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“Money was ‘a deadly sin’ and the Academy was not supposed to be about the business side of orthopaedics,” he said. “This focus excluded most practicing orthopaedic surgeons.”Although he did make progress, “one president can only change so much,” Dr. Rineberg said. “The Academy is a big boat and it takes a lot of energy to change its course.”

AAOS Now

Published 8/1/2008
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Carolyn Rogers

Lessons from history

AAOS past presidents recall challenging times

Does history repeat itself? When asked to recall the key leadership challenges of their individual tenures, many past presidents said their term was dominated by a challenge or crisis unique to the time. Among the past presidents, several recurring themes emerged—such as medical liability, reimbursement issues, or the need for orthopaedic unity—that still resonate today.

“Keeping it all together”
By the time Roby C. Thompson Jr., MD (1986-1987), took office, the fragmentation of orthopaedics had been a looming problem for several years.

David G. Murray, MD (1982-1983), had initiated a program to address the issue during his tenure, “so I sort of inherited that challenge,” Dr. Thompson said.

He and other AAOS leaders met with the presidents of various subspecialty societies to find solutions. Ultimately, they formed the Council of Musculoskeletal Specialty Societies (COMSS), now the Board of Specialty Societies.

“This was a big effort by Roby Thompson and others,” recalled Robert N. Hensinger, MD (1992-1993), who became the first chair of COMSS. “These guys were very determined. I remember them talking in back rooms with various leaders, trying to find a way to keep us all together.”

Although Dr. Thompson doesn’t take credit for establishing COMSS, “I do feel good about my presence in getting the council formed,” he said. “It was a positive step for orthopaedics.”

During the past two decades, however, “those organizations have matured and orthopaedic specialty societies have become more and more diverse, so the issue has come to the forefront again,” he added.

Another challenge Dr. Thomp­son “wrestled with” during his presidential year was the Academy’s legal representation. The AAOS did not have a general counsel’s office at the time and was using an outside consulting firm.

“The leadership wasn’t happy with the consulting arrangement, so the decision was made to bring it in house,” he explained. “I drew the ‘short straw’ and had to call the legal consultants to let them know they had been fired. These guys had been with the Academy for years, so it was a difficult phone call to make.”

Still, he believes it was the right thing to do. “I’ve watched the effect of that decision over the past 20 years and I’m glad that we did it,” he said.

Recurring themes: Recertification, reimbursement
The conflict between the Academy and the American Board of Orthopaedic Surgery (ABOS) over the need for recertification had “polarized the orthopaedic world” when Newton C. McCollough III, MD (1989-1990), took the helm at AAOS.

He confronted this problem head on by meeting one-on-one with the president of ABOS, creating AAOS committees to meet with ABOS, and eventually convincing the two boards to sit down together.

“This created an atmosphere of trust and integrity,” he recalled. “Each side began to understand the other’s position.”

By the next year—during the presidential reign of John B. McGinty, MD (1990-1991)—both organizations agreed to the need for recertification. Dr. McCullough said “constant communication” with the fellowship was key during this difficult time.

“Fellows had very diverse opinions on the process of recertification,” Dr. McGinty said. But in the end, “We were able to work as a group and develop a consensus that was agreeable and manageable.”

The other issue that dominated Dr. McGinty’s term was reimbursement; specifically, the “out-of-control” fees that a number of orthopaedists were charging.

“Some physicians were charging exorbitant fees,” he recalled. “There was no oversight at the time, and the government was just starting to intervene.”

“Money was ‘a deadly sin’ and the Academy was not supposed to be about the business side of orthopaedics,” he said. “This focus excluded most practicing orthopaedic surgeons.”Although he did make progress, “one president can only change so much,” Dr. Rineberg said. “The Academy is a big boat and it takes a lot of energy to change its course.”
The question of whether to convert the Academy to a 501(c)(6) was a topic of “hot debate” among Academy members and the board, recalled Dr. Strickland.The first board vote, in May 1995, ended in deadlock. As president, Dr. Strickland could have cast the tie-breaking vote, but chose not to.

Dr. McGinty urged orthopaedic groups to come up with a reasonable plan of their own. But, “the orthopaedic community shot itself in the foot,” he said. “We didn’t pull together.”

As a result, government interventions were initiated, “which left us in the situation we’re in today—with constantly increasing overhead and decreasing reimbursement,” he said.

“It was about being inclusive”
During his presidency, Robert E. Wells, MD (1981-1982), sought to make Academy leadership more inclusive.

“At that time, the nomination process for committee members consisted of the chairman standing up at a meeting and taking nominations from the audience,” he recalled.

Once one nominee per position had been reached, nominations were closed.

“I wanted to get as many nominees as we could,” he said. “It was about being inclusive.”

Kenneth E. De Haven, MD (1996-1997), distinctly recalls this act of leadership by Dr. Wells.

“Back then, the nominating process could be ‘stacked,’” Dr. De Haven explained. “One group could arrange to have people stationed at the microphones first to make sure ‘their’ people were nominated.”

Dr. Wells changed the process so that nominations would remain open as long as people were still standing at the microphones.

Calling this a “singular moment of excellent leadership,” Dr. De Haven said it brought about a significant change in the composition of committees and other AAOS bodies without requiring a bylaws change.

The private practitioner
Bernard A. Rineberg, MD
(1993-1994), worked to convince AAOS leadership to recognize the need for involving nonacademic surgeons in the Academy.

AAOS leadership was then composed almost entirely of academic surgeons who didn’t understand the small business aspects of orthopaedic private practice, Dr. Rineberg said.

Bernard A. Rineberg, MD

The 501(c)(6) controversy
Both James W. Strickland, MD (1995-1996), and James D. Heckman, MD (1998-1999), cited the creation of a 501(c)(6) organization as one of their biggest challenges.

James W. Strickland, MD

“I felt strongly that it would be improper to resolve such a critically important issue by a single vote,” he said.

Another 2 years of study, debate, and discussion would pass before the Board voted unanimously to establish a 501(c)(6) organization.

“Changes to the tax code made the creation of an independent 501(c)(6) essential during my term,” Dr. Heckman said. “By establishing a parallel membership organization—the American Association of Orthopaedic Surgeons—we could continue to be actively engaged in the health policy and practice arena while maintaining the Academy’s 501(c)(3) status as an educational organization.”

Carolyn Rogers is a staff writer for AAOSNow. She can be reached at rogers@aaos.org