Orthopaedic residents can help shape the future of medicine through healthcare advocacy

Editor’s note: This article is the first in a series on the importance of healthcare advocacy for orthopaedic surgery residents. Part two explores the skills residents gain from engaging in healthcare advocacy. The next article in this series, which focuses on Medicare physician payment reform, will be published in an upcoming issue of AAOS Now.

In the ever-evolving healthcare landscape, empowering the next generation of orthopaedic surgeons to be active advocates is becoming increasingly crucial. Recognizing this, the AAOS Resident Assembly Health Policy Committee is launching a series of articles in AAOS Now focused on resident participation in advocacy. This series comes at a pivotal time, as the new administration moves quickly to implement its agenda, including the sweeping healthcare reforms recently passed in the “One Big Beautiful Bill” and other regulatory and legislative policy proposals that will significantly impact the future of orthopaedic practice.

At the AAOS 2024 Annual Meeting, the committee surveyed resident delegate members to establish a baseline understanding of residents’ engagement and perspectives on health advocacy and policy. The survey results revealed some intriguing insights. Notably, 59.5% of respondents reported never having participated in advocacy during their orthopaedic residency. However, 51% believed that orthopaedic surgeons should engage in advocacy during residency, while an additional 40% thought involvement should begin even before residency. Although these responses came from a select group of residents active in the Resident Assembly, they indicate a strong interest in and desire for greater engagement in health advocacy related to orthopaedics at the resident level.

In response to these findings, this upcoming series will cover a range of topics, including:

1. The importance of resident involvement in advocacy
2. Perspectives from residents nationwide on key AAOS advocacy issues
3. Opportunities for engagement
4. Past examples of resident involvement in advocacy and with the Political Action Committee of the American Association of Orthopaedic Surgeons (OrthoPAC)

The articles will focus on key issues, including Medicare physician payment reform, prior authorization burdens, physician-led hospitals, and workplace violence, among other policy matters relevant to orthopaedics, and why residents should not only care about these issues but actively engage in advocacy to ensure ideal circumstances later down the line in their practice.

This series will aim to highlight the critical role of resident participation in advocacy and provide valuable insights into how early career involvement can shape the future of orthopaedic surgery and healthcare policy.

Staying up to date on key issues
Being knowledgeable about policies that affect orthopaedics is a great first step to getting involved, and many residents may not be exposed to advocacy until later in their careers. AAOS’ federal advocacy efforts aim to create a healthcare environment that supports orthopaedic surgeons in providing the highest quality care to their patients. By addressing these key issues, AAOS works to meet the needs of both physicians and patients, promoting a healthcare system that is both efficient and effective.

AAOS resident members have numerous resources at their disposal to stay informed about advocacy initiatives. First, residents can read the Office of Government Relations’ bi-weekly Advocacy Now e-newsletter. Sent every other Friday, the newsletter provides brief recaps of recent legislative, regulatory, and political developments, along with opportunities to directly engage in healthcare advocacy.

The Office of Government Relations also recently launched two new digital resources for members to stay informed about healthcare policy: a new X account (@AAOSAdvocacy) dedicated to the latest health policy news and updates and the all-new Advocacy Action Center (aaos.quorum.us). Through the new Action Center, it is easier than ever for members to look up where their legislators stand on AAOS’ priority legislation and engage directly by sending pre-drafted emails to lawmakers, posting on social media, requesting in-district meetings, and much more. Members can also use the Action Center to share their own personal stories, in writing or video, of how health policy issues are impacting them and their patients. In addition to these resources, members can also learn more about advocacy issues by listening to past episodes of the AAOS Bone Beat Podcast.

Payment reform
Payment reform is a significant focus for AAOS, as fair reimbursement policies are essential for the sustainability of orthopaedic practices. AAOS works to influence Centers for Medicare & Medicaid Services (CMS) policies to ensure that orthopaedic surgeons receive adequate compensation for their services. This includes advocating for long-term payment reform and inflationary updates to the Medicare Physician Fee Schedule tied to the Medicare Economic Index. Additionally, AAOS advocates for adjustments to the Quality Payment Program, which includes Merit-Based Incentive Payment System, Advanced Alternative Payment Models, and other private payment systems to reflect the actual cost and value of orthopaedic care. By promoting payment models that reward quality and efficiency, AAOS aims to improve patient outcomes and reduce overall healthcare costs.

Physician administrative burden relief
Reducing administrative burdens on physicians is another priority for AAOS. Excessive paperwork and regulatory requirements can detract from patient care and increase burnout among orthopaedic surgeons. AAOS advocates for reforms in health information technology to streamline administrative processes and reduce the time physicians spend on nonclinical tasks. This includes pushing for the simplification of electronic health records systems and advocating for antitrust reforms that promote competition and innovation in the healthcare industry. Additionally, AAOS recognizes that workplace safety is crucial for physician well-being and patient access to quality care and remains deeply concerned about the increasing incidents of workplace violence against healthcare workers. To address this issue, AAOS actively advocates for comprehensive workplace safety measures.

Physician-led hospitals
Physician ownership is a critical aspect of orthopaedic practice, allowing surgeons to have control over ancillary services such as imaging centers, physical therapy, and outpatient surgery centers. This control is essential for providing comprehensive, coordinated care to patients. AAOS advocates for policies that protect and promote physician ownership to ensure that orthopaedic surgeons can continue to offer high-quality, integrated services that are both efficient and effective. This advocacy includes opposing legislation that restricts physician ownership of ancillary services and supporting laws that facilitate physician investment in these areas.

Access to quality care
Ensuring access to quality care encompasses a wide range of advocacy efforts. AAOS works to secure funding for musculoskeletal research and supports regulations that ensure the safety and efficacy of drugs and medical devices through the FDA. Medical liability reform is also a key issue, as it seeks to reduce the risk of frivolous lawsuits and lower malpractice insurance costs, which can be a barrier to care. Additionally, AAOS promotes policies that improve access to graduate medical education, ensuring a steady pipeline of well-trained orthopaedic surgeons. The maintenance of comprehensive registries and research appropriations further helps in tracking outcomes and improving care standards.

Orthopaedic residents represent the future of the profession, and their early engagement in advocacy is essential to shaping a healthcare system that supports both surgeons and their patients. By staying informed, leveraging available AAOS resources, and actively participating in policy discussions, residents can ensure their voices are heard on issues that will directly impact their careers and patient care. As this series will demonstrate, involvement in advocacy is not only a professional responsibility but also an opportunity to drive meaningful change, safeguard the future of orthopaedic practice, and uphold the highest standards of musculoskeletal care.

OrthoPAC is affiliated with and connected to the 501(c)(6) Association. OrthoPAC is not connected to or affiliated with the American Academy of Orthopaedic Surgeons, which is a 501(c)(3) organization.

Nadiya Yerich, MD, is an orthopedic surgery resident at Brooke Army Medical Center in San Antonio, Texas, and a member of the AAOS Health Policy Committee.

William Hill, MD, MPH, is an orthopedic surgery resident and member of the AAOS Health Policy Committee.

Bradley Lezak, MD, MPH, is an orthopedic surgery resident at NYU Langone Orthopedics in New York City and a member of the AAOS Now Editorial Board as well as the AAOS Health Policy Committee.

Joseph Bosco III, MD, FAAOS, is a Professor of Orthopedic Surgery, Vice Chair of Clinical Affairs, and Director of Quality and Patient Safety at NYU Langone Orthopedics in New York City, as well as former AAOS President (2020-2021).