December 2003 Bulletin

Across the President's Desk

Members speak up: AAOS Responds

As I mentioned in my “Across the President’s Desk” column in the August issue, the presidential line has been involving members of the fellowship in our regular teleconferences. Fellows are selected at random and invited to ask questions and discuss their concerns about orthopaedic issues in general and AAOS activities in particular. Originally, these were very open-ended discussions, although recently we have had more focused calls around specific topics.

These conversations have been invaluable to the Academy leadership and I thought this would be a good opportunity to thank those fellows who have participated and to review some of the topics we’ve discussed.

My personal thanks to all the AAOS fellows who have participated in these teleconference calls: Edward M. Adler, MD; Walther H. Bohne, MD; Richard S. Brower, MD; Jorge Bustillo, MD; Charles R. Canty, MD; Thomas B. Edwards, MD; Stephen Fealy, MD; Jonathan E. Fow, MD; George M. Gabuzda, MD; Edward T. Habermann, MD; Karen Johnston-Jones, MD; Lee D. Kaplan, MD; Charles J. Kase, MD; John D. Kefalas, MD; Marvin H. Lipton, MD; Joel E. Mandel, MD; Michael P. Marshall, MD; Roy A. Meals, MD; Kathleen Y. Moen, MD; Edward A. Nalebuff, MD; Eugene A. Nutley, MD; Charles T. Price, MD; Cecil H. Rorabeck, MD; Lex A. Simpson, MD; Alan W. Wolf, MD; David A. Wong, MD, MSD, FRCS(C); Suzanne Yandow, MD; and Christopher A. Yeung, MD.
Included in this list are active members, emeritus members, members who reside outside the 48 contiguous states, presidents of specialty societies and candidate members. These calls occur each month to practicing orthopaedists and emeritus members throughout the United States and Canada.

AAOS is responding
The AAOS is thought of as a “home base” by most of the participants. It was gratifying to realize, over the course of these conversations, that the AAOS is, in fact, responding to many of the issues faced by members that concern them the most. For example, several participants expressed concern about professional liability, not only in the matter of high premiums, but also in the types of claims that are filed and the efforts to pass tort reform legislation on both state and federal levels.

As one member said, “Nothing is going to happen unless it starts among orthopaedists.” Our medical liability reform campaign recognizes this fact. The AAOS was among the first to call for a coalition of high-risk and other medical specialties to address the need for a unified public education campaign. Working on the federal level through our D.C. office and on the state level through grants in support of state society efforts, the campaign, under the direction of Stuart L. Weinstein, MD, and many local leaders, is helping to make tort reform a reality.

Our professional liability committee, through its closed-claim studies and its quarterly Orthopaedic Medical Legal Advisor, is helping orthopaedists to be proactive in addressing potential problem areas. The Patient Safety Committee under Dave Wong’s leadership is working toward a culture of safety so that medical errors can be prevented. Effective communications, informed consent and evidence-based approaches will help reduce the number of lawsuits stemming from complications, which far outweigh negligence as a reason for lawsuits.

There was a corresponding concern about the issue of inappropriate expert witness testimony, particularly when the expert witness is an AAOS member. Many members expressed concern about orthopaedic surgeons who do not practice with ethical standards. The Academy is addressing the expert witness problem, as reported in the October Bulletin, with a program of educational and remedial activities and is investigating the possibility of establishing an assessment/disciplinary program. We are now in the process of analyzing a recent survey of our members on this topic and will report back to you in the February 2004 issue of the Bulletin on our proposed next steps.

Our August conversation focusing on diversity was particularly encouraging. As one participant said, “I believe the AAOS efforts [to increase the number of women in orthopaedics] are very positive ... right on target.” Another member concurred, “The AAOS is moving in the right direction.”

CME challenges
Members recognize that AAOS educational opportunities face increasing competition from specialty societies and industry. Several members expressed concerns about the AAOS Annual Meeting, our premier educational event. Some of these concerns centered on the presence of and relationship with industry at the Annual Meeting. I would be remiss if I did not point out that the support of our partners in the orthopaedic industry is both valuable and necessary for the Academy to continue meeting its educational goals.
Increasing costs make it imperative for the AAOS to attract corporate support and participation in educational events. We receive support in the form of educational grants from industry for a wide variety of educational programs and products. Because of this it is imperative that the AAOS and all participants at our meeting disclose any relationship or other potential conflicts of interest. To do less would raise questions of our ethical standards and possible bias. We can’t allow any possibility for the public or our members to question our behavior. Continuing education is our goal.

We recognize that attendance takes a member away from his or her practice and are looking at ways to address this issue by ensuring outstanding quality of the program, developing new innovative ways to present educational material and at the same time shorten the length of the meeting. Several ideas were outlined at an Annual Meeting workshop led by Richard F Kyle, MD, chairman of the Annual Program Committee, held earlier this year that concentrated specifically on how to improve the Annual Meeting. (See June 2003 Bulletin.) We’ve already acted on some of these ideas, and will continue our efforts to ensure that the AAOS Annual Meeting remains the premier educational event in the field. As a candidate member remarked: “The Annual Meeting is very important ... keeping in touch with colleagues and being kept abreast of current issues in surgical care.”

Courses at the Orthopaedic Learning Center (OLC) got high marks from everyone who had attended them. In addition, nearly all of the fellows we spoke to use online resources, particularly Orthopaedic Knowledge Online (OKO), and find them “extremely helpful.” Several members requested we develop online lectures and supplemental information on devices. Candidate members use the Web site frequently. “It is very user friendly.” The AAOS Web-based education campus continues to grow and is increasingly used by residents.

Issues surrounding specialization were part of every conversation, and the topic of a focused discussion with presidents from four different specialty societies (American Society for Surgery of the Hand, North American Spine Society, Knee Society, and Pediatric Orthopaedic Society of North America) in September. We will continue to work toward increasing communication and cooperation between the AAOS and the various specialty societies. The presidential line has offered to attend Specialty Day meetings to present Academy updates as suggested by the specialty society presidents.
In fact, the Board Workshop in May 2004 will focus on specialty societies and “keeping the house of orthopaedics together.” As one colleague phrased it, “A more collegial effort will be beneficial from an educational standpoint.” Rather than competing with products against each other, the AAOS and specialty societies can look for ways to work together.

James H. Herndon, MD, MBA

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