Dr. Antonio Webb | Becoming a Board-Certified Orthopedic Spine Surgeon

Introduction to the Podcast and Guest

[00:00] Hi, everyone. Welcome back to the Heflinger Podcast. We're joined tonight by a special guest, Dr. Webb. He's a board-certified spine surgeon in Texas and very happy to have you with us. Now we're excited to talk to you. We got two surgeons in the house. Thanks for taking time out of the busy schedule. Sounds like you're very busy. Yeah, thank you.

[00:20] pleasure kind of speaking with you guys today. You know, it'll be an interesting talk because I'm a neurosurgeon and you're an orthopedic surgeon that specializes in the spine and so many people ask us, you know, what's the difference, what's better, orthospine or neurosurgery? We get that question all the time, which I always say my answer is that really it's your surgeon. You know, is your surgeon good? You can have good neurosurgeons.

[00:40] surgeons and bad neurosurgeons and good orthospine or bad orthospines. But do you get asked about that frequently or at all by patients? You know, you're not a neurosurgeon. Do you do anything differently than a neurosurgeon would do? Yeah, it's pretty interesting because a lot of patients will come in and they'll say, hey, you're my neurosurgeon. They'll call me a neurosurgeon and I'll tell them, hey, I don't

Path to Medicine and Early Training

[01:00] neurosurgeon, but we will hopefully be doing surgery soon for your particular case. But the patients, I do bring that up from time to time. My hope is that it will come down to an integrated training program and it seems like that's where it's going. We're all trained together, so I think that will be good. No, definitely. I think that would make

[01:20] most sense because I didn't you know in our field we just train spine every year you know we learn spine every year but do you do in your five years of orthopedics because I honestly can't say I know in the five years of orthopedics that you do do you do spine during that or do you only learn spine after the orthopedic residency? Yeah it usually starts our second year so our first year mostly general surgery

[01:40] And then some orthopedics, but a second year that's when we start some spine rotations. Okay. So you're already in, so it's not just an orthopedic residency and then you do spine afterwards. You're doing spine all along too. Correct. Oh, I didn't know that. So how, for people that wouldn't know, how long was your training or like from undergrad?

[02:00] Medical school and beyond what was your training yes mine was a little bit a typical i go back to my military i was in the military for eight years before medical school and i was in the air force and i went to school full time when i was on active duty it took me seven years to get my undergraduate degree just because i had kept having to drop

[02:20] classes and I got deployed to Iraq, a couple other areas that we had to go to. So it took me a little bit longer to get my undergraduate degree, but went to medical school at Georgetown. I did my residency here in San Antonio and did a fellowship at the Texas Back Institute out in Plano. Cool. Well, first of all, thank you for your service.

[02:40] And I saw that on your website, but what was it? Did you know you wanted to be a doctor before joining the military or why you were there or what kind of, what was your thoughts there? Yeah, I've wanted to be a physician ever since a program in high school. So I was accepted to a medical meditator program. I think I was in Texas.

Transitioning from Residency to Independent Practice

[03:00] ninth grade, ninth or tenth grade and I did that program for a few years. And ever since that program, I wanted to be a physician and I went to the military to get some medical experience, number one, but also have a way to pay for stool. So and ended up doing eight years in the airport. How did you decide on an ortho spine?

[03:20] I went to Georgetown, so a good portion of students from Georgetown go into orthopedics, I would say at least 25 to 30 per year. That's just the thing, we get early clinical exposure in our third year of medical school to orthopedics. So it was really good to see that kind of early on and kind of solidify that decision.

[03:40] I've always liked working with my hands and kind of building things, putting things together. So it's just really just kind of matched up to my interests. How many, just curious, so how many years have you been out of practice, I mean out of residency and in practice? I'm in year four now. So coming up on a four year mark. So I got to ask you something.

[04:00] I kind of remember, I've been out for 25 years, but what was it like that first year? It's pretty different, isn't it? Once you get out of residency and fellowship and there's not an attending there and you're the man, what was it like those first few weeks, those first few months operating on your own? What was your experience? Yeah, it was actually pretty interesting and you come out of training and

[04:20] And you think after residency fellowship, oh, I got this. Do a decompression or ACDF. Get out to practice and then when it's actually time to perform surgery, you're like, oh, crap. But it was good because I joined a large group here in San Antonio. There's about 10 spine surgeons in my group.

[04:40] And I was able to, it's like a second and third and fourth fellowship for me. So I mean, I was able to do a lot of posterior cervical, scoliosis cases with PSOs. I have a scoliosis case tomorrow with one of my partners who's been in practice for about four years. So it's been a great

[05:00] experience just operating with some of my senior partners and just continuously learning. So that first few weeks, few months was, it was good to be done and be on my own. But yeah, I can certainly see. But some, you know, for people out there, you know, when we're in residency, it's like a, it's like a brothership and you become so

Advancements in Spine Surgery and Technology

[05:20] close with your fellow residents and it becomes very fun operating with each other and getting used to that. And then when you get out on your own in your operating room, it can be intense, but you kind of lose that it's nice to have somebody there. So I enjoy operating with other people nowadays. You know, when I get a chance to do a case with somebody, it's a lot of fun because it's fun being in there with another person who does what you

[05:40] do, can anticipate what might keep coming up and it's just a different world. We lose some of that when we get out on our own. Yeah, it's come in full circle because one of my mentees, since he was an intern, I've been his mentor and I actually recruited him to my group and I've been helping him with a lot of his

[06:00] cases. I was like, okay, that's how it was when I first started. Yeah, I'm sure he appreciated it. He's a little timid in terms of, should I do this? I guess it's going to be okay. What are your most common cases? Do you do, I know with him, like ACDF,

[06:20] I mean, what are your most common poster cervical with or without instrumentation in a lot of lumbar cases? I don't do scoliosis. In our town, really, there's only two people, I think, orthospine that do scoliosis. It seems more of an orthospine thing. Yeah. My fellowship, we actually had a

[06:40] neurosurgeon. We did a lot of scully cases, so I was able to do some of that fellowship as well. Most of my practice is degenerative ACDS, miters, laminectomies, posterior cervical. I recently introduced PTP-prone transoas, which has been a huge game changer for my practice. So it's

[07:00] for the lateral surgeries. Oh yeah. I saw it came to our hospital. What do you think? Is it called the Mazor or what's it called? The Mazor. Yeah, that puts the screws in for you like you plan them. Have you found that helpful at all? No. Do you use it at all?

[07:20] and

[07:40] So if I have a really complex lone case, I'll use the robot to just give me a mental break and I could just get my head back in the game when I'm doing a decompression or finishing the case. So for those of you that don't know what we're talking about, so when you put screws in people's backs, you can do it open where you actually feel where you want to put the screw in.

[08:00] which I do a lot of. And then there's computer guidance. But now there's a new technique and you probably know more about it. But it sounds like the surgeon will pre-plan on a computer where the screws are going to go in and then you make the appropriate incisions. And then through those incisions, the robot will actually put the screws in, right? No. It would have done.

[08:20] What it does is it assists you in placing the screw so you can plan it out before surgery. Let's say you get your medial lateral trajectory, you get the size and diameter, the length of the screw. And surgery, either a CT scan is performed at the time of surgery or you can load a CT scan up if it had preoperatively.

[08:40] Then at the time of surgery the robotic arm is brought in and I can tell it to go to the left L2 it will go in the exact trajectory and a Robotic arm I stick my drill down and then put my screw down that drill. Oh, I just giving you the guide. Okay. Yes, sir I got then I go to L3 and then I go

[09:00] Then I go to the right side of the whole group. I gotcha. Okay. How different is that from when you first, like how much was an advanced? Yeah, I mean, well, we didn't even have, there was no computer-assisted stuff when I was in residency that I know of. It was just all freehand and anatomy. And just like the brain, we didn't have

[09:20] stealth-guided computer systems. We would have these archaic cages you put on people's heads called CRX systems that would kind of use 3D coordinates to help us guide our biopsies into the brain. But so much new technology that you probably know 10 times more about than I do because you're on the cutting edge of it.

[09:40] You know what's huge on the forefront is augmented reality which is kind of what I've seen that yeah, I actually have a headset not too far away from here. You should tell people about that because that's awesome. It's like having an Apple things on or whatever those yeah, yeah explain it. Can you explain it?

AI in Medicine and Improving Patient Care

[10:00] I'd like to hear more about too. Yeah, so augmented reality is very, it's similar to virtual reality, but it's if you put a headset on like the Apple headset, you can actually see, you can see your background, your surroundings, but you can overlay images into the headset. So where it's very helpful in surgery is

[10:20] If you have a patient's CT scan that you upload to the augmented reality headset, I can walk into the patient's room in the operating room and I can see their spine without even making an incision. So some people refer to as x-ray vision and that helps me with placing the screws

[10:40] in so it limits the amount of the incision that's needed. So I'm looking through the headsets and looking at their pedicul as I'm putting the screw in. That's kind of next level. So it probably sounds like it'd be good for people who have like fractures of their back called compression fractures when you put the cement into their back. Can you just do it freehand, right?

[11:00] Pretty much using those virtual you can yeah, it would actually decrease the amount of radiation exposure as well. So yeah, so you're not taking multiple shots trying to get your starting point. That's sweet. I think too, it's interesting. You're earlier on your career, like you're more willing I think younger surgeons who are more open to like

[11:20] new technologies or like if you're really ingrained in your ways, I know you've sometimes people because so many surgeons do different things different ways. So it's really interesting to hear new things going on. It's you know, all these technologies, you know, the basic underlying premise is our our goal of surgery is if you can rest and fuse

[11:40] necessary. But I think for me as a surgeon, I think you have to do what works. I mean, you can learn these new techniques, but I know a few surgeons that I can do an open surgeon and have them go home the same day and do just as good or better than someone who does minimally invasive little tiny incisions through a cylinder.

[12:00] So it really depends on what you're good at and how your patient's doing and what you find that works for you, I think. Yep, I totally agree with that. Yeah. Now talking about technology too, so we were talking last week with Bob Baxter, who's the president of Mercy Health for the Toledo Ohio market, it's episode 24.

[12:20] We're talking a lot about AI and what the potential he sees so many things in that field. And he was talking about his potential different applications. But I'd be interested to hear do you guys use AI in any fashion in your practice and or any of your partners? Yeah, whether it be any part?

[12:40] terms of documentation or whatnot. Yeah, AI is huge and I think it's here that's going to revolutionize how we care for patients and deliver better and safe, more effective care. I currently use it in my practice and this has probably been the biggest game changer for me in my practice is using AI for dictation

[13:00] So I use a software that when I walk into the patient's room, I'm not sitting there typing what they're telling me. I'm listening to the patient, allows me to be more connected with the patient. But I have an AI software that listens in the background and their history. I usually verbalize my physical exam and

[13:20] it comes up with an assessment and plan. And that's really revolutionized my practice because before I would either spend late nights or early mornings finishing my note. But now I have this platform that can do that. But we use it a lot and billing also collections for our practice.

[13:40] AI is huge and I think it's only going to get better from here. Yeah, that's the passive. I think that's the, he was talking about that. It's like the passive listening device so you can just focus on the patient and it's documenting. And that's kind of what we were talking about too is that a lot of people want to see the kind of like sexy stuff AI can do or you know.

Social Media’s Role in Patient Education

[14:00] other fields. But a lot of times it's like if it can free up documentation, like you're saying or billing, that frees up your time to do what you do best in terms of listening to the patient doing surgery, everything like that. As far as you know, so you say it comes up with an assessment and plan after you put a lot of stuff in. Did you have to teach it what you

[14:20] typically like for an assessment and plan or does it just figure out what it thinks should be done? You know what I'm saying? Obviously, does the computer have a different opinion than you when it comes to your plan and assessment? It's usually listening to what I tell the patient. You have a grade 1 lumbar spondyloethosis. Then you know how to break it down to the patient. But then it listens to that and then it

[14:40] And it puts it in an assessment. It's basically what I'm saying. I'll give the patient my assessment and the plan and it's basically just taking that for my – Okay. Yeah. That's pretty neat. Switching gears a little bit, this is how I first found you and thought was really cool. It was multiple years ago. So I started social media with him about two years ago.

[15:00] years ago. But before that, I don't know if it was about a year or two ago, I'd seen some of your YouTube videos, which I thought are really cool, like your day in the life ones and whatnot, which I thought were awesome. And then before this, I was doing more research into just how long you've been doing that for. But so you've been doing that, the YouTube videos for eight to 10 years.

[15:20] Alright. Actually, yeah. Since I was a resident, I realized that there weren't a lot of surgeons kind of blogging or vlogging online. And I was like, hey, this is something I can kind of introduce. So, but since then, a lot of people have kind of adopted that into their practice. But I'm also kind of interested in hearing how does it help

[15:40] your practice and you get patients from kind of coming in from seeing your videos. And I know I do have patients like travel. I think for me, it's been more patient education. That's how we started it out. I make videos for my patients and Kevin has helped me do what we do it together. And so if somebody comes in, say they have a herniated disc, right? And I explain the surgery to them.

[16:00] know, patients have a hard time remembering, you know, I mean, it's a stressful situation and they're thinking about other things or they don't understand what you're saying and so they may forget 80% of what you say and I got frustrated with people right before surgery, you know, a month later saying, now what are we doing again? They had no idea. So I said there's got to be a better way. So what I would do is

[16:20] for every condition that somebody comes into see me I have an MRI that corresponds to a generalized idea of that I'll explain the MRI again then I explain the surgery that they're going to have specifically and then I talk about all the aftercare and all the typical questions they ask in the office I put in there so it's like a 13 to 15 minute video and I give that to every patient and it's just wonderful

[16:40] people love it because they can go home, their family can meet me, they can watch it. Some people watch it 10 times. They send it to their kids in California across the internet. But that way they really know what. And I don't get questions anymore about what are you doing anymore. That's all gone. They said, no, I watched your video. It makes perfect sense. So that's how we started into social media. But as far as do I get

[17:00] lot of patients. I mean, once in a while, you know, somebody will come and say, my daughter follows you on TikTok and says, go see him. And so they'll come and see me. But it's minuscule really. I mean, the referrals I get from social media aren't a lot. But I think we've had an educational component that we enjoy, you know, teaching people about neurosurgery and what we do

[17:20] just like you do days in life and talk about procedures and things like that. Have you seen, do you see much referrals increase from what your social media? Yeah, I do. I have quite a few patients that come in, just they'll come in and say, hey, I feel very comfortable with you and I feel like I know you because I've worked with a lot of your patients. That's great.

[17:40] But you're exactly right. You know, you have a patient that comes in and you kind of try to explain to them, you know, what spinal stenosis is or

[18:00] So they do. And don't you hate that when they come in and somebody says, well, I watch the video and this is how they do it. And then you have to say, but that's not how I do it. So I'd rather them watch my videos to see exactly the way that I do it. And it's just been a game changer for my patients. And then in the morning when we're around, you know, six o'clock in the morning, you got to go fast.

[18:20] get the surgery, I can politely say, you know, everything is in that video and they know it. So they'll watch the video at home about all the stuff I would talk about at six o'clock in the morning that they won't remember. Yeah, that's exactly what I do too. Every single patient, they get an email from my personal group and it has their condition, it has their diagnosis.

[18:40] procedure and a video of me explaining what we'll be doing. So and then email me or bring questions back when we meet again. So I think I think people feel a lot more comfortable too when they like they have all that and they can make they're making an informed decision about their health care not just being told like you need surgery. I think another huge aspect is just

Challenges in Patient Care and Mentorship

[19:00] postoperative care anyone who's helping them out can also watch that. But like you were touching on too, I think is so powerful about social media is now if you don't just have that but people feeling more comfortable, they feel like they've seen you before. That's a huge part about picking a surgeon think you have to like the person somewhat, which instead of having 15 minutes, they can

[19:20] watch a lot more before they come see you, which is cool. But I just thought it was so cool because yeah, you had to be doing that when there wasn't much. I was trying to describe that to him. Like short form wasn't a thing. TikTok wasn't big at all and none of the other ones existed. It was more so YouTube. And like us younger people, like I've always watched YouTube and

[19:40] I think there, I just don't know. I know like Dr. Mike was probably on back then and a few other, but there probably were not many, if any, surgeons on there. No, not when I first started. I started actually with my cell phone, just picking up my cell phone and started recording to the premiere. Yeah.

[20:00] I mean, there's a good lesson just getting started. Have you ever had any issues with like in residency or now in terms of recording anything like do it with social media? Like in the hospital? Nothing that I can particularly remember. I know it's

[20:20] It is really important to just check with the hospital policies and make sure that you're okay with filming, patients are okay. And I actually got this from my fellowship program. For every patient that comes into my office as part of their registration package, filling out the paperwork, there's a media consent for

[20:40] They can opt in or out for that and it gives me permission to film certain parts. But if it's a surgical procedure, then I definitely get something else in writing also that they give me permission to report that. I can't think of anything in particular that I've had any issues just trying to... That's very nice. That's great. Yeah.

[21:00] It's a great process. Because do you operate at multiple different hospitals? Mainly two and one of them is a physician-owned hospital. So I actually am part owner there. So I don't get any issues or problems with that hospital. But the bigger hospital I operate at, I just generally have to get things signed off and approved.

[21:20] They actually let you rent the operating room. You just have to pay a small fee to use. So it's an HCA facility, but I've paid to go and operate before and kind of use it for a few hours. Oh, that's really- I think that's what she was mentioning to me. Oh yeah. Because that's something just we've been kind of navigating

[21:40] then try it because that's a good thing if you can write an operating room. Our hospital system has a little more stringent policy about filming in the hospital. So that's been a little bit of an issue. And so we're working on it. But that's it. I think they mentioned something similar to that potentially. Yeah, that's still, that's a good idea. Yeah. So

[22:00] So tell us about you. Are you married or have any kids? What do you like to do for free time? Sounds like you're busy. So married, I have three kids. One is 2, 4, and 12, or 13 actually. So pretty busy household when I get home.

[22:20] and

[22:40] So I try to get all my work done before I get home and I'm an early riser. I work up at 4, 4.30 every morning just to have some peace and quiet and complete some work. But outside of that, love the travel, love the workouts. I train two or three times a week with a trainer early morning.

[23:00] So what's a typical workout for you? It's mostly just core calisthenics cardio. So we don't do really heavy weights, just a lot of core exercises and flexibilities. So we spend a lot of time kind of in a flex position in surgery.

[23:20] And he was really good about picking up on that. He was like, you spend a lot of time like this, everything, the posterior is really tight and constricted and we need to work on that. So that's all he does is work on, try to get me to work on my posture and core. It helps in surgery. What do you, so I get a lot of people ask me like, what's good for

[23:40] my back like, well, exercises should I do and what shouldn't I do? And you probably get a lot of that, maybe more so than I do. Like what do you tell people? Yeah, I tell them, you know, the best thing is that in my experience for back is working with your core, making sure your core is tight and strong. So any core exercises and also keeping your weight down.

[24:00] the pressure off of those those parts of the spine. But specific work exercises, I always go back to that core. I mean if your core is weak you're gonna have back pain. My personal experience when I was in the military, I injured my back. So for the last 20 years I've had some issues with my back and when I work

[24:20] on my core, that's really the biggest difference I've learned that's really helped me. So I try to piece that to my patients. Well, it's such a big problem too because the majority of people that come in, I mean, so many people have back pain and complain of that and neck pain on a chronic basis and there's just, you know, most those people don't need surgery and there's just not a good way to alleviate it completely. And

[24:40] And some day somebody will figure it out. But right now it's a tough thing to figure out how to help people with their back pain because everybody's so different and what works for one person doesn't work for the next person. Yeah, that's exactly right. And just trying to figure out what's actually causing it. Is it the disc or is it stability? I mean, there's a lot of different facets.

[25:00] That's what makes it difficult. Yeah, well, no, a lot of times too. I mean, it is as you get older. I mean, I feel like you even have to put more work into you can get away with away with a lot of things when you're younger. But as you get older, like doing the mobility work, the stretching the core work working out.

[25:20] it becomes more important, not less important and you got to put in that work. But I feel like in your, or what I've seen too is I think, not sure if it's the proper, but you have a fellowship, is it the Dr. Antonio Webb fellowship? I feel like that's a big component of what you

Overcoming Personal and Professional Challenges

[25:40] do as well as giving back and you said you had a mentee, how does that, or what are your feelings towards that? Yeah, I think that's important just because, you know, growing up, nobody in my family was a doctor. I really had to figure this whole path out and kind of try this, didn't work, try this, didn't work until I actually

[26:00] got here. So I have a huge passion for kind of giving back and mentoring. So I have a nonprofit, the Webb Family Foundation, essentially is to increase our provide mentorship and guidance to students that are coming up behind me. So I have a summer program that I do where students spend some two weeks with me.

[26:20] surgery and in clinic. And last this past year I had about a hundred applicants for that program. And also I have a health event, a health day camp this weekend actually on Saturday. We have 90 students registered so far. I think it's about 15 doctors that will be there

[26:40] plastic surgery, ecologist, pulmonologist, family medicine doctor. And we'll have some hands on, some saws, drills, hammer, screws. We have a heart monitor that listen to heart sounds. I have some suturing kits for them. So really just trying to introduce the students into the field of medicine because

[27:00] similar program to that got me interested in medicine is really the reason why I'm a doctor. So I think it's that for like junior high high school age students? Yes, or middle school and high school and some college students, but really middle school, high school, that's where I really want to impact them. Yeah. Well, because yeah, you

[27:20] Like you were saying earlier, you went after you did that in high school, that program you were very interested in. I think a lot of times it's just exposure to the stuff and people seeing what the possibilities are out there. There's certain fields you just don't really see as much. Yeah. I grew up with a really challenging background in Louisiana.

[27:40] several family members that went to prison. My mom was actually shot and she's a T10 paraplegic due to her drug addiction. So just growing up around that type of environment and I didn't have like any role models. There was no YouTube that I can answer a doctor that looks like me and say, hey, I want to do

[28:00] that. So I think that's awesome. How do you think it was that allowed you or what traits that helped you kind of progress and decide you wanted a different outcome out of your life? Yeah, that's a good question. Just a little bit of background.

[28:20] little brother that went to prison for five years, my little sister went to prison. My dad was in a gang when he was younger. He went to prison as well, sold drugs and used drugs, cousins that went to prison, a lot of friends, family. But really it was a program in high school similar to the one

[28:40] I'm having this Saturday that introduced the field of medicine to me and otherwise I wouldn't know it would have existed. And it was me and my best friend who's a cardiothoracic anesthesiologist, we kind of stuck together and kind of stayed away from all the bad things that were happening. And we did that program and ever since

[29:00] that program, we wanted to become doctors. So he's a cardiothoracic and a pathologist out in Alaska. What's interesting about that is that why you found that drive to do something different and move on in a different path compared to your brothers and sisters?

[29:20] And why does one person do that and another person can't? Yeah, I get asked that question a lot. I mean, I can't explain it. I was very focused. I mean, I've always been very focused. And if I see something that I want to accomplish, there's really going to be nothing that's going to stop me from doing it. And I just kind of stuck with it over the years. And I knew going into the middle of

[29:40] I can get out of that environment. So I joined the military at 17 years old and left Shreveport, Louisiana. I think it's a great example of if you set your mind to something, you can make it happen because I would say you probably had a major roadblock to an ordinary person of what was possible.

[30:00] But it was usually something in life that set you on a different trajectory, I think, for a lot of people. For me, it was my brother getting a car accident and having brain surgery in the middle of the night and, you know, living in a nursing home the rest of his life and couldn't walk or talk. But that's what really channeled me in the neurosurgery. I mean, I was all signed up to go to college for gene biology.

[30:20] When that happened, I canceled my classes and decided I wanted to be a nurse surgeon. Like you said, I just focused on it and that's what I did. So, I mean, but usually some event I think for a lot of people, something must steer you that way different than other people, you know. Yeah, yeah, yeah, I definitely agree. I think too, you said you're always been very focused.

[30:40] And that's how my mom would always describe my dad. If you want to do something, you set your mind to it and do it. And that's like one of the top qualities of a neuro-arthopedic surgeon. When you were younger, what did you do? Like I had paper outs and with shovels, snow, and all kinds of stuff like that. I bet you were like that. I bet you had something that you had to have responsibility

[31:00] for all the time. Yeah, I was always kind of on the go. I actually at McDonald's when I was young, at a watermelon stand, that was actually my first job and always trying to figure out over the summer what can I do to kind of stay busy. So yeah, definitely. Switching gears a little

[31:20] What would you say is your favorite part or the best part of being a surgeon and what would be your least favorite or the worst part? I'd start off with the least favorite part first. I would say the least part is just the behind the scenes things I go on at patients and everybody else that doesn't see.

[31:40] dealing with insurance companies and prior authorizations, denials. Computers. Yeah, the whole admin part. Computers, exactly. I enjoy that the least. That takes quite a bit of time and people just don't really see that and it takes a lot of time to administer that.

The Future of Medicine: AI and Physician Roles

[32:00] trait of burden that people talk about. But I think what I get my greatest joy is when patients come back and they're nearly in tears like, hey Doc, you really changed my life. I was suffering with this for four, five, six, seven years and you did a procedure or even something fancy

[32:20] conservative, like physical therapy or an injection after recommending that. And it can be life-changing for a lot of people. So yeah, he asked me those two questions in a TikTok and I answered the same way. Computers was my least least favorite. And then just what you said, seeing people come back, how you change their lives and they're so appreciative. That's definitely far and beyond.

[32:40] some people thought it should be what's the least favorite thing that I like that somebody said like, well, don't you mean talking to families and telling them bad news isn't that the worst thing is actually not for me because I think it's a good thing to help people come to ease to ease their minds about something bad that's happening if you can if you can help that family get through a bad tragedy

[33:00] explain it to them in a way that makes sense to them and make them not feel guilty about it. I think that's a positive, not a negative. So for me, I said computers, a lot of people shot me down for that. Like it was very insensitive. But you know, delivering bad news is part of what we do. And you can turn that into a positive for the family or a negative. But that's how I answer just like you.

[33:20] I agree. Well, I think there's so many things too, like with growing up with my dad being a neurosurgeon, some people just think like, oh, surgeons, they're this or that, they're arrogant, they make so much money or this and that. And it's like, people don't see how much there is that goes behind being a surgeon, all the other things you

[33:40] doing that aren't technically just operating on people, having to tell someone they're paralyzed or something else. There's heavy components to that and all the training you guys have gone through. So I think it's good too. I think people are always interested. A lot of times when we do social media, it's just stuff that over the years from just hearing friends or people

[34:00] people I meet what they would wonder and that's beside generating questions. And like even for you, I think it's important like you know, people always ask how does your family feel about you never being home because when I was younger, I was very busy and never home. But it's nice to hear these guys say you know, they always understood they knew what I did. Now these older Kevin says you know, I understand what my dad

[34:20] did and it's something to keep in mind with your kids. Your kids are young and you're not going to be there for a lot of things, you know, but they do understand as they get older what you're doing and the importance of it, you know. Yeah, I can already see that in my youngest. As soon as I walk in the house, he's like, Daddy, you're at work and he's just two. So he understands that and I'll say, hey,

[34:40] I'm sorry I had a late night and I was helping someone at the hospital so they do get it but I took a lot of trauma call my first two years in practice and that was a pretty busy lifestyle. I was not home a lot so I'm pretty sure you're still taking trauma call or… Yeah okay we do a week at a time which is

[35:00] is this, it's horrible. It's a horrible week, but then when it's over, I mean horrible as far as the hours and just you're there all the time and you know, you're up all night getting calls or getting called in. It's just, it's your, it's one of those weeks that when it's over with I'm happy to move on to my elective life. Yeah. Yeah. But do you still take trauma call then?

[35:20] or it's just not as bad. I don't know. I don't take any emergency call. I take a call from my practice and we have multiple spine surgeons. So we just split kind of call. So if there's a case over the weekend, just you know, someone who calls in or I got a call yesterday from the emergency room about one of my previous patients.

[35:40] like that we take care of and nothing at the hospitals. You guys rotate pracacog. You said there's nine or 10 other surgeons. Yeah, so it's we take a weekend at a time. So during the week we're responsible for our own patients. And then we can we just take turns. So you guys have they have a lot of pracacog.

[36:00] That's okay. I mean, it's, you know what I'm saying? Because you usually had what, three partners or two partners? Yeah, it's always because with our groups have always been smaller. So, you know, at one point for 17 years, we were just three of us at level one and it was busy. So it's just crazy. I mean, it's every third night and then every third weekend. It's not like that.

[36:20] We have a practice call, right? Like I'm on practice call right now, which is not a big deal. And then you're weak at trauma calls. Very busy, but I'm assuming, I don't know if you guys rotate or with having multiple, several partners, but do you have your own PA or do you guys with the X? Because your

[36:40] You guys are private practice or just your group is, I would assume. Yeah, I have a practice. I have two nurse practitioners that work with me. Yeah. Well, because I think a lot of things, it's a good, a lot of people don't pay attention to necessarily, but as surgeons, they think you guys are just doing everything too. But that's a huge ... I know

[37:00] You love Jenny, you're invaluable at helping make everything work. And he's always said that too when we were growing up where when he talks to other people of interest and stuff, there's lots of other, there's lots of great fields to go into within medicine where you can still be necessarily around surgery or some of that without actually necessarily if you don't want to be full surgeon because some people don't.

[37:20] Yeah, there's a lot of other great opportunities and like this weekend I have a physical therapist that's coming. I have a, I believe there's a dietitian that will be coming. So just exposing kids to other, all of the career fields. I mean, there's lots of them.

[37:40] things off there that you're missing. What's the future hold? Like what do you think for your future? Do you have anything exciting ideas that you want to do with your career? Yeah, I think I'm interested to see kind of where this whole AI thing kind of comes and goes. I think from a kind of

[38:00] Using AI to predict which patients will benefit from a particular surgery, those patients will be too high risk by putting all this information that we gather into some system that can give us a score, some type of scoring system. Hey, this patient's high risk will be better with infusion versus a laminectomy.

[38:20] So some kind of standardization, because we have really no standardization right now to some extent. It's really individual. We make, you know, we decide what we think we should do individually. Yeah. Man, if the more it is, but no, in healthcare, it's harder for, I feel like AI to move as fast compared to other fields because so much

[38:40] the data is restricted. You can't just give free reign of data. So it'll be interesting to see how that progresses because I think that's the LLMs and everything else in tech. It's because they've got so much data they're going over and that makes it the model better in all those regards. Yeah, and then outside of that, I

[39:00] have an online course for doctors coming out. It's an online course that teaches doctors how to use social media and supplement their practice. So it's called social media for doctors.com. But for everyone listening, we'll put all these things we've been talking about

[39:20] out in the show notes and you can find them there for anyone interested in this stuff. Just curiosity, like what's your what's your favorite case to do? I know, you know, you probably do a plethora of cases. But what's like, if you had if your ideal day of surgery, like, you know, some days you look at your schedule and I'm going, What was my scheduler thinking? It's a very stressful day. And

Life Beyond Surgery and Closing Thoughts

[39:40] And then there's other days I look at my scuttle and go, wow, this is a nice day. Like what would be a nice day for you? Good question. I would say anything anterior, ACDFs, artificial disreplacements, ALIS, artificial disreplacements. So anything anterior, anterior for me is a good day. Those are my favorite surgeries.

[40:00] Probably like a nice clean lumbar fusion in the back followed by you know maybe a so my typical day would be like a lumbar fusion then a multi-level lumbar decompression and then an ACDF or posterior cervical. I don't know I've noticed like when I was younger never

[40:20] seem like the posterior cervical foraminotomy is blood so much? I don't know if you get that. But then, you know, like the individual foraminotomies, the epidural veins, the bleeding nowadays, it just kind of turns me off a little bit. Do you get into that? Yeah, it's probably, I'm wondering if it's something to do with patient's weight or blood pressure.

[40:40] don't know. But yeah, I did see that pretty frequently. Because you know, when we train, we did everything sitting everything. All our cervical were sitting in posterior and any posterior fossa cases. And then when I came to town in 1999, the anesthesiologists here were very skittish about sitting position. So everything has been done prone

[41:00] But you get more bleeding obviously when you're prone compared to sitting but it seems to be like the standard of care at this point. So yeah, and I'm also curious about you. Their ergonomics, you know, doing this for so many years kind of bending your head down. Yeah. You know, a lot of new systems are coming out. So you're looking at the monitor versus like looking at the or microscratching.

[41:20] So, but you know, I've only been in practice for four years and I can already feel the effects. Well, you know, they got these new so for anybody out there loops, we call them loops, the magnifying glasses that we wear. So mine, I do have to look down. But I'm one of the guys that is in my group. He has you just look straight ahead in it. And so you can look at it.

[41:40] look straight, but you're seeing the field. It's pretty cool. I thought about maybe getting them, but Jesus, I'm almost 60 years old. What's the point of this plant? Yeah, I tell those. They also have what's called the exoscope. It's very similar. You wear these glasses and you're looking up like this, but instead of looking kind of down,

[42:00] Have you noticed though like anytime like where your neck I mean my neck and back get sore when I'm in certain positions but for the most part I don't have a lot I don't have neck or back pain there are days where I'm sore if I'm bent over all day you're right but God knows that my neck looks like on an x-ray right now but I don't know I don't really have much

[42:20] pain. Whenever I ask him this, he's like, I get through it. But do you ever get tired when you're standing for operating all day? Yeah, I can certainly come into play. I mean, it can be pretty exhausting, especially if you're doing some complex cases. That's why I like the straightforward cases.

[42:40] get in and get out and take a little break and get back at it. Yeah. And what about what music do you like listening to in the OR? I usually let the nurses decide. Oh my god, you guys are twins. Sure, we're twins. We do the same thing. I never want to be the person whose music is this and they look at me.

[43:00] So there are certain things I won't listen to like there's a certain music they turn on I say can you please just change the on I mean once in a blue moon but most part listening like really twangy country I don't like and two other things listen to pretty much everything throughout the course of the day it's no it's yeah we

[43:20] But in my fellowship program, my mentor, Dr. Lieberman, Isidor Lieberman, he would have everybody sing Scapes Me Right Now. There's a certain song that's very popular, so he has that song on every end of every case and we would sing it. I can't think of the name of it now.

[43:40] It made you all sing along? Oh yeah, everybody had to sing along. Let me see if I can find the name of this. No, exactly. It's funny because some people don't think, you know, on social media, a lot of people think that we don't play music. We just, you know, you're focused the whole time. Nobody talks. And it's not like that.

[44:00] But sweet Caroline, oh sweet Caroline. Oh, yeah. Yeah. Yeah. Nice Everyone has to sing along to that. Yeah, so we all at the end of every case that's what the song that we we saw no diamond That's great. No, but like you was saying I think I think the first time I saw like popular media where I

[44:20] have some people asking about that because no one ever said anything was after, what's it called? The Marvel with Dr. Strange. He's like operating there listening to music and people are like, no, I would have friends that does your dad do that? I was like, yeah, they always listen to music or something. I was like, do you think

[44:40] people are just always like just sitting there just a dead silence. I don't know. It's pretty interesting that one of the neurosurgeons at my hospital, I mean, he listens pretty hard for like metal, hard metal. That's what he is. I can hear it in that still words. It's really loud.

[45:00] Holy crap. Gonna knock on the wall and be like, turn it down, buddy. I'm surprised the anesthesiologist doesn't make him turn it down because I've turned the music up once a while here and they'll turn it right back down. Yeah. Sometimes I imagine sometimes they probably do try to. Yeah. Yeah, no, it's funny. It's like the obvious things. That's why it's always intriguing

[45:20] Like for like YouTube and social media trying to find those things that are like so obvious to you guys But other people would just be like wait, that's really cool. Yeah, this and that It is interesting. I think it is what I found out with social media is how a Lot of people really don't know what we do because it's a world. No one's allowed into you know for some reason

[45:40] And especially like in the operating rooms, people aren't allowed in there. They're not even allowed back through the doors to head to them. And so people really never have an idea what we do, what goes on. And it's cool when we can show them that side of the world that they don't get a chance to see. Yeah, I mean, that's exactly right. People, they want to know. Even when

[46:00] doctors do kind of when they're time off. That really fascinates a lot of people. That's actually probably one of the most popular requests that I get. Hey, let me see you at home with your kids. And there are certain things I'm a little, no, it's probably a little bit too personal, but I try to give them a quiz.

[46:20] your wife with the social media? Does she like you doing it and not like you doing it? She's okay. I mean, that's an outlet for me. I've always had a passion for cinematography and film. Actually, during fellowship, I hired a film instructor to work with me. But I have a whole team of people

[46:40] now that I don't really touch the camera. They just basically show up and do everything for me. But my wife is, she's pretty supportive. She doesn't like to really be on camera a lot, but it's just really amazing. Yeah. Well, I think too, you're definitely further along the journey if you figured out a lot of those things. But you just, like you said, you started with your phone

[47:00] everything. Now you actually you have like you batch content days it seems like in shooting stuff. Yeah typically we'll shoot like yesterday we shot maybe 10 videos and then a videographer editor slowly release it over the next couple weeks. That's the only way to do it with our schedule like this.

[47:20] Yeah, because he would say that at times it's just like, you're so busy at first, it's like you can be fun and enjoyable and then when you're too busy and then you're trying to do stuff, it gets like in terms of I feel like that's how anyone who gets further along and just content creation of any sort is you have to batch things together and you always want to make it.

[47:40] something we talk about a lot is just like, hey, we don't want to do something, let's not ever make it like it's forced because then it just takes all the fun out because I don't want to get the point where I just have to make something just to get something out to get something out there because then that defeats the purpose. You know, so sometimes we'll go a while without putting anything out because I'm busy, he's busy and we just not gonna put something out that's junk, you know? Yep.

[48:00] I agree. Well, we sure appreciate you taking the time to talk to us. It's been very nice meeting you. You too. Yeah. Thank you. Great person and a great surgeon. But yeah, everyone check out Dr. Antonio Webb on YouTube, TikTok, Instagram. He's on all those platforms. We'll put the links to all of his stuff and other

[48:20] programs we discussed for anyone interested. And yeah, thank you so much for your time. I thought that was a great conversation. Yeah, you're very welcome. Thanks for having me. Appreciate it. Yeah, thanks. Thank you.