February 2003 Bulletin

AAOS in my rear view mirror

As I move away from my year as your president, I would like to highlight a few of the accomplishments of the Board of Directors and AAOS staff in 2002.

Advocacy–The Board of Directors held a workshop in April to evaluate AAOS advocacy efforts and goals, highlighting the increasing importance of advocacy for orthopaedists at both the state and federal level. The Board has begun the development and promotion of a federal legislative proposal and the Washington office continues to be a leader in coalition building to increase our lobbying effectiveness.

The National Orthopaedic Leadership Conference drew more than 300 people to Washington for lobbying efforts this year.

The Orthopaedic PAC had its best year ever, but further improvement is needed as only 8.3 percent of our Fellows contributed financial support.

Organizational review–A thorough review of the AAOS as an organization was carried out in conjunction with our consultants from RSM McGladrey. Several recommendations from this review have already been implemented.

A new executive structure with a CEO and executive team of a chief operating officer, chief financial officer, director of medical affairs and chief educational officer has been developed. This new executive structure is intended to improve coordinated strategic planning for the AAOS as well as to improve horizontal integration in implementation of our programs in the years ahead. The CEO search is on going and the new CEO will be selected by early summer

BOD change–Ms. Leslie Altick, executive vice president of Wells Fargo San Francisco, has joined the Board of Directors as our first lay member. Her financial background and experience with the patient-safety focused Leapfrog Group will be of great benefit to our Board discussions.

International efforts expanded –Our commitment to international orthopaedics has increased with the approval of a three-year plan to increase international membership and meeting attendance as well as to increase our international orthopaedic education efforts. Already 44 AAOS publications have been translated into as many as 9 languages and our revenue from our international programs now accounts for about 15 percent of AAOS annual revenue.

Academic programs –The Council on Academic Affairs has successfully completed its first year of operation, filling a gap that we had in addressing issues particularly pertinent to our academic members.

Online presence grows–The AAOS Web site has expanded significantly over the past year. Orthopaedic Knowledge Online (OKO) now covers more than 35 topics including more than 20 videos of surgical procedures. Although OKO is free for all active Fellows, only about one-third of our Fellows have used this great educational site. I urge you to take a look at it. We also significantly expanded the practice management section of the Web site. Our eventual goal continues to be that the AAOS Web site will serve as the primary Internet portal for the majority of your orthopaedic education and information.

In addition, our patient education Web site, Your Orthopaedic Connection, has soared in usage and expanded in content. The number of page hits on the site totaled nearly 8 million and the number of articles grew to 390. We also added a special En Español section–which includes 20 new patient education sheets in Spanish.

Two excellent products related to osteoarthritis (OA) of the knee became available in 2002. A videotape of treatment options allows you and your patient, through the shared decision making process, decide the best treatment choice for each of your patients. Also, the AAOS Research Department produced an impressive compendium on treatment options, clinical research findings, and outcomes assessment tools related to OA of the knee. This document is free online on the AAOS Web site for active Fellows, under the section on improving musculoskeletal care in America (IMCA).

Leadership Fellows

There are two other programs that I would like to highlight in more detail. The first of these is the Leadership Fellows Program (LFP). The first class of 15 Fellows under the age of 45 years have just completed the yearlong program and were recognized at the Annual Meeting. We set up this program last year to identify and prepare possible future AAOS leaders. The success of this program has certainly exceeded our expectations and the participants gave this program very high marks in their evaluations.

During the year, the LFP Fellows participated in the AAOS leadership orientation program in Rosemont and in the National Orthopedic Leadership Conference in Washington. In addition, they participated in monthly teleconferences addressing various issues important to leadership skills education. Each had a mentor and each visited the home city of that mentor. Each LFP Fellow now has an assignment on an AAOS committee.

This leadership development program is continuing and 15 new LFP Fellows were recently selected from a group of 59 applicants. I would encourage our young Fellows to apply for this exciting program in the future, with applications usually due in late September.

High level of service and costs

The other issue I would like to highlight stems from the success the AAOS has had in the past in gaining our Fellows confidence that we have the ability to address and solve nearly any problem encountered in the orthopaedic world. Our Fellows are eager for us to be involved with new projects, provide new member services, and deal with a myriad of governmental issues. This has led to higher expectations about what the Academy is able to accomplish and it comes at a cost.

The AAOS is a complex and active organization. As noted in the 2002 benchmarking study done by RSM McGladrey, which gathered data from AAOS and 19 other professional medical associations, our expense level per member is nearly double the median, with AAOS per member annual expense being $2278. Much of this is due to the wide variety of programs and services we have.

In 2002, our dues accounted for only 27% of our revenue, with more than 60% of our non-dues revenue stemming from educational programs and publications. During the period from 1996 to 2002, the AAOS had an annual average increase of between 4 percent and 5 percent in staff as new programs and services were added, so that today we have 229 AAOS staff members in Rosemont and Washington. We have 108 programs in the AAOS with annual budgets over $75,000.

Our dilemma relates to how to best select those programs of most value to AAOS Fellows. Education has been the backbone and heart of the Academy and educational products remain the major revenue producing line for us–our emphasis needs to stay on education in the broadest sense. At the same time, funding for non-revenue producing activities – advocacy, public education, research, health policy, academic affairs – is necessary for the AAOS to provide the representation and services that fuel your desire to continue to want to be an AAOS Fellow year after year. Your Board is acutely aware of the need to strike a balance between services provided and cost, particularly in the face of declining orthopaedist income.

To maximize the value of the multiple AAOS programs to our Fellows, the Board has this year put into place an evaluation method to annually rate the performance and effectiveness of all 108 programs with an annual budget of more than $75,000. In the years ahead, the selection of the AAOS programs for that year, which we are calling the Annual Program of Work, will be driven by these evaluations with concentration of resources on successful and valued AAOS programs and with the potential to scale back those performing less well. This is easier said than done, but I think the evaluation mechanism is now firmly in place and is a real step forward in the future to maximize the value of AAOS to all Fellows.

The Academy enjoys a most favorable reputation among professional medical associations, thanks to the work of the staff and the incredible volunteer spirit and work of our Fellows. As I view the AAOS in my rear-view mirror, I see a strong and vibrant organization prepared to deal with the challenges we daily face in orthopaedics. I thank you for the great privilege of having been your president this past year.

Vernon T. Tolo, MD
2002—2003 President

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