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Becker’s Healthcare Podcast
Dr. Nolan Wessell, Assistant Professor and Well-being Co-Director, Department of Orthopedic Surgery, Division of Spine Surgery, University of Colorado School of Medicine
00:18:13
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- [00:00]
A
This is Carly Beam with the Becker Spine and Orthopedics podcast, and I'm thrilled to be joined today by Dr. Nolan Wessel with the University of Colorado school of medicine. Dr. Wessel, thank you so much for being here today.
- [00:14]
B
Thank you so much for having me on board.
- [00:16]
A
Yeah, absolutely. Before we dive into our discussion, I'd love to if you could just introduce yourself and tell us a bit about your background.
- [00:24]
B
Sure. So, as you already mentioned, I currently work at the University of Colorado Department of Orthopedics. But I was born and raised in north central Wisconsin, did my undergraduate studies at the University of Wisconsin, and then after graduation, I worked very briefly in medical research for the Howard Hughes Medical Institute before moving on to medical school at Wayne State University in Detroit. I stayed in Detroit for my residency at the Henry Ford Health System and then moved out to Colorado in 2017 to do my fellowship in adult spine surgery at the University of Colorado. So since 2018, I've been on faculty at the university. Currently, the majority of my practice is spent on the south side of metro Denver in the Highlands Ranch community, but I still maintain a small portion of my practice at the main university campus.
- [01:21]
A
Right. And yet an interesting aspect of your title is reading about you earlier. Well, being co director, can you talk more about that?
- [01:30]
B
Sure. You know, it's.
- [01:34]
Probably no secret to anybody that works in healthcare or has friends or family that work in healthcare that burnout, especially on the heels of the COVID pandemic a few years ago, has run rampant throughout the system. And that's not just isolated to orthopedic surgeons. But what I can tell you is that currently about 40% of active orthopedic surgeons endorse symptoms consistent with burnout and depression. And over the course of an orthopedic surgeon's career, upwards of 60 to 65% of individuals may suffer from symptoms of burnout and depression.
- [02:15]
In a system that's already very strained, this can lead to.
- [02:20]
Early attrition, which we certainly don't need, because as the baby boomers age into those years where they demand more care, orthopedic care is a major part of that, and we really just want to make sure that we're taking care of not just our patients, but ourselves. Right. We can't be expected to care for other people if we ourselves are not in good physical and mental conditions. So the University of Colorado, like many large institutions, has done its best to prioritize wellness. And myself and one of my colleagues from the Children's hospital of Colorado, Dr. Sarah Sibel, serve as the co directors for well being for our department. So it's an interesting role that's kind of always evolving.
- [03:08]
A
Yeah. I was about to say, and I mean, obviously it's burnout being so rampant. And I know there are a lot of different headwinds facing spine surgeons and I'm wondering, how are you tackling those? How are you training your, your students, your residents and spine orthopedics to face these headwinds without completely burning themselves out?
- [03:33]
B
Sure. I think that's an important question and I don't have all the solutions to that.
- [03:40]
Certainly, as you look at an older generation of surgeons and physicians and healthcare providers.
- [03:49]
I think we can all agree that the work life balance really was not there. It was kind of just a mentality of work, work, work, I'll relax when I retire. And then you've got a younger generation. So I'm, I'm 41 or nearly 41 and kind of starting with my generation and those a little bit younger than me, I think they are much better suited to help maintain that kind of work life balance. And people in kind of their mid career are somewhat caught in between, but more and out. Now you see it at the university that prioritizing that work life balance, especially in a state like Colorado where outdoor activities are available to you essentially 365 days a year, people really want to make sure that they're taking care of their own well being in conjunction with caring for patients.
- [04:48]
A
Got it. And I'd love to hear what are some other big trends you're following in healthcare today?
- [04:55]
B
Yeah. So we just had the North American Spine Society meeting last weekend. It was the 40 year anniversary of the organization and to my knowledge, the first time that they had their annual meeting in Denver. So it was kind of nice to not have to get on a plane. I just woke up. Yeah. But when you walk through the exhibit floor, it's really clear to me that integration of kind of robotics and artificial intelligence and kind of patient specific surgical plans is where spine surgery is headed. We've seen robotics in general surgery for quite a while now. We've all heard about the da Vinci robot that's probably been around for 15 to 20 years. Robotics and spine care is somewhat in its infancy.
- [05:48]
But when you start to integrate that with preoperative planning and using large scale database learning and artificial intelligence algorithms to help plan a patient specific surgery, or even custom 3D printed patient specific implants, it really begins to change the game in terms of what we can offer patients right now. The costs for some of those technologies are quite high. But as development progresses, like anything else, we expect those costs to come down, and hopefully that translates to better value and better outcomes for patients.
- [06:29]
A
Definitely. And when you think about cost, what do you think it will take from these companies without, like, you know, naming names, what do you think it'll take for these costs come down to make these technologies more accessible to any practice setting and to patients?
- [06:47]
B
Yeah, I think cost is at the forefront of everything we do in healthcare right now, and we can certainly get into some of those issues later in our conversation. But.
- [07:00]
I work, fortunately, at a large academic institution, and when it comes to development of these new technologies, I really look at the larger centers as the ones that need to lead the charge. You know, being a big academic center, we have a robust portfolio of research projects that are ongoing. We have an easier ability to get large scale federal and regional grant funding, and we need to be smart about how we use that money. And I hope that a portion of it is invested in advancing these types of technologies, because ultimately, I think that's going to benefit not just orthopedic patients, but the broader healthcare system as a whole goal.
- [07:47]
A
Right.
- [07:47]
B
If we have technologies that allow us to do more or a broader spectrum of surgeries in a more ambulatory setting with smaller incisions and reduced recovery, that's going to change the game in terms of orthopedic care.
- [08:05]
A
Yeah, and it does. It's cool that you do have that advantage being in the academic center to really make these changes. And then you mentioned government funding for research, for instance. I'm wondering, how have you been tracking these regular shifts and changes in government policies, whether it's with reimbursement or this research funding you're talking about, how are you tackling those?
- [08:31]
B
Yeah, I think the one thing that we can probably be certain to certain of is that it's constantly going to change. Right. In the American political system, it really doesn't matter what side of the aisle you sit on. We can expect that every two, four, eight years there's going to be a little bit of a shift in terms of which party maintains control. And that is going to result in a shift in various types of funding as providers and as academic institutions. Here at the University of Colorado, we have a new dean, Dr. John Sampson, and he is really working hard to set up a financial structure that provides more stability across the entirety of the med school so that if we encounter periods of time where federal funding is reduced, we have the reserves on hand so that we can Maintain a robust faculty of not only providers, but research staff as well. So hopefully, as endowments continue to grow, as we continue to grow our cash reserves, we're well suited to weather whatever storms we might face as political persuasions fluctuate.
- [09:51]
A
That's great to hear. And then I want to ask, how are you thinking about growth in the next 12 to 24 months? What's really exciting you in that realm?
- [10:01]
B
Yeah.
- [10:04]
I already have a robust practice, so when people ask me about growth, I think, well, gosh, there's only 24 hours in the day. Right. But kind of hearkening the conversation back to some of the artificial intelligence.
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The large language models have pretty quickly found their way into healthcare. So one example I like to cite is that we now use an AI based passive listening system in the clinic setting and within mere seconds, the conversations I have with a patient are transcribed into a note. And like a lot of these systems, like Chat, GPT and others, the more you use it, the more it learns about your conversation style. And I've been using it now for about four or five months and I can leave a patient's room, walk back to my workstation and by the time I get there, my note is written, I do a quick review and boom, the note is signed. That has given me back upwards of 90 minutes a day. And for my nurse practitioner, she's getting 90 minutes back on her day as well. And that can be used a variety of different ways. And we talked a little bit about wellness. Well, you can get some of your personal or family time back, which is fantastic. Or about to say, yeah. Or, you know, based on our clinic schedules, that might open up availability for two to four patients a week and that, that adds up quickly, you know, 200 to 300 patients a year that otherwise might have to wait months to get in to see us now can get into to get their care sooner. And that's all on the backs of technological advancement and artificial intelligence. So when I think about growth, I think more about efficiency. How can I personally better use my time? And then how is an entire health care system, can we better optimize the time we spend with patients and taking care of them?
- [12:09]
A
Yeah, and I really love that how you're describing AI as a tool. Probably the ambient AI probably helps you stay present in visits, brings in more access for patients. Sounds like a real win win.
- [12:23]
B
Absolutely. I mean, instead of staring down at a piece of scratch paper or typing notes into a computer, I'm really focused on what the patient is saying and can develop that More personalized interaction as opposed to staring at a computer screen or staring at a piece of paper.
- [12:43]
A
Definitely. And obviously AI is one of the biggest disruptors to healthcare and definitely spine surgery. Are there any other key disruptors that you'll be watching in the spine space next year?
- [12:59]
B
You know.
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Conversations about declining reimbursements are not isolated to spine surgery. It's across the board.
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A close colleague and friend of mine wrote a paper in the Journal of Arthroplasty last year that said orthopedic surgeons have taken a 31% hit on inflation adjusted income over the last quarter century. And nobody really wants to hear an orthopedic surgeon complain. And I'm not complaining on a personal level, but what this has led to in other specialties are care deserts. So here in Colorado, a healthcare system that covers the Gunnison Valley. If anybody's ever been to Gunnison, Colorado, or Crested Butte, we're talking about some pristine areas of the state and pristine areas of the country. But those healthcare systems, because of declining reimbursements, have had to shut down their obstetrics and gynecology programs. And that's leaving countless women and their babies without a place to receive their care. And if we're not careful, we're going to see those same trends trickle over into other specialties. We've seen it in primary care, we're seeing it in ob gyn. And.
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I'm concerned that not enough red flags are popping up amongst the individuals and organizations that have the ability to influence how funding is allocated and how these decisions are made. So I'm going to be watching that really closely, especially as we learn more about the 2026 CMS fee schedule and how that might affect.
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Practices and patients ability to access care.
- [14:53]
A
Definitely. It sounds like you have a real emphasis on just like kind of the need to speak out and for physicians to advocate for themselves.
- [15:01]
B
Yeah. I think the onus is on us to try to get a seat at the table. Right. You know, I've mentioned a lot that I work at an academic institution, but at the same time now, I'm not that big on research. I like the advocacy side of things. I sit on the executive board for the Colorado Orthopedic Society, which is actually a really fun and rewarding role. We're always keeping a pulse on what's going on within the state of Colorado political scene, but also at the national level. And there have been numerous instances where I feel like we've really made a difference.
- [15:45]
In terms of how health care is regulated and.
- [15:51]
Distributed within our own state's borders.
- [15:54]
A
That's very well said. And Dr. Wessel, was there anything else you wanted to discuss before we wrap this podcast?
- [16:01]
B
You know, not really. I think.
- [16:05]
Hopefully more and more people tune in and subscribe and listen. And I would love to see our podcast reach beyond other healthcare providers. I think we need to have open and honest discussions with our patients about what the healthcare climate is like.
- [16:26]
And if we can bend the ear of patients, hopefully we can bend the ear of our politicians to start to move towards a more sensible policy that really improves the value of the care that we provide and helps us to improve outcomes for our patients.
- [16:50]
A
Yeah, it's like a real collaborative effort.
- [16:52]
B
Absolutely, absolutely. We don't need to be pitted against one another, one side versus the other. You know, the, the 99.9% of healthcare providers I know, they, they genuinely care about the well being of their patients and they're doing their best, usually far above and beyond what patients even realize to, to help deliver the best care possible and, and help people return to a quality of life that they want, want. And I think a lot of patients really understand that. And the more people who.
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Intellectualize with that concept, I think the better we are all going to be served with adapting and modifying our current healthcare delivery systems.
- [17:42]
A
It's very well said. Well, thank you so much for Joining us today, Dr. Wessel, it's been a pleasure speaking with you and I look forward to connecting again down the line.
- [17:51]
B
Yeah, thank you very much. I'm happy to join you anytime. This was fun.