After being named the latest Orthopaedic Political Action Committee (OrthoPAC) Resident Fellow on the AAOS PAC Executive Committee in the spring of 2019, I knew there were big shoes to fill. My predecessors, Chad Krueger, MD, FAAOS, and Jake Calcei, MD, had done an excellent job advancing residents’ roles in the advocacy process. Resident participation within the PAC was on an upward trajectory, and OrthoPAC leadership was ready to make that next big leap forward. When the coronavirus pandemic derailed our plans, including local celebrations for Gold residency programs and our Fifth Annual Resident Leadership Reception at IceBar Orlando, our focus needed to shift quickly. I am extremely proud of the work we have done in the past two years under these unprecedented circumstances.
Now more than ever, residents’ voices are vital to the OrthoPAC Executive Committee. The healthcare policy landscape is ever-changing, and the nation is very polarized on issue priorities and political ideologies. Important decisions are being made, almost daily, about the future of our profession and how we will be able to care for our patients. As residents and fellows, we are the future of orthopaedics. We must play a key role in the direction of our organization and health policy decisions; it is the role of the PAC Resident Fellow to provide this voice.
In 2019, the PAC had its strongest year of resident participation to date. More than 400 residents from 74 programs joined the PAC and made their voices heard. Most impressively, the PAC had more than 10 residency programs reach Gold status by having 100 percent of residents join the PAC. Gold-level participation was the highest ever recorded and was only possible due to the hard work of resident leadership at these programs.
In 2020, our world was turned upside down. Our training was interrupted, and many orthopaedic residents found themselves on the front lines, battling the coronavirus pandemic. All in-person events were canceled, including the AAOS Annual Meeting and the National Orthopaedic Leadership Conference (NOLC), which are the two largest resident events. Although that significantly curbed our efforts, residents once again stepped up to the challenge. Even in these trying times, more than 360 residents committed to advocating for our patients and profession. The PAC proudly recognizes the Gold, Silver, and Bronze programs of 2020 (Table 1). These groups, along with the 10 Gold programs in 2019, will be recognized at the AAOS 2021 Annual Meeting in San Diego, taking place from Aug. 31 to Sept. 3.
Overall, the PAC maintained its strong voice in Washington, D.C., representing the leaders in musculoskeletal care. Credit must be given to the AAOS Office of Government Relations (OGR) staff, who found innovative ways to stay involved and make musculoskeletal priorities heard. Even in the middle of a global pandemic, more than $3.7 million was raised, with $2.4 million dispersed to physician-friendly candidates. These nonpartisan efforts included support for 139 Republican and 114 Democrat candidates.
2020 events and activities
Like everyone else, the pandemic forced the PAC to think outside the box when it came to providing worthwhile programming for members. With the leadership of AAOS President Daniel K. Guy, MD, FAAOS, the PAC held its first-ever virtual In-District Advocacy Event in August 2020. The event was hugely successful and allowed the PAC to have an even larger footprint and impression than the usual in-person NOLC event. The monthlong event resulted in an unprecedented amount of face-to-face, albeit virtual, contact between members of Congress and AAOS residents. Without having to take time off and travel to Washington, D.C., many more meetings were possible. Overall, the In-Distract Advocacy Event resulted in 1,400 orthopaedic surgeons advocating for patients, 4,200 letters sent to policymakers, and more than 150 meetings attended with members of Congress.
The PAC also held its first virtual Specialty Speed Dating event in the fall of 2020—a perk for all resident PAC members. In a new and innovative format, the PAC hosted leaders from the American Shoulder and Elbow Surgeons, American Society for Surgery of the Hand, American Orthopaedic Foot & Ankle Society, and American Association of Hip and Knee Surgeons. Residents rotated in small groups in an open format to speak and establish long-term mentoring opportunities with fellowship directors from each of those orthopaedic subspecialties. Attended by residents from across the country, the event was hugely successful and provided a chance for residents to not only receive small-group mentoring as they look to choose their subspecialty fellowships, but also learn about the importance of advocacy and the role of the OrthoPAC.
Resident involvement in policymaking
As a resident, you may think that advocacy does not affect you and is something you “can worry about later.” This mentality could not be further from the truth, and the pandemic has only reinforced this. In 2020, a record amount of legislation passed through Congress that directly affects orthopaedic care, including the extensive COVID-19 relief packages, which provided orthopaedic surgeons access to the Paycheck Protection Program, expanded telehealth capabilities, relief from burdensome prior authorization processes, and medical liability protection for volunteers. Cuts to Medicare reimbursements were also a critical issue, with significant reductions slated for orthopaedic procedures in 2021. The PAC team worked diligently with members of Congress to successfully mitigate and delay those cuts.
Another significant accomplishment in 2020 included passage of legislation that ends surprise medical billing, for which the PAC has advocated strongly. The legislation that finally passed as part of the combined $900 billion COVID-19 aid package and $1.4 trillion omnibus spending bill represents a multiyear effort of the OGR to successfully lead the discussion on ending the harmful insurer practice. Ultimately, physician- and patient-friendly language and AAOS principles were contained in the final bill, including a process for independent dispute resolution and the removal of a federal benchmark for out-of-network bills.
The large burden of student loans is real and can be the cause of significant stress for many orthopaedic residents. Temporary relief was granted in 2020, with new extensions through September. All payments on federal student loans have been halted without accruing interest. With the new administration, a renewed interest in tackling the massive student loan debt has come to Washington, D.C. Stay tuned for further developments, because this conversation is not over.
How to get involved
There are multiple avenues for residents to be involved with advocacy. The Resident Assembly Health Policy Committee is a great starting point, and any resident can join by registering online. If you want to learn more about advocacy, consider taking the online Health Policy Milestones module, which can be found at learn.aaos.org. Finally, consider becoming a member of the OrthoPAC, and learn more about how to get involved by visiting the PAC Resident Toolkit.
Kevin Cronin, MD, is the current AAOS OrthoPAC Resident Fellow and a shoulder and elbow fellow at the Rothman Orthopaedic Institute in Philadelphia. He will be starting his practice at the Florida Orthopaedic Institute in Tampa, Fla., in the fall of 2021.