Orthopaedic surgery is so broad and deep a specialty that fragmentation is a real hazard—generalist vs. specialist, academic vs. private practitioner, subspecialist vs. subspecialist. This can create problems, particularly when a united front is needed to respond to issues such as tort reform, Medicare payment schedules, or emergency care/on-call responsibilities. As David Lovett, the director of the AAOS Washington, D.C., office once said, “Physicians tend to circle the wagons—and then shoot inward!”

The decline of the American Medical Association shows what can happen when a powerful organization fails to stay unified. The AAOS is strongly committed to maintaining and enhancing unity among orthopaedic subspecialties, state and regional orthopaedic societies, and in fact all orthopaedic surgeons.

Common interests, shared goals

Unity is not a “top down” quality—it cannot be legislated or mandated. Real unity comes from recognition of common interests and shared goals, which in turn arise from a commitment to communication among the interested parties.

The AAOS Board of Councilors (BOC) was originally established to facilitate communication between the fellowship and the (largely academic) leadership of the Academy. At the time, private practice and academic practice were different worlds with little understanding of each other’s challenges. The BOC provided a forum where representatives from both worlds could meet and discuss problems, challenges, and potential solutions. Along the way, the BOC planted the seeds of political advocacy, from which grew the Orthopaedic Political Action Committee, the National Orthopaedic Leadership Conference, and the American Association of Orthopaedic Surgeons.

The fellows who serve on the BOC represent their respective home states, the Uniformed Military Services, Canada, and Puerto Rico. Councilors have typically been leaders in their respective constituent societies, and many have been “tested by fire” in dealing with significant issues in their home states. The following examples are just a few of the most recent “battlefields”:

• medical liability reform in California, Nevada and Texas
• physician owned physical therapy services (POPTS) in South Carolina
• treatment guidelines for Workers Compensation patients in California
• compulsory emergency room call service in California.

The BOC’s demographics parallel those of the entire Academy. About 70 percent of Councilors identify themselves as subspecialists or general orthopaedists with significant subspecialty interest. Councilors come from multiple practice settings including multispecialty groups, academic practices, health maintenance organizations, and traditional “private practices.” Most, if not all, of the orthopaedic subspecialty societies are represented on the BOC.

Giving voice to the fellowship

The Board of Councilors facilitates communication (and, by extension, unity) within the Academy in many ways. The Resolutions process, anchored by the BOC resolutions committee, allows any group of 20 fellows to bring forth resolutions and advisory opinions, thus alerting AAOS leaders and the fellowship to vital issues.

The BOC bylaws committee serves an important advisory function to the Academy’s Bylaws Committee, distilling multiple opinions and viewpoints into a “sense of the fellowship.”

The Professional Compliance Program began with a BOC resolution; the BOC’s professionalism committee continues to act as an advisory body to the AAOS Committee on Professionalism and is actively involved in the development of new Standards of Professionalism.

The BOC’s state orthopaedic societies and state legislative and regulatory issues committees serve as important liaisons to the state societies. The grants they award are used to improve state society infrastructure, as well as to fight important legislative battles on “bellwether” issues such as POPTS.

The Board of Specialty Societies (BOS) has developed a parallel committee structure and is now actively involved in resolutions, bylaws, and professionalism activities. During the 2006 fall meeting, the first joint meetings of these BOC and BOS committees were held, with positive results. The BOC’s famous “open mike” sessions have become even more valuable (and spirited) with the participation and voices of BOS members. Personally, I am pleased that the BOS has recognized the value of our work by emulating our committee structure.

The “conscience” of the Academy

The Board of Councilors was established to overcome a lack of communication among AAOS leadership and its fellowship. The issues we deal with today are, in many cases, the same issues we dealt with 30 years ago. The difference today is an increasing awareness that we are more effective when we are united. We can (and do) continue to have significant differences of opinion, practice setting, specialty, and political beliefs. However, we are all orthopaedic surgeons: “We” are “Them”; “They” are “Us.”

Challenges and opportunities for orthopaedic unity will continue. Among them are closer integration with the state and regional orthopaedic societies and tighter integration with our osteopathic orthopaedic colleagues.

I firmly believe that the momentum we have gained will continue to build, and the house of orthopaedics will not fall victim to the “AMA Syndrome.” As the “conscience” of the Academy, members of the Board of Councilors relish our role and anticipate many more years of service to our peers, the fellows and members of the AAOS.

Dwight W. Burney III, MD, is chair of the Board of Councilors. He can be reached at burneydw@nmortho.net