Many years ago, a young resident paraded behind his mentors, patiently doing rounds and absorbing knowledge. He had no idea that one day, he would sit in the chair…that he would be the chair. But as of August 2015, C. Lowry Barnes, M.D. is the Chair in Orthopaedic Surgery at the University of Arkansas for Medical Sciences (UAMS).
After graduating with honors from the UAMS College of Medicine in 1986, Dr. Barnes remained at UAMS for his internship and residency in orthopaedic surgery. He then went “up East” where he completed a fellowship in Adult Reconstructive Surgery and Arthritis Surgery at Harvard Medical School and Brigham and Women’s Hospital in Boston.
Dr. Barnes went on to found Arkansas Specialty Orthopaedics, where he was president for more than a decade. Regarding his move to academia, Dr. Barnes tells OTW, “I made a gradual transition from private practice because it was only right that I give my patients and partners sufficient notice. The most exciting aspect of this move has been helping transform the department into a growth engine. For instance, in September 2014 the adult practice saw 400 new patients in a month; that number has now grown to 1, 000 per month. Patients previously waited several months to see someone in some of our orthopedic subspecialties; now, we make sure that all patients are seen within two weeks of their initial phone call.”
“The timing was right…and we were very fortunate that the university was willing to allow us to do new things. Rick Smith, M.D., the Dean allowed us to develop a compensation plan that rewards production—not only clinically, but from a research standpoint as well. While that helped to motivate people, it was not enough…we needed new strategies. For example, access to care was difficult for our patients who are in outlying areas (something particularly stressful for those with mobility issues). We established an offsite clinic—a freestanding, one story building that people can drive right up to. I’m pleased to say that I’ve heard from a number of patients I saw in private practice who are convinced that our clinic now works just as well as or better than my private practice.”
Developing a World Class Academic Program in Orthopedics
As for adjusting to how things operate in academia, Dr. Barnes notes, “The reality is that things take longer to get done in a university, largely because more people are required to sign off on projects and because there are so many projects. I was accustomed to a private practice with a single specialty orthopedic group where it was easy to make decisions. It was somewhat different in that private practice shareholders have equal votes. Here at the university, we have had a departmental consensus on each project undertaken thus far. These decisions then require approval of others because it’s an academic institution with a hierarchal system. Fortunately, our early success has created a certain trust factor with those to whom we report.”
“Another adjustment is that the university has adopted service lines for clinical care. Although we have a musculoskeletal service line, many doctors in my department are in other service lines as well. Although you could see that this might cause friction, the chair of neurosurgery and I have worked hard to create a non-competitive atmosphere for our spine surgeons. As of now, we have two trauma surgeons working in the trauma surgery line and two orthopedic tumor surgeons in the cancer service line.”
Step One: Transparency and Cross-Pollination
All of this cross-pollination helps give Dr. Barnes the ability to take a detailed look at the daily, yearly, and monthly activity in the department. “Our motto is ‘transparency, ’ something that allows us to look carefully at the number of new patients seen each week, the total seen each week, etc. Everyone in the department sees everyone else’s numbers, including who has published that month. Each week we even have a report on length of stay for each surgeon. My faculty members see my work RVUs (Relative Value Units) each week. As long as I am producing significantly no one questions what I am doing…and besides, they are the recipients of my early morning and late night emails. Being so open with this information is going a long way toward our quest for excellence.”
Step Two: Build the Talent Pool
“In a very short period of time, we have added a spine surgeon, two other joint surgeons, a foot and ankle surgeon, and two hand surgeons. We have an offer out for another joint surgeon and are also hiring a new Chief of Pediatric Orthopaedics and a staff position in pediatrics. We should be able to treat any kind of orthopaedic injury that occurs in our state. The days of replants, brachial plexus injuries, etc. being transferred elsewhere are over.”
Step Three: Research, Research and More Research
“On the research front, we are expanding our focus on biomechanics, and combining our funding and efforts with that of Dr. Stavros Manolagas, M.D., Ph.D. at UAMS. He is a talented metabolic bone researcher who is exploring bone turnover, bone production, the prevalence of osteoporosis, the effect of cancer on bone, and other things related to the basic biology of bone. Also exciting is our new osteomyelitis program that is led by Mark Smeltzer, Ph.D. a microbiologist who is part of our orthopedic bone research center. Then there is our nanotechnology division where we are working on bone scaffolding, regeneration of bone tissue in large defects, and coatings for implants with Alex Biris, Ph.D. This kind of environment is especially wonderful for residents. They might have a challenge in the OR, go to the lab looking for a better way to do X, talk with the researchers, and then test an idea to see if it works. There are only a few other entities in the U.S. with all of this under one directorship…and the fact that we have the nanotechnology is even more rare.”
Asked what best prepared him to lead the department, Dr. Barnes said, “I was a managing partner and led a number of practice mergers in our city. I also served on the Finance Committee and Board of St. Vincent’s Infirmary. To be able to bring that background to an academic department is a real boost. And fortunately, I am accustomed to managing a demanding practice while still being a busy clinician and researcher.”
Conclusion: Build on Your Clinical Strengths
Asked to imagine how he would react if someone dropped a million dollar grant in his lap, Dr. Barnes said, “I would spend a portion of that money on hiring more people for our lab so that we could support researchers early in their careers when they are preparing for external funding. I would allocate some funds to further resident education, thus allowing them to travel to more meetings and present their research. In addition, I would work more on technological solutions for patient education (such as easy apps that verify that patients truly understand what we are teaching them). We are doing our best on this now, and are working with Kristie Hadden, Ph.D., who is new to our department and specializes in health literacy. Our literature needs to be as clear as possible; we are loading questions into the EPIC software so that when a patient has an intake done we get an idea of his or her health literacy so that we can treat the patient in a more personal manner.”
“We are trying to move our department to the place where we have the right surgeon performing the right surgery at the right time. We will eventually have only pediatric orthopedic surgeons taking children’s call, only trauma surgeons taking trauma call, etc. It’s all part of this exciting growth process that will result in our patients having the best care possible.”
