Without question, it is co-founding Nevada's only allopathic orthopedic surgery residency

program in 2016. I am proud of it not because of what it represents for me, but because of what it represents for the state and for the trainees who have come through it.

When I arrived in Nevada, there was no pathway for an allopathic medical student or surgical intern in this state to train in orthopedics at an academic medical center without leaving. The downstream consequences of that gap were significant: Nevada imported its physicians, which meant we were perpetually dependent on external training pipelines that had no particular reason to prioritize our population's needs. Building the residency program from the ground up — securing GME funding, establishing clinical volumes, recruiting faculty, navigating ACGME accreditation — was among and still is the hardest things my colleagues and I have done professionally.

But the program has now graduated five classes with a 100% fellowship match rate. Those graduates are now practicing fellowship-trained orthopedic surgeons. Some are staying in Nevada. That is the outcome that matters most to me: building a self-sustaining academic infrastructure where none existed.

Every other accomplishment I might name—publications, leadership titles, surgical volume—is secondary to the fact that we created something that will outlast any of us individually.

My involvement with NASS began out of necessity — I was a fellowship-trained spine surgeon entering a state with essentially no academic spine infrastructure, no residency pipeline, and no local community of peers who shared my clinical and scholarly orientation. NASS filled that void. I joined my senior partner, Dr Michael Daubs, to create an allopathic residency in the state.

The Annual Meeting became less a conference and more a lifeline: a place where I could stress-test my clinical reasoning against the best evidence, encounter surgeons who were wrestling with the same complex cases I was managing, and remind myself that what we do is part of a larger, evolving discipline.

What has kept me engaged is watching that relationship evolve. Early on, I came to NASS to learn. Over time, I realized I had something to contribute — whether through peer review, or simply mentoring trainees who had never had the opportunity to engage with a national society. Nevada has historically been underrepresented in organized spine care. I have tried to change that, in part by bringing residents to NASS, encouraging them to submit abstracts, and modeling what it looks like to be a contributing member of a specialty society, not just a consumer of its resources. The Society has given me more than I can measure; the obligation to give back is something I take seriously.

Three come to mind immediately, and none of them are surgical.

The first is critical appraisal. The evidence base in spine surgery is expanding rapidly, and it is not uniformly high quality. The ability to read a Level I RCT and understand not just its conclusions but its methodology, its population, its outcome measures, and the gap between statistical significance and clinical meaningfulness — that skill separates surgeons who practice evidence-based medicine from those who practice opinion-based medicine dressed in the language of evidence.

The second is communication. We operate on patients who are afraid, who are often in pain, and who have frequently been told conflicting things by different providers. The spine surgeon who can explain a nuanced treatment decision clearly, who can discuss the realistic trajectory of degenerative disease without either catastrophizing or minimizing, and who can have a productive conversation with a patient about why surgery is not indicated — that surgeon will consistently deliver better outcomes than a technically superior surgeon who cannot connect with patients.

The third is institutional fluency. Today's spine professionals operate within systems — health systems, payer networks, academic structures, regulatory environments — and the ability to understand how those systems work, where the leverage points are, and how to advocate effectively within them is no longer optional. The surgeons who will define the next generation of spine care are not just excellent clinicians; they are people who understand how to build, sustain, and reform the institutions that deliver that care.