William A. Hazel Jr., MD, is sworn in as Virginia Secretary of Health and Human Resources as his wife, daughter, and son look on.
Courtesy of Warren Mattox

AAOS Now

Published 3/1/2010
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Terry Stanton

Virginia governor appoints orthopaedic surgeon to cabinet

William A. Hazel Jr., MD, takes government post

Orthopaedic surgeons in Virginia have seen one of their own join the upper levels of state government. Republican Gov. Bob McDonnell, whose election drew national attention, named William A. Hazel, Jr., MD, the state’s secretary of health and human resources.

Dr. Hazel started a solo practice in northern Virginia that has grown into a group of 41 physicians in 11 locations. He has had a long history of participation in the American Medical Association (AMA), rising from a state delegate to the board of trustees and secretary.

Dr. Hazel says he had known the governor “a little bit” from his days dealing with the Virginia legislature for the state medical society. He received the call about his position in late January 2010. “I was in the operating room 2 days before the job and then for 6 cases the week after,” he said.

The Department of Health and Human Resources oversees a variety of programs in Virginia, including Medicaid and services for families and children. It has 17,800 employees and accounts for 25 percent of the commonwealth’s general fund.

AAOS Now spoke with Dr. Hazel about his new post.

AAOS Now: What do you view as the major issues in Virginia now?

Dr. Hazel: Obviously, the crisis we have right now is the budget deficit. The recession certainly has hurt Virginia—tax revenues have dropped, and funding for public programs that support social services and medical care has diminished, while, at the same time, the need for these programs has increased. We are wrestling with how to restructure services to reduce expenses. At the same time we’re dealing with more need and trying to do more with less.

From my standpoint, I really see how fragmented our delivery of health care is, and I think over time we’ve become prisoners of the system. The downside of all that is what we see every day: Costs have gone up, and people are unhappy with the service. Patients think that physicians are great and the technology we employ is wonderful. But the system is almost inaccessible at times. It is complex and not user-friendly for patients.

The challenge is to figure out how to organize ourselves, whether in our practices or in information technology, so that as patients move through the system and points of expertise, everything comes with them and it’s easier. When my mother had her gallbladder removed a few years ago, from the time she called me about the pain to her eventual surgery 5 or 6 weeks later, she saw 13 doctors at multiple facilities, with multiple lab tests.

When my grandfather was a surgeon, you’d have gone in, seen him, and had surgery. Now we have technology that makes it outpatient surgery, with remarkable advances. But it was hard for her to get there, even though I was helping her. How do most people manage to progress through the system? From an orthopaedic standpoint, providing specialty care, we have to ensure that there are people who can help patients maneuver through the system.

AAOS Now: A system where someone would have to see that many specialists doesn’t seem to make much economic sense, does it?

Dr. Hazel: That is part of the problem. These specialist sites were not interconnected, and at each site, patients had to fill out the same information. My mother was home in two hours after her surgery, but it took weeks to reach the point where her suffering could be relieved.

I would like to see government make it easier. In medicine, we sometimes practice in silos as opposed to cross-specialty. For one-stop treatment centers you have regulatory issues, such as certificates of need, and payment structures won’t allow you to have multiple procedures performed on the same day. These are just two examples that trap well-meaning people in a bad system.

From an orthopaedic standpoint, specialization has a lot to commend it. People get to know an area, perform volumes of surgeries, do well, and be very comfortable. That helps us provide the care that we’re comfortable providing; we can be sure we are doing the right things. The difficulty is how you balance specialization with the fact that care becomes increasingly fragmented to our patients.

AAOS Now: Do you feel prepared for the administrative aspect of the job?

Dr. Hazel: My career track has actually had several aspects to it. One is the practice of orthopaedic surgery, which I would say I was doing until about 10 days ago. I think I’ve done my last cases, at least for awhile.

I also started a private practice and helped grow our group to about 40 physicians. We have operating rooms, physical therapy, and other services, so I have some leadership and organizational experience from that. Plus, I came through the ranks of hospital administration.

My work with the Medical Society of Virginia and the AMA has been quite an education on leadership and management. I think it is going to serve me well. I also read a lot, particularly on management and leadership. I have tried to put what I have learned into practice.

AAOS Now: How does it feel to come in on this wave of history, with Virginia electing a Republican governor after voting Democratic for president and then with the new governor giving the response to the State of the Union address?

Dr. Hazel: It is an exciting time to be involved in the transition. The appointment was quite last minute. We had the inauguration and, within short order, the governor was asked to give the response.

From a Republican standpoint, the U.S. Senate election in Massachusetts changes things. It creates opportunities in the health system. Reform debate might include and consider options that weren’t really being considered previously. The Democrats now have to reach out, and the Republicans also have a responsibility for solving some of the problems related to insurance markets, denials of coverage, and, frankly, expanding access to health insurance.

I personally go back to the original AMA values of individually purchased insurance and favor changing the tax deduction to encourage individuals to purchase their own insurance and creating the markets where people can buy their own insurance.

AAOS Now: You’ve served in the state medical society, the AMA, and now the Virginia government. What would you say to other physicians about expending that kind of time outside of your practice?

Dr. Hazel: I would not be here without the experiences I had in the Medical Society of Virginia and the AMA. You get enormous civics lessons by participating. You also get a real education on the issues—a nonpartisan, comprehensive view of medical and social issues. The preparation I received from AMA staff was phenomenal. Also, the political processes that you go through—the conditioning, the speaking, working in meetings, particularly as you rise in leadership levels—is good training for this type of work. Now, I’m only into it 2 and a half weeks; we’ll find out whether it’s enough or not. But I feel prepared.

It’s going to be a real challenge. I’m hoping that the economy picks up and with that we have the flexibility to do some creative work in Virginia. I’m really honored to have the opportunity.

Terry Stanton is senior science writer at AAOS Now. He can be reached at tstanton@aaos.org