I am both honored and delighted to be here today. Whatever contributions
that I have made to the American Academy of Orthopaedic Surgeons (AAOS) would
have been impossible without a serious commitment—my wife's. With a
professional plate fuller than my own and with the daunting responsibility of
raising our three teenage daughters, she has nevertheless encouraged and
supported me in my Academy activities. Marybeth, thank you. I would also like
to thank you, the Academy fellowship, for giving me the privilege to serve as
President. The last two years have been incredibly interesting and
challenging, and I have no doubt that this next year will be even more so.
My story of involvement in this remarkable organization is probably quite
similar to many of yours. Nearly twenty years ago, when I was a fledgling
academician, I was unexpectedly asked to serve on a task force of the
Committee on Trauma. The United States Food and Drug Administration had
approached the Academy to assist the government in defining what was a delayed
union and what was a nonunion of a fracture. These definitions would be used
in deciding when the federal government approved and funded the use of various
electrical stimulation devices. The governmental agencies consulted the
Academy—not scientific articles or textbooks, not industry sources, not
their in-house consultants—but the Academy, since we were
viewed as the source of expert opinion and musculoskeletal knowledge. Chaired
by Mike Chapman and assisted by a well-prepared staff, the task force
deliberated for an entire day. While the group reached its conclusions, the
real value of the exercise emerged. The task force of orthopaedic surgeons
unselfishly volunteered their experience, time, and analytical skills to the
Academy to further our knowledge and understanding of an important subject.
What drove the process was the unrelenting desire to understand and to learn.
And, it was being done under the auspices of the leading body of
musculoskeletal information, the American Academy of Orthopaedic Surgeons.
Then and there, I was hooked. Like many of you with a love of learning, I am a
perpetual student. I had found a home in the American Academy of Orthopaedic
Surgeons.
For the next few minutes, I would like to focus on my vision of this core
value of the Academy: the research, validation, and dissemination of knowledge
and how it permeates all aspects of Academy activities. Indeed, the continued
relevance of the Academy to its fellowship and its preeminence as a
professional association demand continued leadership in this primary business
of orthopaedic knowledge.
Knowledge is defined in The Winston Dictionary as the "fact
or condition of knowing something with familiarity gained through experience
or
association."1
Knowledge is more than information. Knowledge facilitates the ability to apply
facts, to turn ideas into action. It is not the who, what, when, or where, but
rather the how and the why of a subject.
The Academy has functioned as a filter of the vast overload of useless,
often inaccurate information and opinion, which bombard us day after day.
Through careful, focused research, our Academy also generates new and timely,
vetted information on an ever-increasing number of topics. The Academy's
imprimatur on educational material warrants it as knowledge for our specialty.
Our most valuable asset, our aggregate intellectual capital, is derived from
dedicated, creative volunteers and staff. It constantly reestablishes our
reputation as the source of applicable knowledge.
Our customers in this knowledge business, or "bidness" as we
say in Texas, include the Fellowship, the international members, our patients,
the public, the media, industry, and government.
We need to ensure that all orthopaedic surgeons view not belonging to the
Academy as inconceivable. The information provided by the AAOS is
indispensable to a knowledgeable practice of orthopaedic surgery. The
foundation of the Academy's mission has always been scientific and clinical
education. However, the American marketplace for musculoskeletal education is
rapidly changing. Competition from the orthopaedic industry, specialty
societies, regional societies, and academic institutions continually
challenges our position as the leader in orthopaedic education. New strategies
are needed.
Our traditional continuing medical-education courses must refocus on
cutting-edge, timely subjects. Collaboration with specialty societies and the
orthopaedic industry on both didactic and surgical skills courses will ensure
high-quality programs and will eliminate illogical competition. Easily
accessible electronic courses and regional courses will fill an educational
void and make life easier for the orthopaedist to demonstrate the six
competencies identified by the American Board of Orthopaedic Surgery for
maintenance of
certification2.
Practice management courses on coding and reimbursement, compliance, clinical
trials, ambulatory surgical centers, patient privacy, and professional
liability must be constantly modified to satisfy the ever-changing regulatory
landscape. Our fellows have less time and money for their education. Focused,
high-intensity, and inexpensive courses will thus be mandatory in the
future.
A major component of the AAOS in 2005 initiative developed by Richard
Gelberman and Larry Rosenthal five years ago was a commitment to
Internet-based education. Orthopaedic Knowledge Online, now over two years
old, has incorporated all of the features of an effective interactive
educational program—focused topics, graduated learning, videos of
state-of-the-art procedures, current evidence-based reference sources, and
links to other educational sites. Nearly fifty topics have been posted. Over
10,000 users have taken advantage of this unique educational experience. With
the growing constraints on our time and funding for continuing medical
education, this readily available, easily accessible program will likely
evolve into the primary mode for information transfer for the next generation
of orthopaedic surgeons. Our successors will demand a single portal for their
electronic education and searches. I would like to see Orthopaedic Knowledge
Online become that ortho-portal. James Boswell, in writing on Samuel Johnson,
noted that "Knowledge is of two kinds: we know a subject ourselves or we
know where we can find information upon
it."3 Working
with our colleagues in the Council of Musculoskeletal Specialty Societies,
leading orthopaedic journals, international associations, and academic
institutions, we should strive for this goal of a central electronic site for
orthopaedic educational material.
While the web is a growing focus for education, one medium does not fill
all fellowship needs. The sustained vitality and popularity of Academy-written
publications is impressive. While the future of this medium as a vehicle for
information transfer is uncertain, the Academy's track record is unsurpassed.
Over 9000 Orthopaedic Knowledge Update specialty texts were sold last
year. The Journal of the American Academy of Orthopaedic Surgeons is
the most read orthopaedic journal in the United States and, incidentally, is
widening its readership with its new Spanish version. The second edition of
Essentials of Musculoskeletal Care has sold over 71,000 copies. Texts
on global service data, coding, and orthopaedic basic-science subjects as well
as the Instructional Course Lectures, to name but a few, are all
acclaimed as superb sources of the current orthopaedic body of knowledge. The
Academy must remain sensitive to the needs of the fellowship and the time
constraints of our volunteer contributors to ensure its reputation as the best
publisher of orthopaedic printed texts.
The future of our Academy hinges on our residents and candidate members.
Over 98% of board-certified orthopaedic surgeons join the Academy as fellows.
This next generation of orthopaedic surgeons possesses different aspirations
and skill sets than you and I do and will redefine what makes the Academy
relevant. Recent knowledge-based initiatives by the Academic Affairs Council,
including the Residents' E-Letter, the resident practice management course,
and the expanded placement service, will ensure continued near-universal
membership and participation in the Academy by the next generation of
orthopaedic surgeons. Like many of you, I have had the privilege of training
these young doctors during my professional life and firmly believe that our
Academy's knowledge culture will thrive uninterrupted under the leadership of
these future orthopaedic surgeons.
Our international members, who now number over 2000, and our international
visitors, who also number in the thousands, attend our Annual Meeting and
value our electronic and print publications for their continued orthopaedic
education. No other professional orthopaedic association in the world offers
the breadth and quality of scientific and technical knowledge to our
international colleagues as the Academy does. Our Annual Meeting serves as the
international fair for the exchange of ideas and technology. Our distributions
and translations of educational material have increased 30% to 40% annually
for the last five years. Interest in Academy-sponsored continuing
medical-education courses throughout the world has mushroomed. The Journal
of the American Academy of Orthopaedic Surgeons and Orthopaedic Knowledge
Online are now prized benefits of Academy international membership.
Nevertheless, we have witnessed just the tip of the iceberg. Most of the
estimated 175,000 orthopaedic surgeons in the world do not have access to
Academy courses and educational materials. By the same token, we as Academy
fellows have not done all that we can to learn from our international
colleagues.
Many of our commonly performed orthopaedic procedures—from
intramedullary nailing to total joint replacement to
arthroscopy—originated abroad. More recently, international advances are
being made in arthroplasty registries, bone morphogenetic proteins, and
cartilage transplantation. In 2002, 35% of all scientific studies published in
The Journal of Bone and Joint Surgery were written by international
authors. The acquisition of knowledge is a two-way street. It is imperative
that we reach out to our international colleagues, benefit from their research
and experience, and secure the position of the Academy as a forum for
international exchange of knowledge.
Perhaps one of the most feared, yet important, customers in our knowledge
business is the government. Within the last two years, the Academy has been
approached by the Centers for Disease Control and Prevention, Food and Drug
Administration, Agency for Healthcare Research and Quality, Occupational
Safety and Health Administration, Centers for Medicare and Medicaid Services,
and numerous other governmental agencies. The Centers for Disease Control and
Prevention requested information and guidance on tissue allografts and
surgical infections; the Food and Drug Administration, information on implant
devices; the Agency for Healthcare Research and Quality, information on
patient safety; the Occupational Safety and Health Administration, information
on ergonomic-related injuries; the Centers for Medicare and Medicaid Services,
information on the role of arthroscopy in osteoarthritis care, and so on. The
Academy is a trusted, respected resource for these powerful legislative and
regulatory bodies that profoundly impact our practices and patients. What is
truly noteworthy is that these agencies, not the Academy, have initiated these
alliances, task forces, and contacts. That reputation as the
authority for up-to-date, accurate knowledge on musculoskeletal diseases and
patient care has never been stronger. The credibility that the Academy gains
from these exchanges of knowledge is invaluable in our advocacy efforts.
Research is the lifeblood of our specialty. The majority of the
technologies and treatments that I can now offer my patients were not known or
available when I was a resident in training. Some treatments have changed
incrementally, and some have changed completely, through orthopaedic research.
The Academy's role in research knowledge stretches across its full
continuum— from the support and encouragement of researchers to the
identification of a research agenda to the assessment of evidence-based
knowledge to its publication and dissemination.
Recent Academy efforts are especially noteworthy. An intramural orthopaedic
program at the National Institute of Arthritis and Musculoskeletal and Skin
Diseases was started. A clinician-scientist program was funded. A joint OREF
(Orthopaedic Research and Educational Fund)-AAOS development office was
created. A unified research agenda through the Council on Research was
developed. A protocol for research endorsement and collaboration was
formulated. IMCA (Improving Musculoskeletal Care in America) compendia on
major musculoskeletal areas were written. The premier peer-reviewed journal
for the dissemination of research knowledge, The Journal of Bone and Joint
Surgery, was provided as a member benefit. The acceleration of
orthopaedic research demands that the Academy remain as a leader in the
research knowledge business so that the next generation of orthopaedic
surgeons benefits as much from the Academy efforts as you and I have.
The Academy also has a major educational responsibility to the public, our
patients. "Your Orthopaedic Connection," the Academy's
patient-education web site, offers pertinent, accurate information on over 400
topics and is accessed by over 6,000,000 patients annually. The addition of
"en Español" and other language versions of the topics
promise to widen the coverage even more. Public service announcements on
television, radio, and billboards covering orthopaedic-related topics,
including patient safety and injury prevention, serve an estimated audience of
120 million. The Academy's public service campaign under the leadership of
Sandy Gordon has won the FREDDIE Award, the 2002 International Mercury Award,
and numerous other accolades for its creativity and positive impact on the
American public. We are committed to continue and expand these efforts,
perhaps partnering with and funded by greater corporate America through our
new development office.
No recent initiative of the Academy better illustrates our knowledge-based
culture than that on patient safety. Under the leadership of Drs. James
Herndon and David Wong, a critical issue that barely appeared on the radar
screen of our specialty has been propelled to the center stage that it
deserves. In a remarkably short time, the Academy conceived and implemented
programs on positive practices, critical incident research, fellowship and
residency education on patient safety, safety alerts, public education,
communication training, ambulatory surgery center screening programs, and a
reinvigoration of the "Sign Your Site" program. The Joint
Commission on Accreditation of Healthcare Organizations has assigned the
Academy a national medical leadership role in this latter program. The
rapidity with which the Academy provided this knowledge to its fellowship is
commendable. This patient safety program, one of the most important
initiatives in the seventy-two-year history of the Academy, will require
sustained, long-term commitment and innovation by the staff and
fellowship.
Advocacy—both for our patients and our profession—has become
critical to the mission of the Association. It is quite fitting that we will
be meeting next year in Washington, DC—the hub of regulatory and
legislative changes that daily impact our practices. Since the establishment
of our Association Washington office over twenty years ago, much in medicine
has changed. The role of government, especially the federal government, has
expanded in all areas, making long-term participation at all levels of the
political process mandatory for organized medicine.
Health-care expenditures constitute an astounding 14% of our American gross
national product. The number of stakeholders demanding a portion of the
health-care dollar is growing annually. Orthopaedic surgery represents only
about 5% of all allopathic medicine. How can we as a small surgical specialty
impact how health-care resources are allocated in our American society?
I believe that the answer lies in knowledge and education. Dollar for
dollar, orthopaedic care improves the health and quality of life for Americans
more than any other medical field does. This fact is unfortunately not
appreciated by the political power brokers. Our role as an organization must
be to get the message out. Through the Association, the Orthopaedic Political
Action Committee, the Board of Councilors, specialty societies, the state
orthopaedic societies, and the Bone and Joint Decade coalition, hard,
irrefutable data on the cost-effectiveness and value of orthopaedic care must
be researched, packaged, and distributed to our elected officials.
Rising liability premiums, frivolous lawsuits, and escalating jury verdicts
are a plague on the house of orthopaedics. The cure for this plague requires
access to political decision-makers, which, in turn, requires money. The
Orthopaedic Political Action Committee along with special campaigns, such as
our recent Medical Liability Reform initiative under the leadership of Stu
Weinstein, provides such access. Advocacy is not a one-shot activity. It
necessitates a sustained, continuing effort to educate and influence our
political leaders. Other interest groups, such as the plaintiff attorneys'
lobby, understand the need for a long-term commitment. Physicians in general
and orthopaedic surgeons specifically have been slow to grasp this concept.
The AAOS thus has an additional responsibility to educate our fellowship on
the political process.
In the 2002 McGladrey review of the Academy governance and operations, the
AAOS was described as an "intellectual capital
machine."4 The
consultants highlighted the numerous, high-quality publications, the Annual
Meeting, the impressive menu of continuing medical-education courses, the
research and communication programs, the aggressive advocacy efforts, and the
ingrained culture for experimentation and innovation as the knowledge-based
core value of the Academy. They were amazed at the breadth and quality of our
programs. They were even more impressed at the dedication and sacrifice of our
volunteers and staff. Our goal must be to nurture this tradition. In the next
decade, the pace of scientific, technological, legislative, and regulatory
change will surely accelerate. So too must the Academy's work. Remaining
relevant and valuable in the future is no easy feat!
In this era of information overload, orthopaedic surgeons turn to the
Academy for valid, concise information on a broad spectrum of issues. That
reputation, developed over years of hard work by volunteers and staff, must
never be compromised. We must remember: Knowledge is our business.
I want the Academy to continue to be the site where the patient goes to
discover the risks of an upcoming surgery, an orthopaedist goes to learn how
to safely perform a new surgical procedure, a government agency goes to
partner on a musculoskeletal initiative, the media goes for expert sources and
information on a story, a resident goes to learn how and where to find a job,
a candidate member goes to get precise practice management education, and even
the senior orthopaedist goes to learn the challenges of retirement. As I begin
my year as President of this wonderful Academy, I commit to you that I will
strive for these goals. As long as we remain the GO-TO authority for
knowledge, we will remain the premier medical association that the fellowship
and the staff have made it.