Dr Arthur Jenkins Of Jenkins NeuroSpine On How To Use Digital Transformation To Take Your Company To The Next Level

An Interview With Cynthia Corsetti

Staff! In particular, you want to start with experienced front desk and practice managers. You want to find somebody who has demonstrated experience in these roles, because they are going to be either the face, or the backbone of the practice. Nothing drives people out of practice more than a rude, careless, or thoughtless front desk. And nothing makes for poor financial times then having someone (whose job it is to keep track of the employees) not know when it is time to hire, fire, or investigate financial irregularities.

Digital transformation has become a crucial component for businesses striving to stay competitive and relevant in today’s rapidly evolving landscape. As technology continues to shape industries and redefine business models, companies must adapt and leverage digital tools and strategies to unlock new opportunities for growth and innovation. In this interview series, we aim to explore various aspects of digital transformation, including best practices, challenges, success stories, and expert insights. We are talking to thought leaders, industry experts, entrepreneurs, technology innovators, and executives who have firsthand experience in driving digital transformation initiatives within their organizations. As part of this series, we had the pleasure of interviewing Arthur L Jenkins III.

Arthur L Jenkins III, MD, is the founder of Jenkins NeuroSpine and is one of the nation’s most recognized and highly respected spine surgeons.

In addition to his academic appointment at Mount Sinai Hospital in New York City, Dr. Jenkins serves as a clinical expert and author of clinical research trials, patented inventor, advisor to biotech companies, and an official neurosurgeon for the New York Police Department and the NFL.

Thank you so much for your time! I know that you are a very busy person. Before we dive in, our readers would love to “get to know you” a bit better. Can you tell us a story about what brought you to this specific career path?

When I was 16, I was fascinated by science medicine and surgery. I knew I wanted to go into a field that wouldn’t be “all figured out“ by the time I retired. I wanted to be constantly challenged, constantly developing and contributing to whatever science and practice that I went into. I was also fascinated by the brain, cognition, and the spinal functions that allowed the body to execute the brain’s will. When I was 17, I shadowed a neurosurgeon: calm, cool, collected, and in control. I saw how he treated patients with complex conditions and was hooked.

I chose to focus on Neurosurgery, and to this day, I am the luckiest guy in the world: I do what I love and love what I do. I have had the opportunity to learn and practice incredibly intricate skills to help “… turn patients back into people”. I am continuing to do research in poorly understood areas of neuroscience, such as cranio-cervical instability that causes neurovascular compression and autonomic dysfunction, Bertolotti’s Syndrome, and other highly challenging and poorly understood conditions. Believe me, none of this is “all figured out” yet, and likely won’t be for some time to come…

Can you share the most interesting or most exciting story that has happened to you since you began your practice?

The most exciting thing that has happened in my practice isn’t any one particular thing; it’s how exciting it is to see my patients have such wonderful recoveries. Office hours are a mix of preop patients and postop patients; and I love going through our days and seeing these postop patients on their “recovery trajectory” as they describe what they’re able to do again, often for the first time in years or even decades. 10 times a day I walk out of a patient’s room, look at my scribe, and say “I love my happy patients!”

The most exciting new technology we have encountered might be the increasing accuracy of stereotactic navigation. This has been an evolutionary process, from when it was first being used for spinal applications more than 20 years ago, to today. Although there are still significant limits on when it can be used and for what purposes, we are developing new protocols for using computer guided navigation (similar to GPS for the spine).

One technology I would love to see, which is not yet available, but would truly and profoundly change how we evaluate patients, would be if there were an MRI sequence that could identify pain in a patient. That is the “Holy Grail” for which we still seek clarity.

There is no imaging study that shows pain, only other things that we often associate with pain, therefore our medical interpretation of an MRI image is all about looking for inferences, or findings that are associated with pain, instead of a “big red flashing light” that shows where the pain is actually coming from. There are so many patients who have no pain at all, but abnormal findings on imaging, so these findings don’t always point to the “pain generator”.

It has been said that our mistakes can be our greatest teachers. Can you share a story about the funniest mistake you made when you were first starting? Then, can you tell us what lesson you learned from that?

Mistakes are critical to learn from. They are often our greatest teachers. However, in my line of work, most of these mistakes aren’t terribly funny. You’ll forgive me, as I remember the mistakes that I have made, and keep them private. They range from hiring mistakes, clinical judgment lessons learned, and practice errors. Those who do not remember the past are doomed to repeat it, and I take that charge very seriously and personally.

It’s not enough to just remember the past; one must learn the right lessons from it, and change what you do so that you do not repeat those mistakes, and ideally not make new ones. “If all you ever do is all you’ve ever done, all you’ll ever get is all you’ve ever gotten”. And every day I want to be better than I was the day before. So, please forgive me for keeping these lessons personal and private. I don’t want to violate patient confidentiality. Even the mistakes of others in this field of study are not to be celebrated.

You are a successful leader. Which three character traits do you think were most instrumental to your success? Can you please share a story or example for each?

Leaders come in different “shapes and sizes”. Style of leadership has to reflect, and be authentic to, both the position as well as the potential leader themselves. Obviously a drill sergeant has a different environment in which to lead then a department chairman, especially when that group being led consists of many different types of personalities, positions, physical, and emotional needs. I find that the two most important skills to have as a leader in a medical field are the ability to listen and the ability to share uncertainty. It is the difference between being authoritarian and authoritative. Being adaptable is probably the third most important quality. One has to be prepared to redirect, or even turn around, in a way that inspires confidence rather than suggest incompetence.

What are some of the most interesting or exciting projects you are working on now? How do you think that might help people?

I’ve never been satisfied working on just one thing to the exclusion of all others, I like to keep my hand in numerous areas, because it’s from cross-pollination of ideas, concepts, and people that you can learn the most, and sometimes a clinician can take a concept from another field, and apply it in a way that’s never been tried before. As a result, my three most exciting projects relate to:

  • My charitable foundation (the Greenwich Neurological Institute, www.greenwichneuroinstitute.com), through which I provide mentorship, education (of both the medical community, and the general community), and other charitable works.
  • Clinical research that we are doing in the field of spinal surgery to develop new treatments and treatment strategies for numerous poorly understood conditions, including thoracic outlet syndrome (TOS), cranio-cervical instability (CCI), and hypermobility syndromes like Ehlers-Danlos Syndrome (EDS-h), Bertolotti’s Syndrome (BSy), and other congenital anomalies. I have developed national collaborations on these subjects with investigators ranging from the Cleveland Clinic, the TOS Education group, and luminaries from around the country and around the world.
  • My patented technology development to improve everything from surgical equipment and techniques to developing smart fabrics to prevent injury and facilitate rescuing those who have already been injured (www.neurotect.com). This comes from my passion for improving peoples outcomes, and if we can start by preventing the complications in an injuries that would normally necessitate seeing someone like me, that’s a way of profoundly impacting entire families at once as the consequences of a spinal cord injury, for example, frequently devastate the entire family, who, then have to take care of their loved one who is no longer able to take care of themselves.

Thank you for all that. Let’s now shift to the main focus of our interview about Digital Transformation in Healthcare. I am particularly passionate about this topic because my work focuses on how practices can streamline processes to better serve their patients. For the benefit of our readers, can you help explain what exactly Digital Transformation means? On a practical level what does it look like for a medical practice to engage in a digital transformation?

Digital transformation” to me is a bit of a buzzword that may mean different things to different people. I view it as technical assistance (or assistants) to facilitate the very personal and intimate process of taking a patient history, performing physical examinations, assisting the decision-making process, and streamlining the collection and output of data. Opportunities include:

  • Improve the accuracy and ease of the information gathering.
  • Improve the precision with which various measurements of the physical exam process can be assessed and then recorded.
  • Improve the information’s dissemination (to patients, referring doctors, and into databases for future reference).

The main areas of a medical practice where this can be implemented range from the basics of taking a medical history, transcribing it efficiently, accurately, and succinctly, and then the ability to share that information with all members of the care team and even back to the patient as well. In addition, the physical examination can be standardized with templates and even smart templates that can open up additional fields to remind the clinician that if a particular finding is positive, additional findings should be searched for.

In addition, physical data can be collected digitally with smart devices that can put the data collected directly into a spreadsheet or electronic medical record in a way that can be both reflected in the notes, and searchable later for performance-improvement or research purposes. These can range from the simple and mundane like a Bluetooth enabled scale for recording peoples weights directly into the medical record, to smart or linked forms of physical examination. Examples of this include photographic and AI guided tests for skin cancer, an intelligent form of strength or balance testing, and visual and cognitive functions that can automate and precisely calculate degrees of cognitive impairment and conditions ranging from concussion to dementia.

What are the specific pain points that digital transformation can help address in a medical practice?

Pain points that limit a medical practice are usually either bottlenecks to adoption of new systems or procedures, as well as the financial costs a practice may encounter. These range from the most obvious, that the doctor’s time is the most valuable asset in the flow of a practice, and therefore anything that takes a task off of the physician in question will improve the pain points of the practice therefore automation and or delegation is one form of pain point mitigation that digital transformation can allow for. Other cost savings may be more mundane, such as automating email or a directly linked EMR note delivery. Practices can reduce their need for postage and shipping by enabling a portal for patients to upload films, images, and reports, which will reduce the need to return these after someone in the practice has manually scanned them in. When that same secretary has more time to answer the phone, rather than be managing the return and scanning of information, all patients benefit. The practice will benefit when the clinician has more time to speak with patients and able to spend less time with tedious tasks (like dictating afterwards), they can then help more people in the same amount of time, or spend more time with each patient.

What are the obstacles that prevent a medical practice from engaging in a digital transformation?

The barriers to a digital implementation are usually financial or administrative. For example, all this tech isn’t free, or the businesses developing them wouldn’t bother doing so. The practice has to have enough cash flow, as well as patient flow, to warrant the investment in these resources that will then make their practice more efficient and able to handle and even larger volume.

Barriers can also be administrative, for example a practice in a larger organization may be limited by what the institution or group will allow them to enable. One of the biggest barriers to adoption of new technology in a large organization, such as a large hospital or a hospital chain, may be that the administrators who make decisions are more worried about the existing fiscal “silos”, or the practice of keeping certain cost centers separated even though the performance in one area my affect the bottom line of another. When administrators do not realize that the clinician’s time is more valuable than the administrators time, and therefore insist on having the physicians (under their supervision) handle tasks that could be delegated or digitally transformed, productivity will fall. It’s the old “penny-wise, pound-foolish” problem that happens when the decision-makers aren’t the physicians themselves, and the physicians get lost in the shuffle.

A distrust of particular types of new technology, such as concerns about patient privacy, or the use of patient or practice data required by the company developing the new technology (such as user data to train AI’s) can also limit individual practices from implementing these newer technologies.

The final major barrier is inertia. “We’ve always done it this way. Why should I have to change?” Change is hard, but at the same time, change is the only constant in life.

Can you share a few examples of how digital interactions or digital intake processes can help create a frictionless patient experience and increase access for patients?

Digital transformation can serve many purposes: efficiency (seeing the same amount of patients in the same in last time), growth of the practice (seeing more patients in the same amount of time), as well as improving the quality of the care provided. Each practice needs to look at its individual strengths and weaknesses, find digital transformations that can strengthen the strength, but also “fill in the blanks” of the weaknesses.

A digital transformation such as adoption of a medical record can improve the bottom line of the practice by improving billing practices, but it also has the ability to provide a means for improved communication with the patients. Getting complete, thorough, and readable notes, and an “after-visit summary” promptly to the patients can improve retention of information, and compliance with instructions, medication, and treatment plans. In addition to just having the notes available on a patient portal from an electronic medical record, getting these notes out quickly, properly, accurately, to the referring source.

One of the best forms of practice transformation used by efficient practices is to use some form of medical scribe. Ever since I went into my private practice, one of the first hires I made was to hire one of my former summer interns to spend a gap year shadowing me as my medical scribe. It was one of the best choices I’ve ever made! My office notes went from being a tedious chore, done sometimes weeks after the event (and frequently rushed because I had to dictate them all myself) to detailed English language notes that serve for me to remember details for the visit, as well as for patients and referring doctors to understand not just our plans, but the thought process behind the plans. In addition to that, the medical scribe assists me in editing my operative notes as well.

Offloading the most tedious aspect of the notes is a great way to reduce stress, improve efficiency, and improve general happiness for the patient and clician. Since then, we’ve implemented AI-driven conversation recording that then transforms the conversation into a classic SOAP (Subjective/Objective/Assessment/Plan) format that then my scribe edits into the final note from their notes, and we’re even looking into newer technologies to improve both digital data collection and note formatting. We want to improve every step in the patient flow process, and will always assess (and perhaps embrace, perhaps hold off) on new technologies.

Another aspect of digital transformation involves the collection of digital data and how that data is collated/kept. Those involved in publishing of research understand the value of good data: we can’t draw good conclusions without good data. An individual practice, though even if not interested in publishing academic articles, can still track its own outcomes, over time, and identify trends that could be beneficial or detrimental to patient’s outcome. There may be a particular implant or device that results in better or worse outcomes than another (in your hands), or there may be certain aspects of procedures take longer because of differences in technique, technology, or personnel.

A practice may identify that certain procedures take longer at certain hospitals than others, or that certain devices don’t work as well as they have been advertised. Identifying these practice optimization opportunities (it may just be it doesn’t work with your workflow or how you would like to do the procedure) can only be done based on your individual data; you can’t rely on somebody else’s impression, experience, or even their data, since only you know how good your data is; you don’t know how good somebody else’s data is, or even whether they have a conflict of interest that might color suggestions on how you should do something.

AI tools (potentially at a lower cost than hiring an individual to do this for you personally) to monitor critical labs and notify you of certain events that are worthy of medical concern. This may be: flagging patients for visit noncompliance who require constant monitoring; monitoring labs for abnormal values, or even concerning trends in these values; as well as keeping track of whether patients are getting the labs or imaging that they require (either in preparation for procedures, or to manage complex medical conditions). There are even AI assistants available now that can perform phone calls to patients, or even initial medical history intakes (using chatbots, and large language models) based on your specific intake processes. While many people have very valid concerns that AI could take jobs away from people who could otherwise do those roles, AI assistants can allow medical practices that don’t have the revenue base to support hiring a full-time person, to do that job, and allow that practice to get that job done more cost efficiently. It doesn’t take away the need for a human interaction and compassion, I can only imagine that it will be quite some time before an AI assistant will have the empathy to provide not just logistical support but emotional support as well, which is a critical part of a successful practice. But that may be coming soon too.

Based on your opinion and experience, what are your “5 Things You Need To Create A Highly Effective Medical Practice” and why?

  1. The most important things one needs in this day and age to make a successful medical or surgical practice: you need to have a vision for what your practice is going to do, what population it’s going to serve, and how you plan to differentiate your practice from those around you.

In this very trying economic climate, it’s not enough to just set up another “me too” style practice doing the same thing everybody else does is in your specialty. Those practices often get swallowed by larger groups, and then you become someone else’s employee, instead of running your own practice. That is not to say you can’t bring on partners or start with a group of people, but you need to all be on the same page, and you should want to meet an unmet or under-appreciated service requirement in your community. That community can be global, if you plan on meeting a small percentage of a given population (such as catering to patients with hypermobility associated medical conditions, babies with certain genetic conditions, or certain specialized, minimally, invasive surgical procedures). Another example is if there is a concern about there being a lower standard of care in a particular field that you can meet through demonstrable superior outcomes and a focus on excellence.

It is difficult to understand the dynamics of a particular medical community, to understand that niche that one could fit into, without some significant understanding of that community so therefore I don’t recommend somebody fresh out of training go to a new area, and think they’re going to just start up that practice. This should be a well thought-out move, either doing extensive research during your training and then planning to set up a practice in the same region where are you trained, and potentially partnering with the faculty there to help facilitate referrals early on, or starting as part of a larger group early in your career, so that you have mentorship and opportunities to get to know the community locally, and then leaving to specialize (generally trying to maintain good relations with the prior practice), or going off on your own would be to understand that community.

2. A thorough understanding of the economics of your specialty. Surgical concierge practices have very specific regulatory and financial requirements that might make collecting enough revenue, with or without insurance, to be able to provide “Concierge“ experience. When starting a medical or surgical practice in an underserved lower economic community, it might be a good idea to either partner with, or start your own not-for-profit foundation, ideally an entity that also serves that same community, that can serve as an economic lifeline, or help with provision of services that might not otherwise be adequately reimbursed through Medicaid, Medicare, managed plans like HMO and EPO’s. these programs traditionally under-value physician services, and do not keep up with inflation or progress in newer technologies. Insurance companies will frequently want to reevaluate (downwards, if they’re asking) your network contract, and the case of Medicare and Medicaid, reimbursement tends to go down than up over time. If you’re starting a medical practice, you need to make sure that you have assured the physical viability of the practice; you can’t take the “Field of Dreams“ approach and assuming that “…if you build it, they will come.” (and pay).

3. Staff! In particular, you want to start with experienced front desk and practice managers. You want to find somebody who has demonstrated experience in these roles, because they are going to be either the face, or the backbone of the practice. Nothing drives people out of practice more than a rude, careless, or thoughtless front desk. And nothing makes for poor financial times then having someone (whose job it is to keep track of the employees) not know when it is time to hire, fire, or investigate financial irregularities.

4. Meeting your own metrics for success. If you’re a diabetes doctor, you need to make sure that you’re tracking not just HbA1C and weight for your patients, but also overall compliance, episodes of other hospitalizations, as well as perhaps even finding a way to partner with or provide counseling services to promote better, economic habits, and better educational opportunities within the population you serve. For example, If you start a scholarship fund for the children or the people in your practice, they will hopefully be able to educate their children, and to avoid diabetes complications, and the patient and their families will hopefully (with better educational opportunities) be able to get better job prospects and be able to afford better food choices. Also there may be opportunities to revise either the technology or the medication that you use, or entire medical practices that you’re using, as not every great new drug turns out to be as effective or as safe as the manufacturer or the representative first tells you, not every procedure works as well in the long term as you think and others may be in need of developing further. There may be an unmet need in your community. These identifications can either be published as a blog, academic paper, or even a lay article in the local press (but only if you have done the review of your practice and have the data to substantiate your claims).

5. Communication. When starting a practice, make sure there is a mechanism in place for communication with your stakeholders. You may be very reliant on referring doctors, in which case you need to make sure that your electronic medical record has a process for automatically sending these to the referring doctors.

If you expect that many of your patients will be coming to you through the Internet, make sure you have a communication strategy for how these people will hear about you, and budget in your time to ensure your compliance with that strategy. Learn all you can about how social media impacts in your targeted patient population, and identify which social media platform(s) your anticipated patient population uses the most for medical information. If you’re running a cosmetic dermatology practice, Instagram, TikTok, and other similar social media platforms might be more appropriate.

If you were meeting a particular unmade need, there are Facebook support groups that you may wish to join and offer non-self interested advice in these groups, to establish your authority on the subject, and this is critical, PRIOR TO suggesting people call you for a consult. Somebody who just joins to direct patients is often seen as an interloper, or a stalker, rather than a helpful resource. Earn their trust, DON’T just assume that you will get it.

If you were planning on a practice that will be very stable in its size and as these people tend to be higher consumers of your services on a regular basis, having an automatic newsletter that goes out at an appropriate time to discuss , topics of relevance as well as general suggestion and regular follow up should be scheduled to your patience and perspective. Patience have similar interest or can be identified elsewhere.

Bottom line: know where your patients are coming from and maintain those relationships.

Because of your role, you are a person of significant influence. If you could inspire a movement that would bring the most amount of good to the most people, what would that be? You never know what your ideas can trigger.

If there were one movement in medicine that I could, by any means implement, it would be to return to the practice of medicine focusing on empathy and excellence in care.

There seems to be in the medical community a general sense of burnout, even in some of the youngest physicians, as more and more clinicians are being driven from private practice into employed positions (private equity firms, large hospital, chains, large, multi specialty practices that are run by and some cases even owned by health insurance related entities). Because these are businesses first, and medical practices second, they are being driven to maximize “profit” for the parent. This is even true in “not for profit” hospitals because, well, they may not pay dividends back to shareholders, but they all are being run like businesses because ultimately the bigger they get, the less dependent they are upon charity to fill the gap in their budget, and therefore they need to provide what services they provide, and have enough money for their bigger expansion plans to continue to provide.

Large hospital chains all seem to have developed a “Wall Street mentality” rather than a “main street ethic”. In the process of increasing “efficiency of the practice“ and a maintenance of favorable financial situations within the individual silos of an organization, sometimes (let’s face it almost every time) administrators (who are usually not clinicians) are telling clinicians to see more patients, spend and therefore, spend less time with each individual patient, to maintain very hectic office and/or surgical schedules. In this day and age, most of my colleagues tell me that they are having to perform more procedures or see more patients in the same amount of time, just to maintain their salaries.

I am a big fan of physicians getting paid fairly for their expertise (that they are able to provide only because of the extensive training that they had to undergo, the sacrifices that they made, and their commitment to patient care that often interferes with any type of a personal life). People who make those sacrifices and spent that time (and in most cases, undertook loans or other expenses to undergo, said training) should be paid at the top of the financial food chain. We’re talking about people who create good health, which helps their patients create their own wealth. What could be more beneficial for society than paying these people well which would then encourage more people to be healthcare experts?

However, these large healthcare entities in trying to drive their costs down (to increase their “profitability”) is essentially encouraging “organized mediocrity,” not excellence. And in the process of increasing the throughput of patients in practice, and decreasing the amount of time spent with each patient, patients with complex problems are being shunted to the side. Somebody who has multiple medical problems that all interact, but managing that interaction is often time consuming, are therefore not “profitable“. In addition, patients with certain complex conditions, such as hypermobility syndromes, may have a constellation of problems that may not seem connected to each other through any common pathway until one dives deeper into their symptoms, and sometimes even their family history. Have empathy for these patients, even if you do not have the experience or the insight to treat them directly. Refer them to somebody who can may be the best way you can help them. Certainly telling them it’s all in their head, or that they shouldn’t have this problem is NOT the answer, and does the medical profession as well as this individual patient a disservice.

Whether it is a psychological problem, an unclear physiological problem, or an emotional problem that patient is suffering from, they are still human beings that deserve respect and empathy. Having the faith that they have a problem creates an environment that their problem might be identified more clearly if a little more time is taken. So many medical providers (physicians, residents, and physician extenders) may feel they don’t have the time to investigate such disparate symptoms, or it would be easier for them to label the patient as simply a troublemaker, a malingerer, or otherwise not worthy of their time. The vast majority of patients who are so labeled are mislabeled, and sadly so many of them become disheartened by the rejection by the medical profession that they stop seeking help through traditional routes. They may spiral into drug use, or unlicensed practitioners who are offering unproven treatments because they see that the medical profession has failed them.

Sadly, to enact this new movement would require leadership within the communities, and pressure upon the insurance companies (who have been reporting record quarterly profits). When the insurer decides what’s important to it, it looks at who it’s primary stakeholders are. For big commercial insurers, their stockholders and their board of directors are the most important people in the process, not the patients or their physicians.

Voices like mine can inspire small communities at a time but whole groups of underserved or poorly served patients need to stand up, be noticed, and take ownership of demanding that insurance companies either change their ways or that they will stop purchasing their products. I’d love to see a new mutual health insurance company come about that would give United Health Care or Aetna a run for their money.

In the 1960s, health insurance is were primarily owned by their patients. The policyholder was actually the primary stakeholder, and therefore was the company’s primary concern. In the 70s and 80s Congress allowed insurance companies to “de-mutualize” and unlock “hidden investor value,“ which really meant taking money out of the healthcare system and giving it to large investors (who often had special or conflicting interests) and then diversify these profits among the stock market. I’m not necessarily advocating a “scorch the earth” policy and to force the existing insurance companies to become non-stock oriented companies, but if there were competition in the industry, and satisfaction were greater in a mutual-owned health insurance company, that would send a powerful message.

How can our readers further follow your work online?

We’d love to have interested stakeholders, clinicians, patients, and curious people follow us through our website (www.JenkinsNeuroSpine.com), through my written and video blogs (https://jenkinsneurospine.com/about/blog/), as well as physically follow us at national conferences and regional talks which I will post my attendance on social media. I am also a guest on other people’s webinars. Here are my social media accounts:

Thank you so much for sharing these important insights. We wish you continued success and good health!

About the Interviewer: Cynthia Corsetti is an esteemed executive coach with over two decades in corporate leadership and 11 years in executive coaching. Author of the upcoming book, “Dark Drivers,” she guides high-performing professionals and Fortune 500 firms to recognize and manage underlying influences affecting their leadership. Beyond individual coaching, Cynthia offers a 6-month executive transition program and partners with organizations to nurture the next wave of leadership excellence.