When did you decide you wanted a career in medicine?
I knew at the age of six that I wanted to become a doctor. My father was a general surgeon who had an office in our house where I was first introduced to medicine. I used to tag along in the office on Friday nights with him when I was six, would make house calls with him and even went to surgery assisting him in an emergency surgery during the weekends. I was always intrigued how he interacted with his patients and the admiration and gratitude that they had for him. His love of medicine transferred over to me at an early age.
Why did you decide to specialise in orthopaedics?
I chose to specialise in orthopaedics because it was where I felt I could do the most good. I always enjoyed working with my hands and I was fascinated by the immediate gratification of repairing fractures and total joint replacements. Later though, I became attracted to spine due to the delicacy of the surgery, working in and around the spinal cord and nerves, and the fact that our knowledge at that time was very limited compared to some of the other specialties. I felt that spine was one of the last frontiers in orthopaedic surgery and that I could make a difference not only in my patients lives and hopefully extending the knowledge in this field.
Who have been your greatest influences?The most important person in my career was my father. He was a general surgeon of the post World War II generation. He was a great clinician and role model for me. The second most important person in my career was Dr Leon Wiltse, with whom I did my fellowship. He was one the founders of NASS and its first President. He was bright and had the energy and inquisitiveness of a child always questioning and pursuing knowledge. We remember him everyday because of the popularity of the ‘Wiltse Paraspinal Approach’ which its variant is utilised in minimally invasive surgery today.
What have been the proudest moments in your career?
To me my proudest moments are when seeing patients after surgery and knowing that I have made a difference in their quality of life. Their gratitude is always very touching to me. There is no better feeling than that. I save every note that patients have written thanking me for my care and making a change in their life. To me their words are more valuable than any amount of money in the world. At the Texas Back Institute I have been director of our Spine Fellowship Program for over 20 years having trained over 70 fellows. It is most rewarding when I see the ‘light bulb’ go on when a fellow understands a concept or masters a surgical technique. To teach and impart knowledge to others also is priceless. I am proud of all of our fellows and many have gone on to make significant contributions to spine. Professionally, I appreciate and find it challenging being the President of Texas Back Institute and really enjoyed being the 22nd President of NASS.
How important do you think Spine Societies are to the field?
Spine Societies like NASS are important because they create an excellent forum for exchange of ideas and education on spine care. They also provide an excellent opportunity to provide leadership to the field on things like ethics. They serve to remind us about what is important: putting the patient first. They also help stimulate research, and advocate for fair reimbursement so we can continue practicing and also advocate for patient access to medical treatments.
What are your primary goals you wish to achieve as President of the North America Spine Society?
My primary goal, and it is one we are still working on, is to stimulate better data collection in the field about the care we deliver. We have very little data in many areas that we can point to that proves – beyond a shadow of a doubt – that our care really makes a big difference. We don’t really know how we compare with each other, even within our practice. We have no benchmarks. We should collect better data to know the areas that we need to improve upon as part of a continuous quality improvement system. Registries though difficult to implement need to be implemented. With the newer electronic capabilities this will be able to be done.
Do you believe that lifestyle plays an important role in problems relating to the spine, particularly low back pain? If so, who do you think should be responsible for educating the public on such issues eg. Government, Healthcare system, Schools etc?About 70%–80% of all people will get back pain at some point in their lives regardless of lifestyle. Like most medical problems there is interplay of one’s genetics and environment. Certainly there are many factors in our lifestyle that can affect our spinal health. It has been shown that smoking can affect the health of the disc. Poor body posture and mechanics, poor fitness and obesity can also affect the spine or at least recovery from problems. Individuals should be taught proper body postures and biomechanics at the work place along with proper strengthening or core exercises. We as societies and the medical professional do little to teach prevention but rather treat end stage disease. I believe it is the responsibility of all the stakeholders including physicians, medical societies, industry, insurance companies and government to play a role in prevention.
What do you think are the current problems/challenges facing spinal surgery today?
As I said previously there are a lot of new treatments in the field and the data that supports their use is lacking. We need to work better within the field to measure what we do. Patients can be demanding and they want the latest technology available to care for them but we need to make sure the new technology equates to an improved outcome. In the meantime, there are many problems with proper reimbursement for the care we render. It is ironic that sometimes the sale representative for an implant manufacturer might generate more commission than the surgeon does for doing the surgery. Insurance companies continue to diminish physician reimbursements. Medicare (for the older than 65 years of age) in the US faces cuts almost every year and the US Congress has to “apply bandages” each year to fix the problem. The underlying issue is a flawed Medicare sustainable Growth Rate formula – until that is fixed we will continue to have to fight these reimbursement battles. This will become an even greater issue as our world wide population ages.
Fact File
Richard Guyer
Born December 27, 1949, Norristown, Pennsylvania
Education and qualifications
1964–1967 Wissahickon High School, Ambler, Pennsylvania
1967–1971 Ursinus College, Collegeville, Pennsylvania
1971–1975 University of Pennsylvania School of Medicine,
Philadelphia, Pennsylvania
1975–1976 Parkland Memorial Hospital, Southwestern School of
Medicine, Dallas, Texas
1976–1980 Orthopedic Surgery, Hospital of the University of
Pennsylvania, Philadelphia, Pennsylvania
1981 Spine Fellowship, Case Western Reserve University
with Henry Bohlman, M.D., Cleveland, Ohio
1982–1982 Spine Fellowship with Leon Wiltse, M.D., Long
Beach, California
Selected medical appointments
1987–present Medical City Hospital of Dallas, Dallas, Texas
1992–present Presbyterian Hospital of Plano, Plano, Texas
1999–present Vice-Chairman, Department of Orthopedics,
Presbyterian Hospital of Plano, Plano, Texas
2005–present Presbyterian of Plano Center for Diagnostics
and Surgery; Plano, Texas
Selected faculty appointments
1980–1981 Orthopedic Consultant for the "The Gulf
State Hemophilia Diagnostic and Treatment
Center", The University of Texas Health
Science Center, Houston, Texas
1982–present Associate Clinical Professor, Southwestern
Medical School, Dallas, Texas
1986 Co-Director of Spine Clinic, Parkland
Hospital, Dallas, Texas
1986–present Fellowship Director, Texas Back Institute,
Plano, Texas
Honors and awards
1971 Graduated Cum Laude from Ursinus College
1996 Volvo Award for Low Back Pain Research
2001 North American Spine Society David Selby Award
Selected organisations
Texas Medical Association
Harris Medical Society
Collin County Medical Society
Texas Orthopedic Association
Southern Medical Association
Western Orthopedic Association
American Academy of Orthopaedic Surgeons
North American Spine Society (President)
American Academy of Orthopaedic Surgeons, Committee on
HCFA Request for Evaluation of Automated Percutaneous
Lumbar Discectomy
Transplant Services Center Medical Advisory Board, UT
Southwestern Medical Center
American Academy of Orthopaedic Surgeons, Regional
Membership Committee
