One of the key elements to the successful operation of any continuum of care pathway is the clinician who will serve as the chief coordinator of patient care, as well as the provider primarily responsible for caring for the majority of patients. For spine care this is the Primary Spine Practitioner (PSP).  The PSP must differentially diagnose spine pain, know when diagnostic testing or specialty referral is necessary, must be able to treat the majority of spine patients, must understand and manage issues related to disability/lost work time, must understand psychosocial issues related to spine disorders and must be able to provide follow up care if the patient does see a specialist. 

The PSP serves as the 'hub' of the spine care wheel. Another role of the PSP is to educate the community about value based spine care. The PSP will educate and engage primary care physicians in the spine care pathway, as primary care physicians will see over 50% of spine pain as the first touch providers. The PSP will educate and engage pain management physicians and surgeons so that appropriate and timely referrals to these specialists are made. The PSP will educate and work with public health agencies, community outreach programs, even employer groups so that population health is enhanced.