Is Stephen Hochschuler, M.D. Really Retiring?

If someone had the capacity to be in the present and the future at the same time, you might think a bit of wizardry was in play. Or perhaps it is just the power of discernment…sprinkled with a heavy dose of enthusiasm. Such is the case with the incomparable Stephen Hochschuler, M.D., 78 years old, co-founder and chairman emeritus of the Texas Back Institute (TBI), who has formally announced his intention to retire.

But among Dr. Hochschuler’s thousands of friends, colleagues and former patients, the notion that the words “retirement” and “Hochschuler” would appear together is still viewed with skepticism. After all, Dr. Hochschuler’s multitude of talents including being present and looking around corners for the next big thing is unrivaled and his energy is legendary.

“First of all, let me be clear: my wife would leave me if I stayed home all day in my slippers,” stated Dr. Hochschuler to OTW. “Besides, I don’t do lunch and I just revel in the VC arena, as I have for more than 25 years.”

Although now strategic about his decisions, Stephen “always looking downstream” Hochschuler, chose the premed track at random. “Having spent my teen years cleaning the beaches of Long Beach and driving a bus, I knew the power of hard work. I attended Columbia College in New York for my undergraduate years, followed by medical school at Harvard, where I studied general surgery and psychiatry. I opted for the former in part because in psychiatry any results you see are typically short- or mid-term in nature.”

After an internship and general surgery residency at the Harvard Surgical Service at the Boston City Hospital, Dr. Hochschuler served in the Air Force from 1971 to 1973. “This was the era of the Berry Plan,” said Dr. Hochschuler, “a time when all physicians had to serve in the military.”

Initial Glimmer of His Talent as an Oracle

It was during Dr. Hochschuler’s military service that he discovered an interest in orthopedics. “I began to realize that the military surgeons lacked an understanding of back pain and did not differentiate between diagnoses. I saw many possibilities for learning and growth in the spine arena.”

Sent to the Sheppard Air Force Base in Wichita Falls, Texas, Dr. Hochschuler was set to take on the position of a general surgeon. Fate had other plans, however, and he was asked to take over as chief of general practice. “I wasn’t pleased with this turn of events, but I made a deal such that I would have two days a week doing surgery. It was then that my love affair with orthopedics and spine began.”

And then he met a man he swore he would never practice with: Ralph Rashbaum, M.D.

Of Dr. Rashbaum—now one of his closest friends—Dr. Hochschuler said, “Rashbaum got away with everything…he was just maddening…and creative and smart.”

As the story goes, Dr. Hochschuler entered the base exchange where Ralph Rashbaum spied him as being new in town. “You’re going to need a formal outfit for the dinner tonight,” said Dr. Rashbaum to Dr. Hochschuler. “Why pay full price for one here when you can buy mine for only $30?”

“I thought that sounded like a deal. But hours later (and just minutes before the event) I was standing in front of a mirror…buttons bursting and unable to move my arms and swearing revenge upon ‘that Ralph Rashbaum.’”

And Now for Dr. Rashbaum’s Side of the Story

“I had arrived at the base a year before Hochschuler. Then one day this guy comes along and becomes my boss. When he and his wife came into the base exchange with their 2-year-old daughter they looked a bit bewildered at their new surroundings. My wife and I introduced ourselves—and yes, I sold him my tuxedo. It was our first business deal.”

And the point they will eternally argue over? Dr. Hochschuler: “Ralph will always say that the distinguished service medal hanging in my office should be in his. Dr. Rashbaum: “Steve has a service medal for all of the work I did.”

“Everything eventually fell into place,” said Dr. Rashbaum. “After a few years I called Steve and told him that I was coming to Texas to start a practice. At that point I was the first fellowship trained doctor in spine outside of deformity. Steve became my fellow and got me a banker, who fortunately asked, ‘How much money do you want?’”

The two brought on Richard Guyer, M.D. and together, the three spine surgeons co-founded the Texas Back Institute in Dallas suburb—Plano.

Dr. Guyer: “Steve and I first met during my PGY-1 year. When I was all set to do a total hip and trauma fellowship abroad after residency, he convinced me to be spine surgeon and to join he and Ralph Rashbaum to start a spine center. Little did I realize 40 years later, under his leadership and vision, we would be able to create the most well-known private academic spine centers in the U.S. and world.”

Describing it as “amazing ride far greater than my wildest dreams,” Dr. Guyer says the best thing about it all is their friendship. “Steve is so very upbeat, optimistic, and persuasive…I think it is said that he could sell ice to the Eskimos, and in fact I believe he just may have sold the Brooklyn Bridge!”

Dr. Rashbaum: “We basically crafted the business of spine, taking it from its embryonic stages. At that point, few in orthopedics were doing disc surgery.”

Describing Dr. Hochschuler as his “brother from another mother,” Dr. Rashbaum told OTW, “The most important thing is that when Steve, Rick and I appear in a crowd together, we are each promoting TBI…not ourselves.”

So how did Dr. Hochschuler’s vision drive the growth of TBI, now the largest freestanding spine center in the world?

“We focus on evolution as opposed to revolution,” stated Dr. Hochschuler. “Moving too fast with change makes people uncomfortable, so we take care to expand our staff disciplines at a reasonable pace. Over the years we have added everything from ergonomic analysis, product development, exercise physiology, chiropractors, and a psychologist.”

But make no mistake. What Dr. Hochschuler and his partners have done all along has been radical. They played an integral part in developing the MRI for spine, bringing the artificial disc to the U.S., and facilitating the development of the pedicle screw fixation system first implanted by Art Steffee, M.D.

Steven Garfin, M.D., interim dean of the school of medicine the University of California San Diego and an internationally renowned spine surgeon in his own right, described the first time he met “Hoch.” “When I met Steve, we were amongst a small number of spine surgeons in the country, most of whom were siloed into different camps. Meetings could be tense, but I was impressed with how Steve and Ralph weren’t afraid to sit on the podium knowing that 90% of the audience disagreed with what they were doing.”

“Steve’s foresight is impressive; he has always been able to look way into the future and see what is coming. He has been light years ahead of most of us.”

And on top of that, says Dr. Garfin, he has a good heart and is a very caring and thoughtful friend.

Echoing that sentiment was Hansen Yuan, M.D., who has known Stephen Hochschuler for over 40 years. “He is a very honest and ethical surgeon who says what needs to be said and manages to do it without being hurtful in any way.”

“Steve has been instrumental in developing a strong research base at TBI. In fact, everyone they have hired were those interested in research and publishing. This is unique because others in the private practice arena did patient care but were not logging outcomes or indications. Because of the system Steve worked to establish, TBI can publish like a university.”

In fact, Dr. Yuan, who is a past president of the North American Spine Society, was recruited by Dr. Hochschuler to participate in the then Spine Arthroplasty Society (now named the International Society for the Advancement of Spine Surgery–ISASS) and recalls Dr. Hochschuler’s influence on the fledgling surgeon society. “I could see that Steve was firmly dedicated to improving and showing the good, the bad, and the ugly of any particular innovation.” Dr. Yuan recalls. “He has left an important imprint on ISASS and continues to support it with total passion.”

Another longtime friend and colleague, Alexander Vaccaro, M.D., said that the thing he loves most about Dr. Hochschuler is, “Steve pays rapt attention to everything going on at a meeting and will readily share his multitude of opinions. An astute businessman, Steve is incredibly insightful, is a discerning investor, and has contributed greatly to my development and learning. I wish him all the best in his ‘retirement.’”

40 Years Ago…Telemedicine!

The future, Steve Hochschuler decided 40 years ago, is telemedicine. “All those years ago I helped Harvard develop a telemedicine apparatus to the tune of $125k per workstation. Now the pandemic has necessitated telemedicine, but it is incredibly cost efficient. I have just raised funds for a telemedicine company and am putting together a digital health system that incorporates a navigator to tell patients who they are seeing, where, and what their copay will be. The landscape remains in flux and as such is very exciting.”

But one future isn’t enough. Dr. Hochschuler has worked on stem cell projects with Harvard and is now working on augmented reality with his alma mater. “Not only that,” he recounts enthusiastically, “but I have helped put together a population health initiative for musculoskeletal disorders. This program, Musculoskeletal Risk Solutions, features predictive analytics, functional restoration and yes, telehealth.”

Wisdom From the Oracle

Dr. Hochschuler has more than a few words of wisdom for those considering a career in orthopedic surgery. “If you love what you do, then you will never work. I am never tired, and my work is always exciting. Why? Because I’ve married the best of medicine with the best of business.”

Speaking of future generations of surgeons, Dr. Hochschuler is of the opinion that things need shaking up in the educational realm. “It’s really in disarray. Half of what we learn in medical school is useless. Yes, we need anatomy and physiology, but why the hell does a surgeon need to know about the citric acid cycle?”

Medical education is being refined, he says, but it is too slow. In the meantime, says Dr. Hochschuler, it is critical to get into the OR. “Work as a scrub tech…see how things run. Know the details of what goes on in an OR. That type of information is much more important as you move through our profession.”

Given that much of Dr. Hochschuler’s time will now be spent in the venture capital arena, it’s a good thing he has a longstanding friendship with Anthony Viscogliosi, principal at Viscogliosi Brothers LLC. Tony recalled for OTW the first time he met Dr. Hochschuler. “The 1993 meeting of the North American Spine Society was my first annual meeting. I was a shy young healthcare industry analyst focused on writing investment research on publicly traded companies in MedTech. I sat in the front row at one of the scientific sessions taking copious notes. Steve noticed me and said, ‘What are you doing?’ He took me under his wing and introduced me around. And the Viscogliosi-Hochschuler ‘love affair’ only grew from there.”

Retirement Re-imagined

At 78 years old, Dr. Hochschuler is still traveling approximately 25-30% of the time, visiting companies, attending surgeon meetings, spending time with TBI colleagues and devoting his seemingly inexhaustible energy to creating the next future in spine surgery.

What will that future look like? According to Dr. Hochschuler, by 2031 spine surgery for patients as well as surgeons themselves will involve regenerative medicine to a significant degree. “We will also see artificial intelligence, data analysis, and predictive analytics take prominent roles. And while robotics will still be active, we will see it supplemented with augmented reality to the point where eventually robots will perform surgery without the hands-on participation of a surgeon.”

Thus, says Dr. Hochschuler, the future of surgery will continue to evolve and demand openness on the part of surgeons and patients alike.