By Roshan Shah, MD, JD, and John Froelich, MD
Exercise your membership in the American Association of Orthopaedic Surgeons
As residents, we’re very aware of what the American Academy of Orthopaedic Surgeons (Academy) offers us—the best in orthopaedic education, from the Orthopaedic In-Training Exam to the Annual Meeting. But we often overlook the efforts of the “other” AAOS—the American Association of Orthopaedic Surgeons—on our behalf, helping to shape our future by educating and advocating on issues.
Most residents can be isolated from the political aspects of medicine. We hear bits and pieces on the news, at conferences, or when talking to our attending physicians, but these rumblings are only the tip of a much larger iceberg that most of us conveniently ignore until we graduate. Once we start practicing, we may be shocked to discover just how much politics affects the practice of medicine.
Learning about these issues now and becoming involved in the efforts to effect change is something every AAOS resident member can do. One of the easiest and most effective ways to get involved is to donate to the Orthopaedic Political Action Committee (Orthopaedic PAC).
A brief background
The other AAOS, the Association, was founded in 1997 to engage in health policy and advocacy activities on behalf of musculoskeletal patients and the profession of orthopaedic surgery. Its Board of Directors formed the Political Action Committee of the American Association of Orthopaedic Surgeons in 1999 to pool contributions from AAOS members and support candidates who share similar beliefs and values and who can help achieve our legislative objectives. The Orthopaedic PAC does not pick favorites and is not aligned with one particular party; it supports those public officials who support the agenda and goals of the AAOS.
Thanks in large part to the contributions from the Orthopaedic PAC and the leadership provided by the AAOS Council on Advocacy, Board of Directors, Board of Councilors, and Board of Specialty Societies, the AAOS has risen to a relative position of power in Washington, D.C. The Orthopaedic PAC is now the largest among medical specialty societies (Fig. 1).
As Stuart L. Weinstein, MD, current chair of the Orthopaedic PAC, often says, “The PAC opens doors.” Many members of Congress now personally meet with orthopaedic surgeons during organized trips to Capitol Hill; only a few years ago, we were lucky to meet with one of their healthcare staff members. This access, along with our successful advocacy efforts, enables us to educate Congress on the high-quality services we provide for our patients—as well as on the issues that prevent us from providing such care.
No one is immune
As residents, we may be sheltered, but we are still very much affected by the issues that the other AAOS works so hard to address.
For example, patients may not show up for clinic appointments because they were told by their insurance company that such a visit was not ‘necessary’ or would otherwise not be covered. Or we may see a patient who sustained a relatively simple injury a few weeks ago, but didn’t have access to appropriate orthopaedic care and now has a complex and potentially life-altering condition.
To address these issues, the AAOS (through the Council on Advocacy in particular) has worked hard to get the America’s Access to Orthopaedic Surgery (AAOS) Act passed into law. This bill aims to increase awareness in Congress that patients need to have access to high-quality orthopaedic care and that treating musculoskeletal conditions delivers incredible value to communities.
The issue of defensive medicine is also a concern. Every resident knows of instances when additional diagnostic tests were ordered for a patient—even though such tests might be unnecessary from a medical standpoint. One study recently showed that up to one third of all imaging completed in an orthopaedic clinic was for ‘defensive medicine.’ Such acts are expensive and potentially increase the risk of iatrogenic harm to patients, which is why the Orthopaedic PAC and groups such as Doctors for Medical Liability Reform focus on the need for tort reform.
Residents who seek funding for large-scale research projects may believe it’s a hopeless endeavor. The AAOS recognizes the need for large-scale, multicenter research projects in orthopaedics and has successfully advocated for increased funding. For example, federal funding for the National Institute of Arthritis and Musculoskeletal and Skin Disease increased by about 3 percent last year. The AAOS’ focus on extremity war injuries and disaster preparedness has resulted in significant funds through the Department of Defense.
Issues of reimbursement may not directly affect a resident’s salary, but that changes with graduation. As any attending physician or administrator in either private or academic practice can attest, a large part of every day is spent trying to ensure that all parties are properly reimbursed for the services they provide. The AAOS continues its efforts to make sure that orthopaedic surgeons are reimbursed fairly for the work they perform and, through the Orthopaedic PAC, supports members of Congress who are committed to finding a permanent solution to the Medicare reimbursement schedule.
It doesn’t take much
These examples show how the other AAOS is working to improve the care orthopaedic residents provide to patients. Residents, however, can improve our efforts to support that work, simply by donating to the Orthopaedic PAC. Although the Orthopaedic PAC raised almost $4 million last year, only 27 percent of AAOS members donated. By comparison, the American Association for Justice PAC (trial lawyers) raised more than $6 million last year and more than 90 percent of their members routinely contribute to the PAC annually.
Granted, as residents, we typically do not have large amounts of disposable income. But the Orthopaedic PAC recognizes resident contributions of as little as $5. At this stage, a demonstration of orthopaedic unity is just as—perhaps even more—important than the amount given. Showing that orthopaedic surgery residents are actively supporting the advocacy efforts of the other AAOS will have a profound effect on the political climate. Imagine the incremental impact of the Orthopaedic PAC’s message if it could boast the support of 100 percent of orthopaedic residents—the surgeons of the future. Undoubtedly, policymakers and bureaucrats would allocate more time and attention to the orthopaedic message. They recognize that residents are not only the future leaders of the profession, but also their constituents and future leaders in communities.
Other ways to get involved
Residents who are interested in greater involvement may want to explore the National Orthopaedic Leadership Conference (NOLC). State orthopaedic societies will often provide funding for an orthopaedic resident to attend the annual NOLC meeting. Residents can gain firsthand experience of the advocacy efforts of the AAOS and see how leaders within the orthopaedic community interact with members of Congress.
Residents can also apply to become a Washington Health Policy Fellow and formally dedicate their time to learning how healthcare legislation, policies, and advocacy affect the orthopaedic community and patients. One or two fellows are selected each year.
Lastly, we as residents can educate ourselves on the issues or topics that interest us the most and contact our representatives directly. Materials that can be used to educate representatives on the issues that affect orthopaedics can be obtained by contacting Graham Newson at firstname.lastname@example.org
Our orthopaedic residency is an investment in our future, and contributing to the Orthopaedic PAC is no different. Our donations support Congressional members and candidates whose objectives and aims are aligned with our own. We all want what is best for our patients and our profession, so join us by donating to the Orthopaedic PAC and taking an active role in achieving those goals.
Roshan Shah, MD, JD, is a PGY-4 resident; John Froelich, MD, is a PGY-5 resident. Both are currently serving as Washington Health Policy Fellows.