This year’s graduating class includes six AAOS fellows: (from left to right) Ken Noonan, MD, of the University of Wisconsin; John Macy, MD, chief of orthopaedics at Mansfield Orthopaedics in Waterbury, Vt.; Andrew Pugely, MD, assistant professor at the University of Iowa; Tom McCormack, MD, medical director at the Advanced Center of Hip and Knee Replacement Program in Kansas City, Mo.; Jeffrey Racca, MD, president of New Mexico Orthopaedic Associates, PC, in Albuquerque, N.M.; and Jeffry Menzner, MD, an orthopaedic oncologist, joint replacement surgeon, and director of orthopaedic quality and value at St. Luke’s Hospital in Boise, Idaho.


Published 4/1/2019
Ken Noonan, MD

Fifteen Percent of Dartmouth Master in Health Care Delivery Science Program Graduates Are AAOS Fellows

When most of us started our orthopaedic journeys decades ago, we focused on the research and science of medicine, which, at the time, translated to hands-on medical and surgical care of patients. Since then, many of us have left the business of healthcare delivery up to hospital and practice administrators, who usually have more conventional business education rather than clinical experience. But times have changed: U.S. healthcare costs are higher than in any other country, and our patients lag behind other countries in many health indices. Physicians are working harder in nonpatient-related tasks, being paid less, and experiencing higher rates of burnout.

In some settings, relationships between providers and administrators have become strained. Evolving regulations from the Centers for Medicare & Medicaid Services are passed down to administrators, who are forced to implement changes, often to the chagrin of providers, who feel that administration doesn’t “get it.” But with challenge comes opportunity; with increasing frequency, physicians are gaining the skills needed to contribute to the healthcare delivery area of medicine. There is a critical need for physicians to participate more broadly in redesigning healthcare delivery. As the old expression suggests: We can either be at the table or on the table. More importantly, physicians have experience and values that place our patients’ interests at the heart of what we do, as well as a practical understanding of what is workable in clinical practice. Our voices must be included as we work through this transition.

Traditionally, physician administrators have attained experience through trial and error, as well as extensive years of on-the-job training. Today, however, there are many different educational options for physicians that are geared toward more traditional business degrees. The offerings include master’s-level training such as an MHA, MPH, or MBA with or without a healthcare focus, as well as master’s degrees in medical management programs. Recently, six AAOS fellows completed the 2019 Master in Health Care Delivery Science (MHCDS) at Dartmouth College in Hanover, N.H. It was the program’s largest class of orthopaedic surgeons—15 percent of the entire class.

The cohort of AAOS fellows began their journey due to the belief that “if physicians did not lead reform, they were not going to fare well.” Another reason for participation in the program was the desire to understand and help implement bundled payment plans. The fellows chose the Dartmouth program to improve their knowledge of the business of medicine.

Many excellent master’s degree programs exist to educate people about the current healthcare system. The mission of the MHCDS program at Dartmouth College is to equip leaders to transform the delivery of health care. The program—a collaboration with the Tuck School of Business, Dartmouth Institute, and Geisel School of Medicine—offers an 18-month master’s degree focused on health system transformation, leadership, and management for healthcare leaders.

An interdisciplinary endeavor, healthcare delivery science combines concepts, methods, and tools from medicine, the social sciences, public health, population health, engineering, and business with the goal of improving individual and community health, while reducing waste and harm. Healthcare delivery science seeks to understand the ways healthcare systems may fail to address the needs and wants of their patients and communities and to provide the new skills necessary for better management and leadership of healthcare organizations.

Aimed at an executive-level audience, the curriculum of the MHCDS program is guided by three overarching learning goals:

  • enable students to envision the future of their organizations in the evolving sectors of health and healthcare delivery
  • equip students to lead change in their organizational settings
  • help students meet their own personal and professional development objectives

Envisioning the future requires understanding value in health care, organizational strategy, population health, health economics and policy, and the importance of meeting patients’ goals. Leading change involves organizational behavior, negotiations, teamwork, and management, as well as mastery of a healthcare organization’s functional areas, including finance, marketing, information technology, and service operations. Professional development entails the application of those disciplines and individualized leadership coaching.

Launched in July 2011, the MHCDS program just graduated its seventh class. As of 2019, there are 316 graduates, and the program enrolls 40 to 50 new students each year. Participants include chief executive officers, presidents, executive directors, chief medical officers, and other senior leaders from diverse healthcare organizations such as hospitals, clinics, insurance companies, and government agencies. The program is delivered in a low-residency model; students are on campus for about six weeks over the course of the 18-month program. The greater part of the instruction is delivered remotely and deliberately structures student interaction. Coursework in leadership and teamwork gives students skills and frameworks for building effective teams.

Past AAOS graduates fondly described their time in the program and how it has advanced their careers. Each AAOS graduate said they would enthusiastically repeat the program “in a heartbeat.”

Geoff McCullen, MD (2013), is an orthopaedic spine surgeon who developed OneHealth
Nebraska ( with private practice colleagues across multiple specialties. They recognized that for private practice to successfully compete in the emerging market, they needed to combine difficult activities to drive value for patients. His education at MHCDS helped him understand evolutions in health care and work with colleagues in multiple practices to build a new capability that answered the needs of the market.

Louis G. Jenis, MD (2018), was chief of spine surgery at Massachusetts General Hospital in Boston when he started the Dartmouth program and has since become chief medical and innovation officer at Newton Wellesley Hospital in Newton, Mass. He feels that “the program is important for physicians in all medical and surgical disciplines, but especially in orthopaedic surgery, where there is tremendous opportunity to redesign our approaches to improving value by training individuals in concepts of healthcare delivery science.”

Theresa Hennessey, MD (2017), is the current assistant chief of staff at Shriners Hospital for Children in Salt Lake City, Utah. She felt that the program added to her career by providing a greater understanding of process improvement and efficiency, which helped her establish multidisciplinary clinics and create positions that were true advocates for patients and families.

Alok Sharan, MD (2015), feels that orthopaedic surgeons need to learn how to think about problems at population health and system levels. Creating integrated systems of care, such as the development of a musculoskeletal institute, requires skill sets that are not extensively covered during medical school or residency. “Programs such as MHCDS will be very important in the future as orthopaedic surgeons move beyond the operating room and become system-wide leaders.”

Robert Hart, MD (2018), is the medical director for spinal deformity and medical director for value-oriented architecture at the Swedish Neuroscience Institute in Seattle. “The MHCDS program has given me fresh insights and approaches regarding the need for change within the U.S. healthcare delivery system. The financial pressures for healthcare delivery organizations are intense and mounting. No amount of reshuffling is going to change the need to squeeze cost out of the system in coming years. We’ve essentially transitioned from a ‘cost-plus’ system to one of fixed or diminished compensation in a very short time frame. Add to that a huge and increasing regulatory burden and a surging tide of burnout among healthcare providers, and you have what feels like a tipping point.”

The challenge of the evolving healthcare system requires dedicated clinician-administrator leaders to navigate and advocate for patients. A total of 20 AAOS fellows have completed MHCDS since its inception. Dr. McCullen concluded, “It’s a lifelong project to keep learning and leading, and MHCDS helps to make that possible.”

Ken Noonan, MD, is the director of the Division of Pediatric Orthopaedics at the University of Wisconsin.