Published 7/1/2012
Frederick N. Meyer, MD; Marty Krawczyk

Preparing Residents for the Challenges of Orthopaedic Practice

For years, orthopaedic training programs have done an excellent job of educating residents on how to diagnose and treat musculoskeletal problems. Graduates of orthopaedic training programs are skilled in surgical procedures of the musculoskeletal system. First-time pass rates on part 1 of the ABOS Certification examination are among the highest of any specialty. But in this increasingly complex world of medical practice, are we truly preparing our residents for practice?

Residents frequently finish their training with little or no education in practice management. Most information comes from anecdotal stories from senior residents, faculty, or, sadly, the school of hard knocks. Few residency programs include any formal training in practice management. As a result, most graduating residents are unprepared for the challenges involved in selecting, or starting and managing an orthopaedic practice. Even though fewer residents are going into solo practice, those who join a group practice or opt for hospital employment can still face many practice management challenges. For the uninitiated, there are many opportunities for costly mistakes.

According to a 2009 Physician Retention Survey conducted by the American Medical Group Association and Cejka Search, 73 percent of all physician turnover is voluntary. In orthopaedics, an estimated half of orthopaedic surgeons will change their practice location within the first 2 years of practice. Such moves can be both emotionally and financially costly and extremely stressful on family life. Not knowing what to look for can frequently result in poor decisions.

Options for learning
Orthopaedic associations have taken steps to address this situation. Both the AAOS and the American Society for Surgery of the Hand offer practice management courses for residents and fellows at their annual meetings. The Orthopaedic Trauma Association has a young practitioners forum. Unfortunately, not all residents can attend these meetings.

The AAOS Now practice management journal club (see “Residents Need to ‘Practice’ Management,” on page 5) is another option for incorporating practice management education into a current program. For a more in-depth program, the Resident Practice Management Lecture Series (RPMLS), a series of webcasts specifically designed to train residents in practice management, is another option. The topics covered in these webcasts are designed to meet the Accreditation Council on General Medical Education (ACGME) criteria for teaching residents systems-based practice. The webcasts cover a wide range of topics, including the following:

  • Tools and techniques for allocating practice resources
  • Understanding financing/insurance structures
  • Practice financials
  • Evaluating risks and benefits of costly prescribing
  • Health system resources
  • Error reduction strategies

The 22 webcasts currently available fall under the following five areas of knowledge that the AAOS Practice Management Committee views as critical to managing the business aspects of a medical practice:

  1. Maximizing current and future practice revenues
  2. Increasing operational efficiency and effectiveness
  3. Achieving compliance with federal and state regulations
  4. Improving patient relations and managing risk
  5. Engaging in ongoing organization development

Each RPMLS webcast is a 20- to 30-minute lecture. Speakers include orthopaedic surgeons, orthopaedic practice administrators, practice management consultants, and AAOS staff. Each speaker is an expert on a particular subject and frequently addresses national meetings on practice management topics.

The webcasts are affordable, easily obtained, and enable programs to prepare residents for the intricacies of orthopaedic practice management.

USA’s experience
The University of South Alabama orthopaedic surgery residency program purchased the RPMLS 2 years ago. Each resident has a personal log-in and can review each topic individually. Then, once each month, the group meets to review one program. We attempt to cover the entire series (all 22 lectures) on a recurring 2-year cycle.

Residents are required to attend these conferences, which are also attended by senior faculty with expertise in practice management. The topic “in focus” is discussed and residents can ask questions of the faculty. We have found this way of incorporating the webcasts into conference discussions to be extremely helpful in preparing our residents for practice. The residents also enjoy these discussions.

In addition to systems-based practice, these webcasts can be used to teach other ACGME core competencies. For example, “Ethical Considerations in Orthopaedic Surgery,” by Howard R. Epps, MD, covers information required for the professionalism core competency. “Communication in Patient Safety,” also by Dr. Epps, and “What Patients Want” by David A. Halsey, MD, covers information on interpersonal and communication skills.

The RPMLS include a wealth of information that will be invaluable not only to residents but also to faculty and those already in practice. New webcasts are added yearly. In addition, the existing webcasts are reviewed and updated as needed to address the ever-changing healthcare environment.

It’s our business
At one medical center, the chair of the pathology department had the residents participate in all department business meetings. When asked why, he explained that graduates were often called upon to be the chief executive officers of multimillion-dollar businesses upon completion of their residency. If they were unprepared to manage these businesses, not only would they have to learn management skills elsewhere but that this could be a distraction from their ability to deliver quality patient care.

Those of us who administer residency programs need to make certain we are not depriving our residents of a learning opportunity that is vitally important to their future as orthopaedic surgeons. The RPMLS is an excellent tool to use for providing residents with this critical information.

For more information on the RPMLS, visit www.aaos.org/rpmls

Frederick N. Meyer, MD, is professor, chair, and the orthopaedic residency program director at the University of South Alabama Health System in Mobile, Ala. He is also a member of the AAOS Practice Management Committee.

Marty Krawczyk is the practice management program coordinator in the AAOS practice management group.

Ledue C: New factors affect physician retention.
Healthcare Finance News, July 14, 2010. Accessed online May 29, 2012: