Addressing the Burning Issues

In February 2007, the 75th president of the American Association of Orthopaedic Surgeons (AAOS), Dr. James H. Beaty, was inducted into office. 12 months on, EHM is keen to find out what have been the highlights of his presidential year – and whether he would have liked to achieve more.

EHM. When you took on the role of AAOS President, you said that one of your key issues was the growing crisis in trauma care and on-call orthopedic services. How has this crisis been addressed since then?
JB. A decreasing number of orthopaedic surgeons are willing to take calls to address the trauma issue. This has to do with a couple of factors. The first one is specialization. More and more orthopaedic surgeons who are specializing do not want to be providing trauma care. They have been fellowship trained in some other area of orthopaedics.

The second issue is medical liability. Patients who are seen and treated in the emergency department are perceived to be more litigious than patients whom you’ve developed a relationship with in practice.

The third reason is a lifestyle issue; trauma care is considered to be a disruption of the lifestyle and practice by the typical orthopaedic surgeon.

In October 2006, we formed a project team that reported to the members. In essence, the message of the academy was that orthopaedic surgeons are the best qualified to provide trauma care for patients. Also, that solving the on-call issue is not something that can be mandated at the federal level; it’s something that is going to have to be solved community by community because there’s no way the solution’s going to be the same in a community with 30,000 people that it will be in a city with three million people.

Orthopaedic surgeons should take the lead in trying to solve those issues in their own community while we as the academy will continue to work on medical liability reform and reimbursement and other issues that affect orthopaedic surgeons directly.

In the past year, the situation has improved in many communities where orthopaedic surgeons have been given information about how to try to directly resolve the problem in their community; and when they become engaged and involved, things typically do get better.

EHM. What have been your efforts to improve physician education?
JB. In November 2007, we gathered many leaders and educators from all areas of orthopaedics and many others areas of medicine and had a one and a half day retreat to look at the topic of physician education. The conclusion that came out was that physician education will slowly evolve as the efforts of maintenance of certification change in this country. The physicians will have to put much more effort into their continuing medical education and documentation to prove for it. We’re working closely with the American Board of Orthopaedic Surgery to make certain that we can provide that information and those vehicles to our members.

Another conclusion was that there will be many opportunities for education using the Internet, but physicians are going to continue to want to meet for both didactic sessions and interchange of information.

The third and most important thing that came out of this meeting was that the concept of self-assessment is going to change dramatically. It is going to turn into what some people call ‘continuous professional development’. In other words, physicians will use self-assessment to determine where their strengths and weaknesses are in their cognitive knowledge base, and then they will use that to shape their education rather than just saying we did it as part of our maintenance of certification.

EHM. Another key issue was to determine how the AAOS would be involved in the assessment of new technology, new procedures and new devices. One year on, is your role an active one?
JB. Yes. For the most part, the academy has been silent on new technology and new devices, mainly because it’s a very complex issue and there are so many financial and legal obstacles to becoming involved in technology assessment.

The reason we now decided to venture into technology assessment is that most orthopaedic surgeons would like to see the academy be some type of resource for new technology or new procedure assessment because they consider us to be a nonbiased and credible source of information.

In April 2007, we gathered physicians and thought leaders from many areas including the orthopaedic industry, government, payors and insurers to evaluate technology assessment. At the end of that, we decided to dip our toe in the water rather than dive into the deep end; so we are going to slowly begin technology assessment in a very deliberative manner. We’re not going to represent any individual physician or individual company; we’re simply going to try to have our best minds that participate in technology assessment provide the most up-to-date information to the patients, the public and the physicians.

EHM. What have been controversial issues you have come across in your presidential year?
JB. Probably the most controversial thing that’s happened this year has been the Department of Justice investigation into the relationship between orthopaedic surgeons, our academy members, and the orthopaedic industry; we’ve certainly been monitoring that and trying to communicate information to the Department of Justice, our physicians, the patients and the public about how those relationships should take place.

EHM. Are you content with the way this has been dealt with?
JB. I think that we really have taken the high road, and our principles are that there must be a relationship between orthopaedic surgeons and industry to be able to design and ultimately manufacture new and improved devices for our patients; that can’t take place in a vacuum. But we believe that those relationships must be ethical, they must be transparent and they have to withstand scrutiny of the patients and the public.

The second thing is disclosure; we certainly believe that physicians who have relationships with the orthopaedic industry – and when they are utilizing devices that are involved in that relationship – should disclose information to the patient directly. But we would like the disclosure to occur with some degree of education and context on what that financial relationship is.

EHM. What have been your main achievements as AAOS President and where would you have liked to have more influence?
JB. I am very pleased that we basically looked at the most pressing topics in the four areas that the academy is involved in: education, research, advocacy and communication. Within our academy, it’s not so much that whoever becomes president has an agenda of things that he or she may want to do. It’s more that there are certain issues that are on the front burner. These are very hot topics that are facing orthopaedics. We as leadership have tried to make every effort to address those issues as they come along rather than having a personal agenda. That’s what I really am the most proud of about the academy.

Dr. James Beaty, a pediatric orthopaedic surgeon, is chief of staff at the Campbell Clinic in Memphis, Tennessee. He is also the current President of the American Academy of Orthopaedic Surgeons. The academy oversees accommodation of education, research and advocacy activities in an effort to represent the interests of the patients, the public and the practicing orthopedic surgeons.