Venu Akuthota, MD, is a physical medicine and rehabilitation (PM&R) physician. His father was a physical medicine and rehabilitation physician. He married a physical medicine and rehabilitation physician. His twin sons are not yet physical medicine and rehabilitation physicians, but give them time. They’re only in the third grade.
Akuthota’s gravitation to PM&R (also called physiatry) might seem predestined. In fact, his current role as medical director of the Spine Center at University of Colorado Hospital appears to be more a product of nurture than nature.
He grew up in a suburb of Dayton, Ohio, graduated at the top of his high-school class, and attended Youngstown State University and Northeastern Ohio Medical School. He did his residency and fellowship training at Northwestern University in Chicago, wrapping up a fellowship in sports medicine and spine intervention in 1999. He moved on, but not far, to Loyola University Medical School in Chicago, where he accepted a PM&R faculty position and also served as Loyola’s lone team physician. Spine was certainly part of all this, but his early research is heavy on lower-limb injuries among runners.
Then, in 2002, he moved to the University of Colorado School of Medicine and his focus changed. The previously spine-focused PM&R doctor and full-time surgeon now had a mandate to create a center worthy of the academic medical center’s name.
“Spine was the need,” Akuthota said. “Pretty much, if you’re alive, you’ll get back pain at some point, so there was a lot of customer base and it was identified as a growth area for the hospital, too.”
A new home
Ever since, Akuthota has quietly led a practice that has grown to one with more than 20 providers, including eight neurosurgeons, seven PM&R physicians, and a dozen advanced-practice practitioners. They cover physical medicine and rehabilitation, orthopedic spine surgery, neurosurgery, pain radiology, and physical therapy (PT). On Oct. 13, the UCH Spine Center moved into a larger space on the first floor of the Anschutz Outpatient Pavilion, roughly quadrupling its clinical capacity.
The entire time, the Spine Center’s goal has been in line with Akuthota’s: to help patients avoid surgery unless they simply can’t, at which point there’s a deep surgical bench. For example, just 10 percent to 20 percent of those with weakness from disc herniation actually need surgery, Akuthota said. But good outcomes hinge on PT – the sooner the better. The Spine Center is now working to get these patients into therapy earlier by arranging to have physicians and PTs in the same room with patients. Doing that can get patients started on rehab two to three weeks sooner.
“It’s not new treatment; it’s new health care delivery,” Akuthota said.
Kimberly Meyers, executive director for Neuroscience and Spine at UCH, has worked with Akuthota since his arrival in Colorado. She said his emphasis on nonsurgical care has well-positioned the Spine Center for insurers’ increasing scrutiny of proposed back surgeries.
“It’s amazing to see how he’s been able to work with so many different disciplines and competing priorities and keep them together on the right path,” Meyers said. “He’s wonderful to work with.”
Moving forward, Meyers said, she sees Akuthota bringing alternative medicine and non-narcotic pain management experts into the Spine Center fold. Akuthota is on the same page: He wants the next Spine Center hire to be a pain psychologist, he said.
Back to research
Akuthota has shifted his own professional and research interests to the spine – in particular, to lower-back pain. His current research focuses on the epidemiological. During what he described as a “mini sabbatical” over about five weeks this summer at the National Institutes of Health in Bethesda, Md., he worked with Leighton Chan, MD, MPH, and the NIH Rehabilitation Medicine Department Chan leads. Akuthota looked at data on the 47 million Medicare patients who reported back pain during the 2001-2011 period.
His goal was to use this massive cohort to determine the effectiveness of epidural steroid injections to settle down nerves inflamed by herniated or slipped disks. The research is not yet published, he said, but it looks like epidurals are as safe as trigger-point injections. Akuthota said he would also like to use the database to investigate health disparities in spinal care – that is, how things like race and economic status impact treatment and outcomes.
He views clinical care as vital to helping patients one-on-one, in having credibility as a medical leader, and in gaining an understanding of what research is most needed (he’s also good at it, as evidenced by his perennial presence on 5280 magazine’s “Top Docs” list). But the research can have the greatest effect in the long term, he said.
“Over time, I feel like you can make a bigger imprint with research than you can by seeing a hundred patients a day,” he said.
He does a lot of his research after hours. In addition to his administrative duties, Akuthota sees patients three days a week in clinic at the Spine Center and spends a half-day a week at the CU Sports Medicine center on Colorado Boulevard. There he serves the runner’s clinic, where his experience in knees, ankles, and hips, as well as the spine, comes in handy. He also directs the PM&R medical residency program, which he’s done since he arrived. He’s got help now, but Akuthota is closely involved with the three-year PM&R program’s 15 residents, and he’s hoping to grow that number.
Akuthota recently stepped back from another major commitment: From 2007 through 2014, he was a founding senior editor of the American Academy of Physical Medicine and Rehabilitation Medicine’s PM&R Journal. He’s also delegating to residents his team-physician work with CU and the University of Denver. There’s only so much time, and he needs to spend at least some of it with his twins. If not, they could one day stray into some other medical field – like pulmonology.
“My brother is a pulmonologist,” Akuthota said. “He said he’s the black sheep in the family.”