Founder and president of the International Spine Study Group Foundation, Shay Bess credits the friendships and research opportunities he has had through his career with the meaning and satisfaction he has found through his work. He speaks to Spinal News International about what he has learned from mentors, his excitement for the evolving role of data in medical research, and the meaning of life.
Did you always want to be a spine surgeon?
As you go through medical school and your training, you tend to pay attention to and stick with the things you like. I do think that we work too hard and spend too much time doing this job for it not to be something you love to do.
I really had no idea what I wanted to be. I was experiencing the day-to-day, as opposed to having this grand plan. But my career development was just like anything else in life—it was a process of evolution.
Have you had important mentors through your career, and what have they taught you?
It’s interesting. I have had mentors that I think I have learned a lot from; excellent people that have showed me who and what I want to be, and ultimately who I wanted to emulate.
I’ve had great mentors with work, with my family, and in athletics. And I think this probably holds true for everybody, but if you have a moment to be able to step back and reflect, you may recognise ‘that’s the kind of person I want to be’, or ‘that’s the kind of person I don’t want to be’. You take the things that you want and leave the rest, hopefully, behind.
What would you say has been the career achievement that you are most proud of, and why?
I wouldn’t say there was one thing! Undeniably, from a career standpoint, it has been the work that I’ve been able to do with the ISSGF. It’s a great group of close friends that is very tight-knit, which makes the work incredibly satisfying. That helps generate that creative spark, and then there is the satisfaction of having a creative outlet. Combining creativity with friendship, which then turns into productive work has been incredibly satisfying. I couldn’t say there has been one piece of work overall… Or maybe the ISSGF encapsulates an entire body of work.
I do remember seeing that the people I admire have a true passion for life, whether that is work or wine, or maybe food, travel, athletics, and having that passion allows me to have peace. Overall I think it gives meaning to your life.
What is something that has changed in this field since you started?
We are constantly refining our data, and that’s one thing that we get criticised for! People say that we change our minds all the time in our research, but I think a lot of it is because we do refine the concepts in regards to the data we put out. As we work within our group, we’re constantly updating and constantly improving. Research, whether that is in sagittal alignment, outcomes, or complications, is a constant process of evolution.
That is the nature of the scientific process of course—to continually build on your knowledge and to continually update and improve what you know.
In that sense, the ISSGF has become a living thing that is constantly evolving and changing.
What are your current research interests?
Right now I am looking at predictive analytics and using data and algorithms to try to predict which patients will benefit, who will have complications or who will reach a particular outcome.
I am also looking at patient satisfaction. We do this by finding out what the patient’s expectations are, but also by analysing the way in which we assess outcomes.
One of the things that are interesting right now is using activity markers to see not only if patients are more active, but if they are more active socially, as opposed to just going about their daily routine. We want to know if, for example, they are engaging more in social settings, which hopefully will make them more engaged and productive in society—and more satisfied with their lives.
We are looking at how effective certain treatments are from a cost standpoint and in improving quality of life. There are a lot of questions that need to be answered.
It is a great time right now to be in research in medicine, especially if you are comfortable with data and you have the capacity and the infrastructure to use it.
What coming developments or promising fields of inquiry are you excited about?
Spine in particular has been very rigid. It has been based on implants; a screw or a type of cage. Whereas I think now the currency for all of healthcare—but especially in spine—needs to switch towards outcomes, and how we can improve then. We need to know how to control, predict and evaluate them; that knowledge will come from data. Again, I think that is the foundation going forward. Data is where the future of medicine lies.
Is that related to what you think is the biggest challenge in spine at the moment?
The challenge is sorting through who is going to benefit and who is not going to benefit, and how might they benefit from the interventions that we do. In order to collect that data you have to have due process, but though it is a hurdle, we need to put those mechanisms in place. If we want to control our own destinies, then the obligation is on us to collect this data and to maintain our interest in research.
What has the most unexpected thing that you have learned through your career?
I think spine is a great field, because there are so many things you can do with it. There is a very technical aspect to it, and it is very gratifying from a patient outcome standpoint. But there is also this whole other area in research, data and collaboration. Those interactions and relationships make it incredibly satisfying as well as an intellectual process.
To have this career is so wonderful, because it allows me to be multi-faceted. I am not just pinned to the OR or the clinic; I can teach, I can write, and I can work with other people.
What was the impetus for you in starting the ISSGF? What need did you see that needed to be filled?
The group had, to some degree, already been in existence, and I was asked to come in to create a database so that the group could collect data. That was the initial inception of the ISSGF, the ISOLA study group. It morphed then into a research group, and then a study group, and we began to find huge holes in spine deformity research. Hopefully, we are plugging the holes now, but as we plug them up we find even more holes! But that is satisfying because also you are able to build on what you have done before.
There is still a gender disparity among the top researchers in spine. How well do you think institutions are doing in assisting more women, and indeed people from all types of diverse backgrounds, into following a career in spine?
We’re fortunate that in the ISSGF we have two women at the very top. Raymarla Pinteric is the administrator—we would be totally lost without her work and input and efforts. And of course Virginie Lafage, who as everybody knows, is a world leader and world-class researcher. In our group, we have two extraordinarily prominent women that lead.
I hope that I would never be gender-blind, just like I don’t want to be colour-blind, because that just makes the world grey. Fortunately, at least within our group, women have as influential of a voice as anybody does.
What advice would you give to someone who is just beginning their career in spine? What do you wish you knew?
My main advice is to always stay positive, because it is such a great field to go into, no matter what you want to do.
I wouldn’t trade any aspect of it. There is the technical piece, which is satisfying, but then the patient care piece, and then also lecturing and research, and then there’s collaborating with your peers. I mean to have something that you do for a living provide all of those different outlets? That’s wonderful. And so my advice would be to stay the course, because the adage that the good times in medicine are gone is totally untrue. I think they still lie ahead of us.
What are your interests and hobbies outside of spine?
I enjoy running, swimming, biking, skiing, snowboarding, and exercising both indoors and outdoors. I also enjoy drinking and sharing wine with my closet friends—many of whom are in the ISSGF. Most of all I love playing sports and spending time with with my seven-year-old son Rowan and doing anything and everything with him.
1991 – Bachelor of Arts, Columbia, University, New York, USA
1999 – Doctorate of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
2005 – Fellowship, Washington University, School of Medicine Barnes/Jewish Hospital Spine Fellowship, St Louis, USA
Selected academic appointments
1996–97 – Research fellowship, R. Adams Cowley Shock Trauma Center, Department of Orthopaedic Traumatology, Baltimore, USA
2005–07 – Assistant Professor of Orthopedic Surgery, University of Utah School of Medicine, Salt Lake City, USA
2007–08 – Faculty, San Diego Spine Fellowship, San Diego Center for Spinal Disorders, La Jolla, USA
2009–present – Founder and President, International Spine Study Group Foundation, USA
2015–16 – Associate Professor Orthopedic Surgery, New York University School of Medicine and Hospital for Joint Diseases, New York, USA
Selected clinical appointments
2015–16 – Chief of Adult Spine Deformity Service and Chief of Spine Research, New York University School of Medicine and Hospital for Joint Diseases, New York, USA
2007–08 – Pediatric and Adult Spine Surgery, San Diego Center for Spinal Disorders, La Jolla, USA
2008–15, 2016–present – Presbyterian St Luke’s Medical Center, Rocky Mountain Hospital for Children, Paediatric and Adult Spine Surgery, Denver, USA
Selected society involvement
1986 – USA Today All-American Athlete, Colorado High School Football
2010 – Volunteer surgeon, Foundation of Orthopedics and Complex Spine, Ghana
2016 – Volunteer surgeon, Addis Ababa, Ethiopia
2016 – Volunteer surgeon, Global Spine Outreach, Cali, Colombia
Present – Board of Editors, Patient Safety in Surgery
Present – Member, North American Spine Society
Present – Fellow, Scoliosis Research Society