The Academy’s first comprehensive, multiyear international business plan was developed 20 years ago by the AAOS International Committee, then chaired by Theodore R. Waugh, MD. That original plan served as a springboard to enhance the Academy’s presence in the global community and as a blueprint for continued expansion.


Published 8/1/2013
Joshua J. Jacobs, MD

Front and Center on the Global Stage

In the global orthopaedic community, few organizations are better known or more highly regarded than the AAOS. The Academy is viewed as a leader, particularly in its educational offerings—from periodicals such as the Journal of the AAOS to books such as Orthopaedic Basic Science, and from instructional courses to the Annual Meeting.

Joshua J. Jacobs, MD

But much has changed since the plan was last updated, and the AAOS is once again looking at international initiatives with a strategic eye. At a board workshop in December 2012 and again during the June board meeting, discussions focused on how we could move to the next level and leverage our experience and expertise to benefit our patients and our members—both in the United States and abroad.

During those sessions, your board heard from other medical associations that have a significant international presence so that we could learn and benefit from their experiences. We also heard from Nikki Walker, global vice president, association management and consulting, MCI Group, who provided an excellent analysis of various international markets and strategies for capitalizing on them. In this column, I would like to share some of those insights with you.

Growing for the future
Although nearly all board-certified orthopaedists in the United States are members of the AAOS, limits on graduate medical education, orthopaedic residency programs, and orthopaedic fellowships mean that U.S. membership will grow slowly. Someday—perhaps sooner rather than later—U.S. membership alone may not be sufficient to support the Academy’s programs. A reasonable, well–thought-out strategy for international growth will likely be vital for the AAOS to maintain its leadership position.

Currently, international affiliate members account for approximately 17 percent of AAOS membership; in other medical associations, international memberships account for 7 percent to nearly 40 percent of total membership. Nearly half of the Academy’s international members come from just 10 countries; Latin American countries—Brazil, Mexico, and Argentina—account for nearly a quarter of all international memberships.

One of every five international members who attend the AAOS Annual Meeting is from Latin America, which also accounts for nearly a third of all international revenues. Obviously, our neighbors in the Americas present a key opportunity for future growth.

During the board workshop, we heard from the American College of Cardiology (ACC), which allows the establishment of international chapters in countries around the world. Currently, the ACC has 25 international chapters, which have triggered significant membership growth over the last 3 years.

Education as our mission
International participation in the AAOS Annual Meeting is strong; about a third of all physician attendees at the AAOS Annual Meeting are from countries other than the United States.

For the 2013 Annual Meeting, the Central Program Committee received six applications for Instructional Course Lectures from international members—and all six were accepted. More than a third of the 1,300 abstracts accepted for scientific papers and/or posters had international coauthors.

We know that orthopaedic surgeons in other countries are hungry for knowledge and skills (Fig. 1). These surgeons are looking for tangible products and skills that will make a difference in their daily professional lives and in the way they treat patients. And, just as in the United States, these surgeons have different learning preferences. In many areas of the world, face-to-face learning is preferred over online learning, although a combination of face-to-face and online learning is often acceptable.

For this reason, the AAOS currently conducts approximately 15 international education programs each year and has established educational programming partnerships with more than 35 different nations. These programs cost the Academy less than $100,000 a year to run; the bulk of the expenses, including faculty travel, housing, and program logistics, is covered by the host nation.

Attendees at these programs eagerly purchase any available AAOS educational materials; in the past 5 years alone, countries in which the AAOS has conducted educational programs have generated almost $8 million in revenues to the Academy.

This year, the introduction of the “Best of the AAOS” brings key elements of the AAOS Annual Meeting to new audiences. This new product combines a patient safety–focused instructional course lecture, a symposium reviewing the best posters and papers of the meeting, and access to the iPosters. In the future, purchasers will be able to customize the product (within specific guidelines), bringing the best in orthopaedic education to surgeons around the world.

Innovative programs, such as our international scholarships and train-the-trainer multiyear programs, have helped build alliances around the world. In Vietnam, a multiyear surgical education program has focused on patient safety issues, resulting in greater attention to sterile techniques, adoption of the “sign-your-site” protocol, and reductions in infections.

But we’ve learned that we can—and must—do better in developing and building local partnerships and programs. In particular, with a revised strategic plan in place, the AAOS can help the global community of orthopaedic surgeons respond to the evolving needs of our profession. An integrated education strategy will benefit both U.S. and international members.

A humanitarian focus
All this can be accomplished without losing the humanitarian focus that engages your Academy and your colleagues on behalf of patients in need. In fact, because “one size does not fit all,” the use of external, globally recognized rankings (such as the World Bank’s list of low-income countries) may help the AAOS establish education and pricing models suitable for various markets.

Naturally, in the event of a true disaster—such as the Haitian earthquake in 2010—the AAOS stands ready to provide support, both to our members who volunteer for disaster relief and to the victims themselves.

Orthopaedic surgeons around the world share our own commitment to improve the musculoskeletal health of patients and improve their lives. They want to acquire the surgical skills that will enable them to treat devastating injuries; they want to learn how to reduce surgical site infections and improve patient safety. As the AAOS develops an international strategy, we will aim to help them meet those goals, without losing sight of the needs of our U.S. members.