Today's News

Saturday, March 3, 2001

The time has come to take charge of the future

Change is a fact of life and there are two ways to respond, but for Richard H. Gelberman, MD, there is only one direction for the AAOS.

"We can react to defend our weaknesses or we can lead with our strengths," Dr. Gelberman said in his first vice presidential speech Friday. Dr. Gelberman comes down solidly on "taking charge of our future."

"The time has come for us to stop reacting to the agendas set by others," said Dr. Gelberman who became AAOS president at the Ceremonial Meeting in the Gateway Ballroom. "It's time to start leading with our strengths. It's time to step back, look around, and see what we're good at. It's time to set our agenda."

The future of the AAOS is evolving out of the work of a special task force called the AAOS in 2005. Dr. Gelberman, who lead the task force, said it was charged "to identify our opportunities based on the evidence of what our members need and what we know we do best; focus on targets and set goals that are achievable, but high; and to push ourselves to new levels of creativity and innovation."

The task force conducted extensive research, and found the data pointed to several broad areas of concern and opportunity-in education, practice, research and the structure of the AAOS.

The AAOS finds itself in the midst of an Internet-led information revolution that could be seen as a threat to its core mission of education because most members are accustomed to learning through face-to-face meetings, hands-on training, personal interaction and publications.

But Dr. Gelberman sees the Internet as a new opportunity rather than a threat. He explained that the AAOS is developing an innovative program-Orthopaedic Knowledge Online. "This is designed to give you access to the latest information whenever and wherever you want it-in the office, at home, or traveling with your laptop," he said. "With this site, we'll have instant access to information developed by recognized authorities in each subspecialty and will be updated quarterly.

"As far as we know there is nothing like this out there for any other medical specialty. By providing answers to your questions when you need them in your practice, this type of clinical, problem-focused information will set the standard for online education, enhancing the competence of orthopaedic practice.

Expanding on the concept, he said the programs will provide crisply described indications, contraindications, pearls and pitfalls, and video demonstrations of operative procedures. The programs will be constructed so viewers can spend less than a minute getting a specific piece of information, or hours reviewing what's new in the field. And, there will be online reminders when there's something new in a member's area of interest.

The comprehensive, integrated programs are under construction and will be online sometime next year.

The second area of concern identified by the 2005 task force relates to the cumulative effect that health care reform has had on the practice of orthopaedic surgery. "Federal reform measures have created some huge craters in the patient care landscape," Dr. Gelberman said.

As an example, Dr. Gelberman cited the experience of his hospital where last year admissions increased more than 5 percent, on many days there were no patient beds, and the ER and admitting were backed up for hours or on diversion. Yet, the hospital barely broke even and had nothing to reinvest in its infrastructure or growth in new clinical programs.

The AAOS in 2005 response has been proactive with "three innovative programs that constitute our agenda," he said. The first is to gather data on the incidence, prevalence, impact, cost and outcomes-the burden of musculoskeletal disease. The data show that musculoskeletal ailments are the leading cause of visits to physicians in America. It's also the leading cause of chronic impairment.

"This year, musculoskeletal conditions have cost Americans a staggering $254 billion dollars-that's more than we spend on clothing, and only slightly less than we spend on food and drink" Dr. Gelberman observed. "And it's a 40 percent increase in just five years."

The second component of the initiative "requires courage for us to look more closely at the impact of our care on society," he said. In a study called "Improving Musculoskeletal Care in America," the AAOS collaborated with Dartmouth Medical School to determine whether or not orthopaedic patients' health care needs vary by region, gender, ethnicity, patient age and other variables.

"A study of 35 million Medicare patients revealed, among other things, that whether or not you have orthopaedic surgery depends a great deal on who you are and where you live," Dr. Gelberman said.

He pointed out that a patient in one city in the central valley of California is 50 percent more likely to have a spine operation than a patient in San Francisco, less than 100 miles away. Patients in that city are four to five times more likely to have a total joint replacement than patients in San Francisco.

A similar study in Canada suggests there may be unmet need in both communities. "If that's the case, we need to mount a public health initiative to inform primary care providers of the benefits of our care," he stressed. Another study found that "when you control for population characteristics and access to care, the dominant variant is the orthopaedic surgeons' enthusiasm for a procedure," he said. "Colleagues, friends, we must gather the evidence and then address this issue."

Sex and race are also factors in who gets treated. African American men over age 65 are 35 percent more likely to suffer hip osteoarthritis, but are 50 to 75 percent less likely to have joint replacement surgery than are white men and women. "We have to change that," he asserted.

Armed with the facts on burden of disease and on the societal impact of musculoskeletal care, Dr. Gelberman said the AAOS now has a stronger case to make for education and advocacy with Congress, the Health Care Financing Administration, National Institutes of Health and others, including the Orthopaedic Research and Education Foundation.

The third component of the initiative calls for the development of new methods to strengthen the relationship with patients. Dr. Gelberman disclosed the AAOS has developed a pilot program called "Informed Choice"-an interactive educational program for patients with herniated disks and spinal stenosis. The program gives patients specific information about their conditions to help them decide how to proceed with treatment. This year the AAOS will create two new programs for patients facing decisions about hip and knee replacement surgery.

The third major area of concern identified by the AAOS in 2005 Task Force is research. "Today, the opportunities in research are huge" he asserted. "At no time in history has there been such explosive growth in scientific discovery.

In spite of the evidence that the burden of musculoskeletal disease is growing rapidly, he pointed out that "funding for NIAMS is pitifully low, $353 million this year. That's 10 percent of what we spend on cancer research. That's 15 percent of what we spend on heart and lung disease, and less than half of research budgets for allergy and infectious disease. It's no surprise that we're seeing a significant drop in the numbers of orthopaedic physician scientists."

Recently, the actual number of first-time MD applicants for NIH research has plummeted-a greater than 30 percent decrease in just three years, Dr. Gelberman said. "At the rate we're going," he stressed, "in two more years there will be no first-time physician applicants."

To change this trend, the AAOS in 2005 has created a project team charged with investigating the special challenges experienced by orthopaedists in academic health centers and with developing a strategy that will improve orthopaedists' standing significantly over the next several years.

"The overall goal of the Academy's new efforts in education, in practice and in research is to force ourselves to raise the bar-to increase the effectiveness of this organization for you and for your patients," Dr. Gelberman said.

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