August 2004 Bulletin

Washington Fellow gets inside look at health policy making

By Sharat K. Kusuma, MD, MBA

The new AAOS Washington Health Policy Fellowship Program is designed to encourage orthopaedic residents and fellows to participate in the federal health policy arena. The program offers participants the opportunity to gain a greater understanding of the health policy process and to contribute to the development of new policies and programs. Sharat K. Kusuma, MD, MBA, is the 2004 Health Policy Fellow. He is currently a resident at the University of Pennsylvania and holds advanced degrees from both the Vanderbilt University Schools of Medicine and Business Management. During the course of his yearlong fellowship, Dr. Kusuma is working several days a month with the Washington Office on various AAOS initiatives, including medical liability reform and physician reimbursement issues.

My tenure as the 2004-2005 AAOS Washington Health Policy Fellow officially began on February 11, 2004. When I applied for the position last November, I wasn’t sure what the ensuing year would entail, but I was excited about the opportunity to learn about many aspects of orthopaedic surgery that are completely ignored by nearly all residency programs. I have always been fascinated by health care policy and how health care legislation intimately affects the day-to-day practice of the orthopaedic surgeon.

Now that I am nearly six months into the fellowship, I realize what an enlightening and valuable experience it has been and want to share what I have learned.

Research Lobby Day

My first activity was the 2004 Orthopaedic Research and Lobby Day, held February 11-12 in Washington, D.C. During this two-day conference, I had the opportunity to participate in Capitol Hill lobbying efforts with leaders in both clinical and basic science research.

We were, of course, advocating for increased funding for musculoskeletal research. However, this year these efforts were a bit more poignant because several grateful patients accompanied us in our visits to congressional offices. These patients had benefited so much from musculoskeletal research that they were willing to travel to Washington, D.C., to make their representatives aware of the huge impact that musculoskeletal research has had on their lives.

During the meeting, I had the opportunity to visit the offices of several members of the U.S. Congress. After the conference concluded, I promptly returned to my day job as a junior orthopaedic resident at the University of Pennsylvania. As I made rounds on all my orthopaedic trauma patients, the majority of whom were healing from horrible traumatic bone injuries, I was reminded that many of these patients would not be doing so well had it not been for the technologies and treatments developed through years of musculoskeletal research.

Learning how AAOS works

My second major fellowship activity took place at the AAOS Annual Meeting, which was held last March in San Francisco. Usually, orthopaedic residents travel to the Annual Meeting to attend scientific and instructional lectures on the latest advances in orthopaedic surgery. However, I had the unique opportunity to spend several days participating in AAOS committee meetings, through which I learned a great deal about the structure and operations of the highest levels of the AAOS.

Again, I am certain that few, if any, residency programs educate their residents about what the AAOS does, or how a resident can become involved in the all-too-important advocacy efforts of the AAOS. I left the meeting excited at the prospect of dedicating a significant portion of my career to participating in the advocacy efforts of the AAOS.

Capitol Hill redux

My next major activity of this year took me back to Washington, D.C., in April, to the National Orthopaedic Leadership Conference (NOLC). I was very excited about this event because one of the main topics of debate would concern specialty hospitals and ambulatory surgery centers. Because of my keen interest in this topic, I spent a great deal of time searching for national experts on this subject who could serve as panelists during the debate.

We were successful in securing the participation of California Representative Pete Stark for the debate; Rep. Stark has long been recognized as a national expert and opponent of specialty hospitals. I had the opportunity to introduce the congressman to the audience at the NOLC, after which a heated debate took place between Stark and the 200 orthopaedic surgeons who were in attendance. Unfortunately, the congressman and the orthopaedic surgeons had little, if any, common ground on this important issue. As I listened to the intense debate, it became clear to me that our entire health care system would benefit if legislation on issues such as specialty hospitals was created by individuals who have actually had the opportunity to practice medicine in both community and specialty hospital settings.

The experience of participating in the NOLC was an outstanding and enlightening one. However, I am certain that most of my orthopaedic surgery resident colleagues are not aware of the importance of the issues surrounding specialty hospitals and ambulatory surgery centers, and how these issues will profoundly affect the way orthopaedic surgery is practiced in this country for many years to come.

Most recently, I participated in the Orthopaedic Device Forum, also held in Washington, D.C. This event is a triennial meeting between leaders in the research and development of orthopaedic drugs and devices and high-ranking U.S. Food and Drug Administration (FDA) officials about current issues and roadblocks in the painstakingly slow process of securing FDA approval for new, cutting-edge orthopaedic drugs and devices. Once again, I was reminded of how little my resident physician colleagues were taught about the FDA and how this powerful government agency affects the ability of orthopaedic surgeons to use new technologies.

In addition to attending several such conferences, I have also participated in AAOS research projects that relate to the new 80-hour workweek guidelines from the Accreditation Council for Graduate Medical Education. These guidelines affect both the practices of attending orthopaedic surgeons at academic medical centers and the training of orthopaedic residents. I have had an intimate role in creating surveys that have been distributed to attending physicians and residents. It is my hope to publish some of the results of that research soon .

Fellowship impact

This brief recount cannot begin to illustrate what a valuable experience this fellowship is proving to be. I am learning, not from a textbook or a lecture, why most health care policies in America in the past 50 years have been legislated in a way that is wholly unfavorable to physicians. It is simply because physicians, including orthopaedic surgeons, have completely neglected the education of our residents on topics such as health care economics and health care policy.

As a result, there are few physicians who are prepared to lead our profession in the health policy arena by participating in health care policy debates and by running for public offices. Through activities such as the Washington Fellowship, the AAOS is taking effective steps to ensure that in the future, the great profession of orthopaedic surgery will be well represented in the health policy arena by orthopaedic surgeons who are as well trained in fighting for the interests of orthopaedic surgeons at local, state and federal governmental levels as they are in treating fractures. Although we as orthopaedic surgeons can influence policy through advocacy efforts, there is no more certain way by which we can change health policy than by working to place our own orthopaedic surgeon colleagues in Congress. I think efforts such as the Washington Fellowship can be important steps by which we attempt to do so.

In summary, I strongly feel that the AAOS Washington Fellowship program should be continued and expanded, if possible, to allow more residents this incredible opportunity to participate in and learn about health care policy.

Sharat K. Kusuma, MD, MBA, is a resident and clinical instructor in orthopaedic surgery at the Hospital of the University of Pennsylvania in Philadelphia. He can be reached at:

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