Distinguished leaders of the American Orthopaedic Association, guests, and
ladies and gentlemen:
I come to you humbled by the honor and privilege to serve as the 118th
president of the American Orthopaedic Association (AOA)—the association
of orthopaedic leaders. Like all others who have served before me, I owe the
honor to those who have preceded me. I am thankful to God for the direct
calling into the medical profession. I stand here today because of His
guidance, protection, and direction. I owe much to those who were influential
in my career: Fred Elliott, J. Paul Harvey, Sig Hansen, Bob Winquist, Dan
Spengler, Mike Copass, Roby Thompson, and to the great foundation that has
been given to me in a career as an orthopaedic trauma surgeon. My partner of
thirty-three years, Beth, and our children have given me much support and have
sacrificed a lot. I am grateful to them. The hard work in patient care,
teaching, and research has been rewarding. The ultimate reward is the pulpit I
have been given in front of the orthopaedic leaders of much of the world. I
intend not to waste it and to speak to a phenomenon that I have witnessed
evolving at an exponential rate over the last decade—the criteria for
orthopaedic leadership.
One of the duties and privileges that one takes on as First Vice President
is the receipt of the copies of all 117 AOA presidential addresses—all
thirty pounds of them. I enjoyed reading them and can attest to the dramatic
range of topics. Seventeen presidents spoke on clinical issues; seventeen, on
an aspect of orthopaedic history; seventeen, on issues related to
specialization; nine, on medical education; thirty-seven, on issues related to
AOA affairs; and eighteen, on controversial topics within the socioeconomic
area of our specialty. More recently, presidents have focused on the concerted
collective effort of our organization to address the elements of
leadership—I intend to follow that path. One of the other aspects that I
noted in my review of the other presidential addresses is the remarkable lack
of brevity—let us see if I can do better.
The aspect of leadership I would like to address is the criteria for
appointment to positions of influence. My premise is that we must select
individuals for high leadership positions on the basis of criteria that are
essential to the future survival of orthopaedic surgery as a profession. I
intend for these comments to be food for thought for ALL of us in
this room—myself included—as none of us are immune from these
basic human frailties. I ask your forgiveness if this comes across as
"preachy"; that is not my intention.
What I have witnessed over the last decade is that individuals are
increasingly chosen for high leadership positions in orthopaedic surgery on
the basis of financial or "empire" success, that is, a form of
flattery based on envy or prominent social values. Individuals often have
achieved this success by avoiding peer accountability and review—by
working within community, industry, or hospital environments that foster and,
in many cases, finance their development—not by working within circles
of physician peers. The metric used to establish credibility for leadership is
the one that is most easily measured: the dollar (therefore, the
"W2" reference in my title). Many of these influential leaders
have frequent contact with fellows, residents, and young orthopaedic surgeons
through fellowship programs and continuing medical-education opportunities.
The attitude of avoiding complex systems, such as multispecialty or large
orthopaedic group practices and academic health centers, to achieve prominence
and rapid fiscal security is readily displayed, and it has an impact on the
younger generation of orthopaedic surgeons who are formulating their own
leadership values. The criteria for success in orthopaedic surgery begin to
shift to starting salaries, avoiding emergency-room call responsibilities,
acquiring European sedans and high-performance aircraft, and increasing net
worth. This attitude shifts the values of the profession, and, in my view, we
are in the midst of this shift. I believe that if we, the leaders of the
orthopaedic specialty—the members of the AOA—take action, this
dangerous trend can be reversed.
The consequences of this shift are that the fundamental underpinnings of
professionalism are devalued. Collectively, we forget why we went into
medicine.
Patient primacy is seriously challenged. We have no recollection of the
values we held when we took the oath (therefore, the "WMD" refers
to "Why I became an MD"). I am of the opinion that nearly all of
us went into medicine to help others (i.e., patients). We chose orthopaedics
because we felt that it would allow us to do "more" for patients
than we could in other specialties. Many of us have lost sight of this as we
have fallen victim to increasing cynicism and changing societal values. As a
result, we are unwittingly passing this tendency on to our trainees and young
partners. We must reverse this trend lest we lose the privilege that society
grants us as professionals. The list of special considerations we have at risk
includes the right to be self-governing and to discipline our members and the
wide-spread societal acceptance of our commitment to continue to act in the
best interests of individual patients as well as society as a
whole1. We can and
will lose these privileges unless we return to the values, hopes, and dreams
that we had at the beginning of our medical careers and select individuals for
leadership positions in orthopaedic surgery who will maintain the commitment
to these values.
As chairman of the University of Minnesota Department of Orthopaedic
Surgery, I attended the medical school graduation ceremony on Friday, May 6,
of this year. As is done in many schools, our graduates recite (along with all
of the physician members of the audience) the "Oath for New
Physicians," which has been adapted from the Hippocratic Oath. The
following are a couple of brief sections:
I acknowledge my limitations and need for continuing education. I will seek
the knowledge and inspiration of colleagues, friends and patients.
My work shall be dedicated to improving the quality of life for those who
seek my assistance. I will honor the wishes and needs of the patient,
recognizing that death is not always an enemy. I will do no harm.
I will strive always to improve the practice of medicine, to provide a
level of care that is ethical, moral and just. I expect the same standards
from my colleagues and will not tolerate their indifference, greed, or
unethical behavior.
We, the educators in orthopaedic surgery, encounter the idealistic interns
and brand-new first-year residents who remember this oath, and, within a mere
four additional years, we graduate individuals from our orthopaedic programs
who are all too often cynical and focused solely on the economic aspects of
practice rather than on the great professional privilege they enjoy. What do
we do to these people in the process that causes this fundamental shift? I
would suggest to you that this is a role-model issue, and all too often we are
part of the problem.
We are not alone in facing these changing forces—they are by-products
of our evolving societal values. Many wise individuals through the ages have
recognized that this tendency is common to all mankind, and they have given us
warnings, encouragements, and sage advice. Aristotle said: "Happiness is
participating in something that brings fulfillment. Fulfillment is helping
others." Tolstoy stated: "The vocation of every man and woman is
to serve other
people."2 In
Proverbs 22:1, Solomon advised: "A good name is more desirable than
great riches; to be esteemed is better than silver or
gold."3
We, the leaders of orthopaedic surgery, must understand our position of
influence in selecting individuals for positions of prominent influence, but,
as importantly (if not more so), we must understand how our attitudes and
values have an impact on the trainees and junior partners with whom we are in
constant contact. Henry Adams stated it well: "A teacher affects
eternity; he can never tell where his influence
stops."2
For those of us who strive for immortality via accomplishment, Mitch Albom,
the best-selling author of Tuesdays with Morrie, warns: "I
buried myself in accomplishments because with accomplishments, I believed I
could control things, I could squeeze in every last piece of happiness before
I got sick and
died."4
In a few more lines from the book, Mitch Albom quotes Morrie Schwartz, his
college professor who was dying of amyotrophic lateral sclerosis: "So
many people walk around with a meaningless life. They seem half-asleep, even
when they're busy doing things they think are important. This is because
they're chasing the wrong things. We put our values in the wrong things. And
it leads to very disillusioned lives. I think we should talk about that...
We've got a form of brainwashing going on in our country... Owning things is
good. More money is good. More property is good.... More is good....
The average person is so fogged up by all this, he has no perspective on
what's really important
anymore."4
On finding a meaningful life, Schwartz says: "Devote yourself to
loving others, devote yourself to your community around you and devote
yourself to creating something that gives you, purpose and meaning....
Everyone is in such a hurry. People haven't found meaning in their lives, so
they're running all the time looking for it. They think the next car, the next
house, the next job. Then they find those things are empty, too, and they keep
running... Even people who have jobs in our economy are threatened, because
they worry about losing them. And when you get threatened, you start looking
out only for yourself. You start making money a god. It's all part of the
culture... Once you get your fingers on the important questions, you can't
turn away from them.... As I see it, they have to do with love,
responsibility, spirituality, awareness. And if I were healthy today, those
would still be my issues. They should have been all
along."4
We all have tendencies to chase after the superficial and easily measured,
but we all have a brighter side, one which George Washington called the
celestial fire of conscience.
Rick Warren, the author of the best-selling book, The Purpose-Driven
Life, offers us some food for thought on this
subject5.
"Many people spend their lives trying to create a lasting legacy on
earth. They want to be remembered when they're gone. Yet, what ultimately
matters most will not be what others say about your life but what God
says. What people fail to realize is that all achievements are eventually
surpassed, records are broken, reputations fade, and tributes are
forgotten."
More insight on how changing societal values can impact a profession is
provided by Laurence Shames, author of The Hunger for
More6.
"As taste was being reduced to a knowledge of what things cost, so
lifestyle, formerly a map of one's adjustment to the world, was coming down to
questions of where one scrimped and where one splurged... The people who felt
poor on $600,000 a year were leading a very privileged lifestyle that wasn't a
free life at all. They weren't free to work less. They weren't free to work
more at something they might like better but would pay them less.
They weren't even really free to buy what they wanted, since the sort of
things that went with their lifestyle constituted a rather narrow and
conventionalized catalog, a menu of luxurious clichés. They were stuck
with the Baccarat, the beluga, and the black-tie Saturday evenings, and they
couldn't give them up without, God forbid, seeming to be slipping. True to the
wisdom of the Chinese, there were people whose hard fate it was to have gotten
what they wished for.... The war between lifestyle and life... often
boiled down to the conflict between money and time. There simply weren't
enough hours in the day to earn a living and go to the health club
and do the shopping and eat the mahi-mahi and
dabble in the kitchen or the workshop or at the keyboard or the easel.
Something had to go. What went?... Things like friendship. Things like
romance. Things like sitting around doing nothing, except maybe looking out
the window. Private things whose value you alone determine."
I think Shames really captures what I am trying to say about our
responsibility in the selection of leaders in this quote: "Making money
is a private affair, but success, so to speak, is by general consent; we, all
of us, define it every day. We have a right to demand a real accomplishment, a
making of something better, before we give some-one our regard and our
applause... A people who are as wealthy as they are likely to become can
always become wiser, more humane, more highly evolved in the uses of their
wealth."6
This notion of chasing after material wealth without considering what it
really costs is not new. From modern literature, Brick in Tennessee Williams'
play, Cat on a Hot Tin Roof, says to Big Daddy: "Worthless!
Worthless!... Can't you understand? I never wanted your place, or money or to
own anything. All I wanted was a father, not a boss. I wanted you to love
me."7 From
ancient history, the Apostle Paul wrote to his advisee, Timothy, in 1 Timothy
6:7 and 9: "For we have brought nothing into the world, so we cannot
take anything out of it either.... But those who want to get rich fall into
temptation and a snare and many foolish and harmful desires which plunge men
into ruin and
destruction."8
Alan McGinnis observed in his book, The Friendship Factor:
"I notice that the happiest people do not have to shove and push. They
do not worry about intimidating others; they are confident in their own
self-worth, much of which comes from making other people happy. There are
rewards for such acts, for the friend who is willing to sacrifice for you is
not easily
forgotten."9
Archibald MacLeish, as quoted by Bob Dylan in his book, Chronicles.
Volume 1, remarked: "The worth of things cannot be measured by what
they cost but by what they cost you to get it, that if anything costs you your
faith or your family, then the price is too high and there are some things
that will never wear
out."10
My good friend Chuck Swindoll has some cautionary words regarding the
avoidance of dealing with difficult issues such as those we are discussing:
"Even though it is easy to buy into a selfish lifestyle and opt for
isolationism instead of involvement, the consequences are bitter and
inescapable."11
We, the leaders of orthopaedic surgery, must deal with this issue before
the trend becomes irreversible and we lose our professional standing in
society. The dangers of sitting by and waiting are real.
Martin Niemöller, who was a Lutheran pastor in Germany in the 1930s,
made a statement about his experience during World War II that may be
relevant: "They came first for the communists, and I didn't speak up
because I wasn't a communist. Then they came for the Jews, and I didn't speak
up because I wasn't a Jew. Then they came for the trade unionists, and I
didn't speak up because I wasn't a trade unionist. Then they came for the
Catholics, and I didn't speak up because I was a Protestant. Then they came
for me, and by that time there was no one left to speak up." Let us not
wake up a decade from now and find out that nonphysicians control all
decision-making in patient care because we physicians could no longer be
trusted to act in the best interests of our patients and society.
What are the solutions to the issue? They are, first of all, our individual
actions and, second, the result of our collective action as the AOA.
Individually, we must return to our professional origins and answer the
question frequently (if not daily): "Why did I become an MD?" We
must return to living out our professional values for the sake of our patients
and the next generation of orthopaedists. In regard to the AOA, too many
scholarly addresses have simply outlined problems with no solution. There are
things that we, the leaders of orthopaedic surgery, can do to try to support a
reaffirmation of our professional origins. With executive committee support, I
would like to consider submission of a formal request to the Accreditation
Council for Graduate Medical Education and the Orthopaedic Residency Review
Committee to insert professionalism into every orthopaedic residency
curriculum.
We will request formal support from the AOA executive committee for
expanded efforts by the American Board of Orthopaedic Surgery to insert an
evaluative review of professionalism into the "Maintenance of
Certification" process.
I intend to ask for executive committee support to convene a task force to
develop criteria for AOA Leadership based on principles of professionalism.
The criteria to be addressed might include whether the individual being
considered for a position of influence has consistently demonstrated local
decision-making that does not benefit him or her financially, documentation
that the individual has influenced promising young surgeons into pursuing
careers that emphasize professional fulfillment (and not W2 statements), and
the testimony of peers confirming that the individual has appealed to their
brighter side and has moved them away from cynicism. Once these principles are
codified, I will request assistance from the presidential line to share this
with the American Academy of Orthopaedic Surgeons and all orthopaedic
specialty societies.
I conclude with my favorite quotation on this essential area of our lives,
which is from Shakespeare's
Othello12:
to serve as the 118th President of the American Orthopaedic Association, the
organization of leaders who are willing to take on the difficult issues facing
our profession.
"Good name in man and woman, dear my lord, Is the immediate jewel of
their souls.Who steals my purse steals trash; `tis something, Nothing; `Twas mine, `tis
his, and has been slave to thousands.But he that filches from me my good name Robs me of that which not enriches
him And makes me very poor indeed."
"Good name in man and woman, dear my lord, Is the immediate jewel of
their souls.
Who steals my purse steals trash; `tis something, Nothing; `Twas mine, `tis
his, and has been slave to thousands.
But he that filches from me my good name Robs me of that which not enriches
him And makes me very poor indeed."
Dear colleagues, in summary, it is all about maintaining balance in our
lives—balance among our professional life, our family life, and our
spiritual life. As with trying to stand on a tightrope, maintaining balance in
our lives requires a series of continuous evaluations and adjustments to avoid
catastrophe.
It is also about privilege; we must remember on a daily basis how fortunate
we are to be entrusted with our patients' lives and how significant our
standing in society as professionals really is. We cannot afford to fail in
either area.
Thank you all for the honor and the opportunity you have given me