AAOS President James H. Beaty, MD, focused on service and leadership

AAOS President James H. Beaty, MD, an orthopaedic surgeon specializing in pediatrics and chief of staff at Campbell Clinic in Memphis, Tenn., believes that a leader should be selfless and should serve an organization by leading. (See “It’s been my pleasure to serve,” page 4.)

AAOS Now staff writer Jennie McKee recently sat down with Dr. Beaty to discuss the Academy’s achievements during the past year and the challenges the AAOS and its members may face in the future.

Ms. McKee: When you assumed the presidency of the AAOS, you pointed to several areas as being the Academy’s priorities, the first of which was physician education. How did the Academy work to improve physician education during your presidency?

Dr. Beaty: The Academy is considered a world-class leader in orthopaedic education and an excellent source of musculoskeletal information for orthopaedic surgeons, patients, and the public. The quality of the Academy’s offerings is obvious at our Annual Meeting and in our continuing medical education (CME) courses.

One of the challenges that we faced in education was strengthening the relationships between the Academy and other medical organizations, such as the orthopaedic specialty societies, the American Orthopaedic Association (AOA), the American College of Surgeons (ACS), and the American Board of Orthopaedic Surgery (ABOS). In the past several years, we began to reach out to these organizations and create collaborative relationships. I believe these efforts will pay off in the future as we work together on issues facing orthopaedic surgeons and our patients.

Another key challenge involved transitioning to the Maintenance of Certification™ (MOC) process, a 10-year cycle for orthopaedic surgeons to improve their knowledge base and enhance patient care. The Board workshop in December 2006 and the AAOS CME summit in November 2007 both addressed how the AAOS could be a vehicle to facilitate our members’ participation in MOC. The Academy and the ABOS have established a wonderful dialogue that enabled us to convey information to our members as the ABOS modified the MOC process.

Enhancing the Academy’s educational efforts is a $5 million education endowment, approved by the Board at last year’s Annual Meeting. Up to 5 percent of the fund balance will be used each year to fund new and innovative medical education projects that are designed to meet member needs and have a significant impact on physician education.

In the future, the emphasis will be on customized education, based on physicians truly using self-assessment to evaluate their strengths and weaknesses. The Internet, individual learning modules, and virtual reality will be incorporated into physician education, although I don’t think the day will ever come when physicians won’t want to gather together to listen to speakers and discuss case presentations. The Council on Education will ensure that the AAOS remains on the forefront of all of these trends.

Ms. McKee: Another high priority of the Academy that you noted is orthopaedic research. How did the Academy increase its contributions in this area?

Dr. Beaty: Historically, patients have found out about new procedures and devices primarily from industry and from a few interested physicians. The Academy remained silent about new technologies because it never considered itself an evaluator of new technology. But with all the rapid changes in medicine, I think orthopaedic surgeons have become more concerned about having credible sources of information on new technology.

According to Academy surveys, the overwhelming majority of members—more than 98 percent—want the Academy to get involved in technology assessment. At our Board workshop in April 2007, we gathered leaders in orthopaedics as well as representatives from the government, the insurance industry, and other fields to discuss technology assessment. We decided to proceed slowly and deliberatively. The Academy is not going to provide a stamp of approval on any device or technique. It will not speak for any company, individual, or device. The AAOS will be, I believe, a clearinghouse and a credible, reasonable, reliable, up-to-date source of information about new devices and new techniques.

The first technology overview—which is distinct from a technology assessment—focused on the gender-specific knee replacement and was released in December 2007. It is designed to serve as an education tool, providing information so that physicians can come to their own conclusions. The Council on Research, Quality Assessment, and Technology will continue to explore possibilities regarding technology assessment.

Ms. McKee: Finally, you emphasized the importance of advocacy on behalf of orthopaedic surgeons. What are some of the key advocacy issues that the Academy responded to in 2007?

Dr. Beaty: Three issues—physician reimbursement, liability reform, and emergency call—are very important right now. The American Association of Orthopaedic Surgeons, through the Orthopaedic Political Action Committee, the Washington office of government relations, and the Council on Advocacy are working diligently to address these issues. I think the overarching concern here is trying to address these issues in a way that continues to afford our patients access to care. We’re in the middle of an election cycle, and we know that it will be difficult to move forward on physician reimbursement and medical liability reform on a national level until after the elections are over. But we have an agenda for change and we are developing ways to address these policy issues on both the national and state levels.

With regard to the emergency on-call issue, last fall the AAOS appointed a new project team and is working with the specialty societies—particularly the Orthopaedic Trauma Association and the Pediatric Orthopaedic Society of North America—as well as with the ACS and the ABOS. In the October 2006 Bulletin, the predecessor to AAOS Now, we published an earlier project team’s accounting of the past, the present, and where we thought the future of emergency on-call was going. We focused on giving information about how other orthopaedic surgeons addressed the problem in their communities, because this has to be solved at the local level. My hope is that more orthopaedic surgeons will become engaged and take leadership roles within their communities to help try to solve the emergency on-call problem rather than sitting on the sidelines.

Ms. McKee: What effect do you foresee the uninsured patient population having on the Academy and its members?

Dr. Beaty: The Academy, along with the rest of organized medicine, will need to respond to the growing problem of uninsured patients, an issue that adds another layer of complexity to the emergency on-call crisis. I think it’s more likely that this problem will be solved at the state and local level than at the national level, because a number of states have already instituted some interesting initiatives.

Ms. McKee: Please comment on the Academy’s response to the Department of Justice (DOJ) investigation into the relationships between orthopaedic surgeons and orthopaedic device manufacturers.

Dr. Beaty: The Academy has taken the high road in dealing with this issue with the press, our members, and the public. We’ve made it clear that “patients come first” is not just a phrase, but that orthopaedic surgeons actually live that philosophy. The AAOS has publicly said that physicians should disclose their activities and relationships with companies to their patients and others. Physicians need to be involved in product design and product development during clinical trials and testing, but this involvement must be ethical and appropriate. The AAOS will not defend any activity by any physician that is unethical and/or illegal.

The Academy has tried to be a credible source of information and input for the DOJ and encouraged the DOJ to attach educational context to the disclosures of physicians’ relationships with industry so that the public would understand the differences between various types of relationships. We disagreed with the DOJ’s approach and directions to the companies in making the disclosures public, but we certainly have no objection to appropriate disclosure. In the future, we will continue to communicate information to our members and patients about this issue and to speak on behalf of the profession.

Ms. McKee: Speaking of the Academy’s communication efforts, how has the Academy kept its members informed of important issues?

Dr. Beaty: Communicating with our members is always a priority. In 2007, we replaced the Bulletin with AAOS Now, a more vibrant newsmagazine that better serves AAOS members’ needs. The Communications Cabinet has also worked hard to facilitate all of our outreach efforts and to ensure that the AAOS is the primary information source for our members, patients, the media, policymakers, and the general public on issues that affect musculoskeletal health.

Ms. McKee: As you leave the presidency, what advice would you offer the incoming president, E. Anthony Rankin, MD?

Dr. Beaty: The AAOS will be in good hands with Dr. Rankin at the helm. He has a wealth of experience as a leader and an excellent background in education, research, and advocacy. He already has accomplished much by updating and refining our member needs assessment survey as well as by leading workshops on advocacy.

The one piece of advice I’d give Dr. Rankin is to enjoy his presidency while it’s happening, because it goes very quickly. He already knows the caliber of all the staff at the Academy, and he understands how fortunate we are to have so many great physicians who volunteer their time on behalf of the Academy and our patients. He’s fortunate, as I was, to have a number of past presidents, future presidents, Board members, and others at his fingertips when he needs a sounding board.

Ms. McKee: Any final thoughts?

Dr. Beaty: When I think of the time I’ve spent involved with the Academy, I don’t see it as leadership; I see it as service. I like the idea of being a selfless servant who focuses on the organization’s agenda. I think it’s very important to be a concensus builder.

I only wish that all AAOS members could see the efforts of the Academy staff and of all the volunteer leaders who work so hard behind the scenes to advance orthopaedics and to make things better for orthopaedic surgeons and their patients. I’ll forever be grateful for the opportunity to have witnessed that and been part of it.

Jennie McKee is a staff writer for AAOS Now. She can be reached at mckee@aaos.org