When Gerald R. Williams Jr, MD, delivered his incoming presidential address during the 2016 AAOS Annual Meeting in Orlando last month, he made it clear that sustaining and encouraging unity in the orthopaedic profession would be a major focus in the coming year.
With a large contingent of his own family members in attendance, Dr. Williams emphasized the challenges and benefits of maintaining a close-knit orthopaedic community, drawing inspiration from Charles A. Rockwood Jr, MD, his residency chair, fellowship director, and mentor, who began his tenure as AAOS president in 1984.
More than 30 years ago, Dr. Rockwood spelled out six key areas involved in building and preserving unity in the orthopaedic profession: communication and trust, fellowship certification, the resident and young orthopaedic surgeon, research funding, socioeconomic and legislative engagement, and education.
"All of these have been addressed in many ways since 1984," noted Dr. Williams. "We have achieved a great deal and our Academy's many parts are well integrated and strong; however, there is much left to be done if we are to remain unified within our profession, which I believe is more critical today than ever before."
A history of leadership
Dr. Williams, an orthopaedic surgeon specializing in the shoulder, practices at the Rothman Institute at Jefferson in Philadelphia, where he serves as an attending orthopaedic surgeon in the division of shoulder and elbow surgery. He has held various faculty positions since 1990 and is currently the John M. Fenlin, Jr, MD, Professor of Shoulder and Elbow Surgery at The Sidney Kimmel Medical College at Thomas Jefferson University.
After earning a bachelor's degree in chemistry from Ursinus College in Collegeville, Pa., Dr. Williams received his medical degree, with honors, from Temple University School of Medicine in Philadelphia. He began his postgraduate training with an internship in orthopaedic surgery at the University of Texas Health Science Center in San Antonio, where he later completed a residency in orthopaedic surgery and a 1-year fellowship in shoulder surgery.
Dr. Williams' long history of volunteer involvement includes various leadership roles at the AAOS, such as a 2-year term on the Board of Directors. He also served as chair of the Continuing Medical Education Courses Committee. As an active member of more than a dozen professional societies and councils, Dr. Williams has served as president of the American Shoulder and Elbow Surgeons and has been a member of the Philadelphia Orthopaedic Society (president in 2002), the Pennsylvania Orthopaedic Society (president in 2009), and the Mid-Atlantic Shoulder and Elbow Society (cofounder and president, 2012–2014).
When Dr. Williams has free time, he enjoys spending it with his wife, Robin, and children, Mark and Alexis.
Communication, certification, and the young orthopaedist
Addressing the various challenges facing orthopaedic unity today, Dr. Williams noted that "communication and trust go hand in hand, and we have made great strides with them since Dr. Rockwood's address." In 1984, surgical specialization was underway, "which caused great concern in some quarters," said Dr. Williams. Today, he noted, "there are 23 separate groups on our Board of Specialty Societies, and Specialty Day, held on the Saturday after the AAOS Annual Meeting, provides a platform for orthopaedic specialty societies to meet."
Another important topic—certification—was "not as important in 1984 as it is today," according to Dr. Williams, adding that the number of fellowship positions and programs "has exploded, with approximately 943 positions in 480 programs."
"Accreditation of these fellowships is spotty," said Dr. Williams, noting that the existence of many unaccredited fellowships may be difficult to justify as oversight increases from the public, the government, and third-party payers.
"The AAOS established a Board project team in 2015 to examine an alternate accreditation pathway," stated Dr. Williams, asserting that the AAOS will move forward with this work in conjunction with multiple stakeholders, including orthopaedic specialty societies.
Taking up Dr. Rockwood's third challenging area—meeting the needs of the resident and the young orthopaedic surgeon—Dr. Williams pointed out that, unlike during Dr. Rockwood's tenure as president, the AAOS now has a candidate membership category as well as resident members. The Academy is also working to engage young orthopaedic surgeons through the new Resident Assembly, the inaugural session of which drew nearly 200 resident attendees from more than 125 programs last year. This year's Resident Assembly had an even bigger turnout.
"I'm thrilled by this strong showing of interest in the Academy by our youngest members," he said. "We all know that residents are our future."
Research funding, advocacy, and education
Dr. Rockwood's fourth challenge was to increase support for research funding in the musculoskeletal arena. Despite a great deal of growth in musculoskeletal research funding in the last few decades, "in the context of actual disease and suffering by Americans, musculoskeletal research remains woefully underfunded," stated Dr. Williams.
"We need to make the case to Congress and society at large for more musculoskeletal research support," he said, "and I think we as individuals need to step up our game as well, with greater support for the Orthopaedic Research and Education Foundation."
The fifth unity challenge was to become involved in socioeconomic and legislative issues. In addressing this topic, Dr. Williams pointed to the importance of advocacy as it relates to patients and the profession of orthopaedic surgery. Noting that the AAOS has been very active in the legislative and regulatory arenas, Dr. Williams said that "our political action committee, the Orthopaedic PAC, has become one of the top 10 association PACs and top medical PACs in Washington, D.C."
He called for the AAOS to maintain its partnerships with orthopaedic specialty societies, "especially those that have their own advocacy arms. We must also increase the participation of our members in our PAC," he stated.
Finally, turning to the challenge of the AAOS providing education to its members, Dr. Williams acknowledged that with the current emphasis on digital learning, "competition is fierce and comes from all directions."
"To maintain our strong educational brand and remain the primary source for the highest quality, unbiased musculoskeletal education, the Academy has invested heavily in both time and money to update our website, convert existing educational products to a digital format, shift our educational product development from a product-based process to a portfolio-based one, and create digital, scalable platforms for creation, management, and delivery of learning content," he said. "In addition, we and key specialty societies have invested in a truly spectacular, state-of-the-art Orthopaedic Learning Center with video-streaming capabilities and opportunities for concurrent courses."
Looking to the future
Dr. Williams noted that the AAOS has made great strides in addressing Dr. Rockwood's six challenges.
"It is truly remarkable that the Academy still successfully admits 96 percent of eligible orthopaedic surgeons and retains 98 percent of those," he said. "Other societies would kill for that record; however, the road ahead is far from easy. Our membership has never been more diverse, by specialty, scope of practice, income, practice environment, gender, age, race, or ethnicity."
Delivering value to such a diverse membership poses challenges, noted Dr. Williams, as do external pressures from entities such as the government, hospitals, and insurers.
"We will be most successful if we remember two things: the patient is king (or queen), and there is strength in numbers," he said. "We must remind all those who have lost sight of our role, both outside and within medicine, that we are the patients' advocate—period, end of story.
"As Churchill once said, a pessimist sees the difficulty in every opportunity; an optimist sees the opportunity in every difficulty," stated Dr. Williams. "I am an optimist and I hope you all will join me in embracing the opportunities that await us. Our patients are depending on us."
(Dr. Williams' complete address will appear in the June issue of the Journal of the AAOS.)
Jennie McKee is managing editor of AAOS Now. She can be reached at firstname.lastname@example.org