Cassim M. Igram, MD, FAAOS, (second from right) with fellow surgeons and several of his orthopaedic surgery residents from the University of Iowa at the U.S. House Speaker’s balcony in 2018 in Washington, D.C. From left: Spencer Dowdle, MD, then-resident; Pat Beulow, CMPE, executive director of the Iowa Orthopaedic Society; Chris Anthony, MD, then-resident; Representative David Young (R-Iowa); Molly Day, MD; Dr. Igram; and Craig Mahoney, MD, FAAOS.
Courtesy of Cassim M. Igram, MD, FAAOS

AAOS Now

Published 12/20/2023
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Cassim M. Igram, MD, FAAOS

Teach Your ‘Children’: How to Encourage Orthopaedic Residents to Get Engaged in Advocacy

Editor’s note: The Final Cut is a reoccurring editorial series written by a member of the AAOS Now Editorial Board.

The song “Teach Your Children” was written by Graham Nash in 1968 and eventually was recorded by Crosby, Stills, Nash, and Young in 1970. Teaching orthopaedic residents is an ongoing process. The surgical knowledge and skills portion is well accepted, but how do we get residents involved in advocacy? Teaching your residents about the importance of advocacy is an ongoing process.

Cassim M. Igram, MD, FAAOS
Cassim M. Igram, MD, FAAOS, (second from right) with fellow surgeons and several of his orthopaedic surgery residents from the University of Iowa at the U.S. House Speaker’s balcony in 2018 in Washington, D.C. From left: Spencer Dowdle, MD, then-resident; Pat Beulow, CMPE, executive director of the Iowa Orthopaedic Society; Chris Anthony, MD, then-resident; Representative David Young (R-Iowa); Molly Day, MD; Dr. Igram; and Craig Mahoney, MD, FAAOS.
Courtesy of Cassim M. Igram, MD, FAAOS

The American Association of Orthopaedic Surgeons (the blue logo) was formed about 20 years ago to oversee AAOS’ advocacy efforts. The Advocacy Council identifies issues and sets policy for the Association. The mission of the Political Action Committee of the American Association of Orthopaedic Surgeons (OrthoPAC) is to fundraise and support candidates who support our causes and deliver our message. OrthoPAC is a nonpartisan organization, and it is extremely important that we maintain this stance, as there are both Democrats and Republicans who support our issues.

Unfortunately, as it stands today, AAOS members have low participation in OrthoPAC, with membership hovering around 20 percent. As a point of reference, the American Bar Association has about 90 percent political action committee (PAC) participation among its members. Despite low participation amongst the fellowship, we are the second highest-funded medical PAC in the country, second to the American Society of Anesthesiologists.

Raising awareness
For the past 5 years, the residents here at the University of Iowa have participated in OrthoPAC at a 100 percent level, and the residency program has been recognized for its dedicated participation at the Annual Meeting. That level of participation did not come by accident.

Each year, I make an effort to educate residents about the importance of advocacy. I share the emails that we get from the Association. From time to time, there is pending legislation that needs our support. I encourage the residents to write to members of Congress and express our concerns on legislation relating to healthcare and orthopaedics. Our voices must be heard. Once our residents understand the issues, then we can build on that knowledge and garner more support for the PAC.

We are fortunate here at the University of Iowa to have Stuart L. Weinstein, MD, FAAOS, on the faculty. As you may be aware, Dr. Weinstein was the second OrthoPAC chairman, serving in that position for 8 years. The OrthoPAC participation awards are also named in his honor. Needless to say, he is well-respected among the residents, and his presence on our faculty has resulted in increased resident interest, awareness, and engagement in advocacy issues. I understand that not every place has someone like Dr. Weinstein on the faculty. However, there are many terrific advocates for AAOS around the country. All it takes is for one person to lead the way, and hopefully others will follow.

Increasing engagement
Once the residents are aware of the issues affecting orthopaedic surgeons, the next step is to get them involved in the process. Several of our residents have been involved in the AAOS Resident Assembly. A couple of our residents have also been AAOS Resident Advocacy Fellows.

For the past 12 years, the Iowa Orthopaedic Society has supported two or three residents, paying their travel expenses to travel to Washington, D.C., for the annual National Orthopaedic Leadership Conference (NOLC). It has become a very popular trip, and we never have a problem getting volunteers. For several of our prior residents, NOLC was their first-ever trip to Washington, and it is a tremendous opportunity to meet with our congressional delegation and also with AAOS leadership. In fact, once we return from Washington, the residents who attended the meeting debrief the rest of the residents and set the stage for the next year.

Typically, the residents who travel to NOLC become advocates within the program and help to build support for the PAC with their colleagues. Peer pressure can be a powerful thing. I must confess that when that approach fails, I have hosted a pizza party in my home once the residents achieve 100 percent participation. As many Academy Fellows may recall, residents can be a pretty hungry bunch, and free food is a powerful driver.

As a whole, residents are keenly interested to learn about advocacy. After all, legislation that is passed now will likely affect their practice for years to come. The feedback we have received on our advocacy education is always positive.

Recognizing success
Our success does not go unrewarded. Each year, OrthoPAC sponsors a resident reception at the Annual Meeting. I have attended several of these events and have brought along my residents as well. As I mentioned earlier, the residency program has been recognized for the past several years at the Annual Meeting for our participation. It is a source of pride among the residents.

Success breeds success. When residents are educated about advocacy early in training, they become aware of the issues and policies that will impact their ability to care for patients in the future.

Once they leave our program, I encourage them to continue their engagement by becoming involved in their state orthopaedic societies or perhaps the AAOS Board of Councilors. Hopefully, over time, they can assume leadership positions.

As the next generation enters practice, they can again “teach their children well” to continue the cycle of leadership.

Cassim M. Igram, MD, FAAOS, is a clinical professor in the departments of orthopaedic surgery and neurosurgery at the University of Iowa. He is a member of the AAOS Now Editorial Board, treasurer of OrthoPAC, and a member of the AAOS Committee on Professionalism.