New AAOS board member Yale A. Fillingham, MD, offers an EBQV perspective

At a Glance

• New AAOS Board member Yale A. Fillingham, MD, FAAOS, emphasizes the value of evidence-based guidelines in helping surgeons navigate an expanding body of orthopaedic research.
• Drawing on his experience with the Evidence-Based Quality and Value Committee, he highlights how collaboration among subspecialty societies strengthens clinical guidance and quality initiatives.
• As the Board’s member-at-large under 45, Dr. Fillingham aims to bring the perspectives of early- and mid-career surgeons into AAOS leadership.

Estimated read time: 4 minutes

Yale A. Fillingham, MD, FAAOS, new AAOS member-at-large under 45, recalls the day his Academy Residency credentials arrived. “It was really that day, even more so than probably residency Match Day, that I felt like I was truly becoming an orthopaedic surgeon.”

After completing his undergraduate studies at Dartmouth College, Dr. Fillingham spent two years in management consulting in New York City. He shifted gears to attend medical school at Rush Medical College and residency at Rush University Medical Center in Chicago, followed by fellowship training in adult reconstruction at the Rothman Institute.

Dr. Fillingham’s first attending position was at Dartmouth Hitchcock Medical Center, where he worked with the chair of orthopaedics, David S. Jevsevar, MD, FAAOS. Dr. Jevsevar has a rich career as an expert in orthopaedic quality and value, serving many roles in AAOS, including chair of the Research and Quality Council. Through this mentorship, Dr. Fillingham learned how to contribute to the orthopaedic profession through involvement in AAOS. Currently, he practices adult reconstruction at the Rothman Institute in Philadelphia, helping to oversee the Research Department as vice chair of research, and also oversees the division as the chief of adult reconstruction surgery.

Evidence-Based Quality and Value Committee
The Evidence-Based Quality and Value (EBQV) Committee was Dr. Fillingham’s entrée into AAOS participation. He summarizes EBQV as an AAOS effort to help surgeons decide which treatments to consider for the best treatment outcomes and which treatments not to consider. He views the committee as a “… hidden secret [of AAOS] membership,” saying that despite the output of the group, most AAOS Fellows are not aware of how it works.

Using an example of NSAIDs in total joint replacements, Dr. Fillingham notes there is an overwhelming body of evidence that surgeons must distill. “It’s not possible for you to know if that one study truly represents the best available evidence out there on that topic or if it really represents the summation average on the topic in terms of clinical outcomes,” he said. This, Dr. Fillingham continues, is what EBQV provides. “[A] PubMed search for NSAIDs and total hip and knee replacements [will] get back close to over 2,000 hits. There is no way for you to go through all 2,000 of those articles on your own,” he said. “This committee does that for [surgeons] and really distills it down.” Dr. Fillingham credits the dedicated staff members behind the scenes and makes a plug for interested Fellows to consider applying to the EBQV: “When you’re having a conversation … with the patient on that topic, you can actually say you helped write the national guidelines.”

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Related Content

• American Academy of Orthopaedic Surgeons names Yale A. Fillingham, MD, FAAOS, to Board of Directors (AAOS Now)

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Across the MSK community
Dr. Fillingham reflected on the AAOS strategic goal of building relationships across the MSK community, noting “We’re all going to succeed together, or we’re not,” and offered his family business as an analogy for the relationship between AAOS and the specialty societies. In 1914, his great-grandfather started manufacturing parts for heavy machinery companies. Generations of his family, now his brother and cousin, have run the company, during which time the landscape of manufacturing has changed. Whereas the company could once compete across the board, domestically and abroad, it has evolved to focus on its strengths and recognize what is being done more efficiently by competitors. Small, high-volume accessory parts of large machinery are now more efficiently produced overseas, while for very large, costly machine parts such as engine housings, the family business in Illinois remains competitive.

“I see that as very similar to how [AAOS] and the specialty societies can work together, [with] [AAOS] as a strong, central resource, or even a kind of center of collaboration for all of our societies,” he said. “At the end of the day, we did not complete a hand residency, a joint residency, [or] a sports residency. We all completed orthopaedic residency, making us all orthopaedic surgeons.”

As a further analogy, Dr. Fillingham compared orthopaedics to an orchestra. “We all have a role together, much like an orchestra,” he said. “The specialty societies are the individual instrumental sections, and [AAOS] can be the conductor, and because without [both], there really is no harmony present.”

His experience on EBQV further informs his perspective. The staff resources include research librarians, analysts who pull data, statisticians, and content experts assessing study grades and methodology. A single subspecialty would not be able to support that infrastructure, but collaboration with AAOS magnifies the value of Academy resources. Dr. Fillingham recalls working with the Pediatric Orthopaedic Society of North America, the American Association of Hip and Knee Surgeons, and the Musculoskeletal Tumor Society, among others, to produce guidelines that the specialty societies believe provide impact.

For most workers, age 45 feels solidly mid-career, but in the designated under-45 seat on the Board of Directors, Dr. Fillingham provides the perspective of the younger surgeon. “It’s kind of comical, but you feel like you’re just starting your job approaching 45,” he admits. “I think of an old saying, ‘Where you stand depends on where you sit,’ and I think age is one of those factors that can be very influential — where you are in your practice and how you think about things. I really want to be somebody that’s going to represent my generation of surgeons on the board, so our voices are heard and our perspectives can be brought into the conversation.”

Alexandra E. Page, MD, FAAOS, is a foot and ankle specialist in private practice in San Diego, California, and the editor-in-chief of AAOS Now.