Dr. Arthur L. Jenkins is a board certified, fellowship trained neurosurgeon who specialises in spinal surgery in his “academic” private practice (Jenkins NeuroSpine). He has developed a dozen minimally invasive treatments to improve surgical outcomes for patients with disorders from the skull base to the tailbone; as well he holds patents and patent applications on a dozen different ways to improve patient outcomes. He is developing new treatments with other academic researchers, start-up biotech companies, and private practice experts in several fields. He specialises in minimally invasive treatments for all treatments to reduce recovery times and improve outcomes (including common spinal conditions such as herniated disks and spinal stenosis), as well as rare, poorly understood conditions (like craniocervical instability and autonomic dysfunction, Thoracic Outlet Syndrome, Bertolotti’s Syndrome, among others) where his insights are changing lives and practice patterns around the world. He treats all patients (local or international) with his combination of passion, empathy, and unparalleled diagnostic and surgical skills, out of his offices and hospitals in the New York City Region. He is on every top doctor list for which he is eligible, including: Vitals “Top 1%” of Neurosurgeons, Castle Connelly “Top Doctors” lists for the New York region, the United States, and for Cancer, New York Magazine’s “Top Doctors”, among others.
SSN: What drove you to choose surgery as a career, and spinal surgery in particular?
AJ: I realized when I was 16 that I had a knack for science, a passion for fixing things, empathy and a desire to help people, and a thirst to always be challenged and rise above those challenges. As I began to cast around for possible career pathways, many things appealed to me: nuclear physics, advanced mathematics, engineering and design, medicine and surgery. I ultimately decided that surgery, and in particular neurosurgery, would be the career choice that would allow me to use my passion to always be improving myself, and at the same time enter into a field that wouldn’t be “all figured out” by the time I finished and retired 50 plus years later.
Even further within surgery and medicine, I decided that neurosurgery in particular would likely be the biggest challenge of all: the heart is a muscle, the digestive system is a filter, but the brain and spinal cord? That’s just one big black box.
While certainly other specialties and their physiology and pathology are more nuanced than that simplistic 16-year-old’s perspective, I must say I have not been disappointed by my choice.
SSN: It is clear that the healthcare industry is still being impacted since the pandemic, what has been the greatest impact for you within the neuro and spinal industry?
AJ: The COVID-19 pandemic affected people on a medical as well as an economic level. It has driven more consolidation in the field of medicine and surgery, forcing many practices to either sell themselves off to private equity or larger hospital chains, and in some cases has driven clinicians affected by COVID into early retirement.
On the other hand, it has sped up the adoption of telemedicine and it’s accepted by insurance companies more than was in place. Although I had been doing telemedicine consults for people from around the world (often for those who had limited access to top-tier spinal consultations in their own home environment), the first three months of the pandemic forced us to go 100% to an all-telemedicine process and forced us to be even more efficient. However, because we were already doing it, we were ahead of the game. I still think we do a better job with telemedicine than most because I have learned how to simulate in-person examinations on people in their home environment.
One negative rebound from the benefits of COVID-19 was the recent rolling back of some of the reimbursements and even the legal environment in which one can perform telemedicine is also creating some stresses on patients and their clinicians. Several states ban physicians who do not have a separate medical license for that particular state from even performing telemedicine on a patient who is in that state. This would make it hard for a person who might travel, say, to Chicago to get specialized care and then go home to California. These states expect any physician treating remotely to take on the extra expense and trouble of first obtaining, and then maintaining, a medical license in a state in which they may never set foot. Telemedicine waivers were initially allowed and encouraged during COVID, but now it seems the state medical societies have pressured states to go back to creating what is essentially an artificial boundary around patients within their state.
On a personal level, I still feel like I am suffering from long COVID and that I do not have the energy that I had pre-COVID. This certainly impacts the amount of time that I can put into all of my personal and professional endeavors, as I feel like I have fewer hours in the day, and I need to spend more time resting and catching up on sleep. I used to be able to work sometimes late in the evening until midnight and I no longer have the energy to do that.
SSN: What’s the best part of your job?
AJ: The best part of my job is the satisfaction and joy from seeing my patients recover from something that was profoundly impacting them. Seeing patients get back on with their lives, seeing them achieve major milestones they never thought possible again, and in some cases saving lives and then seeing the impact that life has on other people is the single greatest part of my job. Other aspects of my job also give me great joy. I love mentoring young up-and-coming students in the art and science of medicine and surgery, and seeing their successes and being proud of having molded them towards their success. I am immensely proud of doing practice-changing research that raises the bar for patients and other clinicians..
But at the bottom of it all, and the top of the list: I love my happy patients.
SSN: … and the worst?
AJ: The worst part of my job? Absolutely, dealing with insurance companies. 50 years ago, when commercial insurance companies were mutual-owned, the policy holder was actually a part owner in the company, and therefore very important to the company itself. However, in the 1970s and 80s, these insurance companies were allowed to “demutualize”, and become publicly traded companies. When one becomes a publicly traded company, its shareholders become the “most important person”. And their board of directors, the second most important. And so maximizing profit rather than maximizing clinical outcomes for their customers has become the number one goal of insurance companies.
Customers for whom premiums get collected but payments don’t get paid out are the most valuable customers of all. One way to try to achieve that goal is to simply not pay doctors what was contracted under their plan. There are many ways that this is done:
- “interest-free loans” by simply delaying payments for doctors is a simple way for the insurance companies to keep more money on their balance sheets and just take their time paying whatever they decide to pay.
- Paying doctors, like myself, who are out of network (and get paid at a different fee schedule than in-network doctors), but choosing to pay them at an in-network rate initially is a similar “delay and deny” tactic.
- If the doctor doesn’t appeal the underpayment because their billing and collection system isn’t as aggressive (and wants to simply “close the loop”), the insurance company isn’t going to complain because they just got a deal.
- Pre-authorizations can be time-consuming and laborious. In fact, frequently I need to be on the phone and sometimes even on hold for extraordinary times (which for a surgical sub-specialist whose time would really be better spent treating patients rather than arguing with an insurance company about what is clinically valuable treatment).
However, insurance company pay “reviewers” and “medical directors” at a much lower rate than I get paid to tell me “no”, and I have to try to convince them why “yes” is the right answer. Even if one gets through this Byzantine process and gets a pre-authorization for the procedure, they tell you up front: pre-authorization is no guarantee of payment. Then you have to fight for payment, and in some cases, it may take me up to five years to get paid on a surgical procedure.
SSN: What has been the highlight of your career so far?
AJ: It’s hard to pick a single highlight of my career. I do enjoy the fact that I’ve gone into private practice after achieving most of the goals that I set for myself academically and realizing that the political battles of working within a large institutional-type hospital and medical school environment were actually holding me back rather than helping me. I’m also honored to be invited to participate in so many different types of activities, including having taken the emergency calls as one of the spine surgeons for the New York Jets, being one of the surgeons the NYPD calls when it needs help, as well as being on the advisory boards of multiple biotech companies over the years.
However, I still think I have a few years to go before I truly reach the pinnacle of my career. And when that happens, I’ll be sure to let you know.
SSN: As a surgeon who is constantly researching into new technology and techniques, could you tell us more about your current research and the impact it will have on the patient experience?
AJ: I’d love to tell you about my research, it’s one of the things that I’m most passionate about. Although some people do research “just for research sake”, my primary goal is to do the research that teaches me how to treat my patients better. I use the findings in my research to improve how we work up patients, how we treat them, and how we take care of them afterwards. And in some cases, how to prevent people from becoming patients in the first place.
I treat several challenging patient conditions that my team and I are actively researching; as well as developing several novel surgical procedures to treating an old condition; and I have several inventions related to medical conditions including eight patents issued already.
Let’s start with the neurologic conditions:
- Patients with certain hypermobility syndromes have laxity of certain joints and this can result in neurologic syndromes that can cause pain, discomfort, weakness and in some cases severe disability. We started out developing a minimally invasive new surgical procedure to remove cervical ribs (ie, extra ribs that can pinch nerves) from patients, and wound up discovering an entire population of patients who were being untreated, medically “gaslit”, and otherwise ignored. What’s sad is that these are patients I really had no formal education about their condition during my residency, as the lack of knowledge about these patients and the reality of their problems and the interconnectedness of their conditions just was not appreciated and therefore was not passed on to me formally. It was something that I only discovered after listening to them, hearing them, and deciding to take action to educate myself, and then try to change the course of their history for the better. This includes Ehlers-Danlos Syndrome hypermobility (EDSh) as well as other general hypermobility syndromes.
- Bertolotti Syndrome is a similarly underappreciated condition due to a common misinterpretation of a single article from 40 years ago that has led to a generation or more of patients being told there’s nothing wrong with their spine, when in fact they are disabled from the pain that this condition can cause. The gratitude from these patients is palpable and immense just for being heard in the first place; seeing them get on with their lives and become, in many cases, pain-free or fully functional again, is priceless.
- We are also developing new technologies to help diagnose patients as well as to treat them in surgery.
- And in one case, my dynamic neck collar device to prevent injury in the first place. I currently hold several patents on this turtleneck-like device that people doing high-risk activities (like contacts sports, backcountry skiing or snowboarding, military activities, etc.) would wear to try to prevent, or at least mitigate, disabling spinal cord injuries and fractures that might otherwise change their lives forever. My motto is “We turn patients back into people”; we also try to prevent them from becoming patients in the first place.
SSN: What could this research mean for patient outcomes and the future of spinal surgery?
AJ: Obviously the spinal research already is paying off by improving patient outcomes and changing which procedures I do on which patients, as well as offering procedures to patients who previously were told there’s nothing we can do to help them, period. But how I hope my research, in particular as a private practitioner who is funding the research out of his own revenue, I hope that this becomes a wider model for all physicians in practice to recognize that it’s our obligation to research what we’re doing to constantly be improving our practice. I want to be better every day than I was the day before. We’re focusing on the caring part of providing care.
Unfortunately, so many people in practice get into a rut where they keep doing over and over the exact same thing, assuming that it’s good enough to just keep doing the same thing over and over. I go to meetings to find new things to learn, new skill sets to acquire that might add to my tools that I have for my patients, as well as to learn new insights that may help me look at diseases and patients’ problems in different ways. Even sometimes going to meetings outside of my area of expertise to learn other ways of even looking at conditions in the first place. So I hope to be able to lead the practice of medicine back to a state of constant research, constant process improvement, where it is not enough to just be average and strive for nothing more than being an average practitioner of the arts, which seems to be what organized and corporate medicine is shooting for these days, where the bottom line of the practice is viewed only in the volume of cases performed and not by how much that physician or practice has raised the bar or developed innovating treatments.
SSN: Will you be attending or speaking at any medical conferences or events this year?
AJ: I attend conferences all over the world, and I’m in the process of selecting these conferences right now. I go to a wide spectrum of conferences ranging from the big national meetings for organized neurosurgery and spinal surgery like the American Association of Neurologic Surgeons, the Congress of Neurologic Surgeons, the American College of Surgeons, and the North American Spine Society. I also regularly go to one or two ski meetings, as I find those smaller, more intimate meetings allow for a mixture of family-oriented networking, one-on-one discussions with rising stars and and established luminaries in the field, comma, not to mention getting some impressive vertical footage in some beautiful and challenging terrain.
I have been invited to speak as a major speaker at multiple meetings and I’m in the process of deciding which ones to attend. After all, the value of the meeting has to be worth taking time away from my patients. It’s important to get rest and relaxation to come back fresh and be able to give my all when I’m on, but if you take too much time time away, the practice and the patients that we treat suffer from that.
SSN: If you weren’t a spinal surgeon, what would you be?
AJ: I’m going to look at this from two possible outcomes.
- What would I do if tomorrow, I couldn’t practice spinal surgery.
- What would I have done had I never been able to become a spinal surgeon?
First, if tomorrow somebody said, lay down your scalpel, start the rest of your life, I would likely turn my focus 100% to entrepreneurial attempts to finish developing my patents and in particular the neck collar device. I want to prevent people from becoming patients in the first place, especially preventing spinal cord injuries (SCI) that devastate entire families. SCI devastates a whole family, who now have to take care of somebody who previously was either a caregiver themselves, or the breadwinner for their family, or hadn’t even yet begun to be that person. The cost of taking care of spinal cord injured patients ranges from half a million dollars a year to four to $5 million a year depending upon the level of injury and the severity of the injury. And this happens 12,000 to 14,000 times per year in the US alone with such a profound impact upon so many people that I think that would be the single area where I could have the most impact for what I can do.
Now, if somebody went back in time and told my 20-year-old self, you’re not going to be able to be a neurosurgeon or a spinal surgeon, now what do you do? I either would have become a nuclear or theoretical physicist, delving into the deepest corners of scientific discovery on the microscopic scale. I actually was a biochemistry major because I thought that the easiest way to understand the brain would be to start at the subcellular, microscopic level and build up an understanding of how nerves interact with each other and from that derive how conscious thought and voluntary movement comes to be. The analogy is: to program a huge operating system, you start with understanding how the smallest computer code interacts before you devlop the bigger programs. Through the study of Physical Chemistry, we start with the physics of atomic level interactions and derive “Chemistry 101”.
Modelling and learning about these subatomic interactions was fascinating, but at the time I had a self-imposed mandate that “This is the way” towards neurosurgery. I didn’t discover my calling in medical school. I went to medical school because I had already discovered my calling, and that was a necessary stop along the way.
SSN: What would you tell your 21-year-old self?
AJ: I would tell that 21-year-old “…all this hard work will pay off in the end. Your passion for excellence will not dim as you grow older and wiser. It will actually be fed by your knowledge, your successes, and your failures”. I would also tell my 21-year-old former self to be a little more cautious and maybe a little less trusting in the field of romance. Although, in retrospect, some of those hard lessons needed to be taught and learned somehow. And I wouldn’t give up the passion I have now, to protect an earlier version of me from the pain that comes along the way. So maybe I would leave that out and just say, …”be prepared for some rough rides. But if you hold on tight and hold true to your principles, you’ll come out okay in the end”.
SSN: If you were Health Minister for the day, what changes would you implement?
AJ: The most important one would be that I would mandate that insurance companies must be regulated by a board of practicing physicians, and that the rules and guidelines that they use to apply health care decisions need to be vetted by teams of top practicing physicians. So many problems I see now come down to the fact that insurance companies in this day and age seem to be acting as though their business model is to take premiums in under the promise of providing and helping to pay for excellent care. But the reality that physicians on the ground are seeing is that it is a denial “game”, hoping that the physician and patient will go away rather than stick it out. This is a different form of medical gaslighting where patients are gaslit by their insurance company. And in some cases, I feel that this process, instead of being called “insurance” should really and honestly be called “un-surance”.
SSN: Away from the clinic and operating theatre – what do you do to relax?
AJ: Well, I think we’ve already established that I love to ski. I’ve been skiing since I was three, and I’ve been fortunate enough to share that love of skiing with all three of my daughters and my wife, for whom it’s now her favourite sport. She’s even written a song about it. In addition to that, I have love for almost all things related to the water. I grew up swimming. I was blessed and fortunate enough to be on the number one “day school” swim team in the country when I was in high school, and swam under the greatest coach ever, Richard Shoulberg, who is still coaching after more than 60 years. I still swim to this day for exercise and for enjoyment. In addition to that, I enjoy boating, both power boating and sailboating. And that’s also something I’ve been fortunate to share with all three of my daughters and my wife. Perhaps a song will be coming from that, too.
I love to listen to music in the OR as well as at home. Music can both soothe and establish a mood, and it’s a great way to relax, wind down, or get wound up for a night out on the town. Finally, I love to read. One of life’s great pleasures: reading to my daughters (before they were able to do so on their own) some of the books that I found most formative; lately I have been sharing with my oldest daughter our reading lists.
Finally, my last “dirty” little pleasure is my garden, which I enjoy getting my hands “dirty” providing food for myself, my friends, and my family. It is very gratifying to be able to provide healthy, pesticide-free food to the ones I love, and to be able to eat the fruits of my labours, literally.
SSN: How do you think the future looks in the field of neurosurgery and spinal surgery and what are your predictions for 2025 and the next decade?
AJ: The future of neurosurgery and spinal surgery is and always will be one of evolution and the occasional revolution. The individual introductions of endoscopes, microscopes, and stereotactic navigation have revolutionized the way neurosurgery and spinal surgery can be formed safely and with less impact. Evolutionary changes include a progressive reduction in the scope and the impact of surgery through improvements in techniques, improvements in anaesthetics, and medications used in surgery, as well as neuromonitoring to ensure that the surgical procedures are going as intended, and alert the surgeon at the first sign of trouble, perhaps before they would have otherwise. Robotic surgery has the potential to be one of these such revolutionary technologies, although it may be very disruptive in the sense that it may take the manual dexterity aspect of surgical practice and essentially throw it away as robots will be able to be programmed to do the surgical procedures for us, changing the skill set from those able to perform the surgery to those able to program the robots to perform the surgery. But the judgment of when to, and when NOT to, perform the surgery will remain the same.
And it will be that judgment that determines the difference between excellence and mediocrity in surgical outcomes. Other future evolutionary technologies are likely to include genetic and or advanced metabolic/pharmacologic treatments that are hybrids, requiring a surgical implantation of a targeted treatment vector to get past the body’s natural barrier to the neurologic system (the blood-brain barrier). While many other organ systems in the body can be treated medically via injections, this blood-brain barrier frequently requires surgical interventions to bypass the body’s natural defenses. In addition, improved diagnostics and potentially even genetic testing may predict which patients respond to earlier and potentially even preventative surgical procedures.
“Big data” (LLM’s, AI’s and Machine Learning) helps us to understand not only the natural evolution of aging, degenerative cancer, and traumatic processes, but also to identify novel and or early interventions that may arrest or even reverse some of these processes. Finally, neuroprosthetics, brain and spinal cord implants are the final transformative and revolutionary processes that can truly change the fields of neurosurgery and spinal surgery. Companies like Synchron (caveat emptor: I am an early investor in Synchron), Neuralink, and others are working on commercial versions of devices that have been proposed since the early days of science fiction and experimentally developed over the last 40 years in bench labs.
The future of neurosurgery and spinal surgery is certainly bright. And the only constant in life is change. But for those willing to ride that change, it’s going to be a fun ride.
As far as my predictions for 2025 and the next decade, I don’t see more significant changes in the next year or so. But I do predict that we will see more consolidation, more private practice doctors giving up their autonomy and their practices because they can’t afford to stay in business. That will certainly continue to accelerate in 2025.
But for the next decade, I hope that doctors who feel almost forced to provide mediocre care because they have to work within a framework that prioritizes efficiency and maximization of the amount of care provided to each patient, whether they need it or not, will eventually cause patient groups to organize, and eventually Congress will take notice and begin to mandate that many of the regressive and negative changes pushed upon the medical community by insurance companies’ lobbyist groups to maximize their profits at the expense of the patients and the companies that pay their premiums. Currently insurance companies are making record profits. And one way that they have achieved that is by minimizing the amount they actually pay physicians for the services they have rendered.
They have the deepest pockets, they play the long game, and they know that to under-pay, “slow-pay”,and/or to deny payment for care (usually already provided) gives them the opportunity to hold on to the money and hope that the doctors give up on collecting the money that they are owed under the patient’s insurance benefits.
Eventually, since Congress is made up of human beings, each of whom has family, friends, and sometimes their own personal experience with medical conditions that require physicians to treat, will realize that maintaining physicians’ autonomy is in the country’s best interest, so much more than maximizing insurance company profits at the expense of how their family members and even themselves are treated.
But if history is any guide, things have to get worse, before they get better and there is a reaction against this corporatization of medical care. I must say, I am a bit of an optimist in believing that this change will come to pass. And I have to believe that when investors, and regulators realize that profits are so much more important than patients to insurance companies, something will give.
