In delivering his address as incoming AAOS president at the 2018 Annual Meeting on March 8, David A. Halsey, MD, invoked a biomechanical principle—Wolff’s law—to describe how under his leadership he envisions an Academy that continues to respond to the various disruptive changes affecting the practice of orthopaedic medicine.

The principle that a bone will adapt to the loads under which it is placed embodies the notion that “form follows function,” Dr. Halsey said. “That’s exactly what’s happening at your Academy today. We are purposefully adapting to those disruptive forces, in order to help you grow professionally and provide the best possible care for your patients.”

Your Academy 2018

Among the dramatic changes that orthopaedic surgeons and other physicians have witnessed in the past two decades, he noted, are an explosion of technology, “the promise of personalized medicine,” the transformation of healthcare delivery and payment, and “an increasing encroachment on the autonomy of orthopaedic practice with the implementation of onerous regulation and unfunded mandates.” The opioid epidemic has only exacerbated the tumult.

In response to these formidable challenges, Dr. Halsey said, “Your Academy is evolving through four strategic initiatives in the coming year:

1. building new, more effective models for governance and strategy,
2. managing orthopaedic tribalism through partnersip,
3. enhancing the value of your Academy relationships, and
4. supporting advocacy through research and quality.”

In addressing the challenges of governance and strategy in the face of factors such as changing member expectations, disruptive technologies, competition within the orthopaedic community, and “the explosion of commercial CME and surgical skills training, Dr. Halsey said, “We need to rethink our approach to governance”—one that in current form was adopted in 1985 “and served us well in simpler times.

“However,” he continued, “I believe the orthopaedic professional society of today, and tomorrow, must respond to member demands more effectively and more efficiently, in order to deliver the optimal member value. Our Board of Directors and council and committee leaders must bring an appropriate mix of diverse orthopaedic practice experiences and competencies to make the best decisions for our members given the resources we have.”

To this end, Dr. Halsey said he will lead the 2018 Governance Review Project Team “to examine the terms, composition, and required competencies of the Board of Directors and other governance structures.”

Your Academy 2018

The desired outcome for this endeavor is “laser-focused”: To erect a new AAOS governance structure that “will be based on the best practices for a 21st century medical professional society,” said Dr. Halsey. Deliberations and decisions will be “data-driven, transparent, and clearly communicated,” and he observed, “We know that diversity and specialized competencies are important in all areas, be it the exam room, the operating room, or the board room.”

The “deep dive” review will ensure that the Academy’s emerging strategic plan, being crafted under the leadership of First Vice-president Kristy L. Weber, MD, “will be successfully executed to meet the diverse needs of our membership and the organization,” Dr. Halsey said.

In regard to the trend of “tribalism” that has arisen with the mushrooming of subspecialization, Dr. Halsey said the orthopaedic profession “has both thrived and suffered.”

Noting that the Academy has entered into a variety of agreements with “our specialty society tribes” that have been beneficial to both partners, he also observed, “Unfortunately some of these collaborations have been less successful, leading to a breakdown in credibility.” A series of partnership summits with specialty societies will seek to establish a revamped culture grounded in a defined set of “principles of engagement.”

Addressing the goal of “enhancing the value of your Academy relationship,” Dr. Halsey noted that the proliferation of educational offerings from both other societies and commercial providers, has forced the Academy to reevaluate its own portfolio of member service. To this end, AAOS will focus on remaining the online hub where members can manage their education activities.

An asset that surgeons can add to to their personal portfolios will be the growing complement of Academy Clinical Registries. “When you enroll your practice and patients in a centralized family of integrated registries,” Dr. Halsey said, “your data will serve many masters.” Participation will enable surgeons to sync with emerging reimbursement paradigms, meet public reporting requirements, benefit from streamlined credentialing, and fulfill maintenance of certification requirements.

Turning to the topic of advocacy as achieved through research and quality, Dr. Halsey implored surgeons to build relationships with policy makers, legislators and regulators “to protect access for our patients to the full spectrum of orthopaedic care they need and deserve.” Advocacy efforts, he said, must promote “two key patient-centered principles”: the use of “best available” evidence to ensure effective and efficient care to those who need it; and support and reimbursement for delivery of this evidence-based care at a sustainable level, with the effect of fostering future innovations.

Dr. Halsey told his audience that AAOS initiatives including quality initiatives like Clinical Practice Guidelines and highly trusted communications to Congress and the U.S. Centers for Medicare & Medicaid Services “have provided you, the practicing orthopaedic surgeon, access to the halls of public policy in your state capitols and in Washington, D.C.”

He said that the advent of meaningful performance outcomes will lead to new cost-effective treatment standards and allow AAOS to “more effectively advocate for the uniquely valuable work we do as orthopaedic surgeons.”

Dr. Halsey closed his remarks with words about his guiding principles, and he left his audience with the following three challenges:

1. Remember to listen to your patients, really listen … for they are your most valuable educational resource.
2. Take a risk and let your voice be heard, through service in various assemblies and boards, wherever you are in your career.
3. Lean in and become engaged in your state orthopaedic society, for truly all politics is local!

“If we embrace these calls to action and seize the day,” Dr. Halsey said, “together we can build on the great accomplishments of our past leaders and mentors.”

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

A New England Physician
Dr. Halsey is the chief of orthopaedic surgery division at Martha’s Vineyard Hospital and a professor in the department of orthopaedics and rehabilitation at University of Vermont College of Medicine in Burlington, Vt. Prior to joining the full-time academic faculty there, he was in a private practice for 18 years in the Upper Valley region of Vermont and New Hampshire.

Dr. Halsey earned a bachelor’s degree at Middlebury College in Middlebury, Vt., and his medical degree from the University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School. He completed a general surgery internship and orthopaedic surgery residency at University of Vermont.

He and his wife, Katie, have two adult children, Stephen and Kirsten, who are both pursuing careers in medicine.