Dr. Kevin Bozic

Senators seek him out, as do seniors with bad hips. By designing an expansive life, Dr. Kevin Bozic, an orthopedist at the University of California, San Francisco (UCSF) and acclaimed health policy expert, is nothing if not impactful.

A Well-Rounded Childhood

Kevin Bozic grew up in small town America in a family with strong values and an international outlook. “My dad, originally from Yugoslavia, and my mom, a native of Canada, raised my brother, sister, and me just outside of Bethlehem, Pennsylvania. Although we spent a lot of time playing competitive sports, the primary emphasis was on family and community. My parents were emphatic that my siblings and I learn to take care of ourselves, and emphasized academics as an important part of the equation. My grandfather, father and older brother were all engineers so early on I gravitated toward that field—but I knew I wanted a medical and/or human slant to it.”

His roots having been solidified, but not ossified, Kevin Bozic had his hat set for orthopedics from a young age. Along the way, he set out to pepper his life tale with broader experiences. “When I entered college at Duke University I aimed for a degree in biomedical engineering, knowing that I eventually wanted to pursue a career in orthopedic surgery.”

The part of medicine that interested me the most was in the realm of engineering and physics and how things work. In particular, I wanted to earn my engineering undergraduate degree in a nontechnical/liberal arts school. Why? Because I could see the downside of being too technical, i.e., not seeing the forest for the trees. My goal was to leave college as a well rounded person.

Before heading to medical school, however, Kevin Bozic had a little more rounding out to do. “I knew engineering ‘by the books, ’ but I wanted to actually work as an engineer for one year in order to solidify my knowledge. So I deferred my application to medical school and came to the San Francisco Bay area to work for an engineering consulting firm. During this time I matured as a person and got a better perspective on what I was trying to do with my career and what I needed to do to be successful. The experience gave me much more focus.”

Medical Training and Memorable Mentors

Kevin Bozic definitely saw the trees now. Not having to meander through the “what specialty should I choose” decision tree, he quickly hunkered down on the orthopedic track. “I began medical school at the USCF School of Medicine in 1990 and the next year sought out the new Chair of Orthopaedic Surgery, Dr. David Bradford, who became an important mentor. At the end of the first year, he invited me to spend one day a week with him over the summer seeing patients. I also worked on a research project on finite element modeling of the cervical spine, which allowed me to combine my interests in engineering and orthopedics.”

This promising start took him to the Harvard Combined Orthopedic Residency where he met other trailblazers who helped guide his career. “I was fortunate to have a number of visionary mentors in my residency who helped me decide on a career in academic medicine. Dr. Jesse Jupiter, a gifted hand surgeon who is very committed to teaching and research, helped me realize the rewards of a career in academic orthopedics. He traveled all over the world teaching others and was very interested in propagating his knowledge beyond his immediate sphere of influence.”

One mentor in particular taught Dr. Bozic how to be impactful from the business side of medicine. “Dr. Jim Hernden, who became Chair of Harvard Orthopaedics during my residency, had come from the University of Pittsburgh and had a business background; he got me interested in the idea of pursuing business management training. I could see that his education afforded him a broad perspective on medicine and the problems that needed to be addressed. It was clear that this training had also prepared him well for running a department as well as interfacing with hospitals and insurance companies. He opened my eyes to the fact that there are many perspectives on the challenges faced by our healthcare system, and that being able to understand different viewpoints can be helpful when thinking about solutions to our health care problems.”

“The interesting thing about Harvard, ” continues Dr. Bozic, “is that it’s a Combined Residency Program such that residents rotate through different hospitals and get exposed to different surgeons and their ways of doing things. Toward the end of residency, I felt very confident in my orthopedic training, but I was convinced that I was missing an understanding of how healthcare fits into the bigger picture of our economy and society. I applied to Harvard Business School’s MBA Program, and two days after completing my residency, I began the 18 month program, which ended up being quite a transformational experience.”

Among the things I learned was that medicine is only 15% of the GDP and not 100%! I came to see that the way I had been trained to think as a doctor was somewhat narrow; I also gained an understanding of how other stakeholders think. In particular, I was pleased with my decision to earn an MBA from a program whose emphasis was not healthcare. I believe that some of the problems we experience in healthcare are because we assume that ‘healthcare is different, ’ and as a result, we are reluctant to apply conventional business principles and logic that could be very helpful in addressing some of the most significant problems that plague our healthcare system.

Up to his ears in finance and operations management for nearly two years, Dr. Bozic soon thought it prudent to re-familiarize himself with OR life. “I did a six month, informal fellowship in orthopedic traumatology at Harvard/Mass General in order to regain my surgical skills—and do so in an environment in which I was comfortable and familiar. I then headed to Rush University Medical Center where I did a fellowship in adult reconstructive surgery.”

Dr. Bozic: “I had the opportunity to learn from some of the most talented surgeons in the field of hip and knee arthroplasty, including Dr. Josh Jacobs, the current Chair and one of the most thoughtful, accomplished clinician scientists I’ve ever worked with. He planted the seeds in my head with regard to my considering a career that combines clinical medicine with rigorous, clinically relevant research. Drs. Richard Berger and Wayne Paprosky are two of the most technically gifted surgeons I have ever worked with; they taught me how to think critically about problems in adult reconstructive surgery.”

For advice about constructing a career, Dr. Bozic didn’t have to look far. “Dr. Aaron Rosenberg, my Fellowship director, gave me the opportunity to train in the Rush Adult Reconstructive Surgery Fellowship Program, an offer I was pleased to accept. Although I learned a great deal from Dr. Rosenberg, the message that resonated with me the most is that the biggest challenges we face in our careers are time management and balancing one’s personal and professional commitments. We orthopedists often take it for granted that we can manage these things and don’t spend time thinking about them or planning for them in our many years of clinical training. These days, I convey these same messages to the orthopedists I train.”

Two years later, Dr. Bozic encountered another old mentor. “Happenstance led me to run into Dr. David Bradford, who invited me out to UCSF to discuss career opportunities. I quickly realized that he was truly interested in investing in me as a person and was not just trying to fill a spot on his roster. He inquired as to what it would take to make a success of my academic career and what resources I would need. Encouraged and intrigued, in 2003 I joined the faculty at UCSF. Nowadays, when I advise residents and fellows who are looking at academic positions, I tell them, ‘Seek out a department with a Chairman who is interested in investing in you and your career, rather than a place that is simply looking to fill a specific clinical need in their department.’”

Shaping Health Care Reform

As for his love of shaping public policy, Dr. Bozic explains, “I became interested in this area because I felt it was important for doctors to have a bigger voice in shaping health policy in this country. I was fortunate to be invited to join UCSF’s Philip R. Lee Institute for Health Policy Studies, a multi-disciplinary research institute where clinicians and social scientists work together to develop meaningful, policy-oriented research.

The fact is that historically, when doctors got involved in the political arena, they tended to focus on subjects that are viewed as ‘physician-centric’—physician compensation and medical liability reform. Although these issues are important, we have so much to offer in other areas, including healthcare delivery reform, but our voice has become marginalized because policy makers know what they’re going to hear from us—‘Our malpractice premiums are too high and we don’t get paid enough.’ They have started tuning us out in part because we tend to come across publicly as trying to preserve the status quo, rather than being truly interested in trying to fix the problems with our health care system.

“In order to have a bigger voice in health care reform, we must be able to think beyond our own issues, ” adds Dr. Bozic. “However, I am optimistic that our profession is changing, and more and more physicians are interested in critically evaluating the bigger issues and being part of the solution to our health care crisis. This change in mindset offers the possibility for physicians to play a bigger role in influencing positive change in our healthcare system.”

Because his work affects such a broad array of people and institutions, in 2006, the Orthopaedic Research and Education Foundation (OREF) honored Dr. Bozic with the Clinical Research Award, laurels given for the most impactful clinical research. Dr. Bozic: “My colleagues and I looked at the cost of delivering care for primary and revision hip and knee replacement patients to determine whether the procedures were being coded and reimbursed in a way that reflected the true cost and complexity of the surgeries. We looked at the administrative codes that are used to characterize hip and knee replacement failures and found that they weren’t sufficiently specific to understand the cause of failure.”

“Additionally, ” says Dr. Bozic, “we examined Diagnosis-Related Group (DRG) codes related to hip and knee replacement, which have always been lumped together for hip and knee replacement patients whether they’re undergoing their first replacement or tenth revision. We measured all of the clinical characteristics and costs of caring for both primary and revision patients at four high volume hip and knee replacement centers and found that they were very different for primary and revision procedures. The result of this work was that we presented the data to Medicare and convinced them to alter their policy and create separate DRG’s for each group.”

Physicians in Congress

“Ask an orthopedist if advertising is right for you.” At least that’s what Congress did…they asked Dr. Bozic about the impact of direct to consumer advertising in healthcare. “My colleagues and I undertook a study in which we surveyed patients and doctors as to their attitudes in response to advertising for orthopedic procedures and devices. After examining the data from 400 patients and 400 surgeons it was clear that they had quite different viewpoints. For the most part, the physicians found advertising annoying and said that it interfered with their autonomy, as well as the doctor patient relationship. They also indicated that the information was not helpful in clinical decision making, and, because it was inaccurate at times, was actually dangerous.”

“On the other hand, ” said Dr. Bozic, “patients found the advertisements to be helpful in gaining a better understanding of their disease and the treatment options available. After the results of our study were published, I was asked to testify before the United States Senate Committee on Aging as to if or how direct to consumer advertising should be regulated. I was asked if I thought it should be legal in the United States, to which I replied, ‘Yes, as long as it is properly regulated.’

“There are two types of advertising that the FDA recognizes, one labeled ‘help seeking ads’ (if you have arthritis see a doctor and ask if xyz is right for you). The others are product specific ads (if your knee hurts talk to your doctor about the xyz brand of knee replacement implant). These often include biased information that is not always supported by evidence.”

I recommended to Congress that there be more emphasis on the help seeking ads, and that the product specific ads be more properly vetted. There is now legislation related to this work being considered in Congress; the lawmakers check in with me periodically for input and recommendations.

When asked why he thinks more orthopedic surgeons are not actively involved in health policy research, Dr. Bozic states, “This is a new area for orthopedic surgeons, so they have to get acclimated to not only its importance, but the language, stakeholder expectations, etc. One of the things I tell younger surgeons is that it is still an area where they can make their mark professionally. I tell them, ‘Look, if you want to make an impact in a field like bone biology it will take you half your career to establish yourself. Because health policy research is relatively new for orthopedics, you can help shape the development of the field—and make an impact early in your careers.’ Then I tell them the only downside is that because of this newness, there are not as many role models and mentors, at least in orthopedics, to model their career after.”

At home, there are also young people to be mentored. “My wife Christi and I have two daughters, Ava, who is four years old, and Alexa, who is two. More than anything else in the world, I enjoy being with my family. I still strive to achieve a balance between a rewarding professional career and a fulfilling family life, something I will be working towards for the rest of my life.”

Dr. Kevin Bozic…influencing individuals and systems.