Your Voice Is Required NOW and the AAOS PAC Is HOW
There’s no way around it, says Stuart Weinstein, M.D., chair of the American Association of Orthopaedic Surgeons Political Action Committee (AAOS PAC)…the world of politics DOES affect your practice. And he thinks it’s downright shameful that some doctors don’t get involved. Dr. Weinstein tells OTW, “The number of changes occurring in both the legislative and regulatory arenas is astounding, and demands involvement from all doctors. Although many physicians have seen themselves as being on the sidelines when it comes to politics, we have reached the point where NOT trying to help our patients and our profession by getting involved is downright irresponsible. ‘But this is not part of being a doctor, ’ many say…yet political problems affect their practices daily. Take the issue of the sustainable growth rate formula. Since 2002 every physician has clamored to get rid of this. Now that we have a real chance of it being repealed and replaced, it is more important than ever to be actively involved.”
“We can’t hide from the fact that our daily lives are being driven by those in the state and federal legislatures. Look at the health exchange situation. The implementation of the Accountable Care Act [ACA] has so many things that we don’t even know about yet. These ‘warts’ may come out in upcoming year as the federal government tries to implement the ACA, meaning that being involved and staying in touch with politicians is important. Even they are behind the eight ball…they’re trying to figure out if they and their staff members have to buy insurance on the exchanges. If they are in the dark where does that leave us?”
“And for those in private practice who are essentially small business owners, they especially need to be participating on a political level. How does the healthcare law apply to you practice business? Can you afford the increased insurance premiums for your employees? Will you face the penalty? Will these increased costs prevent you from expanding your practice? Get involved! Host an event for a member of Congress, attend a town hall meeting…and if you can only do one thing contribute to the AAOS PAC, but…do something.”
Fellowship Accreditation: Coming Soon?
Residents are accredited uniformly by the ACGME (Accreditation Council for Graduate Medical Education)…why not all fellowships? Harry N. Herkowitz, M.D. is chair of the Department of Orthopaedic Surgery at Beaumont Health System in Michigan and is a senior director of the American Board of Orthopaedic Surgery (ABOS). He tells OTW, “Accreditation of spine fellowships will insure that a balance exists between service and education in the fellowship year. At present, only a handful of fellowships are accredited. In order to move toward uniform accreditation for spine fellowships it may be necessary to pursue subspecialty certification in spinal surgery. This process has already occurred for hand surgery and orthopedic sports medicine. Both of these subspecialties have certification and 100% fellowship accreditation. The idea of spine certification has been discussed for many years. Because orthopedic spine surgery and neurosurgery are coming closer together, the timing to consider certification may be here. The fellowship year is critical for a trainee and fellows need to have a good balance between operating, patient care, education and research.”
“As a member of the ABOS board of directors I am working with orthopedic spine surgeons and neurosurgeons to bring the discussion to a higher level and find common ground. The issue is that many surgeons don’t feel the need to do this and don’t want to go through this process because it requires testing and data gathering. We need to know what is being taught in that all-important last year of training. Some fellowships might be service heavy, so they’re getting a lot of clinical time…but it may be at the expense of research or education opportunities. We have no oversight of these programs and that needs to change.”
New Technique = Better ACL Outcomes in Young Athletes
James Lubowitz, M.D. is director of the Taos Orthopaedic Institute, Taos Orthopaedic Institute Research Foundation, and Taos Orthopaedic Institute Sports Medicine Fellowship Training Program. He tells OTW, “I’m pleased to say that my ACL [anterior cruciate ligment] outcomes have improved in my most difficult patients. It is well known that in patients over the age of 25, the re-rupture rate after surgery is about 1%; however, in young athletes, the re-tear rate approaches 10%. Given this extraordinarily high ACL graft failure rate in young athletes, I have changed the way I practice, and I am collecting prospective data to test the hypothesis that we can substantially improve our outcomes in this cohort. The changes have been in three areas: the first involves our knowledge of anatomy. Even though the study of anatomy dates to the times of Leonardo Da Vinci, and even the ancient Egyptians, the endoscopic ACL technique popular at the end of the 20th century placed the ACL femoral and tibial footprints in the wrong position. Now, by placing our grafts at the centrum of the anatomic footprints, I think that we are achieving better outcomes. Second, there are rehabilitation issues. We are paying a lot more attention to this. Now, instead of just focusing on strengthening the knee, we are also paying attention to core strength, hip abductor strength, and proprioceptive, plyometric, and perturbational training. Finally, we have improved ACL fixation with second generation, adjustable loop length, cortical suspensory fixation devices. Such devices, as opposed to interference screw fixation, allow graft collagen to fill the entire area of the ACL graft socket footprints, and in addition, are the only ACL fixation option that allows graft tensioning after graft fixation has been achieved. To date we have published our anatomical studies, and our adjustable loop length, cortical suspensory fixation device techniques, and colleagues have published the advances which I now employ with regard to rehabilitation techniques, but it will take more time to achieve adequate clinical follow-up on large cohorts of cases until we can truly test the hypothesis that our failure rates are lower.”
Mayo Clinic: Quality Care Delivered More Efficiently
The joint replacement folks at Mayo Clinic have figured out how to cut length of stay and maintain quality…and “optimization” is the key word, says Henry Clarke, M.D., of Mayo Clinic. Dr. Clarke, an associate professor of Orthopaedic Surgery at Mayo Clinic in Arizona, tells OTW, “We have undertaken an innovative program at Mayo Clinic to improve quality and to reduce costs. The program, which has been in effect for about two years, is a comprehensive effort to improve the consistency of care delivered at our facility. One way we do this is to thoroughly prepare patients preoperatively, something that involves a mandatory medical evaluation and a class on the procedure and the postop experience. This class involves our nurses, therapists and others, and is important so that patient better understand what will actually occur.”
“Essentially, we took a look at group of practitioners who had their own way of approaching knee replacement surgery, and we began integrating more standard measures into their practices, best practices if you would. For example, we can optimize patients’ preoperative blood count and use medication (tranexamic acid) to reduce the bleeding associated with total knee. This has essentially eliminated the need for transfusion in total knee patients. In addition, we do our best to lower the risk for DVT [deep vein thrombosis] by having each patient screened preoperatively by a nurse practitioner. I’m thrilled to say that through this integrated approach we have reduced our length of stay for these surgeries by nearly a day and a half while maintaining low complication rates.”
Terrific New Orthopedics Program in Bolivia
Orthopedic training is ramping up in Bolivia, thanks to Health Volunteers Overseas (HVO) and HOPE worldwide. At the Hospital Arco Iris (HAI) in La Paz, Bolivia, there is a group of well-organized orthopedic surgeons who would like to host volunteer surgeons who can help provide training in desperately needed specialty areas. These skills would help them provide up-to-date orthopedic care to the surrounding communities who have limited access to health care. It would also, says Dr. Rex Haydon, help them care for the victims of the mass casualty accidents that occur frequently along the Yungas Highway (aka, Highway of Death, the most dangerous stretch of highway in the world). Rex Haydon, M.D., Ph.D. is an associate professor of orthopedic surgery at the University of Chicago reviewed the new orthopedics program for HVO. He tells OTW, “This program was put in place to help broaden the skills and knowledge of practicing surgeons, interns and nurses. The group, including five orthopedic surgeons, would like to learn advanced techniques in arthroscopy, complex trauma, pediatric spine, microsurgery, and other areas. To date these surgeons have not had CME [continuing medical education] opportunities so they would like to host specialists in these areas to sharpen their skills. This program will address that.”
“HVO will offer three training courses each year, each of which will last from six to eight weeks. Two to three HVO volunteers—most from the U.S. and Canada—will lead each course and volunteer assignments will be for a minimum of two weeks during the training course. Retired orthopedists may also volunteer, and final-year residents and fellows could be eligible if they agree to work with an attending physician.”
“La Paz is safe, the accommodations are excellent, and there is a well-organized and motivated support group on sites in Bolivia all year. The hospital has well-equipped ORs, with a C-arm, microscope and arthroscopy tower, among other essential equipment. I believe that this could be a very meaningful and educational volunteer opportunity for a variety of surgeons.”
For more information, please contact Andrea Moody, Volunteer Coordinator for HVO: a.moody@hvousa.org
