David L. Skaggs, MD

And there's probably only a handful of those or do a true spine fellowship and then do additional time, uh, at a busy pediatric spine center.

And I think this raises a larger question of, you know, how are spine surgeons training?

And there's now so many new techniques that.

Martin Joh Hershock, Many people are feeling increasingly you can't learn it all in one year.

Martin Joh Hershock, And here, I think the neurosurgeons were a bit ahead of the orthopedic surgeons having in folded fellowships.

Martin Joh Hershock, So without increasing the length of a fellowship neurosurgeons are able to do one year of a spine fellowship during the residency.

Martin Joh Hershock, And then, if they want to do something special or go into academics right say probably more common than not, they then do an additional.

Daniel Katz- Post residency year fellowship so a lot are doing essentially two years of spine fellowship.

Daniel Katz- And I think that the next step for orthopedics is if people are going into spine the PG y five years should probably be all spine and then do an additional.

year of spine surgery.

So I think increasingly, if people are going to sub-specialize in endoscopy, MIS, robotics, tumor, pediatric spine, you know, whatever it is, there's going to have to be a little bit of additional training because there's really just too much to learn for one year to know all of spine and really be good at it all.

yes yep and you know it's just like cardiac surgery branched on its own plastics did vascular did you know as we know more and more um we have to admit that we're not experts at everything you know the general practitioner is not doing heart surgery spine surgery and vascular surgery got it and dr skaggs my last question i want to ask you what are two or three of the biggest health care trends that you'll be following headed into 2026.

Oh, you know, people get tired of hearing about cutbacks in the government, but I think that that's going to affect us a lot over the oncoming years.

You know, there's been good studies in the past showing that if a doctor sees a patient on government insurance, such as Medicaid, they actually lose money because their overhead is more than Medicaid pays.

Robert B. So we're starting already from a bad place of access and if that government support is going to be cut back even more.

Robert B. I think the patients on medicaid are going to have even more difficult time with access to medical care.

Robert B. So I think that's one of them, and you know throw on top of it, the academic centers are being cut back on research.

Daniel M. You know, I think that it's going to take a long time of going downhill before we have any possibility of unwinding this all so that's a negative.

Daniel M. The positive and it almost sounds tried to talk about Ai, but I think that Ai really is going to offer us.

Daniel M. Solutions that are better faster and less expensive than existing technology, you know I think radiology may be leading the field in this.