AAOS Now

Published 12/1/2009
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Mary Ann Porucznik

Economy is changing education needs

One orthopaedist’s top 10 reasons for changing medical education

Orthopaedic education is changing. Technology, economics, Maintenance of Certification™ (MOC), and practice patterns are forcing changes—not only in what is taught, but also in how it’s taught. At the 2009 Fall Meeting of the Board of Councilors (BOC)/Board of Specialty Societies, BOC Chair-Elect Richard J. Barry, MD, outlined his top 10 reasons for changing the way the AAOS does continuing medical education.

Get smart
“We need to be better at what we do than the local podiatrist, but that also goes for the neurosurgeon, physical medicine/rehabilitation specialist, and all of the other specialists who are nibbling away at the edges of the traditional practice of orthopaedic surgery,” said Dr. Barry, who is a spine specialist. “They not only use our educational content, they also produce a lot of educational content and are very aggressive in marketing it. We have to make sure that the Academy remains the educational source of choice for content in these educational areas. We must continue to deliver the best ‘bang for the buck’ in musculoskeletal education.”

Maintain certification
“Many of our fellows think that the increasingly rigorous requirements for the MOC process makes the Spanish Inquisition look like show-and-tell,” said Dr. Barry. He called on the AAOS to use its educational resources and connectivity to help community surgeons make timely progress and track their achievements toward MOC.

Find a sweet spot
“I’m thinking of changing my name to Rick, the One-Trick Pony,” he joked. “My practice (minimally invasive spine surgery) has been reduced to a single page in the coding book.” Many community practices, he noted, survive because they identify a “sweet spot” in the practice, where surgeons are able to do procedures most efficiently, effectively manage ongoing risk, and make the best of tough economic times in the face of falling reimbursement.

Web wonders
“Younger fellows spend an incredible amount of time on the Internet,” said Dr. Barry, who proposed a “bar-snacks method of picking up continuing medical education (CME) credits.” He urged the Academy to enhance Web resources and make education materials easy to access, so that fellows can earn credits online at their convenience, rather than taking time away from their practices to attend skills courses. “Education must be time- and cost-efficient,” he said.

Make the political personal
“Importantly, the AAOS is strategically focused on advocacy. But I don’t think the Latin verb ‘advocare’—to speak for—is strong enough,” said Dr. Barry. “We need to be active. Orthopaedic surgeons are a minority in a representative democracy, and we have a duty to speak out and make sure that whatever changes come forth, health care remains centered on the patient’s ability to access quality care, within the community, on a timely basis.”

As solutions to healthcare problems evolve, he said, fellows need to know how various states are proceeding.

Emphasize the fundamentals
“We have to make sure that we use our powerful educational organization to mitigate risk,” Dr. Barry said. “If we can prevent a single adverse outcome, if we can prevent just one complication, if we avert one episode of litigation over an unanticipated outcome, then we’ve achieved our goal. Healthcare reform cannot take place unless physicians can effectively manage the unavoidable potential liability risks inherent in a surgical practice.”

Don’t count on the company
“Our relationships with industry are changing and correctly so,” said Dr. Barry. This has huge implications for the future of surgical education. “When you go to a course sponsored by an implant manufacturer,” he pointed out, “there’s that unspoken quid pro quo that they want something in return. This is a potential ethical dilemma that should make you uncomfortable.”

The AAOS, he hoped, would be able to offer technologically contemporaneous information about new procedures. “For the community orthopaedic surgeon, it’s all about efficiency in doing a procedure in the least possible operative time with the lowest possible risk while delivering consistent, quality outcomes. Industry is going to have a smaller and smaller part of surgical education,” he said.

X-rays on an X-box?
“We’re surrounded by tremendous technology these days,” Dr. Barry said, “but unfortunately, surgical education has not changed dramatically in 500 years. We’re still using physical objects to teach spatial relationships.”

A former military instructor pilot, Dr. Barry compared pilots and surgeons. “We do exactly the same thing,” he said. “We use highly instrumented products in a high-risk environment, but pilot training has embraced the use of computer simulations much more ably than medical training.” He urged the development and use of home computer-based virtual reality simulators in teaching surgical skills.

Charging up books
The Academy’s enduring educational products are great, admitted Dr. Barry, but electronic books take up less space, don’t weigh as much, and are easier to search. “I’ve only purchased one book in the past two years, and it lives on a charger. I’ve got a Kindle™,” he said. “We need to explore and embrace evolving technology to facilitate professional education.”

Let’s not fight over a penny
“It’s been said that copper wire was invented by two orthopaedic surgeons fighting over a penny. In the past, we’ve competed with each other for patients, revenues, and contracts; community surgeons competed with group and academic surgeons for referral patterns,” said Dr. Barry. But as more fellows get some sort of salary support for their income, the number of community orthopaedists who rely on fee-for-service payments will drop. “When that happens, support for all salaried positions is going to decrease,” said Dr. Barry, “because salary models are based on the overall value of our services in the marketplace.

“The California Orthopaedic Association’s (COA) Economic Factors Committee is looking at the potential failure, bankruptcy, or early retirement for up to 25 percent of our fellowship’s practices,” said Dr. Barry, who is the current COA president. “That’s a staggering number and will have a significant impact on the AAOS. We have to be efficient, cost-effective, and as insightful as possible going forward, to support the strategic objectives of the Academy in education and doing the best for orthopaedists,” he concluded.

Mary Ann Porucznik is managing editor of AAOS Now. She can be reached at porucznik@aaos.org