Strengthening the physician team at DISC Sports & Spine Center in California (“DISC”), two new partners have recently joined the practice. Dr Neel P Shah is an orthopaedic spine surgeon specialising in minimally invasive surgery, and Dr Puja Shah is an interventional pain management specialist with a holistic focus on wellness. Husband and wife, they share a fierce dedication to individualised patient care, one they will continue to hone under the vision of DISC founding director, Dr Robert S Bray. Here, we chat to Dr Neel P Shah about his work in orthopaedics
OPN: As a specialist in spine surgery, could you tell us more about your experience and training background in this field?
NS: Spine surgery has evolved to become a subspecialty. Traditionally, the work around nerves and the spinal cord was undertaken by neurosurgeons, and the work to fuse segments, place hardware and correct deformity and/or instability of the spine was done by orthopods. Over time, they have merged and both orthopaedic surgeons and neurosurgeons do all segments of spinal surgery.
I was lucky to have great training experiences during medical school, residency and fellowship. This makes me comfortable tackling any kind of pathology that comes my way. I completed a very hands-on residency in orthopaedic surgery at Rutgers New Jersey Medical School, which is a level 1 trauma centre where we saw every kind of orthopaedic pathology. After this, I was fortunate to complete a fellowship in spine surgery at the New England Baptist Hospital, where I was able to train with both orthopaedic surgeons and neurosurgeons. Here, I learned traditional open techniques of spine surgery as well as the latest in minimally invasive surgery. Given the sheer volume of spine surgery that occurs at the New England Baptist Hospital in Boston, I felt comfortable and confident becoming an attending spine surgeon.
OPN: What drove you to choose surgery as a career – and orthopaedic spine surgery in particular?
NS: Ever since I was a kid, I wanted to be a doctor, and not because my parents pushed me to become one (haha). I saw how my mother’s healing touch truly impacted her patients and tried to emulate the compassion and empathy I witnessed her give her patients. My father was an engineer and a self-proclaimed Mr Fix-It-All, which allowed me to develop a true joy of working with my hands. Along with my love of sports and being active, this naturally led me to orthopaedic surgery.
While in residency, I realised spine surgery was the field of orthopaedics I gravitated towards. I really enjoy the puzzle that is spine surgery.
In essence, there are four main principles of spine surgery: 1. Take pressure off the nerves and/or the spinal cord (decompression); 2. Correct or address any instability (stabilisation); 3. Correct or address any deformity; and 4. Preserve motion if possible (this is an emerging part of spine surgery). This sounds very simple, but there are many different ways to attack each of these principles with their own risks and benefits, and putting these pieces of the puzzle together for individual patients is a process that I truly enjoy.
OPN: As we head in 2021, it is clear that the healthcare industry has been greatly impacted by this year’s events, what has been the greatest impact within the orthopaedic and spinal surgery industry?
NS: This year has been eye-opening. In regards to healthcare and orthopaedics, I think it has really accelerated how healthcare will look in the future. I believe this will lead us to improve patient care and lower healthcare costs. It is showing us how the traditional hospital model is inefficient.
Elective surgery has slowly been moving to the outpatient setting, and the pandemic has only shown us the value of moving out of the hospital in terms of elective surgery. At DISC Sports & Spine Center, we have been able to increase the volume of outpatient spine surgery during a pandemic, as patients want to avoid the hospital. We have, with appropriate safety measures, been able to continue treating patients with spinal issues. Outpatient surgery has shown better outcomes and lower costs to the system.
Additionally, telemedicine has really been thrown onto the main stage. Both providers and patients seem to appreciate the convenience of telemedicine. Before the pandemic, payors (insurance companies) were hesitant to reimburse physicians for doing work via telemedicine. They have begrudgingly started reimbursing us during the pandemic, and we hope they will continue to allow us to provide care virtually once we’re on the other side of the pandemic.
OPN: What’s the best part of your job?
NS: It would have to be each and every patient that I am lucky enough to treat. I enjoy the process of properly working with a patient and solving their individual puzzle, then giving them reassurance and hope that they we can make them better. I feel I am an advocate and teammate with my patients through their journey of spinal issues.
OPN: … and the worst?
NS: The worst part of our job is having outcomes that aren’t expected, or complications. Unfortunately, they do happen, though the percentage of complications during spinal surgery is quite low. When a patient experiences a complication, suddenly that 1-in-1000 chance becomes 1-in-1 to them. With my training and experience, I feel confident in handling any issues that may come up and believe that addressing complications swiftly and correctly makes all the difference to patients.
OPN: What has been the highlight of your career so far?
NS: The highlight of my career would be each and every patient I have been lucky enough to care for. I love to see patients transform after they’re given the correct treatment.
OPN: Are you currently involved in any scientific research within your work?
NS: I have worked on various types and topics of research throughout my journey to becoming a spine surgeon. Currently, I am focusing on patient outcomes and patient perceptions regarding spine surgery.
OPN: If you weren’t an orthopaedic spine surgeon what would you be?
NS: This is a tough one. Realistically speaking, if I didn’t go to medical school, I would have loved to be an architect or a watch maker (I love working with my hands!). If money were no issue, I would love to work as ski patrol somewhere in the Rockies and maybe run an orthopaedic clinic at the base of the mountain.
OPN: What would you tell your 21-year-old self?
NS: When I was 21, I was applying to medical school, worried about where and if I would get in. I would tell myself, “Life is a journey with no specific destination. Continue to work hard and continue to be kind to those that you encounter.”
Also, looking back, I have been lucky to have great role models throughout my journey, from my parents to professors in medical school, the attending physicians I worked with in residency and fellowship and now working with Dr Bray. I would tell my younger self to be humble and respect the process. Hard work and patience pays off.
OPN: If you were Health Minister for the day what changes would you implement?
NS: Where do I begin? Treating patients that have pain, both acute and chronic, I have gained an immense appreciation of the mind-body connection. There is definitely a psychological connection to pain. Unfortunately, there is still a stigma regarding mental health, along with the barrier to access of quality care. I would tackle this by helping raise awareness and increase the access patients have to mental health professionals. Part of the problem is how providers are reimbursed. In an ideal world, doctors would work together on a multispecialty team to treat patients, but business, logistical and insurance issues make this quite difficult. Patients should be treated as a whole and not just separate body parts.
OPN: Away from the clinic and operating theatre – what do you do to relax?
NS: When we were living and practicing in New York City, my wife and I loved to check out the latest restaurants with our friends, or just enjoy the culture and diversity of the greatest city in the world, NYC!
Now that we have moved and have both joined DISC in Southern California, we have been jumping into the California way of life. You can find us on the beach playing fetch with our Australian shepherd, Bodhi, and riding bikes down Pacific Coast Highway to catch the sunset. We are both truly excited to be here.
OPN: How do you think the future looks in the field of orthopaedic and spinal surgery and what are your predictions for 2021?
NS: I’m excited about the prospects of orthopaedics and spine surgery in the coming future. Improving technologies in motion preservation and artificial disc replacements are game changers. At DISC, we are definitely pushing the envelope in changing the old treatment algorithms by including the use of artificial disc replacements in both the neck and lower back. We are becoming better at allowing our patients to get back to the things they love rather than sidelining them, which was more common in the past with orthopaedic and spinal pathologies.
