Orthopaedic unity: Collaborating with specialty societies
Robert W. Bucholz, MD
In May the AAOS Board of Directors conducted a three-day workshop on specialization and its impact on the Academy and the unity of orthopaedic surgery. Although this issue is b, it i y no means news arguably the most important trend shaping the future of our surgical field.
In preparation for the workshop, individual Board members contacted presidents and officers of 18 orthopaedic-related specialty societies.
We solicited their opinions regarding the Council on Musculoskeletal Specialty Societies (COMSS), AAOS interactions and collaborations, and contracts for management services with the AAOS. Nearly all specialty society leaders were candid in offering their assessments and concerns. Current COMSS leaders — Glenn B. Pfeffer, MD, Mark C. Gebhardt, MD, and Andrew N. Pollak, MD — as well as the immediate past president of COMSS, David G. Lewallen, MD, led the workshop discussion. In this report, I would like to summarize some of the deliberations and conclusions of our meeting.
Growth in specialization
The marketplace factors that stimulate the continued specialization within orthopaedic surgery are numerous. Technological advances and the exponential growth in the body of orthopaedic knowledge in the last few decades have made specialization imperative and have contributed to the growth of specialty societies.
By their very nature, orthopaedic surgeons aspire to be on the leading edge of their clinical practice. Focused, specialized practices often provide economic benefits and enhanced job satisfaction. AAOS surveys point to the continuation of this demographic change with more of the fellowship identifying themselves as specialists or generalists with a specialty interest. Because surgeons enjoy interfacing with peers with similar focused interests, specialty societies offer a valuable forum for social and educational exchange.
There is wide variation in the scope, mission and budget — and therefore, the potential impact — of orthopaedic-related specialty societies. Several small specialty societies limit their activities to an annual meeting and modest educational ventures. The largest specialty societies are actively involved in the full spectrum of educational, research and advocacy programs. Not surprising, therefore, are the wide differences in the interests and needs of various societies to partner with the AAOS.
Collaboration a challenge
Academy collaborations with specialty societies can occasionally be problematic. Certain specialty areas, such as hand, spine and adult reconstruction, are represented by multiple specialty societies that compete among themselves. The AAOS must be cautious and avoid favoring one association over another. The annual turnover of leadership in both specialty societies and the AAOS also complicates long-term planning and collaborations on different initiatives.
Currently, the AAOS is often perceived as heavy-handed in its relations with specialty societies. Concerns were expressed about contract negotiations in joint CME courses and enduring educational material development and sales. Whether this perception accurately reflects reality is disputable but the perception is there. Similarly, the AAOS rates for specialty society rental of the Rosemont office space and services are perceived as high even though research shows they are at or below market levels. Several specialty society leaders have expressed an interest in a more customized approach to negotiating fees based on specific services provided by the AAOS.
The Academy is really the only professional association with a strong interest and the requisite resources to foster orthopaedic unity. Specialty societies narrowly focus on their funding and programmatic activities and do not have orthopaedic unity as a priority in their missions. COMSS serves as the AAOS-funded forum for the interchange of ideas and projects. In our discussions, several specialty society leaders questioned its effectiveness in promoting unity. Specialty societies seek more one-on-one contact with the Academy and an equal partnership in the planning, risk and rewards of different joint programs.
After thoughtful consideration and deliberate discussion of these factors, the AAOS Board of Directors approved several action plans to address them. Principles for equitable Academy partnerships with the specialty societies were formulated and subsequently distributed to specialty society leaders.
At the fall COMSS meeting with specialty society and AAOS leaders, a summit will be convened to address the recommendations on restructuring COMSS. Richard F. Kyle, MD, second vice-president of the Academy, was appointed chair of the summit planning team that will ensure a meeting structure conducive to productive discussions.
The American Board of Orthopaedic Surgery (ABOS) maintenance of certification (MOC) program was identified as another good opportunity for collaboration by the AAOS and specialty societies. The AAOS Council on Education was charged to develop a plan on how to use our current educational offerings and expand them in collaboration with specialty societies and the ABOS in formulating an orthopaedic MOC curriculum.
Academy staff was assigned the task of surveying the current marketplace and benchmarking our service fees against those of other providers. They were also asked to develop a plan to customize AAOS services as much as feasible given our current infrastructure.
Orthopaedic unity must continue to be a central goal in the mission of the Academy. Without unity, orthopaedic surgery as a medical field will fragment and lose its voice and influence in the American health care system. Your AAOS Board of Directors is committed to implementing whatever changes are needed to ensure that the orthopaedic family remains intact and functional.
Robert W. Bucholz, MD