I would like to call attention to an important injustice occurring as a result of “dirty doctors”—orthopaedic surgeons who provide untruths for the benefit of plaintiffs in legal action. I have been doing medical legal work for several years [and] have been appalled at the number of doctors willing to knowingly provide false information and distort the truth for the plaintiff’s benefit. [Likewise,] many doctors hired by the defense simply write off or downplay real injuries and provide inappropriate opinions. Many of these opinions and recommendations are completely inconsistent with sound orthopaedic knowledge and judgment.

We have devised a [Professional Compliance] system to protect doctors from untruths related to medical malpractice testimony. However, we have done little to police ourselves when it comes to third-party injuries. Orthopaedics has ignored this problem and has done nothing to curtail what I believe is progressive irresponsibility and fraud on the part of many doctors.

I appreciate that this is not an easy problem to deal with, but if we, as orthopaedic surgeons, don’t address it, it is not likely that anybody else will until it becomes a crisis. I have evaluated many cases in which doctors have provided inconsistent and inappropriate orthopaedic opinions as well as care. I wish the AAOS would consider addressing this growing problem. I believe it is our duty and obligation that we require high standards for all orthopaedic surgeons.
Gary L. Painter, MD
Loma Linda, Calif.

I am a PGY3 in the orthopaedics program at Brown University. I read the AAOS Now series on performance enhancing drugs (PEDs) and find that topic extremely interesting. I’m currently working on a project with Michael J. Hulstyn, MD (one of our sports medicine attending physicians), regarding the use of supplements and steroids in adolescent athletes. We are planning to do a survey of high school athletes in Rhode Island to determine their current thoughts and perceptions on PEDs. We also hope to get an idea of which high school athletes are currently using PEDs.

Dr. Hulstyn and I hope that our study may have an impact on the high school athletic community in Rhode Island, in terms of educating coaches, athletes, and parents. On a higher level, we hope that our study may even provide the state with information to support the institution of formal drug testing for high school athletes.
Mary K. Mulcahey, MD
Providence, R.I.

I support Dr. Akins’ letter to the editor (AAOS Now, September 2008) regarding nonparticipation in Maintenance of Certification™ (MOC) for experienced practicing orthopaedists. I am in my late 50s, have passed my initial boards, and recertified at the specified time, but I will not go through the reapplication required by the American Board of Orthopaedic Surgery (ABOS). This change in reapplication is, in fact, a significant disappointment to me regarding the ABOS, an organization I once held in high esteem.

The ABOS should understand that different levels of practicing orthopaedists exist. Having practiced for almost 20 years, I have learned what my limitations are, and have adjusted my practice accordingly. Jumping the hurdles that MOC reapplication requires is more than I am willing to do at my stage of practice. Therefore, my board certification, something that I am proud to have obtained and maintained, will expire. My personal orthopaedic practice will continue and I will continue to maintain my membership in many orthopaedic societies, continue my Continuing Medical Education activities, and maintain my education through journals and other avenues.

As for the suggestion of Emeritus Certification after 30 years, I think that 20 years of practice would suffice. ABOS investigation into each practitioner applying for this level of certification would and should be encouraged.

The requirements for MOC are unrealistic for the established orthopaedist and will accomplish nothing more than having us relinquish our “mantle” but to continue to practice “excellence.”
Frederick R. Nusbickel, MD, PhD
Thomasville, Ga.

AAOS Now welcomes reader comments and efforts to “set Now straight.” We reserve the right to edit your correspondence for length, clarity, or style. Send your letter to the Editor, AAOS Now, 6300 N. River Rd, Rosemont, IL 60018; fax them to (847)823-8033; or e-mail them to aaoscomm@aaos.org