After 53 years, the last Bulletin rolls off the press

By E. Anthony Rankin, MD and Mary Ann Porucznik

In 1953, AAOS members received their first issue of the Bulletin. It was a simple, six-page newsletter, designed, as President Harold Boyd, MD, wrote, to “keep you informed of the business of the Academy, the activities of the Central Office, and serve as a forum for the expression of your ideas.”

That first issue included a description of the Central Office, then located at 122 S. Michigan Avenue in Chicago; abstracts from the pilot study conducted for the Committee for the Advancement of Orthopaedic Surgery; a listing of the contents of the film and pathological slide libraries, and a member survey on possible sites for the AAOS Annual meeting. The Waldorf-Astoria Hotel in New York City, Chicago’s Palmer House and Conrad Hilton hotels, Atlantic City, Boston, Cincinnati, Cleveland, Detroit, Los Angeles, Philadelphia, Pittsburgh, St. Louis and San Francisco were among the options offered.

Although the Bulletin was a small publication (just 7” x 10”), issued four times a year, the editors and the Executive Committee of the Academy had high hopes for it and were willing to consider enlarging it as the need arose.

Bylaws and poetry
By 1955, The Bulletin was publishing an occasional issue with as many as 16 pages. The first issue that year announced the formation of the Orthopaedic Research Foundation, which eventually became the Orthopaedic Research and Education Foundation (OREF), and included the Articles of Incorporation and By-Laws. Not the most inspiring reading, perhaps, but times were different.

Most articles in those early years were written by physician members of the AAOS and focused on reports of meetings, such as the International Society of Orthopaedics and Traumatology or the National Foundation for Infantile Paralysis. “Tribulations,” a poem in the February 1958 edition, bemoaned the trials and difficulties faced by the members of the American Board of Orthopaedic Surgeons (ABOS). With the current turmoil over maintenance of certification, I think that today’s ABOS members would agree with the last couplet: “Please let me tell you, to a man/The Board just does the best it can.”

In September 1960, The Bulletin underwent a metamorphosis. Instead of starting stories on the front page, there was an actual cover to the publication! Perhaps due to those psychedelic times, the covers often featured abstract art and loud colors, such as turquoise, fuchsia and mustard. Covers had little to do with contents; a large black exclamation point decorated the June 1962 issue, which also included an “Orthopaedic Flashback” on the Balkan frame used for fracture treatment.

Today, a major aspect of physician education is using video to capture a surgical technique. But in 1964, it was 16 mm film and a “camera with a ‘through the lens’ view finder.” An article in the May Bulletin of that year by J. William Fielding, MD, provided advice to those who wanted to make a movie. I think today’s producers would agree with many of his suggestions, including the following:

• Minimize narration to the essentials.
• Avoid casting shadows.
• Film only the most important steps.

The genesis of the AAOS Report
By 1969, the Bulletin had grown to 32 pages, with a variety of features. Issues were regularly dedicated to “orthopaedic surgeons who have distinguished themselves by their unusual contributions to orthopaedic surgery and to the Academy.” Among those so honored were Alan DeForest Smith, MD; James A. Dickson, MD; Leo Mayer, MD, and Allen Fiske Voshell, MD. A biographical sketch of the honoree appeared under the title “Our Orthopaedic Personality.”

Other regular features included “The President Says: (no closed quote!), a regular report from the ABOS, committee reports and the Secretary’s Notes. Specialty society events and elections were also covered. An occasional cartoon decorated the pages. As a former secretary of the Academy, I particularly appreciated the drawing of the bleary-eyed secretary, a piled-high “in” box, an empty “out” box, and an overflowing circular file on the floor next to the desk.

So much was happening that the editors decided to include a new publication within the Bulletin. The Newsletter, which eventually became the AAOS Report, debuted in December 1969. The four-page insert presented “capsule news reports of happenings of interest to our specialty.” That first edition described a reorganization of the committee structure of the AAOS and the establishment of the Philip D. Wilson, MD, Memorial Fund at the OREF.

Annual Meeting Coverage
Throughout the years, The Bulletin promoted and provided coverage of the AAOS Annual Meeting (see the special section in this issue). The 40-page issue that celebrated the Academy’s 40th anniversary (January 1973, pictured on the cover) prepared members for that year’s Annual Meeting in Las Vegas.

At various times, the business meeting announcement, by-laws and resolutions, and award recipients were featured, as well as restaurant listings and program notes. A “Focus on New Officers” in the April/May 1980 edition introduced the fellowship to incoming president William R. MacAusland, Jr., MD, as well as to the newly elected members of the Board of Councilors.

The Bulletin’s preview of the five-day (Jan. 21-26) 1982 Annual Meeting in New Orleans included a special promotional section on that city’s history, shopping, restaurants and nightlife. It also noted that five specialty society meetings (American Society for Surgery of the Hand, American Orthopaedic Society for Sports Medicine, Orthopaedic Research Society, American Orthopaedic Foot Society and The Hip Society) would be meeting in conjunction with the Academy’s meeting.

The February 1983 Bulletin noted that the Academy’s 1983 Annual Meeting would mark “Fifty Years of Progress” and pictured Maxwel the Robot, who could have served as a prototype for the R2D2 character in “Star Wars.” It also introduced a series of historical features about the AAOS, with an article on the “History of Surgical Implants” by executive director Charles V. Heck, MD. We also began to pay attention to our lives outside the office, with features that ranged from an orthopaedist who collected clocks and watches (Warren D. Bundens, Jr., MD, of Woodbury, N.J.) to one who owned five Bugattis (Richard R. Riddell, MD, of San Clemente, Cal.).

Liability, unity, payment cuts emerge as recurring themes
In 1981, the Bulletin was again redesigned, assuming its current 8-1/2” x 11” format. About this time as well, we begin to see the emergence of certain themes—medical liability and malpractice issues, the need for orthopaedic unity, access to care, new technologies, Medicare payment cuts and more government involvement in health care—that still resonate today.

For example, the May 1985 Bulletin urged orthopaedists to get involved to help solve malpractice problems; the April 1990 cover story focused on federal tort reform initiatives, and in June 2004, a special insert from Doctors for Medical Liability Reform delivered the same message. The July 1988 Bulletin asked “How do we measure quality?”—a question we are still grappling with.

In October 1991, we were fighting a 16 percent cut in the conversion factor for Medicare fee payments, and just this year, President Richard F. Kyle, MD, announced that a united effort with the American Association of Hip and Knee Surgeons had helped avert major cuts to reimbursement for hip fracture treatment and total knee and total hip replacements.

We started talking about communication, in efforts to reduce medical errors and to reach out to diverse populations. Who would have imagined that we only listened to patients for 18 seconds? The relationship between orthopaedists and industry came under scrutiny in the early 1990s, and remains a topic of concern today.

In addition, the Bulletin covered social issues—the impact of acquired immune deficiency syndrome (AIDS) and its precursor human immunodeficiency virus (HIV), the aging population and the increase in the numbers of uninsured. Legislative coverage ranged from self-referral bans to scope of practice issues.

Education assumed more importance, and the Bulletin covered review courses, symposia and the Summer Institute. The July 1992 issue even included clinical policies on lateral epicondylitis of the elbow, hallux valgus, osteoarthritis of the knee, pes planus, and humeral neck fractures. Calendar listings of the Academy’s continuing medical education (CME) courses assumed more prominence.

More recently, practice management issues have come to the forefront, including news and columns on coding, on legal issues and on the use of computers and electronic records.

What a benefit!
As a member benefit, I think the Bulletin is unsurpassed. For most of its history, the Bulletin contained no advertising. Finally, in the late 1980s, the Academy started to promote its own products, such as patient education videotapes, Instructional Course Lectures, and Orthopaedic Knowledge Update. Only within the last decade has the Bulletin accepted paid advertising.

But it is time for a change. Recent readership surveys and focus groups with fellows have found a need for more current information than a bimonthly publication can provide. There’s also a need to reflect the controversy and diversity inherent in the practice of orthopaedics. As one fellow said, “Everything is always sanitized and wonderful, and that may be a problem.”

And so, in 2007, the Academy will be introducing a new member publication—AAOS Now. As a monthly, AAOS Now will be able to bring you current news; and with S. Terry Canale, MD, at the helm, AAOS Now will take a practical, journalistic approach to the issues that affect AAOS members most. Sections in the new publication will include the following:

• Managing Your Practice: Business-related information to help you become more effective and efficient in your office practices
• Clinical News & Views: Educational articles and debates on orthopaedic techniques and issues
• Reimbursement & Regulations: Updates on government decisions that affect the practice of orthopaedic surgery
• Research & Technology at Work: Reports on topics such as guidelines development, new technologies and applied research
• Your AAOS: Specific information on Academy initiatives, programs and products

In addition, AAOS Now will cover “Orthopaedics around the world” and have pages dedicated to news and information about state, regional and affiliated orthopaedic organizations, as well as announcements from the orthopaedic industry on new products. An “Outside the office” feature will highlight AAOS members with interesting hobbies or avocations. And there will be much, much more.

As the penultimate editor of the AAOS Bulletin, I will be sad to say “good-bye” to it, but I am excited about the opportunities that the new AAOS Now presents. I hope you will share my enthusiasm when it debuts at the 2007 Annual Meeting.

E. Anthony Rankin, MD, is second vice president of the AAOS. He served as the Bulletin editor-in-chief from 2001-2006. Mary Ann Porucznik is managing editor of the Bulletin.