June 1999 Bulletin

Orthopaedists shun clinical research

Seek new strategies

A critical question for the future of the orthopaedic specialty is whether there will be enough orthopaedic clinical scientists to continue to produce the life-saving and life-enhancing treatments that up to now have improved the quality of life and productivity of millions of people.

Today, there are about 45 million people in the United States who have chronic disorders of the musculoskeletal system; about 24 million acute musculoskeletal injuries occur each year. These disorders cause more disability among working-age people than any other group of medical conditions.

The challenge of the future is clear. In 20 years, there will be 10 million more people over age 65 than people between the ages of 25 and 50 and by 2030, 2.7 million people will be 85 years old or older. A growing and aging population brings with it a demand for more treatments for chronic and acute musculoskeletal disorders and injuries.

"Currently, we have too few well-prepared PhD and orthopaedic surgeon scientists involved in research, inadequate opportunities for education in orthopaedic research and insufficient funding for basic and clinical orthopaedic research," concludes a new report by the Academy department of research and scientific affairs.

"Partially because of these problems, few PhD students and orthopaedic residents pursue a career that includes a major commitment to orthopaedic research; and many that initially choose such a career do not find adequate research education or fail to continue in research because of the limited funding."

The report, "Orthopaedic Research: Resources and Areas of Study, 1996," found the number of clinical investigators declined 9 percent to 2,273 between 1990 and 1996.

The lack of young, well-educated orthopaedic scientists, says the report, "will further compromise the productivity and quality of orthopaedic research at a time when an expanding population of elderly people suffering from limited mobility due to musculoskeletal disorders and when expectations for an improving quality of life for all members of society will increase the need for advances in orthopaedic research."

In an editorial in the March 1999 issue of the Journal of Orthopaedic Research, Joseph A. Buckwalter, MD, editor, and S.R. Hurwitz, MD, sound the warning that the orthopaedic surgeon scientist is an endangered species. "Most academically inclined orthopaedists agree that if the current trend continues, orthopaedic surgeon scientists will survive in no more than a few of the most protected environments and as with any endangered species, once the numbers drop below a critical level, extinction becomes a possibility."

The outlook is "ominous" unless something is done to get more orthopaedic surgeons into clinical research, says Douglas Jackson, MD, 1997 Academy president.

It's not a question of talent. Dr. Jackson believes "the talent pool in orthopaedic residency is the most outstanding in all of medicine."

He says there is a need for new strategies and models for "funding, mentoring and creating a protected environment to allow orthopaedic surgeons to be engaged in clinical research." Dr. Jackson will be moderator of a strategic planning meeting on the "Future Orthopaedic Clinician Scientist," held by the Orthopaedic Research Society (ORS) June 30.

The problem is rooted in "the number of years in-training to finish orthopaedic residency, the debt incurred and the inability to see a promising future in this area," Dr. Jackson explains. "By the time they finish residency, they want to get on with their lives instead of two or three more years in school. They see private practice is more lucrative and they may not see job security in the long term."

Richard Brand, MD, past president of the ORS, agrees income plays a role in the problem, observing the increased clinical demand and decline in reimbursements. He says the orthopaedic surgeon doesn't want to accept the same lower rate of pay as the scientist receives.

Dr. Brand also cites the lack of research training in the orthopaedic residency curriculum. "There's barely enough time to teach the clinical training."

In their editorial, Dr. Buckwalter and Dr. Hurwitz say, "Many junior orthopaedic faculty are not prepared to become scientists and are not given an opportunity to acquire the necessary skills. They are led to believe that an interest in research and a nominally free day per week are what they need to establish a successful research program."

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