Vector Medical Group
Publication Date: July 21, 2025
Author: Marney Reid

Over the past decade, healthcare has undergone major transformation, driven by evolving care delivery models, rapid technological advancements, and shifting insurance landscapes. For spine surgeons, these changes are intensified by the growing demands of treating an aging patient population with an increased prevalence of spinal pathology, continuous downward pressure on reimbursement, and increasingly complex practice environments. In response, today’s spine surgeons must not only adapt to innovations in technology and shifts in surgical site-of-service but also navigate the intricacies of the business side of medicine with acumen they’ve not needed before.

Several ongoing trends continue to add layers of complexity to the practice of spine surgery and continue to shift power dynamics from the surgeon, to the local and national health systems. Among them is the steady consolidation of healthcare systems — hospital affiliations with large health systems rose from 56% in 2010 to 67% in 2022 — and reshaping referral dynamics and administrative structures. At the same time, the traditional model of wholly physician-owned practices is diminishing, with the percentage of physicians in private practice declining by 13.4% between 2012 and 2022.

Further compounding this shift is the growing influence of value-based care models, such as ACOs and HMOs, and the rapid expansion of retail-affiliated primary care groups like VillageMD, One Medical, and Oak Street Health. These entities are increasingly managing the front line of musculoskeletal care, often controlling the path to, and treatment options, with their subspecialty referrals.

Spine surgeons are also navigating a wave of technological disruption. The expanded use of telehealth and EMR platforms demands greater investment and operational adaptation. Meanwhile, innovations in machine learning and AI are beginning to influence diagnostics and clinical decision-making. Surgical technologies, including robotics and virtual reality, are seeing broader application in spine procedures, necessitating new skills and infrastructure.

Finally, the ongoing migration from inpatient to ambulatory surgery center (ASC) settings continues to reshape perioperative workflows and patient care pathways, underscoring the need for adaptable models that prioritize efficiency without compromising outcomes.

As change continues to shape the practice of spine surgery, we look to healthcare leaders to help make sense of what’s coming in the decade ahead. Dana Jacoby, MBA (CEO and Founder of Vector Medical Group) recently presented two didactic sessions at the Twentieth Annual State of Spine Surgery Think Tank in June 2025 to share insights on the latest business trends in and discuss a path forward to keep up with the evolving healthcare landscape. The topics at this meeting ranged from Clinical discussion such as: “The scalable future of customizable spine surgery,” “Automated 3D pre-surgical planning & patient-specific solutions for your complex cases,” “Augmented reality, machine learning, AI and where we go,” and “Have we evolved to different prosthesis designs for different patients or pathologies?” to business topics such as “Spine practice models: Aggregation, PSA, joint ventures,” “Pro fees dwindling: Building an ancillary network,” “Ethical considerations with AI and ML when caring for spine patients” and “Why Value-Based Care Isn’t Working For Spine Surgeons.”

I caught up with a few of the meeting’s leading voices to get their take on how spine practice is evolving and what the future might look like.

Frank Phillips, MD
Ronald DeWald, Endowed Professor of Spinal Deformities
Director, Division of Spine Surgery
Section Head, Minimally Invasive Spine Surgery
Fellowship Co-Director, Spine Surgery
Rush University Medical Center, Chicago IL
President, Society for Minimally Invasive Spine Surgery (SMISS)
Past President, International Society for Advanced Spine Surgery (ISASS)

The meeting has evolved from a small upstart meeting to becoming THE meeting on the Spine calendar for both surgeons and industry executives from major spine companies to innovative start-ups. In addition to open and
no holds barred clinical discussions focused on improving patient care, we have also emphasized getting an understanding of the socio-political-economic factors that affect our practice of medicine by bringing in
outstanding experts in these topics.

I am also very proud of how we have transformed the format of the meeting over the past two decades. This meeting was the 1st to implement multiple elements such as provide early career surgeon with educational grants, include industry leaders in panel discussions, and more recently the launch of our Investment Summit which brings together investors and early-stage spine companies for collaboration opportunities. Many major societies have now incorporated these concepts into their programs which is a tribute to what we have accomplished.

Dana Jacoby, MBA regarding physician practice strategies and how best to position themselves to win in today’s healthcare setting
CEO and Founder of Vector Medical Group

There were some exceptional presentations at this meeting and the one regarding private equity and spine surgeon practices was particularly interesting, mostly because of the questions that came up. One of the most surprising trends I noticed was how quickly the conversation shifted from traditional transaction metrics—like multiples and EBITDA—to questions about post-close scalability and physician engagement. Investors are no longer just looking for well-run practices; they’re asking, “What does integration look like in year two?” or “How aligned are the physicians beyond the payout?”

This reflects a deeper recognition that value creation isn’t just about financial engineering—it’s about cultural alignment, infrastructure readiness, and clinical scalability. At Vector, we’ve seen this evolution firsthand. The smartest investors are leaning into strategy earlier—sometimes 12 to 18 months pre-transaction—which is a major shift from years past. It’s a sign that the market is maturing, and that both sides—clinical and capital—are starting to speak a more common language.

Spine surgeons need to quickly deepen their understanding of payer dynamics, platform consolidation, and practice-level value creation—or risk being “on the menu” instead of at the decision-making table.

Too many talented surgeons are still operating with a siloed view of clinical excellence, without fully appreciating how site-of-service shifts, private equity alignment models, and digital health integration are redefining value in musculoskeletal care. If they don’t engage with these forces, decisions will be made for them—by payers, investors, or health systems.

The most urgent topic? Understanding enterprise value. Knowing how your practice is valued—and what levers you can pull to increase that value—is essential. That includes productivity benchmarks, ancillaries, referral pathways, and your team’s scalability. Surgeons who don’t speak the language of ROI, contribution margin, and patient acquisition cost are at a disadvantage in any negotiation.

One of my career passions is to work with surgeons to get ahead of the trend—helping them own equity in their ecosystem rather than simply being employees within it. The future favors those who think like operators, not just clinicians.

Michael Wang, MD Regarding the state of academia and the future of the spine subspecialty
Robert M. Buck Distinguished Chair in Neurological Surgery
Spine Fellowship Director
Chief of Neurosurgery, Univ. of Miami Hospital
University of Miami Miller School of Medicine

The academic employment model is changing significantly. Most universities now see the academic spine surgeon as simply a clinician who can produce institutional revenue, professional fees, and philanthropy. This is unfortunate, and almost all the academic surgeons I know have given up their wet labs, as the systems do not incentivize research. In addition, most academicians would bristle at being defined as “employed,” as that was traditionally used to refer to physicians paid by a hospital, not an ivory tower institution. That change in verbiage speaks volumes as to the present state my academic colleagues and I find ourselves in, as well as a look into the future of academia, and the pursuit of continuous research in spine pathology.

When I think about how the practice of medicine has evolved and what is expected from a busies acumen standpoint, I think the real elephant in the room is a conversation that would make all of us uncomfortable: How vulnerable are we as a specialty? Seemingly, there is no shortage of pathology to treat, and the spine surgeon remains as one of the highest paid and sought after specialists, at least for now.

However, as we see the way capital markets view the spine industry, one cannot help take notice. In addition, there are constant threats from non-surgical specialists. The way in which healthcare is bought and paid for is changing rapidly, and there is a real risk that we, as surgeons, will be on the losing end of any changes; even if it means reduced access to the excellent care we provide.

Hyun Bae, MD regarding the topic of the future of spine practice and what else we need to be teaching the future generations of surgeons
Professor of Orthopaedic Surgery
Department of Orthopaedic Surgery
Medical Director
Co Director of Education
Cedars Sinai Medical Center

More surgeons are choosing employment, and the majority of my fellows are gravitating toward positions within large health systems. While many express interest in the “priva-demic” model — a hybrid that offers the autonomy and ancillary income potential of private practice, along with opportunities to teach and publish — these roles are increasingly rare.

The entrepreneurial era of private practice, as we once knew it, is largely behind us. Today, success in private practice not only involves good patient care but often hinges the ability to generate ancillary income. But identifying and building those opportunities requires time, business acumen, and an understanding of community needs — resources many early-career surgeons simply don’t have at their disposal. As a result, we’re seeing a steady decline in private practice participation and a parallel rise in employed physician models.

Dr. Ahilan Sivaganesan gave a compelling talk on the urgent need for surgeons to begin assuming risk and stepping into leadership roles — or risk being sidelined entirely as corporate players like Optum, Amazon, and Walgreens continue to consolidate control over patient access and care delivery. His message was timely and clear: if we want to preserve our voice and influence, we must start moving in that direction. What we need now is a roadmap — and leadership that can help guide us forward.

Neil Badlani, MD, MBA regarding the importance of private practice in healthcare
Orthopedic Spine Surgeon; The Orthopedic Sports Clinic (Houston, TX)
Course Director; IEP Young Spine Surgeons

Physician leadership remains critical to the future of healthcare. Patients — and the system as a whole — benefit when physicians remain actively engaged in shaping care delivery, particularly through independent practice models that continue to evolve. Transitioning appropriate procedures to lower-cost settings like ambulatory surgery centers (ASCs) is a key part of that evolution.

Yet the future of private practice is increasingly uncertain. Declining physician reimbursement, rising overhead costs, continued health system consolidation, and growing market activity from large corporate entities — ranging from strategic players like Optum to private equity groups — are all applying significant pressure.

To sustain private practice in this environment, we must fully leverage our ability to deliver efficient, high-quality care in lower-cost settings like ASCs. That includes developing aligned ancillary services, building direct relationships with the self-insured market, and in some cases, stepping into risk-bearing arrangements. These shifts demand strategic execution—and trusted business partners who understand the value of physician leadership and patient-centered care. Together, we can shape a specialist-led care model that preserves quality, autonomy, and long-term viability.

Dustin Massel, MD regarding his concerns on healthcare consolidation and the future of employment models
Orthopedic spine surgeon; Endeavor Health Medical Group

The ongoing wave of consolidation in healthcare presents both opportunities and challenges. For surgeons, one of the major trade-offs is the gradual erosion of clinical autonomy — leaving many of us functioning more like cogs in a much larger system. This trend is inching us closer to a more socialized model of care, which raises real concerns about delayed access to treatment and a growing divide between patients who can afford expedited, high-quality care and those who cannot.

Like any practice model, employment comes with its pros and cons. Personally, I’ve found value in being employed by a health system. While the pace has been slower than I’d like, it’s given me the space to refine my process and remain thorough — something that can be lost in a high-volume approach. And from a practical standpoint, employment has also offered benefits like Public Service Loan Forgiveness (PSLF) which is meaningful when starting out with over $350,000 in student debt.

Do I sometimes wonder what life in private practice would be like? Of course. But given the financial and market realities I faced early in my career, health system employment was the right path for me.

Alexander Butler, MD regarding the today’s patient population and the evolution of spine surgery along with his thoughts on the State of Spine Meeting overall
Orthopedic Spine Surgeon
Lenox Hill Hospital Northwell Health
Assistant Professor in Orthopaedic Surgery
Zucker School of Medicine

Patients today are more informed than ever when it comes to their treatment options —especially regarding surgery — and that’s a welcome development. An educated patient not only contributes to better shared decision-making but also pushes us to continually refine our indications and surgical techniques. As cost transparency and outcome accountability gain prominence, practicing in a system that can clearly demonstrate value will be increasingly essential.

One of the most exciting aspects of spine surgery is the constant innovation—new techniques and technologies that aim to improve precision, consistency, and recovery times. In many ways, we’re just scratching the surface of what’s possible.

Ultimately, though, what sets this field and especially the State of Spine Surgery meeting apart is the people and the culture. The chance to connect with colleagues, both in structured sessions and informal conversations around them, is some of the most valuable and enjoyable time I spend all year.