In June 2006, Elizabeth Hofheinz, Senior Writer for Orthopedics This Week, and a native New Orleanian, traveled home to interview four orthopedists and a physical medicine specialist. The city and its orthopedic community were in dire straits. Programs were struggling to retain their residents, orthopedists were getting “emergency” calls from their contractors during surgery, surgeons were telling people to leave the state because their particular problem couldn’t be handled, hospitals were closed with no openings in sight, the uninsured population exploded, and all of this happened with a level one trauma center that had been flooded and destroyed.
It is May 2010, and the landscape has improved dramatically. Following are the impressions of several physicians, some of whom were interviewed in 2006.
Training to be an orthopedic surgeon is rigorous, no doubt. Fortunately, the path is well established, and there are veteran orthopedists to guide you. When Katrina struck New Orleans nearly five years ago, orthopedists in the city had no guidelines. There was no book to consult on rebuilding a practice or a residency program in a city with half its population gone, the remaining half in varying degrees of psychological distress, offices and homes destroyed, governmental confusion, and loved ones dispersed around the country. They had to figure things out for themselves…and figure things out they did.
Dr. Ollie EdmundsDr. Ollie Edmunds, President of the Louisiana Orthopaedic Association, states,
“While a number of orthopedic surgeons have left the state, we have also attracted new orthopedists from around the country. Although the population of the city remains less than before the storm, the number of patients per orthopedist has returned to its pre-Katrina level. Our residents are now doing significantly more surgical cases per resident than they were before Katrina.”
Dr. Edmunds, Professor of Orthopaedic Surgery and Chief of Hand and Upper Extremity at Tulane University Medical School, adds, “New Orleans still has that cultural uniqueness and charm that makes living here very special.”
Attracting New Residents and Surgeons
Dr. Jacques WhitecloudDr. Jacques Whitecloud, a specialist in Physical Medicine and Rehabilitation at Tulane was thrilled to see the doors open to a trauma solution. “Although there was a temporary trauma center after Hurricane Katrina closed Charity Hospital, the new trauma center at LSU Interim Public Hospital was officially renamed ’The Spirit of Charity Trauma Center’ and is the only Level 1 Trauma Center (as designated by the American College of Surgeons) in south Louisiana.”
Dr. Whitecloud says, “We have at least three orthopedic residents per year now at Tulane. With a five year program, that means we have fifteen residents at various levels of training. Prior to Katrina we had six residents a year—it was a great loss to suddenly have no residents to cover the emergency rooms in the middle of night. The Accreditation Council for Graduate Medical Education (ACGME) required us to show that our residents had plenty of cases during their training. Tulane is now fully accredited by the Residency Review Committee (RRC) of the ACGME and has more faculty than before Katrina.”
Dr. Whitecloud: “In the wake of Katrina, there was only one person doing pelvic reconstructions for all of greater New Orleans. Now we have three. We still face the reality that the surgeon will often be willing to come here, but the family is hesitant.”
Dr. Paul GladdenOne intrepid surgeon willing to join the orthopedic rebuilding efforts is Dr. Paul Gladden, a Tulane traumatologist who came from Jacksonville, Florida. “In deciding to come here after the storm, I factored in a new wife (who is growing to love the city), and issues such as crime and weather. I decided that natural disasters are part of most intriguing major cities, and that crime is an issue in every major city. The benefits of the culture and environment of NOLA significantly outweigh the risks.”
Traveling around the U.S., Dr. Gladden meets those who almost seem to think that rescue efforts are still underway.
“I am surprised to learn how naïve people outside of New Orleans are about the city’s status. People think it is still underwater and won’t make it back. The citizens of this city have done a terrific job of rebuilding, and I am glad I am here to help. The city’s infrastructure is stable but could use some improvements; in particular, flood management and street repair need a boost. To my colleagues around the country I say, ‘don’t count us out as strong supporters and contributors to the field.’”
Dr. John DavisDr. John Davis, a spine specialist at Tulane, came to New Orleans from Cleveland three months before Katrina. “I was going to embark on a spinal cord injury project at Charity Hospital, but the facility didn’t survive the storm and many projects were delayed. So we ended up covering the majority of orthopedic trauma call for Tulane—without residents.”
Describing the path back for the residency program, Dr. Davis says,
“As part of the approval process, the RRC has requested a copy of our hurricane plans. One obstacle to getting residency slots was that we didn’t have enough facilities. Not only are there more hospitals open now, but we have a presence at a hospital on the North shore of Lake Pontchartrain so our residents could continue training there in the event of yet another hurricane.”
Ideas on Further Development
Dr. Frederic WarrenDr. Frederic Warren, Chair of Orthopaedics at Ochsner Health System, says that at times there is additional pressure on its surgeons. “Ochsner has rebuilt to a full contingent of 13 orthopedists covering all subspecialties. But the workload has changed because in addition to elective surgeries, we have had an increase in trauma. While there is now a level one trauma center, at times they get overwhelmed and have to distribute the work. In many cases it is not distributed equally because of the shortage of orthopedists at some hospitals.”
The next time he has the gavel at a local orthopedics meeting, Dr. Warren has a message: “Let’s join forces.” He explains, “We have three training programs in metro New Orleans…we should combine our efforts. While turf issues would likely arise, together we could build one of the best training programs in the country.”
Dr. Andrew King, Professor and Chairman of Orthopaedics at LSU Health Sciences Center, thinks philosophically:
Dr. Andrew King“There is no bad event that doesn’t have some good outcome. Everyone had to examine things in a new light, something that we don’t often get to do in life. The most challenging issue has been recruitment because there is the lingering perception that New Orleans is unsafe. Anyone who comes here will definitely have an ample supply of interesting patients. Aside from the city having a certain zest and fascinating history that is celebrated by the local populace, New Orleans has always been a center of medical education.”
Dr. King: “The days of teaching people through a charity hospital are gone from the city. You must teach medical professionals in integrated hospitals of academic excellence. The idea of having a hospital that is for the indigent while the rest of the population goes elsewhere shouldn’t be resurrected.”
Dr. King adds that LSU will be bringing several new people on board. “We have had a lot of interest in our program and hope to hire four or five new faculty members by the end of the year. Most will be young surgeons just out of fellowship, something exciting for residents because they’re closer to them in age.”
Few orthopedists have the opportunity to participate in re-creating a city’s orthopedic infrastructure. Those who are doing so in New Orleans are finding an unparalleled experience that provides rich growth…and seasoning.
