April 1998 Bulletin

ACROSS THE PRESIDENT'S DESK
Workforce solution: expand orthopaedics

As I begin this year as your president, I look forward with enthusiasm to many of the opportunities before us. Being a generally optimistic individual, I want to focus in a positive way on what has been called the "work force problem in orthopaedics." With almost 20,000 orthopaedic surgeons practicing in this country, managed care models and the demand model recently described in The Journal of Bone and Joint Surgery by the RAND research organization say emphatically that there are too many orthopaedic surgeons and that this over-supply is going to continue for at least the next 20 to 30 years.

Some of the simple solutions that people have proposed, such as decreasing the number of residency positions or cutting back arbitrarily on the amount of work performed by practicing orthopaedists, either by decreasing the number of hours worked per week or forcing early retirement, will not have much of an impact or simply will create a void that will be filled by other providers of musculoskeletal care.

The RAND study has several shortcomings, but it shows clearly to me that one key element in the work force equation is the demand for reasonably priced orthopaedic services. Who is better educated and trained to provide musculoskeletal care than orthopaedic surgeons? I suggest that one effective way to address the work force problem is to actually expand the scope of what we are currently doing. There are several ways in which we can accomplish this objective:

• The Academy will continue to work through the Patient Access to Specialty Care Coalition in Washington to ensure that our patients continue to have wide-open and direct access to our services without going through intermediary steps or being sidetracked to the care of a nonorthopaedist.
• The Academy is going to explore attractive alternative forms of orthopaedic practice to provide options for those fellows who wish to leave a surgical practice. As the size of the surgical aspects of our practice decreases, we have more time to spend in the office with our patients and, more importantly, more time to expand the actual scope of what we do there. A Board of Directors task force is exploring the expansion of the scope of orthopaedic practice, which we hope will not, in any way, compromise our commitment to the practice of orthopaedic surgery but will provide an enhancement to the quality of office practice for both the orthopaedic surgeon and his or her patients.
• We are going to explore the creation of a shared interest group within the Academy to include all those fellows who wish to explore new and alternative pathways for the delivery of musculoskeletal care.
• We will work in collaboration with orthopaedic industry through our newly created Corporate Advisory Council and with the FDA through our device forum to bring new safe and effective orthopaedic technologies to the marketplace in a timely manner.
• We will work through our International Committee to explore further opportunities to deliver high-quality orthopaedic care to underserved areas of the world.
• Through the newly created task force on volunteerism, we will look for ways to enhance, in a meaningful way, the delivery of high-quality musculoskeletal care to underserved populations here at home.
• And finally, through our Council on Research we are going to re-double our commitment to support both clinical and basic research. As we move into this era of biological solutions to biological problems, who knows what new advances are just around the corner? Each new advance will create another opportunity to serve our patients and grow the practice of orthopaedic surgery. However, we will see such advances only if we continue to allocate a certain proportion of our time, energy and resources to both basic and applied research

Over this next year we are going to focus on these methods to incubate and promote the development of new ways to expand the scope of the practice of orthopaedics that will make that practice 25 years from now as different as the current practice of orthopaedics is from what it was 25 years ago. The combination of all these efforts should expand the scope of practice to such a degree that in 25 years there will be a demand for more, not fewer, orthopaedic surgeons.

I hope that you, the fellowship, will buy into this concept of expanding in a positive way those things that we, as the best educated and trained providers of musculoskeletal care, can and should do. If you have additional, positive suggestions about how we might apply our skills and experience to this task, I would love to hear from you.

James D. Heckman, MD
President