Incoming AAOS president will focus on front-burner member needs: On-call crisis in trauma care, physician education, technology assessment

The 75th president of the AAOS—James H. Beaty, MD—will be inducted into office on Thursday, Feb. 15, during the 2007 Annual Meeting in San Diego.

Q. What issues do you think will have the most direct impact on orthopaedic surgeons in the year(s) ahead?

A. I think the key challenges we’ll face in the coming years can be divided according to the Academy’s three priority areas—education, research and advocacy.

In education, the challenge will be to 1) maintain the high quality of continuing medical education (CME) offerings; 2) determine how to partner with specialty societies so that both organizations benefit, and 3) learn to work with industry in an appropriate manner for the benefit of orthopaedic surgeons.

On the advocacy side, we face a number of challenges. The medical liability crisis is ongoing and will continue to be a top priority until we conquer the problem—at both the state and federal levels. The trauma care and orthopaedic on-call crisis is another significant challenge. Also of great concern is how we will provide appropriate care to the growing Medicare population in the years ahead.

In terms of research, funding has been cut at both the national and state levels. Yet we work to have research as the base support for all of our activities.

Q. Will you have a special area of interest, or ‘focus’ for your presidential year? If so, what will it be and how do you plan to address this issue?

A. In years past, when an orthopaedic surgeon got into a leadership role—the presidential line in particular—the question would always be asked, ‘What’s your thing going to be?’ Times have changed. The question today should be ‘what are the high priority needs and issues that must be addressed right now and looking beyond that horizon a few years?’ That’s a real change from the way the Academy operated as recently as 10 years ago.

Currently there is a long list of concerns, so we must address those key issues on the front burner. Some of those issues can heat up quickly. A good example would be Medicare reimbursement for joint replacement. Working with the specialty societies, the Academy stepped right in and began a dialogue with our colleagues in Washington, D.C., to address the issue.

In terms of my presidential year, a few key issues have bubbled up over the past 12 to 14 months. First, there is the growing crisis in trauma care and on-call orthopaedic services. Orthopaedic surgeons are the best qualified physicians to provide care for patients with musculoskeletal injuries, so the Academy is working closely with specialty societies to secure appropriate support and reimbursement from hospitals, insurers and government. We assembled an excellent Trauma/On-call Project Team that published a position statement on the topic (www.aaos.org/about/papers/position/1172.asp) and worked with the Orthopaedic Trauma Association to develop guidelines on appropriate needs of physicians and patients. We also devoted a large portion of the October 2006 Bulletin to discussion of the crisis, and will continue to report on the issue in the coming year.

The second front-burner issue is physician education—the heart of our Academy. I believe our CME offerings are the highest quality in the world, and the Academy staff is a role model for other medical organizations. That makes this the ideal time to assess what we’re doing, and look at what’s coming down the pike in physician education over the next five to seven years. Where will the Internet fit in, and how will our education programs adapt? How will surgical skills efforts evolve? In December, the Board spent an entire day studying this issue in detail. The information coming out of that session will have a great impact on how we improve and respond over the next few years.

Technology assessment is the third “hot-button” issue. The Academy is working to determine how we, as an organization, will be involved in the assessment of new technology, new procedures and new devices. Should we take an active role? If so, what are the implications? It’s clear that we have to cooperate with orthopaedic industry, but this must be done in a highly ethical manner. The Board of Directors is devoting an entire three-day session to the topic this spring, so we should emerge from that meeting with a much clearer idea of how we’ll be moving forward.

Q. What do you believe orthopaedic surgeons need most from the AAOS today?

A. Orthopaedic surgeons look to the AAOS for first-rate educational resources, a strong voice for their concerns in Washington, leadership in musculoskeletal research and guidance in evidence-based practice, to name a few. The best news for the Academy is that the leadership, the Board of Directors and the staff are working very hard to keep in touch with members’ needs through surveys and direct communication, and by engaging and soliciting feedback from the Board of Councilors and the Board of Specialty Societies. The Academy is actively engaged in determining what the members’ needs really are, so that products, programs and other initiatives to meet those needs can be developed.

Q. Why should the average working orthopaedic surgeon care about the AAOS, its programs and activities?

A. I only wish the average member could see what I see going on behind the scenes at the Academy. Orthopaedic surgeons who are not familiar with the inner workings of the AAOS may sometimes wonder: “How does an organization with 29,000 members affect me on a personal basis?”

I have several answers to that question. First, members view the Academy as their primary source of orthopaedic education. All of us benefit from the first-rate programs, courses and online education offerings the Academy provides.

In addition to education, so many efforts take place “behind the scenes” in the advocacy arena—both on the state and federal levels—that have a direct impact on patient care, how it’s provided and how orthopaedists utilize their time. The Academy wants to serve, and should serve, as the voice of the orthopaedic surgeon when we interact with government agencies and the private sector. We are the voice of the orthopaedic surgeon.

Finally, everything the Academy achieves through its strong communications and research programs directly benefits the practice of orthopaedic surgery and our patients.

Q. Who are the people who have most influenced and inspired you in your life and career?

A. My dad was a Methodist minister and was extremely influential in my life—most importantly by teaching me that the best thing you can do in life is to serve other people. He instilled that belief in me and the rest of my family from the time we were very young. Ultimately, that’s why I decided to go into medicine.

Within medicine, I’ve had several significant role models and mentors. Alvin J. Ingram, MD—a pediatric orthopaedic surgeon who was Chief of Staff at the Campbell Clinic—was one. Dr. Ingram was a great role model, and was very active in orthopaedic organizations, serving as president of the American Orthopaedic Association (AOA) and the Pediatric Orthopaedic Society of North America (POSNA).

Another mentor is S. Terry Canale, MD [2000-2001 AAOS president]. Terry is a friend and colleague, and he’s also served as a great advisor for matters both inside and outside of medicine.

Dean MacEwan, MD, was my pediatric orthopaedics fellowship advisor at the A.I. duPont Institute in Wilmington, Del., and was another strong influence and mentor.

Q. How did you first become involved in the Academy and its activities?

A. When I initially started practicing at the Campbell Clinic in Memphis, the leadership made it clear that part of the responsibility of being an orthopaedic surgeon meant giving something back to orthopaedic organizations. Fortunately, some of my mentors helped me get involved at the AAOS, and I stayed involved.

I really ‘grew up’ in the education arm of the Academy. Although I started on the Evaluation Committee and the Pediatrics Committee, I became very interested in CME, and ended up on the Committee on Surgical Skills. That group later evolved into the Committee on CME Courses, which I chaired until recently. Over the years, I became closely involved in CME courses and in the leadership of the Orthopaedic Learning Center.

At the same time, I was becoming active in advocacy issues through my state society in Tennessee. Through that involvement, I was able to make some contacts within the advocacy arm of the Academy. I addition, I’m very interested in many of the issues the Academy addresses in the research arena.

Q. In what ways has the AAOS changed since your early days as a member?

A. I’ve seen significant changes in certain areas over the last 20 years, including the addition of the 501 (c)(6) organization in 1998. Our efforts and involvement with advocacy issues—both in Washington and on the state level—have increased dramatically in the past 10 years. Fortunately, we’ve been able to maintain our strong foundation in physician education, so this surge in advocacy efforts is very much a positive for the Academy.

Another striking difference from 20 years ago is the growth of the specialty societies. The Academy adapted well to this change by partnering with the specialties so that all organizations would benefit.

The other major change I’ve noticed is with the volunteer effort. More and more physicians are willing to spend their time working on Academy courses or serving on AAOS committees and councils. The level of participation has increased dramatically since I first became involved.

Q. In what ways can/will the AAOS work to address those issues on behalf of orthopaedic surgeons and their patients?

A. We have revamped the communication efforts of the Academy to make them more timely and valuable to members. In 2007, I believe members will notice a significant streamlining in our communications effort.

The most important thing the membership should know is that a phenomenal amount of effort is going on behind the scenes on their behalf. We welcome their participation and would like to see every orthopaedic surgeon become involved with the Academy at some level—whether by utilizing the Academy’s CME vehicles, getting involved in advocacy efforts at the local, state or federal level, or by contributing financially to orthopaedic research or the PAC.

Q. What is the most important thing AAOS members should know about you?

A. Members should know that I consider myself to be a true orthopaedic “hybrid.” I have one foot in the academic world and another foot in the trenches, practicing clinical orthopaedics every day. I feel just as comfortable talking to my friends in academic medical centers as I do talking to colleagues who practice in towns with 30,000 people to 3 million people.

They should also know that I feel very strongly about the mission and vision of the Academy. As times change, we have to change as well. The recent reorganization is a good example of that. With its new structure, the AAOS will be a more nimble organization that can address issues much more rapidly and with greater ease.

Clearly, I am very enthusiastic about the Academy, and I’m eager to take on this leadership role. I look forward to leaving things a little better after my time at the helm, and I hope to see things improving for us and our patients.