Dr. Daniel Choi, Orthopedic Spine Surgeon and Owner, Spine Medicine and Surgery of Long Island

Summary

Becker’s Healthcare Podcast: In-Depth Summary of Dr. Daniel Choi’s Insights on Orthopedic Spine Surgery and Healthcare Trends

Episode: Dr. Daniel Choi, Orthopedic Spine Surgeon and Owner, Spine Medicine and Surgery of Long Island
Release Date: August 8, 2025
Host: Grace Lynn Keller
Recording Location: 22nd Annual Spine, Orthopedic and Pain Management Conference

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1. Introduction to Dr. Daniel Choi and His Practice

Grace Lynn Keller opens the episode by introducing Dr. Daniel Choi, an orthopedic spine surgeon and the owner of Spine Medicine and Surgery of Long Island. Dr. Choi provides an overview of his practice, highlighting its growth and operational dynamics.

Key Points:

• Establishment and Growth: Dr. Choi founded Spine Medicine and Surgery in Long Island in February 2021 during the COVID-19 pandemic. Previously, he was part of another group for three and a half years.
• Team Composition: The practice has expanded to include three orthopedic spinal surgeons, two interventional pain management physiatrists, one Physician Assistant (PA), and one Nurse Practitioner (NP).
• Patient Volume: Last year, the practice recorded over 10,000 patient visits across two offices.
• Market Position: Operating in a consolidated market with numerous hospitals and private equity groups, the practice maintains 100% independence, addressing a significant demand for specialized and minimally invasive spine care.

Notable Quote:

"We're providing an alternative to that to be in a true private practice model. And we're meeting that demand and we're really seeing a lot of interest in private practice again."
— Dr. Daniel Choi [00:57]

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2. Current Trends and Shifts in the Healthcare Industry

Grace prompts Dr. Choi to discuss the prevailing trends and shifts within the healthcare sector that leaders should monitor. Dr. Choi delves into the critical issue of the physician shortage and its multifaceted causes.

Key Points:

• Physician Shortage: Dr. Choi emphasizes the growing shortage of physicians, exacerbated by factors such as early retirement due to burnout and challenging working conditions.
• Mid-Level Providers: Consolidated systems are increasingly relying on physician assistants and nurse practitioners to bridge the gap, though this is seen as a temporary solution.
• Demographic Shifts: There is a notable disparity between male and female physicians. With female medical graduates constituting 50% of new graduates, many are seeking part-time positions or roles with more flexible hours to balance family responsibilities.
• Impact on Shortage: These demographic trends are likely to intensify the existing physician shortage as the demand for more flexible work arrangements grows.

Notable Quote:

"There is a physician shortage. There's a lot of physicians who are retiring. We don't have enough younger physicians to fill the gap."
— Dr. Daniel Choi [04:32]

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3. Navigating Staffing and Workforce Challenges

Addressing the pervasive workforce challenges in healthcare, Grace and Dr. Choi explore strategies that Spine Medicine and Surgery of Long Island employs to manage staffing pressures.

Key Points:

• Talent Acquisition: The practice faces difficulties in filling essential roles such as medical receptionists, front desk staff, and billers. To combat this, they have a dedicated human resources department that actively posts job listings and seeks local talent with the required experience.
• Leveraging Technology: To alleviate the administrative burden on staff, the practice has integrated artificial intelligence (AI) solutions. Specifically, they have implemented ChatGPT through a Business Associate Agreement (BAA) with OpenAI to generate letters of medical necessity.
• Efficiency Gains: This AI implementation has drastically reduced the time required to produce these letters—from 30-45 minutes down to approximately 15 seconds—thereby decreasing workload strain on the staff.

Notable Quote:

"We've actually started implementing ChatGPT and we actually have a BAA with OpenAI... a letter that used to take 30 minutes to 45 minutes for a staff member to write. Now we can do it in literally 15 seconds on ChatGPT."
— Dr. Daniel Choi [04:46]

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4. The Evolving Role of Orthopedics and Spine in Outpatient Care

Grace inquires about the future of orthopedics and spine within the expanding outpatient care landscape. Dr. Choi shares his observations and experiences transitioning spine surgeries to ambulatory surgical centers (ASCs).

Key Points:

• Shift to ASCs: While orthopedic sports and joint specialties have moved towards ASCs, spine surgery is only now beginning to make this transition. Dr. Choi personally conducted his first cervical disc replacement in an ASC.
• Technical Adaptations: Successful spine surgeries in ASCs require meticulous technique, advanced anesthesia protocols, and careful patient selection to minimize complications.
• Peer Insights: Participation in Becker’s meetings has revealed that other spine surgeons are also adopting ASCs for various procedures, including T lifts, fusions, and OLIFs.
• Caution for New Surgeons: Dr. Choi advises that only technically proficient spine surgeons should perform surgeries in ASCs due to the complexity and risk of postoperative complications.

Notable Quote:

"Patient went home the same day. You have to be meticulous. I think the technique... and patient selection too, making sure that you don't have sick patients that are being done at the ambulatory surgical center."
— Dr. Daniel Choi [06:27]

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5. Innovations and Initiatives Enhancing Efficiency and Outcomes

In the final segment, Grace asks Dr. Choi about promising innovations or initiatives that can improve efficiency and patient outcomes within healthcare organizations.

Key Points:

• Financial Strategies: A significant advancement for Dr. Choi's practice has been the utilization of the No Surprises Act's independent dispute resolution process. This allows the practice to contest underpayments from insurers, advocating for fair compensation for procedures.
• Economic Impact: By challenging underpayments, the practice aims to secure better financial terms, ensuring that physicians receive a more equitable share of facility fees.
• Future Implications: Dr. Choi anticipates that increased use of arbitration will lead to improved in-network rates, fostering more equitable contracts between doctors and payers.

Notable Quote:

"The big shift in our practice that has allowed us to grow is utilization of the no Surprises act independent dispute resolution process... Now they're doing T lifts, they're doing fusions, or they're doing OLIFs at ASCs."
— Dr. Daniel Choi [08:39]

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6. Reflections on Private Practice and Advocacy

As the conversation wraps up, Dr. Choi shares his hopes for the future of private practice and the importance of advocacy in sustaining it.

Key Points:

• Resilience of Private Practice: Dr. Choi reflects on the historical challenges faced by private practices, noting a renewed interest and potential resurgence.
• Physician Autonomy: There is a strong desire among physicians to regain autonomy, moving away from restrictive models imposed by larger health systems.
• Advocacy Efforts: Dr. Choi is actively involved in advocacy through organizations like the American Medical Association and State Medical Societies to highlight the critical role of private practices in the healthcare system.
• Future Outlook: He remains hopeful that elected officials will recognize the importance of maintaining and supporting independent practices to ensure the sustainability of the healthcare system.

Notable Quote:

"I'm very hopeful and that the pendulum is potentially swinging back the other way... I'm looking to as, you know, as a hope for the future for medicine."
— Dr. Daniel Choi [10:29]

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Conclusion

Dr. Daniel Choi’s insights offer a comprehensive view of the current landscape in orthopedic spine surgery and broader healthcare trends. From addressing the physician shortage and workforce challenges to embracing technological innovations and advocating for private practice, Dr. Choi underscores the adaptability and resilience required to thrive in today’s healthcare environment. His experiences and strategies serve as valuable lessons for healthcare leaders aiming to navigate the complexities of the modern medical field.

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Note: This summary captures the essence of Dr. Choi's discussion, integrating his key points and notable quotes with accurate timestamps for reference. All advertisements, introductory remarks, and non-content segments have been excluded to focus solely on the substantive content of the conversation.

Transcript

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[Grace Lynn Keller]

Is Grace Lynn Keller with the Becker's Healthcare Podcast and we are recording live at the 22nd annual Spine, Orthopedic and Pain Management Conference. I'm currently joined by Dr. Daniel Choi, who is an orthopedic spine surgeon and the owner of Spine Medicine and Surgery of long Island. So Dr. Choi, thanks for joining me today. Would love to have you start off by sharing a little bit more about yourself, your role and your organization.

[Dr. Daniel Choi]

Great. Thanks for having me. It's a pleasure to be at another Becker's Spine Conference and I am the owner and operator of Spine Medicine Surgery in Long Island. We cover two counties in Long Island, New York, Suffolk county and Nassau County. The practice was started by me during COVID in February of 2021 and I had actually been with another group for about three and a half years prior to that. And this private practice has actually now grown tremendous over the last four years. We are now actually at three orthopedic spinal surgeons total and two interventional pain management physiatrists as well as one PA and one NP. Last year we did over 10,000 patient visits between two offices and we're really filling a need in Long island, especially where it's a pretty consolidated market with a lot of hospitals, hospital systems, as well as private equity groups growing. We're 100% independent and we're really meeting a demand not just for patient care, for specialized spine care, specialized minimally invasive spine care, but also we're meeting, I think, a demand for physicians who are looking for a different form and different way of practicing, especially young physicians who are really just really just being presented with options for employment with big health systems. We're providing an alternative to that to be in a true private practice model. And we're meeting that demand and we're really seeing a lot of interest in private practice again.

[Grace Lynn Keller]

Wonderful. Well, thank you for being here to share your insights and let's start off with what trends or shifts you're currently seeing Right now in the industry that you think are most important for leaders to pay attention to?

[Dr. Daniel Choi]

Absolutely. So Scott Becker, I read all of his LinkedIn reports and as well as what he's writing on X these days and I have to agree with him that one of the biggest trends and concerns about the current healthcare system is our physician shortage. And it's an, it's, it's a shortage now and it's just going to get worse as there's multiple factors that are dry, that are exacerbating the shortage. There's early physician retirement happening typically due to, I think burnout as well as intolerable working conditions. And you're seeing that a lot of the consolidated systems are utilizing mid level care so physician assistants and nurse practitioners to try to fill in the gaps. But that gap is only going to be filled that way, you know, for a limited time before some something breaks in the system. So I think that's really important for industry leaders to pay attention to that. There is this physician shortage. There's a lot of physicians who are retiring. We don't have enough younger physicians to fill the gap as well as I think we also see a trend where there's disparities between male and female physicians too in this setting too, where I do see that younger female physicians who are now 50% of graduating US positions are looking for different types. Not all the time, but I have noticed that, you know, as they are shifting more attention to maybe their families, that they're looking for part time work or you know, less than full time and so more flexible hours. And when that happens, that also is going to inherently exacerbate the physician shortage.

[Grace Lynn Keller]

And you've actually provided a great segue to my next question which touches on stacking, staffing and workforce challenges as those continue to be a concern across healthcare. So how is your organization navigating these pressures and what strategies have you seen work?

[Dr. Daniel Choi]

Well, absolutely. So you know, I, I think that, you know, our private practice having workforce challenges is kind of a theme that I talk about with a lot of practice owners. We have a hard time filling those bas roles of medical receptionists to as well as front, sorry, front desk as well as billers and it's, it's hard. So you know, we have definitely have a human resources department within our practice that spends a lot of time posting job posts and finding those people locally that have the experience that we need to fill those spots. We're also using creative ways to offload some of the more mundane and burdensome tasks. So generating letters of medical necessity. We've actually started implementing ChatGPT and we actually have a BAA with OpenAI where we can actually put in patient specific materials to ChatGPT, but they can't train on that data and they basically have to, you know, delete that patient specific data. After we generate our letter of medical necessity. That's actually what a letter that used to take 30 minutes to 45 minutes for a staff member to write. Now we can do it in literally 15 seconds on ChatGPT. So that's. We're utilizing AI in very creative ways to try to decrease the strain in the workload on our staff in house.

[Grace Lynn Keller]

And as outpatient care continues to grow, how do you see the role of orthopedics and spine evolving with the broader healthcare ecosystem?

[Dr. Daniel Choi]

Yeah, absolutely. So, you know, I do think that ASEs have a very critical role, you know, within the spine and orthopedic world. We're seeing it in orthopedic sports. We're now seeing a huge push in orthopedic joints. I would say that spine is probably one of the last orthopedic specialties to push over to the ASCs. I'm actively at this point. This, this past year was the first year that I actually started doing spine cases in an ambulatory surg center. I did my first cervical disc replacement at the asc. I'm also doing endoscopic spine cases at the asc. The ASC is definitely a different environment. I remember in residency and fellowship I was like, there's no way you could ever do spine surgery in an, in an asc. That's crazy. But as I've come to actually the Beckers meetings in the last three years and I've talked to other spine surgeons who were doing it doing. Now they're doing T lifts, they're doing fusions, or they're doing OLIFs at ASCs. And I remember my jaw dropping when I heard about that. But as I've learned more about the protocols that they've implemented, the anesthesia protocols, the hydration protocols, local blocks, erector spinae blocks that, you know, allow them to do these, it, it's definitely possible. And so, you know, it was very exciting to do my first cervical disc replacement in the ambulatory surgical center. Patient went home the same day. You have to be meticulous. I think the technique. Not every spine surgeon can do cases at an asc. I don't think I recommend new graduates to do these cases at an ASC because you have to be technically very sound as well as kind of know what may create more of a tendency for post operative complications to happen. And those are not the patients. That and patient selection too, making sure that you don't have sick patients that are being done at the ambulatory surgical center. So a combination of all that knowledge and experience I think will be driving more spine cases into the ASC for our practice. Definitely.

[Grace Lynn Keller]

Absolutely. And then my final question, as many organizations are exploring new technologies, partnerships or care models that improve efficiency and outcomes, are there any innovations or initiatives that you found particularly promising?

[Dr. Daniel Choi]

You know, I, I think the one game changer in our practice, our, we have a very kind of like a, it's a unicorn practice in the sense that it's five young physicians now, probably around the age of 40 or younger, and we are completely independent. We're actually able to stay independent and grow. And that requires access to capital which physicians historically have been limited from and cut off from through their professional fees. Our professional fees are never valued at, I think, the proper market rate. And it's always been fee setting by the government or by payers benchmarking our payments to Medicare rates which have only gone down year after year. And so I would say that the big shift in our practice that has allowed us to grow is utilization of the no Surprises act independent dispute resolution process, which allows us to take an underpayment by an insurer and actually go and argue to an arbitration company and say, actually no, the ACDF that I did is not $1,000. That's not the fair payment. It should actually be 15,000, which is, you know, when you're talking about a hospital system getting paid $80,000 for that facility fee, I think it makes sense that the doctor who performs that surgery gets some much bigger percentage of it than is currently being paid. And so I would say this independent dispute resolution process has been the game changer for us and we've been implementing it very successfully. And I, and I believe that what will happen as there's more utilization of this arbitration is that in network rates will also improve, allowing doctors to have more fair contracts with payers.

[Grace Lynn Keller]

Well, Dr. Choi, thanks so much for joining me today. Is there anything else you'd like to share that we didn't touch on in our conversation?

[Dr. Daniel Choi]

You know, I think that I've heard that there is a pendulum in medicine that swings back and forth in the past between private practice doing well and not doing well. You know, I've been in practice nine years, so all I have seen is private practice getting crushed and steamrolled and I'm very hopeful and hopeful and that the pendulum is potentially swinging back the other way. I think there's a lot of factors. There's a lot of physicians that are really sick and tired of having their autonomy stripped and I think that it really I, I'm, I'm hoping that our elected officials and our elected leaders start to see that the viability of private practice is so critical to the future of our entire healthcare system. And so, you know, this is why I participate in advocacy events. I participated the American Medical Association Medical Society, State of New York to try to get that message across to our elected officials through organized medicine. And you know that's what I'm looking to as, you know, as a hope for the future for, for, for medicine.

[Grace Lynn Keller]

Absolutely. Well, thank you so much for joining me today on the Becker's Healthcare Podcast. Again, we are recording live at the 22nd annual Spine Orthopedic and Pain Management Conference.