Solo Practice–Sun Valley

I moved to Sun Valley in late 1999.  I joined another spine surgeon in a small spine practice.  I had been practicing spine surgery in downtown Seattle for 13 years.

It was a challenging transition.  A significant aspect of major spine surgery is having a large hospital with an ICU.  I still did spine surgery, but on a much smaller scale.  I was at the peak of my skills in regards to my ability to perform large cases.  I also did not have all of the non-operative resources at my disposal.  I had to learn to be innovative to bring as many resources into my practice as possible.  I eventually felt good about the level of spine care I brought to the valley.  I was able to send the large cases to Boise and follow them post-operatively in Sun Valley. It was in this scenario that the DOCC Project began.

I was a tertiary referral surgeon who ended up seeing primary low back pain.  I had a lot of prior experience with physiatrists in supervising non-operative care.  I had access to excellent physical therapists.  I also had access to physicians who could perform excellent cervical and lumbar blocks when needed.  I had already been working on helping patients sleep, and I knew which patients were under a lot of stress and at high risk for becoming disabled.  Because I’d had a lot of personal success with using David Burn’s “Feeling Good,” I started to have my patients use the book to deal with the stress of chronic pain.

As a surgeon, we become used to triaging our patients.  We are trained to look for problems that we can solve surgically.  If surgery is not a promising solution, we will do the best we can do provide some non-operative treatments.  As it is not our primary training and interest, we generally don’t tackle it that aggressively.  In Sun Valley, my situation was a lot different than in downtown Seattle.  Over 90% of my practice was non-surgical, which isn’t ideal for a surgeon.  However, I was the main resource, so I just put my head down and went to work without expectations.  I did have a strong non-operative background, but what was different in this situation was that I applied my surgical mind set to non-operative care.  I also had some training as an internist and understood that the mind-set of a physician often has to be “managing” rather than “curing.”  It was about two years into my small spine practice setting when the “rhythm” of the DOCC program began to develop.

BF