling, uh, amazed that people trust me to do this to them because they’re, they’re putting a whole lot of trust in, in me to perform this operation on them. But I think some of the best days are actually when I’m in clinic and seeing patients in the office where I see someone who has had a big operation. In fact, I just saw, uh, someone that I operated on about a month and a half ago who had a very, very difficult, uh, recovery process and was really not feeling good. And then she came back today, and she said, “thank you so much. I’m so happy. I’m so much better than I was before. So many people have seen me and commented about how straight I’m standing now; I’m not bent forward anymore.” Um, those are the, those are the moments I think that are really, uh, amazing to me and make me happy that I chose the career that I did.
MARK WRIGHT 48:07
I have to ask you, this podcast is called BEATS WORKING, Winning the Game of Work. What part, what part of your job doesn’t feel like work?
DR. VENU NEMANI 48:17
Uh, I have to say that, you know, so I’m, in my job, I have multiple roles. So, I see patients in the office, I do surgery, I do research, I teach spine fellows, um, I teach other surgeons around the country, uh, surgical techniques. Um, and so all of these things are, are integral to my job and none of them feel like work. I often say, especially doing surgery, I would do surgery for free. You know, I, I, I love what I do. It’s, it’s amazing what I do. Um, some of the, uh, you know, dealing with insurance companies, I think that part certainly feels like working.
MARK WRIGHT 48:56
Oh, you too?
DR. VENU NEMANI 48:57
I can skip that part of my job. But, but, but it really, you know, it, it’s, it’s a blessing to be able to do what I do to, to help people. I think that it’s, uh, the, the job that I have is very intellectually rewarding and stimulating. Uh, being able to interface with colleagues around the country and world at meetings and um, and other academic, uh, endeavors that we, that we do, I think is also especially rewarding. Not feeling like I’m in a silo, just clock punching in and, and doing my regular day. Uh, being able to interface with people all over the place, uh, and, and try to advance the field forward is, is really amazing.
MARK WRIGHT 49:39
Well, Dr. Venu Nemani, it’s such a pleasure talking with you, and I know I speak for a lot of people when I say thank God that people like you, um, want to do what you do for a living because we are so much better off as a society because of that. So, thank you so much and keep up the fantastic work and I’d love to catch up with you on the golf course sometime.
DR. VENU NEMANI 49:53
Yeah, that sounds great. Certainly, on the, on the golf course not, not in the office here as a patient, okay?
MARK WRIGHT 49:58
For sure!
DR. VENU NEMANI 49:59
Thanks so much, Mark, for having me on. I really enjoyed it.
CREDITS 50:01
I’m Mark Wright. Thanks for listening to BEATS WORKING, part of the WORKP2P family. New episodes drop every Monday. And if you’ve enjoyed the conversation, subscribe, rate, and review this podcast. Special thanks to show producer and web editor, Tamar Medford. In the coming weeks, you’ll hear from our Contributors Corner and Sidekick Sessions. Join us next week for another episode of BEATS WORKING, where we are winning the game of work