August 1998 Bulletin

Profession, public need orthopaedists' time, talents

I would like to take this opportunity to discuss with you what I perceive to be an erosion in interest in volunteerism among the Academy fellowship. As the pace of our practices and the pressure to perform continue to increase, it becomes more and more difficult to volunteer our services readily to society and to our societies. Our days are filled with demands to provide more services for less reimbursement. Thus, it is only natural to decide that one must work harder and spend more hours to maintain the same standard of living.

The unfortunate result of this decision is that there is less time to volunteer for activities that by definition, will have no financial reward. There are other rewards, however, that can be even more satisfying than earning another dollar, at least 40 percent of which must go to the government as soon as it is earned.

Volunteerism can take many forms, and I certainly do not pretend to prescribe a specific activity for anyone. There are, however, special niches in our communities and in orthopaedics that require the particular skills and interests of orthopaedic surgeons and deserve your consideration.

First and foremost among these options is care of the indigent patient. Many opportunities, both formal and informal, exist to provide access for indigent patients to the same high quality orthopaedic care that we provide to funded patients. While many excuses can be given, and in some cases true impediments exist to effect the delivery of care to indigent patients, many opportunities are available for each and every one of us.

If you live in a community of any size, there is an indigent clinic nearby that could benefit greatly from your voluntary expertise. If that clinic is staffed by residents, an excellent mechanism is already in place for you to become actively involved in the teaching program as well as provide your expertise to the care of the indigent population it serves.

One of the greatest impediments to voluntarily providing services to the indigent has been the threat of malpractice litigation. The Task Force on Volunteerism that I established this year is exploring possible new mechanisms to deal with this issue, including a federal government program to provide liability coverage for retired physicians who wish to provide "free care" in established clinics vs. a possible low cost liability policy developed by the insurance industry to cover retired physicians wishing to provide free care. As always, a third option of the "good Samaritan law" also is being revisited recognizing the reluctance of federal and state legislation to grant this type of immunity.

Secondly, as I mentioned earlier, the Task Force on Volunteerism, chaired by John J. Callaghan, MD, of Iowa City, is just developing its ideas and recommendations. Should you have an opportunity or an idea you would like this task force to explore, please contact John at the University of Iowa Department of Orthopaedics and let him know about it now.

As a third option, within the organization of orthopaedics there are many societies and organizations looking for volunteer help. The Orthopaedic Research and Education Foundation certainly needs your monetary support. It also needs committed volunteers who will solicit support from their fellow orthopaedists and from other sources in its effort to raise $40 million for research and education in "Campaign 2000" over the next two years. When contributions are being solicited, nothing works more effectively than encouragement from one's peers. You can make a big difference here!

Other orthopaedic organizations such as your state orthopaedic society, the regional orthopaedic societies, and the specialty societies are all looking for members who are interested in giving some of their time to support their programs. I am virtually certain that a letter from you to the president of your state society will be a ticket to active involvement for years to come.

When I was a young orthopaedist, one of the first things I ever did on a voluntary basis was to make a face-to-face appeal to my congressman to enact a seat belt law in the state of Texas. After he patiently listened to my three-minute pitch on how many lives could be saved and how many healthcare dollars would be conserved, he looked incredulously at me and said, "But, doctor, that won't be good for your business, will it?" We have come a long way in the last two decades in understanding the importance of seat belt legislation. Perhaps today that congressman might appreciate that my reason for being involved was not to affect my business, but to enhance the care of my patients.

Your active participation in community projects, patient-oriented legislative initiatives and civic organizations whose primary focus is on the welfare of the community can have a beneficial effect on your patients. Such participation also can do much to enhance your standing in the community. Being so involved can also soften the sometimes harsh image that many have of the orthopaedic surgeon as an individual who just operates on people for a living. Active involvement in the community is but one way in which we can repay the kindness with which we as physicians have been treated during our professional lives.

I hope that we all can step back from the ever increasing pace of our practices and spend more time sharing the talents that we have in some substantive and frequent way. Please find a way to be a volunteer. I am sure that society will benefit, and I am equally certain that you and I as individuals will benefit as well.

James D. Heckman, MD


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