To paraphrase President Abraham Lincoln, you can please some of the people all of the time, and all of the people some of the time, but you can’t please all of the people all of the time. I know that not every AAOS member has been pleased with the positions we have taken on healthcare reform and other issues. During the year I heard from more than 1,400 of our members and I responded to each one. Although they didn’t always agree with the AAOS position or policy, I was very pleased with the constructive exchanges that took place and the respect expressed for the differing opinions.

Practice challenges
I put emphasis on enhancing the Academy’s practice management programs, to help AAOS members enhance the quality of practice life. The recent recession has underscored the importance of understanding business operations and finding ways to capitalize on them. To support these efforts, the AAOS has introduced some new programs, improved some ongoing programs, and made plans for future programs.

For example, the Academy has introduced a subscription lecture series on practice management for resident programs and conducted a Webinar for residents. We also entered into an agreement with the Medical Group Management Association that enables AAOS members to purchase selected practice management books at a discount price.

The group purchasing program—discounted pricing, online ordering, and expanded offerings—continues to grow. Practice management courses, such as the “Building Essential Skills” course and the Practice Management Symposium for Practicing Orthopaedists at the Annual Meeting, continue to provide the knowledge and skills necessary to keep a practice flourishing—even in a down economy.

Several initiatives are still in development, including a technology course planned for next year, the construction of an orthopaedic practice database, and a primer on hospital-employed physician agreements, which will be available at the 2010 AAOS Annual Meeting.

Shifting demographics and practice patterns will increase the importance of providing practice manage- ment support for individual, small group, and large group orthopaedic practices. During the past year the AAOS has made considerable progress in this area, and the new initiatives will continue to carry us forward to meeting this goal.

Government challenges
A year ago, I called government involvement in the practice of medicine “unprecedented.” As I write this, with the healthcare reform measures currently wending their way to President Obama’s desk, I could now say it’s ubiquitous.

The American Association of Orthopaedic Surgeons (AAOS) early on established several principles of healthcare reform, which have guided our actions. Our office of government relations; our Council on Advocacy, under the leadership of Peter J. Mandell, MD; and many individual members have worked hard to ensure that our views are known and to clarify for members of Congress the impact of their actions. Some of you wanted us to take even stronger stances than we have. But we must also be aware of the need for a larger perspective. We have worked hard to build relationships in Washington, and we know that, in the long run, we will be able to capitalize on those relationships.

I have done my best to keep you informed of the challenges we face in achieving the goals of permanently fixing the sustainable growth rate formula and crafting a reform bill that reduces costs, reduces barriers to access, protects the patient-physician relationship, and supports high-quality specialty care. I have been truly impressed by the time and effort that individuals such as Stuart L. Weinstein, MD, and the members of our office of government relations have put into these efforts, connecting with other organizations in the orthopaedic and surgical communities to develop coalitions and campaigns, such as the Surgical Coalition, the Alliance for Specialty Medicine, and Physicians United for Patients.

Although at times it may seem that the healthcare reform debate has overshadowed everything else, the AAOS recognizes the importance and impact of activities at a number of regulatory agencies at both the state and federal level. We continue to monitor developments surrounding the device approval process at the Food and Drug Administration; the push to implement health information technology, comparative effectiveness, and pay-for-performance programs; and the efforts to enact tort reform, particularly in the states.

We have seen substantial progress in obtaining funding for orthopaedic research. Research Capitol Hill Days, which enable orthopaedic patients to make the case to Congress for additional funding, have been quite successful in building a patient support team for orthopaedics. The Orthopaedic Extremity Trauma Research Program, which was created in large part due to the efforts of the AAOS, provides funding through the Department of Defense for peer-reviewed intramural and extramural orthopaedic trauma research. In fiscal year 2009, $117 million was appropriated for orthopaedic research, with another $22.5 million appropriated thus far for fiscal year 2010.

“Internal” challenges
Our CEO Karen Hackett has said that working with orthopaedic surgeons is like trying to herd cats. Although there may be some truth to the view that orthopaedic surgeons, myself included, can be opinionated, headstrong, and fiercely independent, these very same qualities strengthen our commitment to our patients and to our profession. I have seen that commitment from our members this past year.

We faced some challenges (primarily from outside the orthopaedic community) in working together to create the American Joint Replacement Registry (AJRR). Recognizing, however, the importance of this venture, we turned those challenges into opportunities, thanks to the work of many dedicated volunteers, especially John J. Callaghan, MD, first vice president, and Daniel J. Berry, MD, second vice president. Now established as a separate, nonprofit organization, the AJRR is unique because it involves all stakeholders in decision-making. Board members will come from orthopaedic specialty societies, the AAOS, industry, payors, hospitals, and patients.

As both an orthopaedic surgeon and a shoulder specialist, I am committed to unity, not fragmentation, and have worked toward that goal throughout the past year. Meeting with the leadership of the specialty societies has been—and will continue to be—one of our most important priorities. We have seen much progress, particularly in orthopaedic education, culminating in the recently signed agreement between the AAOS and the Orthopaedic Research and Education Foundation (OREF). Under this agreement, the OREF will serve as the official fundraising arm for the Academy’s orthopaedic education programs—just as it is for approximately 40 other orthopaedic organizations.

Was it worth it?
During the past year, I’ve spent countless hours on the phone and answering e-mails, days in meetings, and weeks away from my family and practice. Although challenges to my general optimism continue, I remain incredibly thankful to be an orthopaedic surgeon, to be a part of a specialty that does so much to enhance the quality of life for millions of patients.

In Las Vegas, I said, “there is no other professional organization to which I would rather commit my time and effort than the AAOS.” Today that commitment remains stronger than ever. This is a truly outstanding organization and I thank you for giving me the opportunity to serve you.