By Robert C. Fine, JD, CAE, and Mary Ann Porucznik

It may be only a coincidence, but the election of three AAOS fellows provides a unique opportunity for the “voice” of orthopaedics.

When the American Medical Association (AMA) held the 2007 Annual Meeting of its House of Delegates this past June, approximately 1,500 physicians—from family practitioners to medical specialists—assembled in Chicago to take part in the organization’s main policy-making activities. Among them were more than 50 AAOS mem-bers—including three who now hold significant leadership positions in the country’s largest physician organization.

AAOS Now spoke to these new leaders about their priorities, what orthopaedists bring to the AMA, and how the AMA can benefit orthopaedics.

William A. Dolan, MD
For the past 12 years, William A. Dolan, MD, orthopaedic surgeon and clinical professor of orthopaedics and rehabilitative medicine from New York’s University of Rochester, has served as a member of his state delegation to the House of Delegates. He was chair of the AMA Council on Medical Service when he was elected this year to the AMA Board of Trustees.

“I’m glad to see orthopaedics come to the forefront at the AMA,” says Dr. Dolan, who recalls a time when he and the late William W. Tipton Jr., MD, former executive vice president of the AAOS, were two of only a dozen or so members of the orthopaedic caucus. “Orthopaedists may be only 1 percent of the medical population, but we now have a large ‘footprint’ in the AMA that can translate into the adoption of many policies that orthopaedists support.”

Dr. Dolan’s top priorities while in office include stopping Medicare payment cuts to physicians that harm seniors’ access to care and developing meaningful programs for covering the uninsured. “I don’t support a single-payor system,” he says, “but we have to improve the system. It’s important for orthopaedics, as well as all of medicine.

“We also need Medicare reform. We need to replace the SGR (sustained growth rate) formula with a better system, and we need medical liability reform,” he continues. “We may need to look at different ways to address tort reform, including alternative dispute resolution and medical courts, for example, but this is a problem that needs to be addressed at the federal level.”

Increased participation in the AMA by AAOS members is one way to achieve these goals, believes Dr. Dolan. “Working together, we are stronger,” he says, “and that may make it easier to achieve our shared goals.”

Andrew W. Gurman, MD
Hand specialist Andrew W. Gurman, MD, of Pennsylvania, was elected the vice-speaker of the House of Delegates—the first orthopaedic surgeon ever to hold the position. A firm believer that participation in professional activities is both a “birthright and a responsibility,” Dr. Gurman has served as speaker of the Pennsylvania Medical Society House of Delegates for the past 5 years.

“Presiding over a deliberative assembly is the most engrossing thing I’ve ever done outside of surgery,” he claims, admitting as well that he enjoys both parliamentary procedure and debate.

As vice-speaker, Dr. Gurman hopes to find ways to make the delegate assembly more effective. “Each of our resolutions is filled with ‘whereas’ clauses that spell out the difficulties, the impediments, and the hassles that we face as physicians. But when the vote is taken, only the ‘resolved’ clause remains. We need to have all the stakeholders present to hear those ‘whereas’ clauses, so they understand what we are fighting for—and why.

“Involvement is not a retirement activity,” claims Dr. Gurman. “If you are in the prime of your career, you have a certain gravitas when you approach a legislator about the need for making change. You can say, ‘Senator, this is a problem I faced in my office yesterday, and if you don’t fix it, I’m going to face that same problem in my office tomorrow.’”

William A. Hazel Jr., MD
An orthopaedist in the Washington, D.C., area, William A. Hazel Jr., MD, has served on the AMA board of trustees for the past three years. This year, his fellow board members elected him secretary.

Dr. Hazel has been involved with the AMA throughout his professional life. A member of the Virginia Orthopaedic Society as well as the Virginia Medical Society, he sees participation in professional organizations as an “obligation, a duty of the profession.” In addition to being AMA board secretary, he is chair of the compensation committee and a member of the finance committee; he also serves as the liaison to the Scope of Practice Partnership and as board liaison to the AMA’s Political Action Committee.

“As an orthopaedist, I have the perspective of someone with both surgical and office experience,” he says, “which is very helpful when dealing with coding and relative value issues.” Even though AMA activities are taking up to a third of his time, he is continuing his full-time orthopaedic practice, with a focus on sports medicine.

Although “specialty societies are well-represented in the AMA,”

Dr. Hazel hopes that more specialty society members will become active in the organization. “We became physicians before we became orthopaedists, and we have much in common with our medical colleagues, regardless of their fields of practice. We all care for patients, we all must deal with hospitals to obtain privileges and with health plans to obtain reimbursement. We all know about the problems with medical liability insurance,” he points out.

Because the AMA looks for the common denominator among all physicians, regardless of their specialty field, Dr. Hazel believes it strengthens advocacy and access to care proposals. He points out that it may be beneficial to have someone outside the specialty speak on your behalf.

“When it comes to scope of practice issues, for example, a family physician may be able to present the issues surrounding physical therapy, chiropractic, or podiatric care better than an orthopaedist, because he or she doesn’t have the financial conflicts of interest that the orthopaedist may have,” he says.

The Orthopaedic Section Council
In addition to these three orthopaedic leaders, more than 50 orthopaedists serve in the AMA House of Delegates, representing their states, the AAOS, or one of the musculoskeletal specialty societies, including the following:

• American Association of Hip and Knee Surgeons
• American Association for Hand Surgery
• American Orthopaedic Association
• American Orthopaedic Foot and Ankle Society
• American Society for Surgery of the Hand
• North American Spine Society

Orthopaedists gather at House of Delegates meetings in a forum known as the Orthopaedic Section Council. According to Section Council Chair, Laura L. Meyers, MD, “The Section Council gives orthopaedic delegates the opportunity to caucus together so that we can speak with a unified voice on issues of concern. After the Section Council meets, members will then try to influence their colleagues in other specialties on how the House and the AMA, in general, should act on these issues.”

In recent years the Orthopaedic Section Council has grown, with the inclusion of more musculoskeletal specialty societies and more orthopaedists in the House of Delegates. This expansion, combined with the rise of orthopaedists into key leadership roles, positions orthopaedics to speak with a powerful voice in AMA’s decision-making processes.

As Dr. Gurman notes, the AMA is still seen by policymakers and the general public as the “primary voice of medicine.” Dr. Hazel concurs. “If we isolate ourselves and fight over turf issues, the world outside will have a field day.”

Only time will tell, of course, if the AMA is able to counter the widely held perception among many orthopaedists that it does not represent their interests. But, with the increase of orthopaedic influence in the AMA’s leadership structure, there has never been a better chance for orthopaedists to shape the organization’s future directions.

Robert J. Fine, JD, CAE, is director of health policy and governance initiatives. He can be reached at fine@aaos.org. Mary Ann Porucznik is managing editor of AAOS Now; she can be reached at porucznik@aaos.org.