Inside NYP: Dr. Peter Angevine

My dad is a doctor. His brother is a doctor. Their dad was a doctor. Naturally, my friends thought I was going to go right into medicine, but instead I went into teaching. It was a bit adolescent, “I don’t want to do what my dad does.” He had always told me that if I went into medicine, it should be because I wanted to do it, not just because he was a doctor. He said if you want to teach high school, go try teaching high school, see how you like it. Because it’s a lot easier to go from that to medicine rather than go through medical school, become a doctor, and realize, yeah, I’d rather be teaching high school.

I did Teach For America in a rural town in North Carolina. I was 22 and I taught chemistry and physics. Standing in front of a class of 30 high school seniors who were only four years younger than me and engaging them was tough. After two years, I thought maybe there are other people who could do that better and I could better help people as a doctor. It was a great experience, but teaching high school was the hardest thing I’ve ever done. I decided going to medical school might be easier.

When I began med school at Columbia, where I met my wife, who became an oncologist, I thought I would be a primary care doctor in the mountains. I thought I’d leave New York after medical school and never come back. But in my third year, I realized I wasn’t cut out for primary care. When I finished my rotation in neurosurgery and my mom, a school librarian, asked how I liked it, I said it was all right. She said, “Oh. I thought that would be something that would really appeal to you.”

As it turns out, my mom really knows me. I was drawn to the kinds of patients, the acuity and seriousness of the problems that neurosurgeons treat, the small teams that work very closely together, and the technical side of neurosurgery. One of the things that kept me from thinking about it initially was I wasn’t sure if I could hack it. After talking to my mom, I thought, to heck with it. Let’s see if it’s possible.

I also think the combination of the intellectual and physical challenges of neurosurgery attracted me. I raced on the cross-country ski team in high school in Rochester, New York, where I grew up, and in college, and today I do ski marathons. I go to Wisconsin, where my parents are from, for the American Birkebeiner, the largest cross-country ski race in North America, a 55-kilometer marathon. I’m out there in the woods, sweating and breathing heavily. In the summer, I roller ski. It looks like skis on wheels and you use your regular ski boots and bindings. I go out to a loop of quiet neighborhood streets where I live and get a lot of funny looks. There’s an endurance element that’s common to both skiing and surgery, and my fitness for skiing helps me remain mentally fresh when I’m physically tired after a long surgery.

When I became a neurosurgeon, my main focus was the spine. The traditional division had been that the nervous system part was the neurosurgeon’s domain and the bony part that encased the nervous part was the orthopedic surgeon’s domain. Never mind that to get to the nervous system you have to go through the musculoskeletal system. I felt it would be an advantage to train with orthopedic surgeons, and that the more I understood about the spine from the different directions, the better I’d be able to help my patients.

So I became one of the first neurosurgeons to also do a fellowship in orthopedics. Dr. Paul McCormick, one of my neurosurgery professors at Columbia, was instrumental in encouraging me to apply to the orthopedic fellowship program at Washington University in St. Louis, where I learned from Dr. Lawrence Lenke. I was the first neurosurgeon to do that fellowship, and one of the first in the country to combine these subspecialties. I was the canary in the coal mine. I guess I didn’t mess things up too much, because since then Dr. Lenke has had a number of neurosurgeons in the orthopedic fellowship as orthopedic surgeons. He and Dr. McCormick, both of whom are now surgical chiefs at NewYork-Presbyterian Och Spine Hospital, were visionary in understanding that the convergence of neurosurgery and orthopedic surgery was the next frontier in neurosurgical spine care, that having a thorough understanding of all the elements of the spine — neurological and musculoskeletal — best equips a spine surgeon to understand, diagnose, and manage spinal disorders.

Today I focus on adult spinal deformity and revision spinal fusion surgery, and on teaching and training our fellows and residents. One of the great things about the surgeries I do is it’s not just cutting something out, like an appendix, and never seeing the patient again. Many of my patients I may see indefinitely. I treat a lot of problems that are degenerative and there may be long-term issues related to the condition or the treatment, so I follow some patients for five years, preferably longer. I encourage my patients to come back at least every few years. I enjoy sitting with them and helping them understand what they’re going through.

One of the foundational ideas of a place like NewYork-Presbyterian Och Spine Hospital is that by focusing on a small area, you become an expert. You may only be an inch wide, but you’re a mile deep. What I bring to the table is I’ve straddled the two stools of neurosurgery and orthopedic surgery. I speak the language of both subspecialties, but those lines continue to blur. At the end of the day, we’re all treating the same part of the body. Patients ask me, “Should I have a neurosurgeon or an orthopedic surgeon do surgery if I need it?” That’s an easy question for me to answer. I say, “You should have a spine surgeon.”

What to me is most exciting, and I think best for the patients, is the world-class spine care we provide at NewYork-Presbyterian Och Spine Hospital — not just surgery but every kind of spine care. We have orthopedic surgeons, neurosurgeons, and non-operative specialists, and everybody understands the unique needs of spine patients. It’s top-notch, super-subspecialized, high-tech care, but it almost has a community feel, which I think people find comforting.

Peter Angevine, M.D., M.P.H., is director of the neurosurgical spine fellowship at NewYork-Presbyterian Och Spine Hospital and an associate professor of neurological surgery at Columbia University Vagelos College of Physicians and Surgeons. He specializes in adult and pediatric spinal deformities, neuromuscular spinal deformities, complex revision spinal surgery, and global and regional sagittal imbalance.