Uniting for Better Spine Care with Dr. Stephen Hochschuler

Summary

Becker’s Healthcare Podcast: Uniting for Better Spine Care with Dr. Stephen Hochschuler

Release Date: August 11, 2025

In this compelling episode of the Becker’s Healthcare Podcast, host Scott Becker engages in an insightful conversation with Dr. Stephen Hochschuler, a pioneering spine surgeon, mentor, and visionary behind the Global Spine Initiative. The discussion delves into Dr. Hochschuler’s illustrious career, the evolution of spine care over the past three decades, and the collaborative efforts aimed at enhancing patient outcomes in the spine healthcare landscape.

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1. Introduction to Dr. Stephen Hochschuler

The episode kicks off with Scott Becker introducing Dr. Hochschuler as a legend in the field of spine surgery. Highlighting Dr. Hochschuler’s multifaceted roles—as a teacher, mentor, and investor—Becker sets the stage for an in-depth exploration of his contributions to healthcare.

Notable Quote:

“Dr. Hockschuler, you're going to talk to us today about the Global Spine Initiative. Before we do that, can you take a moment and tell us a little bit about you and your background?”
[00:00] Scott Becker

2. Dr. Hochschuler’s Background and Early Influences

Dr. Hochschuler shares his journey from Long Beach, New York, through prestigious institutions like Columbia University and Harvard, to his service in the Air Force stationed in Wichita Falls, Texas. His military experience profoundly influenced his patient-centric philosophy, emphasizing the importance of prioritizing patient care over financial or administrative considerations.

Notable Quote:

“The patient should be the center of the universe, not the doctor, not the insurance company, not the attorneys, none of the others. But really the patient, you need to give the best care you can give to the patient.”
[01:30] Dr. Stephen Hochschuler

3. Evolution of Spine Care Over Three Decades

Dr. Hochschuler provides a retrospective on the transformation of spine care since the establishment of the Texas Back Institute 50 years ago. He underscores the institute’s commitment to blending academic research with private practice, allowing them to contribute significantly to global spine care advancements.

He observes a notable shift towards multidisciplinary approaches, inspired by his visit to Rancho Los Amigos rehab hospital, where the integration of various specialists enhanced patient outcomes. However, he also highlights emerging "turf battles" between spine surgeons and interventionalists, reminiscent of historical disputes in cardiovascular care.

Notable Quote:

“We have always felt you've got to integrate these separate specialties. [...] But the interventionalists are taking over more and more.”
[04:43] Dr. Stephen Hochschuler

4. The Global Spine Initiative: Bridging Specialties for Patient Benefit

The conversation pivots to the Global Spine Initiative, Dr. Hochschuler’s brainchild aimed at fostering collaboration between spine surgeons and interventionalists. He emphasizes the necessity of assembling top-tier professionals from both domains to ensure that patients receive the most appropriate and effective care, whether it involves surgical interventions or less invasive procedures like facet injections and epidural steroids.

Dr. Hochschuler advocates for a model where the expertise of interventionalists and surgeons is leveraged seamlessly, minimizing professional conflicts and enhancing treatment efficacy.

Notable Quote:

“The goal would be if you somehow could come into a combined practice or a referral base from one to the next and try to make sure that the best person's doing the procedure. That would be what the goal is for the patient.”
[07:03] Dr. Stephen Hochschuler

5. Sustaining a Long and Impactful Career

Becker praises Dr. Hochschuler’s enduring passion and asks about his secret to maintaining motivation and energy. Dr. Hochschuler attributes his longevity to a positive attitude, strong personal relationships, continual learning, and an active lifestyle. Despite approaching the age of 83, he remains as vibrant and engaged as ever, driven by a love for action and a commitment to advancing patient care.

Notable Quote:

“If you ask me how I feel, I feel like I'm 30 inside now. I know. Just take a look at me. You recognize I'm not. But I feel that way.”
[07:23] Dr. Stephen Hochschuler

6. Final Insights and Reflections

In his concluding remarks, Dr. Hochschuler touches on the evolving challenges within healthcare, particularly the increasing influence of attorneys and insurance companies. He advocates for a system that prioritizes patient care over financial motivations, drawing inspiration from healthcare models in South America and Europe.

Expressing a willingness to return to practice under ideal conditions, he underscores his unwavering dedication to patient-centered care, even in retirement.

Notable Quote:

“Money should not be the motivator. [...] I’d go back to work if my hand skill sets were as good as they used to be.”
[08:30] Dr. Stephen Hochschuler

7. Closing Remarks

Scott Becker wraps up the conversation by lauding Dr. Hochschuler’s exceptional career and his pivotal role in the Global Spine Initiative, reinforcing the episode’s theme of unity and collaboration in spine care.

Notable Quote:

“Dr. Hocksler, one of the very best. Stephen Hawkshore, brilliant spine surgeon, founder of Texas Back or co-founder of Texas Back of the best in the business. Thank you so much for joining us today on the Becker Celia podcast. Always great to visit with you.”
[09:56] Dr. Stephen Hochschuler

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Conclusion

This episode of the Becker’s Healthcare Podcast offers a profound glimpse into the advancements and collaborative efforts shaping spine care today. Dr. Stephen Hochschuler’s insights highlight the importance of interdisciplinary collaboration, patient-centric approaches, and the relentless pursuit of excellence in healthcare. Listeners gain valuable perspectives on overcoming professional silos and fostering environments where the best interests of patients remain paramount.

For those invested in the future of spine healthcare, Dr. Hochschuler’s experiences and the initiatives he champions provide both inspiration and a roadmap for enhancing patient outcomes through unity and innovation.

Transcript

[A]

This is Scott Becker with the Becker's Healthcare podcast. I'm thrilled today to be joined by a true legend in spine. We're joined today by Dr. Steven Hochschuler. Stephen is brilliant. He was one of the pioneers in spine surgery. He's a teacher, he's a mentor, he's an investor. Dr. Hockschuler, you're going to talk to us today about the Global Spine Initiative. Before we do that, can you take a moment and tell us a little bit about you and your background?

[B]

Certainly. Basically, I'm originally from the East Coast, New York. Grew up on a little island called Long Beach. Three miles long, half a mile wide. Left there for college. I went to Columbia undergrad and then up to Boston to Harvard, and then the military got me to move down to Texas. I was in the Air Force for two years in Wichita Falls, Texas, and actually loved it. I liked the military. I liked the fact when you needed to do surgery, you didn't have to go through insurance. You just had to justify why you were doing it. And you did it. You made no more money, no less money. You just took good care of patients. Well, that whole philosophy has kind of followed me through. That is, the patient should be the center of the universe, not the doctor, not the insurance company, not the attorneys, none of the others. But really the patient, you need to be give the best care you can give to the patient.

[A]

Fantastic. And talk to us about the evolution in the spine world over the last 30 years. What have you seen? Give us a quick backdrop on what trends you've watched over those 30 years. What are you seeing in the world of spine? Then talk to us about the Global Spine Initiative, certainly.

[B]

Well, what I've seen is, first of all, we started Texas back Institute about 50 years ago. Our goal there was to be the most academic private practice of spine that exists. I'm pleased to say we're considered such at this point. Non academic. We were not academic. We were a private practice. But we decided to do research, and we, at several points in time, did more than any three universities and been on the world stage. Initially, when the initial founders, myself and Ralph Rashbound, who I met in the military, he actually worked for me. I swore I'd never go into practice with him. And here he's my best buddy 50 years later and in practice for that period of time, we went out to California and visited Rancho Los Amigos, which was a rehab hospital. And we learned there that you really needed to take good care of patients by having a multidisciplinary Team, not just surgeons, not just interventionalists, but psychologists, psychiatrists, physical therapists, exercise physiologists, chiropractors. You need everything to take the appropriate care of patients. What I've seen evolve through the years, however, is turf battles almost similar to what you saw in cardiovascular surgery as compared to interventional cardiologists. The smart guys joined together so they could cover the gamut and take care of patients. Well, it took a lot of the cardiovascular guys a long time to accept that, and with not accepting it, they kind of lost the poodle. So in essence, we have always felt you've got to integrate these separate specialties. Well, lo and behold, as time evolved, when we started practicing, there were very few interventionalists. In fact, we taught them how to do facet injections, epidural steroids, you name it, we taught them because as a surgeon, it wasn't very exciting to do those things. But with time, these guys, the interventionalists, were much better at placing needles than we would be because of practice, skill set, et cetera. In essence, I saw an evolution. Now even more so. The interventionalists are taking over more and more and more. Their surgeons, both spinal surgeons from the neurosurgical world and orthopedic world, that are trying to fight the evolution that's inevitable. That's one of the reasons I was key in putting together the Global Spine Initiative.

[A]

And tell us what the Global Spine Initiative is doing. Tell us about that.

[B]

Well, as I mentioned a minute ago, the patient should be the center of the universe, not the interventionalist, not the surgeon, nothing else but the patient. So how do you give or deliver the best care for the patient? Well, sometimes it's by the interventionalist, not the surgeon. But surgeons have always thought they're king of the mountain, and I'm no different. But nevertheless, always looking where the puck's going, not where it's been. Not a me too endeavor. And despite being of older age, I still keep very involved with all of this. And I came to the conclusion we've got to get some of the best spine surgeons, both neurosurgeons and orthopedic, together with interventionalists the best of breed. And figure out how do we get us to work together for the benefit of the patient. So if patient needs a needle placed, well, most often it's the interventionalists. When I talk about interventionalists, that includes physical medicine, rehab, pain specialists, anesthesiologists, dolerologists, interventional radiologists. And these guys have perfected their skills. But now they're starting to get into areas that spine surgeons feel threatened by, ie, fusion, minimally invasive, using different kinds of scopes, et cetera, et cetera. And there's some kind of turf battle, which I don't think is good. I think what needs to be done is people need to be trained appropriately to do a procedure. And really now with the crossover between interventionalists and spine surgeons, Spine surgeons aren't as good at certain things that the interventionalists are good at, and the interventionalists aren't as good as spine surgeons are. The goal would be if you somehow could come into a combined practice or a referral base from one to the next and try to make sure that the best person's doing the procedure. That would be what the goal is for the patient.

[A]

Thank you. Let me ask you this. You've been an inspiration to me and a leader for as long as I remember. As good as they come. How do you stay motivated and active and engaged? We do an incredible job. How do you keep that energy left energy level up? Because we all need some of that. Talk to me about how you keep yourself motivated and going and thriving.

[B]

Well, probably like you, Scott, and I admire what you've done. People thought I'd burn out since I'm five years old. Well, I'll be in November. I'll be 83. I'm not close to burning out. I like the action. I like the involvement. I think it's important. Nutrition, I'm not too good at. I eat too much, but I work out so I can eat. Bottom line. I think it's positive attitude, good friends, good family, keep motivated, keep involved. I enjoy learning in every different space and every different sphere, and it just keeps you going. If you ask me how I feel, I feel like I'm 30 inside now. I know. Just take a look at me. You recognize I'm not. But I feel that way. And I think as long as I feel that way and I'm active and my mind is okay, then I'm going to keep doing it.

[A]

Well, it's literally amazing what you've done throughout your career. I love what you're doing with the Global Spine Initiative. Dr. Hocksler, anything else you want to share with us today that we ought to make sure that we make sure we're on top of?

[B]

No, not really. I think what's changed is. And Scott, you're well aware of this. What's occurred in the recent past or not even so, recent attorneys have had too big a role in. And I'm not insulting you. You're a great attorney. But in health care, same with insurance companies. If you look at what's happened, UnitedHealth, I mean, their stock went from 600 a share on a Friday to 300 on a Monday because of criminal investigation, et cetera, et cetera. I think really what we've got to do, and I'm not looking at government health care, but in South America, they have a system that seems to work in some places in Europe, and that is you donate your time in the morning and in the afternoon you have your private practice. Now would I practice under those conditions? Absolutely I would. But money should not be the motivator. And that's easy for me to say because I'm retired, but I still feel that way. And I'd go back to work if my hand skill sets were as good as they used to be.

[A]

No, I hear you've done an incredible job with your career. It just is a great pleasure to get to talk to you again. Dr. Hockshaw, one of the very best. Stephen Hawkshore, brilliant spine surgeon, founder of Texas Back or co founder of Texas Back of the best in the business. Thank you so much for joining us today on the Becker Celia podcast. Always great to visit with you.

[B]

It's a pleasure, Scott. Thank you for allowing me this time.