A sea of change in health care is constraining physician access. Mid-level and Allied Health providers are increasingly called upon to serve as first-point and follow-up spine subspecialty evaluators. The effective evaluation and triage of spine patients can be complex and requires nuanced examination and differential diagnostic skills intrinsic to care planning. Effective treatment and rehabilitation and associated psychosocial, med-legal, occupational, disability, pain management and co-morbid health issues must also be considered.

Technology advancements in imaging, interprofessional communication and medical records have become valuable tools to time-challenged clinicians managing high patient volume and related clinical responsibilities. Potentially compromised in this new health care milieu are the time honored fundamentals of hands-on evaluation and the interpersonal and communication skills that have historically defined excellence in patient care. There is increasing recognition that no technology is of greater importance than real-time, face-to-face evaluation as the basis for clinical decision-making, including appropriate diagnostic work-up and value-based care planning.