One of those challenges is gov­ern­ment involvement in the practice of medicine. Whether it is the Medi­care physician payment formula, emergency department (ED) call, physician ownership and self-referral, access to specialty care, medical liability reform, or scope of practice, legislative issues are affect­ing the quality of practice life. Our role in the political arena has never been more important than it is now.


Published 4/1/2009
Joseph D. Zuckerman, MD

The opportunities are within the challenges

Those of you who weren’t at the 2009 Annual Meeting in Las Vegas—and those of you who were, but didn’t attend the Business Meetings on Feb. 26—missed my Presidential Address. It will be published next month in the Journal of the AAOS.

I would like to take this opportunity to summarize the key parts of the talk. I did put a lot of thought into what I had to say and since it provides a map of my anticipated activities during the next year I think it is worth repeating here.

To say that we live in challenging times would be a gross understatement. But within each challenge lies an opportunity, if we can identify and act on it. That is what I hope—with your help—to do.

Practice challenges
All of us face challenges within our practices as we try to provide the best musculoskeletal care possible for our patients. During the past 2 years, the Academy has expanded its practice management programs to help enhance your quality of practice life—and it will continue to do so. I hope that, over the next 5 years, these efforts will have a positive impact on how you practice orthopaedic surgery and will enable you to better respond to the practice challenges you face.

We are already seeing glimpses of President Obama’s national health­care reform plan. As it takes shape, physicians—and specifically ortho­paedic surgeons and the Academy—must be involved in the design and decision-making processes.

The AAOS has a unified advocacy agenda designed specifically to match our legislative goals with the utilization of our resources. Our political action committee (PAC), under the leadership of Stuart L. Weinstein, MD, has brought us to the table and is helping us become a recognized player in Washington. It provides access and opportunity, two key elements to a successful advocacy initiative. In the election cycle just completed, 25 percent of our members contributed more than $3.3 million, which made us the number one specialty society PAC.

Think how effective we would be if we had 50 percent member participation—and by the end of the 2010 election cycle, with your help and commitment, we can achieve this. I ask each of you to join our PAC.

DOJ challenges
Although the monitors assigned by the Department of Justice (DOJ) have gone, the challenges presented by the investigations into the relationships between industry and consulting orthopaedic surgeons continue. Orthopaedic surgeons have been portrayed as unethical or worse. The ongoing media response has detracted from the public perception of orthopaedic surgeons.

We realize, however, that the collaborations must have one goal: the enhancement of patient care. Collaborations with industry have resulted in the development of new and improved technologies that have improved the lives of millions of patients. We must continue to use every opportunity to deliver this message.

Industry funding for research and education has changed also. Funding of fellowships, continuing medical education (CME), and research will now be directed to conflict-free third-party organizations, that will be responsible for distribution. To comply with the new paradigm, the Academy formed the Center for Orthopaedic Advancement as a separate organization to receive and distribute CME funding; the American Orthopaedic Association established OMeGA to receive and distribute funds for graduate medical education (GME); and the Orthopaedic Research and Education Foundation expanded and enhanced its portfolio to include both GME and CME. Going forward, we need to work together and coordinate our efforts and this will be an important focus during the next year.

Even more challenges: ED call, unity and patient communication
Emergency care in this country is a complex multifactorial issue and the provision of emergent and urgent musculoskeletal care is a relatively small component, but it is the one that most concerns us. We can agree, for example, on the following points:

  • Orthopaedic surgeons are the most qualified to provide care of emergent and urgent orthopaedic injuries.
  • Responsibilities for ED coverage should be ful­filled in an environment that provides the resources necessary to ensure the proper level of care.
  • Medical liability reform is a key element in the equation.
  • Solving this problem will require collaboration among all stakeholders—and we are major stakeholders.

If we do not believe that the answer to the emergency call issue is to develop an acute care fellowship or allow nonphysician health care providers to expand their scope of practice, then we must continue to work at all levels—federal, state, and local—to solve this problem, and I am committed to moving this agenda forward.

I am both an orthopaedic surgeon and a shoulder specialist. I am among the 45 percent of our members who describe themselves as orthopaedic specialists. The growth of specialties is good not only for patients, but also for our profession. The Unity Summits in 2004 and 2008 have helped the AAOS and specialty societies to work together closely in many areas. We are committed to unity, not fragmentation, and will continue to work toward that goal.

Perhaps the greatest challenge—and thus the corresponding greatest opportunity—occurs during our interactions with patients. We have the opportunity—one patient at a time—to enhance the public’s perception of orthopaedic surgeons.

Our 1999 image surveys found that 85 percent of our patients want us to listen and 89 percent of us thought we listened very well. But only 35 percent of our patients reported that their orthopaedic surgeon exhibited a caring and compassionate attitude and spent sufficient time listening to them.

We thought we were listening, but most of our patients didn’t think so. They perceived us as “high tech and low touch.”

Since 2001, under the leadership of John R. Tongue, MD, and S. Terry Canale, MD, the communication skills mentoring program has trained 47 mentors, conducted 229 workshops, and reached almost 2,500 orthopaedic surgeons and more than 2,000 orthopaedic residents.

In the 2008 consumer survey, 55 percent of patients reported that their orthopaedic surgeon was caring and compassionate, and 51 percent said we spent sufficient time listening to them. Although these are significant gains, the goal of getting to 100 percent is another opportunity to pursue.

The cup is half full
Overall, I think I am a very positive person. Each and every day I am very thankful to be an orthopaedic surgeon, to be a part of a specialty that does so much to enhance the quality of life of millions of patients.

As orthopaedic surgeons we can have such an important impact on the lives of so many patients and the care we provide can be among the most satisfying of any specialty. With your help, we can respond to the challenges we face and turn them into opportunities.