Getting Innovative with Spine Interventions

[Douglas Beall]
What I really would like to do is put my money where my mouth is and test this. Yeah, I think it's better, so let's test. Test the adverse events, safety and efficacy, put it down and record it for posterity. By doing that, we'll really be able to figure out if what we're doing is right, advance the science, and advance the treatment down the field. That's exactly what we need to be doing.

One of the criticisms I get a lot from my colleagues is that they say, "You're always focused on failures." That's true, because I don't want to focus on successes. There's nothing there, except an atta boy or a pat on the back. Trying to make each condition treatable in a minimally invasive fashion all the way down to the point where you're ultimately very successful at doing that, that's the goal. You take something like interspinous decompression spacers. That's a little bit of an arcane and esoteric topic. I don't care that the five-year outcome is 80% decreased leg pain, 65% decreased back pain and corresponding improvement on Westry disability function. Yeah, super. Hair tussle. But what about the people that have recurrent symptoms, people that have a disc herniation, recurrent stenosis, subsidence? What do we do about those? That's really where I focus to try to perfect the technology.

[Michael Barraza]
Just from the cases that I've seen that you've shared on Twitter and from educational materials, I would have guessed you were an orthopedic surgeon or neurosurgeon.

[Douglas Beall]
Don't feel bad. I've known guys for 20 years that come up to me at parties and introduce me as the wrong specialty. There are patients of mine that still don't know what specialty I practice. One of the issues that I'm still dealing with, literally 20-plus years later… is what is an interventional radiologist? It doesn't seem like that's what I do at all...I want to talk about name and value. I don't know that what we do is named appropriately. I don't know whether you call it radiologic surgery. I don't know if you call it something else, but the public still doesn't really know what we do for a living. I think now that we've really advanced the field in a lot of different areas, peripheral vascular disease, interventional oncology, interventional pain, I think it's probably time to really rethink that. I love diagnostic radiology, but I'm worried about it. I think the satisfaction that I've seen has decreased by 20% in the most recent article I saw in JACR, and the burnout rate is up. For years, I worked away and didn't really understand. I just ignored it. I thought, "This is not true. It can't be true. I have high satisfaction level in what I do.” Then article after article about burnout. I think burnout has to do with a combination of feeling valued and maybe autonomy and independence. I think that's what gives value.

[Douglas Beall]
I remember the first year of residency, 1994, I looked up the word commodification because I thought about image interpretation becoming a commodity. Part of the reason I do what I do is because I didn't want to be a commodity. I wanted to preserve what we do as a specialty, maybe as an artful specialty. I'm doing exactly what I want to do now in the way that I want to do it, and it's tremendously rewarding. It hurts to see other people that have maybe burnout or don't feel valued... What I'd like to see is, with involvement of the specialties, people involved with things that really make a difference...If you put that together, you will not be burned out and you will experience the maximum possible value. You will never want to stop, because you'll be making people better at the highest possible rate for a very long period of time.