Dr. Izzy Lieberman, Orthopaedic Surgeon, Texas Back Institute

Summary

Becker’s Healthcare Podcast: In-Depth Summary of Dr. Izzy Lieberman's Episode

Podcast Information:

• Title: Becker’s Healthcare Podcast
• Host: Grace Lynn Keller
• Guest: Dr. Izzy Lieberman, Orthopaedic Surgeon at Texas Back Institute
• Episode Release Date: July 28, 2025
• Recording Location: 22nd Annual Spine Orthopedic and Pain Management Conference

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Introduction to Dr. Izzy Lieberman

The episode begins with host Grace Lynn Keller introducing Dr. Izzy Lieberman, an esteemed orthopedic surgeon at the Texas Back Institute. Dr. Lieberman provides a brief professional background, highlighting his extensive experience:

“I’ve been at the Texas Back Institute for the last 15 years. Prior to that, I spent 13 years at the Cleveland Clinic and five years training and working at the University of Toronto in Canada.” [00:57]

He emphasizes his specialization in orthopedics and spine surgery, focusing on complex cases such as revision surgeries and deformity corrections. Additionally, Dr. Lieberman mentions his involvement in development work, strategic consulting with multiple companies, and his own startup within the spine sector.

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Current Trends and Shifts in Spine Surgery

a. The Impact of Social Media on Spine Surgery

Dr. Lieberman identifies social media as a double-edged sword in the realm of spine surgery:

“Social media is embellishing what's going on out there in spine surgery... individuals are promoting themselves inappropriately to a certain extent.” [01:59]

He expresses concern over misleading representations by spine surgeons on social platforms, which often highlight swift, minimally invasive procedures. This misinformation attracts patients who later return dissatisfied due to unmet expectations and inappropriate surgical outcomes:

“Patients are saying, 'I did this operation under 45 minutes, minimally invasive, skin to skin.' But then they're back with me six months later because the surgery was not done appropriately.” [02:15]

Furthermore, Dr. Lieberman points out the challenges posed by online ratings, citing the prevalence of fake reviews and the difficulty in addressing unwarranted negative feedback:

“When there is a negative, unwarranted rating on somebody, that becomes very, very difficult to correct.” [04:10]

He advocates for better regulation and monitoring of social media usage within the spine surgery community to maintain professional integrity and patient trust.

b. The Rise of Private Equity and Practice Consolidation

The second major trend Dr. Lieberman discusses is the increasing influence of private equity (PE) firms in spine practices. He observes a growing movement of physicians transitioning to employee models or being absorbed by PE-backed conglomerates:

“The pendulum is swinging towards the private equity and the roll-up of the groups, but it's self-limited. And that pendulum is going to swing right back and knock people over.” [04:50]

At Texas Back Institute, Dr. Lieberman and his partners chose to resist PE acquisitions by focusing on maintaining their financial independence. He highlights the necessity for surgeons to retain control over their practices unless PE firms can demonstrably add value beyond mere operational efficiencies:

“If these guys think they can make money off of myself and my partners, we have to figure out how to make money off ourselves. Why are we giving it away to them?” [04:00]

He remains skeptical about the long-term benefits PE firms bring to surgical practices, emphasizing the importance of surgeon autonomy in sustaining relevance and quality care.

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Staffing and Workforce Challenges in Healthcare

Addressing the pervasive issue of workforce mobility, Dr. Lieberman outlines the strategies Texas Back Institute employs to navigate staffing pressures:

“The employment workforce is mobile. We're not getting beyond that." [05:22]

In the post-pandemic landscape, there's a notable shift towards remote work desires. To adapt, the institute has implemented flexible working arrangements, allowing employees to work from home, the office, or a combination of both. However, this flexibility comes with the challenge of maintaining productivity:

“It's pretty clear that they are not as productive at home as they are in the office. So that's been a challenge for us as a group, but we've been able to work through that.” [05:45]

To mitigate high turnover rates, Texas Back Institute fosters a collegial and family-like workplace culture. They host events and activities that build camaraderie among staff, resulting in decreased turnover rates over time:

“We have to add something to the mix. And what we've tried to add at Texas Back Institute is more of a collegial, family-related type of approach... we've started to see this, and over time we're seeing a drop in that turnover rate.” [06:15]

Dr. Lieberman underscores the importance of creating a supportive and engaging work environment to retain talented personnel in a competitive healthcare job market.

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The Evolving Role of Spine Care in Outpatient and Broader Healthcare

Dr. Lieberman offers a forward-looking perspective on the integral role of spine care within the expanding outpatient sector:

“The good news about spine care is that everyone has a spine. The better news is that over your lifetime, everyone with a spine has got an 80% chance of a problem.” [07:11]

He asserts that spine surgery will remain a stable and growing field due to the universal nature of spinal issues. Advances in diagnostics, treatment planning, and surgical precision have enabled more effective and less invasive outpatient procedures. These improvements not only enhance patient outcomes but also reduce recovery times and healthcare costs:

“Our diagnostics are so much better at this point. Our treatment plans have improved substantially. The execution of surgery has become more precise, more efficient.” [07:20]

Additionally, Dr. Lieberman anticipates spine care becoming a significant economic driver, particularly with an aging population increasingly seeking spinal treatments. He remains optimistic about leveraging emerging technologies to further advance spinal healthcare.

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Innovations and Technological Advancements in Spine Surgery

In response to the burgeoning interest in technological innovation within healthcare, Dr. Lieberman highlights several initiatives and tools that hold promise for enhancing spine surgery:

a. Data Analysis and Efficiency Tools

Texas Back Institute employs comprehensive data analysis platforms to evaluate various aspects of their practice, including clinic efficiency, surgical outcomes, patient flow, and satisfaction levels:

“We can look at our efficiency in the clinic, our outcomes in the operating room. We can look at our patient flow, patient satisfaction.” [08:43]

This data-driven approach allows for continuous improvement in clinical practices and patient care strategies.

b. Artificial Intelligence (AI) Integration

While acknowledging the widespread attention AI is receiving in healthcare, Dr. Lieberman emphasizes its practical applications in spine surgery. He envisions AI as a tool for enhancing surgical precision and outcome predictability:

“If I know that I do operation X on patient Y the same way every time and I get this result, the AI is going to remind me, this is patient X. Do operation Y. This is what you're going to get.” [08:50]

By integrating AI into surgical planning and execution, surgeons can achieve more consistent results, reduce complications, and personalize treatment plans based on historical data and predictive analytics.

Dr. Lieberman believes that such technological advancements will significantly benefit both surgeons and patients, driving the field of spine surgery toward greater efficiency and efficacy.

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Final Thoughts and Conclusion

As the conversation winds down, Dr. Lieberman shares an encouraging message about the future of spine surgery:

“Despite all the rhetoric and scrutiny on spine surgery, it is an exciting time. There's a lot that we can do. We can really change our patients' lives now.” [09:46]

He dispels common misconceptions surrounding spine care, asserting that advancements have made treatments more effective and less daunting for patients:

“The myth that having a bad back and undergoing spine care is going to be problematic is all just a myth. We can, we are doing better.” [10:00]

Dr. Lieberman's optimism underscores the potential for continued progress in spine surgery, driven by technological innovation, improved clinical practices, and a commitment to patient-centered care.

Grace Lynn Keller concludes the episode by thanking Dr. Lieberman for his insights, reiterating the significance of the discussions held at the Spine Orthopedic and Pain Management Conference.

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Key Takeaways:

• Social Media’s Double-Edged Sword: While beneficial for marketing, social media can propagate unrealistic expectations and misleading information in spine surgery.
• Private Equity Concerns: Surgeons should critically evaluate the true benefits PE firms offer beyond operational efficiencies to maintain autonomy and quality care.
• Workforce Retention Strategies: Building a supportive and engaging work environment is crucial in reducing turnover rates amidst a highly mobile healthcare workforce.
• Outpatient Spine Care Growth: Technological advancements are making spine surgery more precise, efficient, and accessible within outpatient settings, ensuring sustained demand.
• Technological Innovations: Data analysis and AI integration are pivotal in enhancing surgical outcomes, personalizing patient care, and driving the future of spine surgery.

This comprehensive discussion with Dr. Izzy Lieberman provides valuable insights into the current landscape and future directions of spine surgery, offering actionable perspectives for healthcare leaders and professionals in the field.

Transcript

[A]

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[B]

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. Izzy Lieberman who is an orthopedic surgeon at the Texas back Institute. So Dr. Lieberman, thanks for being here. Let's start off by having you introduce yourself a little bit further and share more about your role in organization.

[C]

Thank you very much. It's a privilege and a pleasure to be here and sharing this information with you. I do work at the Texas Back Institute. I've been there for the last 15 years. Prior to that I was at the Cleveland Clinic for 13 years. I trained and worked at the University of Toronto in Toronto, Canada for five years. Before that. I principally do orthopedics and spine surgery. Today the easiest way to describe my practice is I do whatever anyone else doesn't want to do and I do a lot of revision, a lot of deformity work. I'm also involved in a lot of development work. I've got relationships with multiple strategic companies in terms of consulting and I've got my own startup company also that's involved in the spine space.

[B]

Wonderful. Well, thank you for being here and let's start our conversation by talking about trends and shifts. So what are you seeing right now in the industry that you think is most important for leaders to pay attention to?

[C]

There's there's two big trends that that I'm seeing right now, both of which personally are a little concerning to me. The first trend is the use of social media in spine surgery. Now it's permeated in everything in society today and absolutely there are benefits to it, but there are also some non benefits to it. It can be problematic. As spine surgeons we want to make sure that we competitive, we stay in the in in the practice, we can attract the right patients to us and the use of social media for that is exceptionally important. But I do see a trend where social Media is embellishing what's going on out there in spine surgery where individuals are promoting themselves inappropriately to a certain extent. I do a lot of revision surgery and unfortunately I see the guys on social media and then I see the patients coming to me, they're on social media and they're saying, oh, I do this operation under 45 minutes, minimally invasive, skin to skin. But then they're back with me six months later because the surgery was not done appropriate. So the use of social media has to somehow be regulated and monitored and, and likewise the ability for ratings online has become problematic now. There's a lot of fake ratings out there, there's a lot of legitimate ratings out there, but when there is a negative, unwarranted rating on somebody, that becomes very, very difficult to correct. So we need to figure all of that out. The second issue that I see as problematic now in spine surgery is the amalgamation of groups and essentially a lot of physicians moving towards an employee model or the PE firms that are coming up and are starting to gobble up spine practices. Now at Texas Back Institute we're a big group and we were looking at ways to maintain our relevance and sustainability. And we met with a number of the private equity groups and it dawned on me that if, if these guys think they can make money off of myself and my partners, we have to figure out how to make money off ourselves. Why, why are we giving it away to them? And until the private equity group can actually bring a benefit to the table to the surgeons and that benefit obviously is some form of contracting rather than just practice efficiency by rol. Unless they can do that, I really don't see any role. And we see this pendulum swinging towards the private equity and the roll up of the groups, but it's self limited. And that pendulum is going to swing right back and knock people over.

[B]

Absolutely. And I'd also love to touch on staffing and workforce challenges as these continue to be a concern across healthcare. So how is your organization navigating these pressures and what strategies have you seen work?

[C]

Well, the reality today is that the employment workforce is mobile. We're not getting beyond that. The post pandemic reality is that people want to work from home. If we want to maintain our current business profile, we have to be able to adapt to that. So we have taken steps to provide our employees with the ability to work fully from home, from the office, combination things. Working from home, you have to be able to monitor the employees. It's pretty clear that they are not as productive at home. As they are in the office. So that's been a challenge for us as a group, but we've been able to work through that. The transient nature of the employee workforce, they're just going after the, the higher paycheck. They'll go from our practice to the practice next door to the practice next door. And then eventually they come back to our practice again because they see that it's really not that much better, they're making any difference there. So we just have to accept that fact. But we have to add something to the mix. And what we've tried to add at Texas Back Institute is more of a collegial, family related type of approach to this, where we have events, we bring people together, we do things. So you're building some camaraderie in the team and over time, and we've started to see this. But over time we're seeing a drop in that turnover rate.

[B]

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

[C]

The good news about spine care is that everyone has a spine. The better news is that over your lifetime, everyone with a spine has got an 80% chance of a problem. So we know we're always going to be in business. There is no doubt that we can do more and we can do it better now in a less invasive, potentially outpatient environment. Our diagnostics are so much better at this point. Our treatment plans have improved substantially. The execution of surgery has become more precise, more efficient. The understanding of physiology has improved where we can be more predictive and avoid some of those complications. So spine is here to stay in the global healthcare. I think spine is going to be a much more important, important economic driver as well, especially with the aging population. And I see exciting things ahead of us with the technology that's out there. There is so much technology at hand right now. We just have to figure out how to use it to the advantage of our patients.

[B]

And that is a perfect segue, actually into my final question. Many organizations are exploring new technologies, partnerships or care models to improve efficiency and outcomes. Are there any innovations or initiatives you found particularly promising?

[C]

Critical review of how we do things is important. Now. We do have a lot of data analysis packages where we can look at our efficiency in the clinic, our outcomes in the operating room. We can look at our patient flow, patient satisfaction. So looking at all that, the ultimate though, and I'm kind of reluctant to use that term, but the AI component, everyone's using AI, AI. But the reality is that data information that's going to come back to us is going to help us do better for our patients in the future. If I know that I do operation X on patient Y the same way every time and I get this result, the AI is going to remind me, this is patient X. Do operation Y. This is what you're going to get. So that's where I think we're going to see a lot of benefit in spine surgery.

[B]

Wonderful. Well, as we wrap up, is there anything else you'd like to share that we didn't touch on today?

[C]

Just to reemphasize? Despite all the rhetoric and scrutiny on spine surgery, it is an exciting time. There's a lot that we can do. We can really change our patients lives now. And the, the myth that having a bad back and undergoing spine care is going to be problematic is all just a myth. We can, we are doing better.

[B]

Wonderful. Well, Dr. Lieberman, thanks so much for being here today on the Becker's Healthcare Podcast. Again, we're recording live at the 22nd annual Spine Orthopedic and Pain Management Conference.