Charles Timothy Floyd, MD, FACS
What first brought you to NASS, and what do you remember about the early years?
I joined NASS after my first spine fellowship at Texas Back Institute in the days of FDA litigation surrounding pedicle screws. There were federal law enforcement agents standing in the back of the meeting rooms, making sure pedicle screws were not discussed. Prominent surgeons were threatened for pushing boundaries for medical progress. Of course, pedicle screws became the standard of care and it was almost malpractice not to use them in many cases. It was an example of ignorant government overreach and harassment.
Can you share your favorite NASS memory?
I was honored to receive the NASS Traveling Fellowship in 1999, with which I was able to spend time with Thomas Zdeblick in Wisconsin, Jürgen Harms in Germany, Dieter Grob in Switzerland, Henry Bohlman in Ohio, John Webb in England, Ronald Apfelbaum in Utah and Stephan Boriani in Italy. This experience greatly enhanced both my knowledge and my confidence.
What was spine care like when you entered the field and how did it evolve throughout your career?
Spine care was primarily carried out by orthopedic surgeons, who created the field in the late 19th century with traction and casting of adolescent scoliosis. They then advanced the surgical management of scoliosis and other disorders. When I finished my training, almost all of the named surgical procedures were attached to the name of an orthopedic surgeon who described it.
In the 1990s, neurosurgeons began to operate on the spine more and more frequently. I remember being a fellow at Johns Hopkins in 1998 and being asked by Dr. Long, the chairman of neurosurgery, to instrument his cervical spines because he had no training in that. Slowly, the neurosurgeons seemed to wrestle spine surgery from the orthopedic surgeons to the point where spine is a minor component of the annual meeting of orthopedic surgeons.
The other trend was minimally invasive and percutaneous procedures by a growing cadre of pain specialists. By 2025, it seems to me that so many providers are procedure oriented.
Who were some of the people who shaped your experience in NASS?
Rick Guyer, John Kostuik
Looking back, what was one of the biggest challenges the spine field faced during your active years, and how was it addressed?
The biggest challenge was government overreach in pedicle screw use as I mentioned in the first question.
If you could preserve one lesson or philosophy for future generations of spine care providers, what would it be?
Read William Osler.
What did you learn from patients that changed how you approached your work or saw your role in the field?
Truly treat each patient as you would like to be treated.
What does "service to the profession" mean to you, and how did you try to live that out?
I tried to live up to the ideals long established that defined ethical and moral treatment of patients.
What do you see as the most important challenge or opportunity facing the future of spine care?
Physicians need to remain engaged with their patients. I see an over reliance on midlevel providers - nurse practitioners and physician assistants - for diagnosis and management. Often, the NP or PA is the only one seeing the patient, making the diagnosis, ordering the tests and even scheduling the surgical procedure. The surgeon just shows up on the day of surgery, does what the PA said to do, then never sees the patient again. I've literally seen this time and again. NPs and PAs do not have the training, education, or experience to be in this role.
What emerging innovations do you think will have the most impact on patient care?
Probably AI to assist physicians in care of patients, which should displace the over reliance on midlevel providers. AI already is a good match for physicians in many areas, so they probably have surpassed the midlevels.
If you were entering the field today, what area would you be most excited to pursue?
Not sure I would enter it today because medicine seems to be so oriented toward maximizing charges. It wasn't that way when I started, but now hospitals and even the structure of the EMR are driving physicians to maximize RVUs.
In your view, what role should professional societies like NASS play in shaping the future of medicine?
Maintaining a moral and ethical compass.
What's one hope you have for the spine community 40 years from now?
That there will still be a strong physician/patient relationship.
What would you most like to be remembered for in your career?
That I cared about my patients.
If someone finds your message in this time capsule decades from now, what would you want them to know about the people who built NASS?
It was a great idea when it started. Keep it that way.
What has being part of NASS meant to you personally?
Comradarie and education.
What do you believe is NASS' greatest legacy to the field, and what do you hope future members carry forward?
Multidisciplinary collaboration.
If someone in 2065 is reading this and just starting their career in spine, what do you want them to know?
Read William Osler.