Xiaofei Zhou, MD - Associate Program Director, Neurosurgery, Section Chief of Neurosurgery, Southwest General Hospital

Summary

Podcast Summary

Podcast: Becker’s Healthcare Podcast
Episode: Xiaofei Zhou, MD – Trends and Education in Neurosurgery
Release Date: January 1, 2026
Host: Carly Beam
Guest: Dr. Xiaofei “Sophie” Zhou, Associate Program Director, Neurosurgery; Section Chief of Neurosurgery, Southwest General Hospital

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Main Theme & Purpose

This episode focuses on the evolving landscape of neurosurgery, both in clinical practice and education. Dr. Sophie Zhou shares insights on preparing neurosurgery residents for a complex healthcare system, the balance between surgical innovation and patient outcomes, thoughtful adoption of artificial intelligence, and the overlooked importance of surgeon well-being. The conversation offers practical advice for training the next generation of neurosurgeons within the broader context of U.S. healthcare trends.

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Key Discussion Points & Insights

1. The Gaps in Modern Neurosurgery Education

[01:08 – 02:54]

• Surgical skill remains the cornerstone of neurosurgical training, but Dr. Zhou points out a deficit in teaching how to navigate the broader medical system.
• She emphasizes the importance of understanding:
  • Insurance mechanisms and private vs. academic practice
  • Business aspects like RVUs (Relative Value Units)
  • Broader patient care beyond the operating room, including access and financial barriers

Quote:
"To be a better physician, we should understand where our patients are coming from… What does it mean to take care of them, to get them access to care? I think that's a really important part of medicine nowadays that we really should refocus on." — Dr. Zhou [01:56]

2. Educational Approaches for the Next Generation

[03:23 – 05:01]

• Encouraging residents and fellows to attend national coding and advocacy courses.
• Emphasizing multidisciplinary perspectives by engaging with both academic and private practice settings.
• Highlighting the importance of advocacy in understanding healthcare policy and access.

Quote:
"There was a real drive towards understanding how does insurance work, how does access to medicine work, and how do we provide care at a sustainable, cost effective way." — Dr. Zhou, referencing a recent Becker’s conference [04:12]

3. Innovation vs. Overuse in Surgical Advances

[05:21 – 06:53]

• There’s a constant temptation to embrace every innovation, but Dr. Zhou argues for a data- and outcome-driven approach.
• Assessing whether new technologies truly improve patient care and offer cost/value advantages.
• Academic research and outcome studies play a key role in discerning beneficial innovations from mere “flashiness.”

Quote:
"You have to look at it as: does it effectively change my management of my patients? … Is it beneficial to my patient for the cost and … the effort?" — Dr. Zhou [05:41]

4. The Role and Scrutiny of Artificial Intelligence

[06:53 – 09:40]

• Surgeons are now growing into AI alongside their careers, integrating tools like AI dictation to streamline documentation, not to replace decision-making.
• AI's current utility is mainly in speeding up workflows and aiding with imaging, but it does not outpace human expert nuance.
• The need for continuous and cautious integration, maintaining a curious but critical mindset: “AI is a tool … you can help make better.”

Quote:
"Would I trust my radiology partners over an AI read? 100%. Because there are just nuances of patients that experience teaches you. And that's the part about AI that will get better." — Dr. Zhou [08:13]
Quote:
"That curiosity… if you just trust it blindly ... you don't realize the pitfalls. But on the other hand, [if] you say, 'I don't trust it, nothing about it is good,' then you're gonna fall out of favor." — Dr. Zhou [09:40]

5. Surgeon Well-Being: The Overlooked Curriculum

[10:19 – 12:57]

• Dr. Zhou stresses the importance of surgeon self-care, emotional health, and maintaining interests and relationships outside of work.
• The well-being of the surgeon is crucial not just for longevity in their career, but for fostering real, empathetic connections with patients.

Quote:
"We forget that we're human too at the end of the day. … Having a friend circle, not making this job your entire life… are all critical towards being a really good doctor." — Dr. Zhou [10:34]
"They're not just a spine that I need to operate on. They're a person who I can help. And I think if we look at ourselves that way and treat ourselves as humans... we're going to be that much better." — Dr. Zhou [12:04]

6. Top Trends in Healthcare and Spine Surgery

[14:14 – 16:17]

• Major trends include:
  1. The changing landscape of insurance, coding, and bundled payments and their effect on care access
  2. The accessibility and structure of medical training—concerns about student debt and specialty choices
  3. Rapid advancement and adoption of technology, with the need for rigorous evaluation based on research and large-scale data

Quote:
"We should embrace change, but we shouldn't just rush into things like we've always talked about." — Dr. Zhou [16:13]

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Notable Quotes & Moments

• On broadening physician training:
  "Our greatest focus is our patients, and that should always remain true. But … what does it mean to take care of them ... to get them access to care?" — Dr. Zhou [02:21]

• On technological innovation:
  "Sometimes you can do something, but it may be slower, it may cost more. And does that time and money cost really benefit the patient?" — Dr. Zhou [05:49]

• On AI in medicine:
  "That's the greatest thing about growth in medicine—you start from the beginning. So if you wait … then you're behind. But if you integrate as it becomes available, then you're part of the learning process." — Dr. Zhou [08:50]

• On the human side of care:
  "The best doctors I've ever seen have always been able to talk to me like I'm their friend. … That's what I try to emulate in my practice." — Dr. Zhou [11:33]

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Timestamps for Key Segments

• Introduction & Dr. Zhou's Background – [00:00 – 01:08]
• Modern Neurosurgery Education Gaps – [01:08 – 02:54]
• Practical Training Beyond the OR – [03:23 – 05:01]
• Balancing Innovation and Restraint – [05:21 – 06:53]
• AI in Neurosurgery: Adoption & Caution – [06:53 – 09:40]
• Surgeon Well-Being in Training – [10:19 – 12:57]
• Healthcare Trends & Technology Assessment – [14:14 – 16:17]

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Overall Tone

Dr. Zhou speaks with warmth, candor, and a practical, systems-minded approach. Her emphases on curiosity, empathy, and lifelong learning reflect a humanistic philosophy within advanced surgical and academic practice.

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For New Listeners

This episode will resonate with clinicians, educators, and healthcare administrators interested in the evolving training landscape, pragmatic integration of technology, and the necessity of supporting surgeon mental health for better patient care. Dr. Zhou’s insights underscore the importance of coupling technical mastery with systems savvy and human empathy in modern medicine.

Transcript

[A]

This is Carly Beam with the Becker Spine and Orthopedics podcast, and I'm thrilled to be joined today by Dr. Sophie Zhou, a neurosurgeon at University Hospitals. Dr. Zhou, welcome back to the podcast, and thank you for being here today.

[B]

Yeah, of course. Thank you so much for having me. So before we get started, could you.

[A]

Just introduce yourself and share a bit about your background?

[B]

Yeah. So I am an assistant professor of spine surgery and neurosurgery at University Hospitals in Cleveland. I am the associate associate program director as well. So part of my role is to help guide new residents and new medical students into the field of neurosurgery. It's one of the best parts of my job is to, you know, bring in the. The new people, the new fresh blood into our field. It's. It's very, very rewarding.

[A]

I bad. And, you know, we're recording this in December, heading to 2026, and I'm wondering, what are the most important shifts, neurosurgery education that we need to see?

[B]

I think one of the things that really we all focus on is surgery itself. Right. And I think when you go through neurosurgery, it's seven years of training, you do thousands of cases, and you come out very experienced in surgery, and you come out very nuanced in your. In your decision making. And I think that's across the field in all of the different programs that I've seen throughout the U.S. but I think one of the things that we don't have a focus on is how does that translate in the current medical world? Right. I think we see neurosurgery and surgery and any kind of medical practice as medicine itself, but it doesn't exist alone. It exists in our medical system. So I think there should be a broader teaching of how does that translate with insurance? How does that translate in private practice? How does that translate in academic medicine? What is an rvu? I think those are the things that we don't focus on as much because, you know, at the end of the day, our greatest focus is our patients, and that should always remain true. But I think to be a better physician, we should understand where our patients are coming from, the financial background. What does it mean to take care of our patients, not just in their disease process, but what does it mean to take care of them, to get them access to care? I think that's a really important part of medicine nowadays that we really should refocus on.

[A]

Definitely. And I mean, I imagine for surgeon. Surgeons and patients are both navigating very different kind of elements of the healthcare system that still may be just equally as shifting, potential confusion, et cetera. I'd love if you could dive a bit deeper into what you've been telling your own fellows and residents. How are you, what are you doing in your own work to equip them with this full spectrum.

[B]

Yeah. So we really encourage our residents and our fellows to go out to courses because I think when you go to these national courses there, there are always coding courses and you can learn more about, you know, what is a code, what does it mean. I think there's also courses about healthcare and you know, neurosurgery also has advocacy programs that are involved in different aspects of healthcare. You know, we're involved in the Washington committee and things like that. So I think really just looking beyond the pure medicine and allowing your residents to have that kind of focus is, is critical because I think there's such a lack of focus audit in our training that just by telling them this is an aspect that you should focus on is great. For example, when we went to the Beckers meeting last year in June, there was a real drive towards understanding how does insurance work, how does access to medicine work and how do we provide care at a sustainable, cost effective way. And I think that kind of dialogue between not just academic medicine, which really focuses on patient outcomes, but with private practice as well, which has this other aspect, other dimension of medicine. I think this kind of dialog is really what drives our understanding of medical care in the United States.

[A]

Definitely. And hey, thank you for the kind words about our conferences. You know, with spine surgery, there's always, you know, a lot of new innovations coming out. And I'm wondering how are you balancing between teaching innovations but also, Neil, restraining unnecessary interventions?

[B]

Yeah, I think that's like such a great question. Right. Because you, we're always at the cusp of the next new thing and you always think that the new thing you're trying, well, you, at least you hope the new thing you're trying is going to be the next biggest and greatest. And I think one of the things that you have to really understand when you try a new thing is that you have to look at it as does it effectively change my management of my patients, does it provide good quality care? And it's not just, oh, I have this new cool thing, but really looking at it with some amount of focus on is it beneficial to my patient for the cost and is it beneficial to my patient for the effort? Because sometimes you can do something, but it May be slower, it may cost more. And does that time and money cost really benefit the patient? And I think one of the things that academic medicine does a really good job on to try to create that balance is that we do research projects. Right. We look at outcomes. And I think really focusing on the outcomes, being driven by the data is how you discern what is good and what is just flashy.

[A]

Yeah, it's a great way to think about it. And obviously AI, it's everywhere in healthcare always. People are always exploring new applications, new new tools. How should spine surgeons and neurosurgeons be taught to evaluate these applications so they don't over rely on like black box decision support?

[B]

Yeah. I think the good thing about our generation of surgeons is that we're kind of growing up with AI. Right. It's not like AI was something that kind of occurred 20, 30 years ago. It's something that we're integrating actively now into our practice. So as a practicing surgeon, you are kind of looking at AI as it integrates into practices every day. And one of the best examples right now is how we use AI in dictations. It kind of increases our speed in writing documentation, but it doesn't necessarily change our decision making. It takes away some of the busy work as of right now. It helps with scheduling, it helps with some aspects of medicine that are tedious but are very rote. There's also AI applications in imaging. Right. It helps refine some of the reads. But would I trust my radiology partners over an AI read 100%? Because there are just nuances of patience that experience teaches you. And that's the part about AI that will get better. Right. It's about training these programs. They also rely on experience. And I just don't think we're quite there yet. But the greatest thing about being a part of, you know, growth in medicine is that you start from the beginning. So if you're one of those people who waits until everything is already said and done, then you're behind. But if you integrate as it becomes available, then you're part of the learning process. And I think that's how you avoid the pitfalls, because you are able to look at it from a perspective of it's learning. With me.

[A]

Yeah. And it's kind of like that approach of curiosity and what can this do? Well, where can we refine things?

[B]

Yeah, that curiosity. That's. That's such a good way of putting it, because I think if you just trust it blindly because you're so far behind and you're like, well, it must be good. Well, then you don't realize the pitfalls. But subs, you know, on the other hand, if you're just like, I don't trust it, nothing about it is good, then you're gonna fall out of favor. Right. Because the things that are good about AI you're gonna miss. So I think just having that balance and knowing that it's a tool and it's a tool that you can help make better, I think that is what creates that balance.

[A]

Got it. And I wanted to pivot a little bit. I was wondering what part of surgeon well being do you think is missing from today's education right now?

[B]

Oh my gosh. I think that's such a good topic, right? Because we're all humans at the end of the day, and I think that is the part we forget. There's so much machine learning, there's AI, there's all these things that, you know, are designed to make our practice better, to make our patients better, but we forget that we're human too at the end of the day. And so we talk a lot with our residents about, you know, you have to focus on your own well being. And sometimes, you know, it's just taking a five minute breather after a hard case or a hard outcome and real realizing and recognizing your own humanity. And sometimes it's more than that. Right. Five minutes may not be enough, but I think eating right, exercising, having a friend circle, not making this job your entire life, and having outside interests are all critical towards being a really good doctor. Because when I have doctors that I really respect that take care of me, what I really love about them is that they're human and they connect to me on an emotional level. Right. And I don't think they can do that if they were burned out and tired and can't even focus on themselves. The best doctors I've ever seen have always been able to talk to me like I'm their friend. They asked me how I'm doing, how, how things are going in my life, and that's what I try to emulate in my practice. I always want to know personal details about my patients because I think it also helps me focus on not just the medicine, but how their back pain or how their leg pain, how does it translate in their life. Because they're not just a spine that I need to operate on. They're a person who I can help. And I think if we look at ourselves that way and treat ourselves as humans, then as we train and as we get better and as we, you know, evolve in our physician practices, we're going to be that much better.

[A]

I like that the way you're framing that, too. It's like the surgeon takes care of themselves, and then that translates to just the positive interactions with the patients, etc.

[B]

Yeah. I mean, how many times have you ever had a doctor where you're like, wow, that guy is a machine, and you think he's probably technically really good, but is he going to take care of me in a moment of hardship? Like, is he someone I can trust and talk to? I think when you really reflect on the physicians that kind of have been great, their technical skills have to be good, but it's their humanity that kind of triggers that emotional response. Right. Because when I want to take care of someone or when I want someone to take care of me, I don't want a machine. I want a doctor who understands there are nuances to my life. And so I think by embracing the nuances in your own life, through training afterwards, throughout your entire career and after, I think that if you can focus on those aspects of your life, you will come out that much better of a doctor.

[A]

Very well said. And, Dr. Jo, last question I had for you. What are the three top trends that you're following in healthcare today? You can think broadly. Spine specific.

[B]

Yeah. I think the things that we really face are the changes in insurance. There's just been so many issues with insurance companies with the way that spine coding is going forward, whether or not we're going to have bundled care. And then I think those aspects of medicine, the financial aspects of medicine are a huge component of how our patients receive care. I think medical training is also a huge trend or not trend. But medical training and access to training, whether or not, you know, medical students can afford to train and whether or not they pick specialties based on income, that is going to be huge, as in medicine in general, probably less so in subspecialties like spine and neurosurgery. But I think that is a huge player in medical education going forward. And I think that the biggest trend in spine is our embrace of, you know, technology. I think there are just so many different inventions coming forward that we just need to be critical in the way that we assess them. I think we assess things with research, with outcome studies, and now that large population databases are so readily available, I think we just need to be really keen on how we integrate those things into our practice. I think that we should embrace change, but we shouldn't just rush into things like we've always talked about.

[A]

Right. Well, Dr. Zhou, thank you so much for joining us today. It's been a pleasure to catch up, and I hope you have a happy holiday.

[B]

You too. Thank you so much for having me.