Rachel Bratescu, MD, Orthopaedic Surgeon and member of the GW Spine and Pain Center at George Washington University Hospital,

Summary

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Becker’s Healthcare Podcast: Interview with Dr. Rachel Bratescu, Orthopaedic Spine Surgeon

Episode Released: January 11, 2026

Episode Overview

In this episode, host Carly Beem interviews Dr. Rachel Bratescu, an orthopedic spine surgeon and faculty member at George Washington University Hospital’s GW Spine and Pain Center. Dr. Bratescu discusses her top goals for the year, the drive toward less invasive spinal procedures, interdisciplinary collaboration, mentorship, navigating insurance challenges, and the future of spine surgery technology.

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Key Discussion Points & Insights

Dr. Bratescu’s Top Goals for the Year

• 1. Incorporating Spinal Endoscopy (00:39)

  • Dr. Bratescu’s primary goal: to bring spinal endoscopy into her surgical practice at GW.
  • She explains, “Spinal endoscopy is a technique that a lot of people are more familiar with in the context of other joints…The idea of doing what you need to do as a surgeon through one portal while viewing and seeing what you’re doing in another portal.” (00:45)
  • She was trained in biportal endoscopy at NYU and emphasizes its ultra minimally invasive nature.
  • Patient benefits: less postoperative pain, accelerated return to normal activities.
  • Applications include decompressions, microdiscectomies, and select fusions.
  • She is awaiting hospital approval to begin using this technique.

• 2. Creating a Comprehensive Spine Center (03:13)

  • Dr. Bratescu advocates merging orthopedic and neurosurgical spine services.
  • “This is really the future of spine surgery, especially at many large academic centers…you have orthopedic and neurosurgeons who are spine surgeons collaborating and working together.” (03:19)
  • The model integrates surgeons, pain management, injections, physical therapy, and improves patient access and coordination.
  • She stresses the advantages for continuity of care and patient outcomes: “This promotes better patient care, better access, streamlining of appointments, of staffing, and having everything in one place...” (04:13)
  • Implementation is in progress with strong support from both disciplines.

• 3. Enhancing Provider Education and Collaboration (05:54)

  • Dr. Bratescu is working to educate the broader network of referring clinicians, including primary care, endocrinology, and rheumatology.
  • She notes the importance of aligning on the multi-step process for spinal surgery: physical therapy requirements, MRI protocols, osteoporosis management, surgical optimization.
  • “Facilitating that communication, educating other providers about how this process works and how we can better take care of our patients, I would say, is another thing that’s on my list of goals for the upcoming year.” (06:51)

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Faculty Work & Mentorship

• Dr. Bratescu highlights mentorship as a core theme in her academic role.
• She reflects:
  • “As a resident…when you think back to the people who influenced your choice in the field you go into…not every orthopedic resident that comes to work with me is going to be a spine surgeon, but there are people who want to be.” (07:34)
  • Enjoys mentoring and helping trainees identify fulfilling career paths—whether in orthopedics, spine, or other specialties.

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Biggest Challenges / Headwinds for 2026

• Insurance Denials & Authorization Hurdles (08:36)

  • “The continued challenges that we have and whether or not insurance companies are going to continue increasing things like denials and peer to peers. The authorization process—this goes for imaging, but also surgeries in general—has just been incredibly time consuming. It’s challenging.”
  • Growing frequency of peer-to-peer reviews and denials even for well-indicated spine surgeries.
  • “A lot of these patients are really well indicated and really suffering leading into their spine surgeries, and it’s something that we fight for and almost every spine surgeon that I know is fighting for on a daily basis.” (09:10)

• Strategies for Navigating Insurers (09:43)

  • “The foundation of this [is] indicating your patients well for surgery, doing the right surgery for the right patient at the right time, as well as documenting…your documentation supports your clinical decision-making.”
  • She stresses strong, objective documentation as not just a necessity for clinical quality but also as a “medical legal document.”

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Practice Growth & The Future of Spine Surgery

• Embracing Advanced Technologies (11:02)

  • Dr. Bratescu looks forward to integrating robotics, navigation, and emerging tools like augmented reality.
  • Goal: “To do a less invasive spine surgery through a microscope where you can see an overlay of the pathology without actually looking at it.”
  • She’s engaged in discussions with technology companies and is optimistic about making surgery safer and improving clinical outcomes.

• Vendor-Agnostic Navigation Systems (12:18)

  • Highlights the increasing sophistication of navigation systems:
    • “Navigation systems that are vendor agnostic, meaning you can use any implants that you would like from any company…sub-millimeter accuracy when you’re placing a screw in the pedicle of the spine…This type of technology is developing and being utilized [rapidly].”
  • She expects these systems to rise in popularity for their precision and flexibility.

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Notable Quotes & Memorable Moments

• On Minimally Invasive Techniques:
  • “This is incredibly important when we are looking to offer patients less invasive forms of surgery that can get them out of surgery with less pain in the acute post-operative period and get them back to the things that they love to do…” — Dr. Bratescu (01:04)
• On the Comprehensive Spine Center Model:
  • “Instead of being two separate departments, you are working under the same department…the department of spine surgery. And a comprehensive spine center isn't just about the surgeons. It's also about everything else that we can offer patients.” (03:37)
• On Navigating Insurance Barriers:
  • “We’ve really noticed a drastic increase in the peer to peers required, not just to get things like MRIs done, but also for denials related to surgeries. And a lot of these patients are really well indicated and really suffering leading into their spine surgeries, and it’s something that we fight for and almost every spine surgeon that I know is fighting for on a daily basis.” (09:04)
• On Faculty Impact:
  • “This is one of the reasons that I really enjoy being in academic side of things, because I do get to mentor and teach and really guide people and figure out from both a medical student and a resident standpoint what makes them happy and what might provide them with a fulfilling career.” (08:06)

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Timestamps for Key Segments

• 00:21–01:46 — Dr. Bratescu’s Background & Goal: Spinal Endoscopy
• 02:26–03:10 — Endoscopy’s Advantages for Hospital & Patients
• 03:13–05:38 — Comprehensive Spine Center Vision
• 05:54–07:11 — Interdisciplinary Education & Collaboration
• 07:26–08:29 — Faculty Role and Mentorship
• 08:36–10:46 — Insurance Challenges and Response Strategies
• 11:02–12:14 — Advanced Technology in Spine: Robotics, AR, and Navigation
• 12:18–13:06 — Vendor-Agnostic Navigation & Technology Outlook

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Summary Takeaway

Dr. Rachel Bratescu’s interview is a forward-looking discussion on the transformation of spine surgery—championing minimally invasive approaches, interdisciplinary care, comprehensive spine centers, and embracing cutting-edge technology for patient benefit. She shares a candid perspective on the systemic hurdles faced by surgeons, especially with insurance, and underscores the enduring value of mentorship in medical education. This episode provides concise yet in-depth insight into both the clinical and operational future of spinal care.

Transcript

[A]

This is Carly Beem with the Becker Spine and Orthopedics podcast. And I'm thrilled to be joined today by Dr. Rachel Protescu with George Washington University Hospital. Rachel, thank you so much for being here today.

[B]

Thank you. Thanks so much for having me. I'm thrilled.

[A]

Absolutely. And before we dive into our discussion, could you introduce yourself and tell us a bit about your background?

[B]

Yeah. So my name is Rachel Bertescu. I'm an orthopedic spine surgeon in the Department of Orthopedic Surgery at George Washington University where I'm faculty in Washington D.C.

[A]

And Dr. Petescu, what are your top three goals in your work this year?

[B]

Yeah, I would say great question to kick off the new year. Number one. My number one goal, I would say is incorporating endoscopy in my practice. So if you're not familiar or those are not familiar, Spinal endoscopy is a technique that a lot of people are more familiar with in the context of other joints. Right, right. So the shoulder, the knee and the hip, for example. It's the idea of doing the work that you need to do as a surgeon through one portal while viewing and seeing what you're doing in another portal. What's really exciting is that this technique can also be translated to spine surgery. This was a technique I trained in during one of my fellowships. In my orthopedic spine fellowship at nyu, I was trained in B portal endoscopy. What makes this unique is that it is essentially doing ultra minimally invasive spine surgery. This is incredibly important when we are looking to offer patients less invasive forms of surgery that can get them out of surgery with less pain in the acute post operative period and get them back to the things that they love to do, whether that's working, whether that's spending time with your family or any other recreational activities that patients wanna get back into, whether that's sports or just staying active throughout your life. So this is a really amazing technique in particular for spinal surgeries such as decompressions and microdiscectomies. But, but it's also being utilized as well in some fusion surgeries. I'm currently in the process of having this approved at our hospital. I'm hopeful in the next few months that that will be the case and that I can start employing this technique with my patients.

[A]

That's awesome to hear. And you know, so it sounds like things are looking pretty good. Can you dive into sort of your sales pitch the hospital to, you know, have them thinking about this?

[B]

Yeah, I think when we consider what goes into patients having spine surgery. There's a lot of things there's not only from a hospital standpoint, considering things like length of stay, length of surgery, anesthesia, efficiency of surgery, or time staffing and things of that nature, really doing these surgeries in less invasive manners allows us to be more efficient, to help more patients, and also consider doing things on more of an outpatient basis or ambulatory surgery. So. So it's really advantageous from a hospital standpoint and also from a patient standpoint. And I think that's one of the greatest advantages of doing surgery this way.

[A]

Sounds like an absolute win. Win. And what were some of your other goals besides this? If you want to say two more.

[B]

Sure. So I think the next one that I'm really excited about, which is also founded in my training as a spine surgeon, having done both orthopedic and neurosurgical spine fellowships, is creating a comprehensive spine center. And what that means is merging both the orthopedic and neurosurgery spine departments. I am fortunate that I have a great relationship with the neurosurgeons here. And this is really the future of spine surgery, especially at many large academic centers in the United States and around the world that employ this model. And what that really means is that you have orthopedic and neurosurgeons who are spine surgeons collaborating and working together. Instead of being two separate departments, you are working under the same department. The department of spine surgery and a comprehensive spine center isn't just about the surgeons. It's also about everything else that we can offer patients, whether that is pain management, injections, physical therapy. These are other departments and other providers that I work very closely with who take care of my patients. And there's often multiple steps that happen before a patient even goes to surgery, in addition to patients for whom surgery is not in their best interest. So it really makes sense to have all of these offerings under the same roof and in the same place at the same time. This promotes better patient care, better access, streamlining of appointments, of staffing, and having everything in one place, both figuratively, but also in many cases, under the same roof. Like sharing clinic space when you can walk down the hallway and speak to one of your colleagues about a mutual patient, or come up with a plan, or even see that same patient both in the same day or have their intervention done, whether that's an injection, an ablation, et cetera, and then go check in and see how they're doing. It's just better involvement in your patient's care and can also contribute to better patient outcomes. So that makes a lot of sense. Obviously, these things can take some time, but I'm hopeful that by the end of this year that that's another thing that will be on our horizon. And both from a neurosurgery and an orthopedic standpoint here at gw, we both agree that this is the future and we look forward to offering this to our patients.

[A]

Yeah, absolutely. I mean, I've heard from a lot of other spine surgeons and orthopedic surgeons about the importance of having more interdisciplinary, multidisciplinary collaborations.

[B]

Exactly. Yeah.

[A]

And so what are some other exciting things going on with the spine program out here? Obviously you mentioned this comprehensive spine center you're working on. Endoscopic. Endoscopic spine surgery. What else is going on?

[B]

Yeah, I would say that probably the most important thing is creating the comprehensive spine center. We're also working on collaboration by educating other providers in our referral base. So that's not just things that are very spine adjacent, like pain management and spine surgeons in general, but this also includes our primary care physicians. This includes other disciplines like endocrinology and rheumatology, people that we work with very closely as well, or have common patients with. And right now, in most cases for spine surgery, there's a process by which patients are seen. In many cases, you require six weeks of physical therapy in order to get an mri. In other cases, we're looking to get patients treated for things like osteoporosis. We're looking to get before spinal fusions, for example, and just looking to have patients worked up by other means for other medical conditions to get optimized for surgery.

[A]

And.

[B]

And so really facilitating that communication, educating other providers about how this process works and how we can better take care of our patients, I would say is another thing that's on my list of goals for the upcoming year, but is an exciting thing that's happening at GW so that we can all work on collaborating and taking better care of patients.

[A]

Yeah. And I'd love to also pick your brain a bit on the faculty work you've been doing. What are some of the most important lessons, themes that you're instilling in residents, fellows, students, et cetera?

[B]

I think one of the most important things is mentorship, and that's something that you and I may even have spoken about previously. It's such an important thing as a resident. Not that that was terribly long ago for me, but as a resident, when you think back to the people who influenced your choice in the field. You go into and into your subspecialty, and you. You think about it like, not every orthopedic resident that comes to work with me is going to be a spine surgeon, but there are people who want to be. So whether I'm serving as a mentor for somebody who is interested in the field of spine surgery from someone from a research standpoint or academics, a medical student who's trying to decide what subspecialty they might want to go into, whether that's orthopedics or not. This is one of the reasons that I really enjoy being in academic side of things, because I do get to mentor and teach and really guide people and figure out from both a medical student and a resident standpoint what makes them happy and what might provide them with a fulfilling career.

[A]

Absolutely. And what are some of the biggest headwinds you're bracing yourself for in 2026?

[B]

Yeah, I would imagine that there are a number of other spine surgeons who have some of the same feelings on these issues. But one of the main concerns for me for the upcoming year is really the continued challenges that we have and whether or not insurance companies are going to continue increasing things like denials and peer to peers. The authorization process, this goes for imaging, but also surgeries in general has just been incredibly time consuming. It's challenging. And we've really noticed a drastic increase in the peer to peers required, not just to get things like MRIs done, but also for denials related to surgeries. And a lot of these patients are really well indicated and really suffering leading into their spine surgeries. And it's something that we fight for and almost every spine surgeon that I know is fighting for on a daily basis. So that's one of the challenges that we kind of brace ourselves as the years progress for in the upcoming year. But we will continue to fight it for our patients.

[A]

Yeah. Can you kind of dive into kind of your strategy when it comes to dealing with insurers, these peer to peers?

[B]

I think that one of the most important things, number one, is just the foundation of this. Indicating your patient's well for surgery, doing the right surgery for the right patient at the right time, as well as documenting, I mean, your documentation supports your clinical decision making. You can look back at your note or your office visits and you can say, this is why this is what this patient's symptoms were. This is, from an imaging standpoint, what I believe the pathology is, and this is why these are the things that they've tried and why I believe they're indicated for this specific surgery, and you can demonstrate that that's your logical mode of thinking. I think that's one of the most important things, as well as it being a medical legal document. So I think having really tight and strong indications, as well as documenting in the medical record appropriately and providing very objective evidence for what has been done and why you are recommending this are probably the most important things going in, because then you have a leg to stand on.

[A]

Yeah. So like, really having that paper trail to back you up.

[B]

Exactly. Yeah, yeah.

[A]

And then, Dr. Bertuscu, the last question I had for you is how else are you thinking about growth in your practice? I know you touched on wanting to, you know, expand with your endoscopy work, but, you know, what are some other areas of growth that you're envisioning?

[B]

Yeah, I think on. Along the lines of incorporating less invasive options for patients, which we touched on already. Another thing that is very exciting as far as spine surgery goes, is the incorporation of advanced technology. So these are things like not only robotics and navigation, which I use very frequently, but additional things in the pipeline like augmented reality. I mean, the goal is to be able to do a less invasive spine surgery through a microscope where you can see an overlay of the pathology without actually looking at it. Right there. There are companies here that are working on these technologies. And so these are. These are things that other companies I'm talking to, things we're exploring, and we're always looking for ways. The bottom line is not just that these things are cool and exciting, but we are looking for ways to make surgery safer and incorporate them into our workflow and our practice so that we can take care of patients better and for them to have better outcomes. That's the goal.

[A]

Yeah. And then I share a quick follow up. I mean, obviously without like naming names, but are there any particular types of spine technologies that you think will really soar, really develop in the next 12 months?

[B]

I think in terms of what I know is available and what I know is out there, there are navigation systems that are vendor agnostic, meaning you can use any implants that you would like from any company. In addition to having the accuracy that is incredible. Right. So what that means is sub millimeter accuracy when you're placing a screw in the pedicle of the spine, when you're doing a spinal fusion, for example, that's very close to the nerves or the spinal canal. I mean, these are things that are real and that are out there and that are gaining in popularity. So I wouldn't be surprised, especially at the rate that this type of technology is developing and being utilized, that it doesn't come to a head and become even more popular in the next year.

[A]

Yeah. So it sounds like that versatility is probably just especially important, I imagine, for spine surgeons.

[B]

Yeah.

[A]

Well, Dr. Bertuscu, thank you again for joining us on today's podcast. I hope you enjoy the rest of your evening, and I look forward to connecting again in the future.

[B]

Yeah, likewise. Thank you so much for having me. It's been great.