McCann PD

This month will mark the end of my 10-year tenure as Editor-in-Chief of The American Journal of Orthopedics (AJO). Every successful organization goes through periodic transitions, where past successes are reviewed and future challenges addressed. AJO is no different. I would like to reflect on these past 10 years, share some highlights, and acknowledge those who have contributed to the success of AJO.

The Editorial Staff of the Journal has consistently performed beyond the call of duty, producing outstanding issues month after month. Of this excellent team, several members deserve special mention: Group Editor Glenn Williams, Managing Editor Joseph Kinsley, and Assistant Editor Kellie DeSantis. I offer my gratitude to all for a job well done.

I am particularly proud that under my leadership, the Editorial Board nearly doubled and clinical submissions increased almost 4-fold. I want to thank all members of the Editorial Board. Your expertise and dedication has enabled AJO to accommodate the vast increase in submissions and greatly improved the quality of papers published in recent years. I have so appreciated your efforts and hard work.

The addition of the Residency Advisory Board several years ago provided an excellent forum for orthopedic surgeons in training to share their thoughts on subjects of particular interest and address issues not typically covered during the course of their clinical training; such as the importance of mentorship, how to organize a practice, and how to decipher an employment contract for one’s first “real” job. I have been immensely impressed with residents’ insights and their willingness to share them with their colleagues. I hope that this experience at AJO will encourage them to join other Editorial Boards during their professional careers.

Over these past 10 years, I have tried to satisfy the mission of The American Journal of Orthopedics: “… to provide timely, practical, and readable technical information of the highest caliber to the orthopedic surgeon involved in the everyday practice of orthopedics.” To this end, I expanded the “expert opinion” 5 Points series originally introduced by John Gould, MD, my predecessor as Editor-in-Chief. In addition, I added the Practice Management articles, prepared by Karen Zupko and her associates, which have been especially informative and popular.

I have thoroughly enjoyed sharing with you my nonclinical editorials touching on the “topics of the day.” Among my favorites were “Customer Satisfaction: Are Hospitals ‘Hospitable’?”¹ which anticipated the growing influence of patient satisfaction scores in our professional lives; and “Are Surgeons Accepting Bribes?”,² addressing a subject that predated the 2007 Deferred Prosecution Agreement³ which has transformed the relationships between orthopedic surgeons and the orthopedic device industry. I hope you have enjoyed reading my musings as much as I enjoyed writing them.

Our incoming Editor-in-Chief is Bryan T. Hanypsiak, MD, Director of Sports Medicine, Peconic Bay Medical Center in Riverhead, New York, and Chairman of the September 2015 Innovative Techniques: The Knee Course, sponsored by AJO in Las Vegas. Bryan will remain committed to the original mission of AJO and its high editorial and peer reviewed standards. However, the format will change with the March 2016 issue and have the feel of a clinical magazine. I have every confidence that, with Dr. Hanypsiak’s leadership and the support of the publisher, the AJO brand will continue to thrive in an ever-changing and challenging marketplace.

Finally, I wish to thank all the readers of AJO who have supported the Journal, one of only a handful of orthopedic publications that still caters to the professional interests of the general orthopedic surgeon with a comprehensive scope of clinical and non-clinical topics. Leading the Board as Editor-in-Chief has been one of the most fulfilling and rewarding activities of my professional career, and it has truly been my honor to serve you. I wish all of you the best.

This month will mark the end of my 10-year tenure as Editor-in-Chief of The American Journal of Orthopedics (AJO). Every successful organization goes through periodic transitions, where past successes are reviewed and future challenges addressed. AJO is no different. I would like to reflect on these past 10 years, share some highlights, and acknowledge those who have contributed to the success of AJO.

The Editorial Staff of the Journal has consistently performed beyond the call of duty, producing outstanding issues month after month. Of this excellent team, several members deserve special mention: Group Editor Glenn Williams, Managing Editor Joseph Kinsley, and Assistant Editor Kellie DeSantis. I offer my gratitude to all for a job well done.

I am particularly proud that under my leadership, the Editorial Board nearly doubled and clinical submissions increased almost 4-fold. I want to thank all members of the Editorial Board. Your expertise and dedication has enabled AJO to accommodate the vast increase in submissions and greatly improved the quality of papers published in recent years. I have so appreciated your efforts and hard work.

The addition of the Residency Advisory Board several years ago provided an excellent forum for orthopedic surgeons in training to share their thoughts on subjects of particular interest and address issues not typically covered during the course of their clinical training; such as the importance of mentorship, how to organize a practice, and how to decipher an employment contract for one’s first “real” job. I have been immensely impressed with residents’ insights and their willingness to share them with their colleagues. I hope that this experience at AJO will encourage them to join other Editorial Boards during their professional careers.

Over these past 10 years, I have tried to satisfy the mission of The American Journal of Orthopedics: “… to provide timely, practical, and readable technical information of the highest caliber to the orthopedic surgeon involved in the everyday practice of orthopedics.” To this end, I expanded the “expert opinion” 5 Points series originally introduced by John Gould, MD, my predecessor as Editor-in-Chief. In addition, I added the Practice Management articles, prepared by Karen Zupko and her associates, which have been especially informative and popular.

I have thoroughly enjoyed sharing with you my nonclinical editorials touching on the “topics of the day.” Among my favorites were “Customer Satisfaction: Are Hospitals ‘Hospitable’?”¹ which anticipated the growing influence of patient satisfaction scores in our professional lives; and “Are Surgeons Accepting Bribes?”,² addressing a subject that predated the 2007 Deferred Prosecution Agreement³ which has transformed the relationships between orthopedic surgeons and the orthopedic device industry. I hope you have enjoyed reading my musings as much as I enjoyed writing them.

Our incoming Editor-in-Chief is Bryan T. Hanypsiak, MD, Director of Sports Medicine, Peconic Bay Medical Center in Riverhead, New York, and Chairman of the September 2015 Innovative Techniques: The Knee Course, sponsored by AJO in Las Vegas. Bryan will remain committed to the original mission of AJO and its high editorial and peer reviewed standards. However, the format will change with the March 2016 issue and have the feel of a clinical magazine. I have every confidence that, with Dr. Hanypsiak’s leadership and the support of the publisher, the AJO brand will continue to thrive in an ever-changing and challenging marketplace.

Finally, I wish to thank all the readers of AJO who have supported the Journal, one of only a handful of orthopedic publications that still caters to the professional interests of the general orthopedic surgeon with a comprehensive scope of clinical and non-clinical topics. Leading the Board as Editor-in-Chief has been one of the most fulfilling and rewarding activities of my professional career, and it has truly been my honor to serve you. I wish all of you the best.

This month will mark the end of my 10-year tenure as Editor-in-Chief of The American Journal of Orthopedics (AJO). Every successful organization goes through periodic transitions, where past successes are reviewed and future challenges addressed. AJO is no different. I would like to reflect on these past 10 years, share some highlights, and acknowledge those who have contributed to the success of AJO.

The Editorial Staff of the Journal has consistently performed beyond the call of duty, producing outstanding issues month after month. Of this excellent team, several members deserve special mention: Group Editor Glenn Williams, Managing Editor Joseph Kinsley, and Assistant Editor Kellie DeSantis. I offer my gratitude to all for a job well done.

I am particularly proud that under my leadership, the Editorial Board nearly doubled and clinical submissions increased almost 4-fold. I want to thank all members of the Editorial Board. Your expertise and dedication has enabled AJO to accommodate the vast increase in submissions and greatly improved the quality of papers published in recent years. I have so appreciated your efforts and hard work.

The addition of the Residency Advisory Board several years ago provided an excellent forum for orthopedic surgeons in training to share their thoughts on subjects of particular interest and address issues not typically covered during the course of their clinical training; such as the importance of mentorship, how to organize a practice, and how to decipher an employment contract for one’s first “real” job. I have been immensely impressed with residents’ insights and their willingness to share them with their colleagues. I hope that this experience at AJO will encourage them to join other Editorial Boards during their professional careers.

Over these past 10 years, I have tried to satisfy the mission of The American Journal of Orthopedics: “… to provide timely, practical, and readable technical information of the highest caliber to the orthopedic surgeon involved in the everyday practice of orthopedics.” To this end, I expanded the “expert opinion” 5 Points series originally introduced by John Gould, MD, my predecessor as Editor-in-Chief. In addition, I added the Practice Management articles, prepared by Karen Zupko and her associates, which have been especially informative and popular.

I have thoroughly enjoyed sharing with you my nonclinical editorials touching on the “topics of the day.” Among my favorites were “Customer Satisfaction: Are Hospitals ‘Hospitable’?”¹ which anticipated the growing influence of patient satisfaction scores in our professional lives; and “Are Surgeons Accepting Bribes?”,² addressing a subject that predated the 2007 Deferred Prosecution Agreement³ which has transformed the relationships between orthopedic surgeons and the orthopedic device industry. I hope you have enjoyed reading my musings as much as I enjoyed writing them.

Our incoming Editor-in-Chief is Bryan T. Hanypsiak, MD, Director of Sports Medicine, Peconic Bay Medical Center in Riverhead, New York, and Chairman of the September 2015 Innovative Techniques: The Knee Course, sponsored by AJO in Las Vegas. Bryan will remain committed to the original mission of AJO and its high editorial and peer reviewed standards. However, the format will change with the March 2016 issue and have the feel of a clinical magazine. I have every confidence that, with Dr. Hanypsiak’s leadership and the support of the publisher, the AJO brand will continue to thrive in an ever-changing and challenging marketplace.

Finally, I wish to thank all the readers of AJO who have supported the Journal, one of only a handful of orthopedic publications that still caters to the professional interests of the general orthopedic surgeon with a comprehensive scope of clinical and non-clinical topics. Leading the Board as Editor-in-Chief has been one of the most fulfilling and rewarding activities of my professional career, and it has truly been my honor to serve you. I wish all of you the best.

Health care financing and the nature of orthopedic practice have changed dramatically in recent years and will continue to do so. Driving these changes is the emphasis on “value,” defined by Porter1 as the quality of care divided by the cost of care, as opposed to the traditional volume-based care, in which reimbursement is based on a fee for services rendered. Exploring this concept of value in orthopedic care is a favorite topic of mine, succinctly summarized by Black and Warner2 in their 2013 article in  The American Journal of Orthopedics. Two papers in this current issue of The American Journal of Orthopedics make important points regarding value and the orthopedic surgeon.       

In “Orthopedic Implant Waste: Analysis and Quantification” (pages 554-560), Payne and colleagues examine the costs of wasted implants across 8 orthopedic subspecialties at  1 academic institution over the course of 12 months. The take-home points were these: wasted implants accounted for nearly 2% of the implant cost of the institution; the incidence of waste was related to surgeons with less experience (in practice less than 10 years) but not case volumes (ie, busier surgeons); and nearly two-thirds of the cost of wasted implants occurred in total joint and spine fusion cases.

At my institution, orthopedic implants represent one of the 3 major costs of inpatient hospital care (the other 2 being operating room time and length of stay). Hence, a 2% savings of total implant costs by minimizing waste can make a significant difference in an institution’s profit margin. Since the attending surgeon makes the intraoperative decision on implant type, the burden of minimizing implant waste falls primarily on the orthopedic surgeon. This is just one example of how the individual orthopedic surgeon can improve “value” by decreasing the “cost” of care.

In “Orthopedics in US Health Care” (pages 538-541), Yu and Zuckerman review 5 points on the evolving role orthopedic surgery plays in the changing landscape of US health care. Among many important topics reviewed, the authors raise  2 important issues specifically related to value and the orthopedic surgeon that I believe warrant special attention.

In point 2, “The Cost Equation,” Yu and Zuckerman state that new technology (always more expensive than existing technology!) must “clearly improve outcomes” prior to its introduction to the market. The adage “newer is better” is sometimes true, but new and more expensive technology (which increases the denominator of the “value” quotient) must afford even greater improvement in quality outcomes to justify its widespread use. Hence, as practicing orthopedic surgeons, we should resist the temptation to embrace new technology without clear evidence that said new technology actually improves the quality of care.

The second topic of interest to me is how we measure “outcomes” in this new value-driven health care world. While many important outcome metrics can be measured by hospital data systems, such as length of stay, unscheduled returns to the operating room, transfusion and infection rates, and 30-day readmissions, equally important clinical outcomes (eg, pain and function scores, joint range of motion and strength, and radiographic findings) are obtained primarily from office-based outpatient medical records. These clinically based quality metrics are far more difficult to obtain for individual practicing orthopedic surgeons and require an investment of time and staff to gather meaningful data. How to record and incorporate these clinical outcomes remains a challenge for the practicing orthopedic surgeon, especially in the nonacademic setting, but these clinical metrics must be a component in the “value equation.”

The concept of value in orthopedic surgery will be the primary driver of future health care financing and policies. To succeed in this changing world, orthopedic surgeons will need to not only understand this new paradigm  “value = quality/cost,” but be fundamentally involved in the process, institutionally and politically, that both defines and  rewards value.

Health care financing and the nature of orthopedic practice have changed dramatically in recent years and will continue to do so. Driving these changes is the emphasis on “value,” defined by Porter1 as the quality of care divided by the cost of care, as opposed to the traditional volume-based care, in which reimbursement is based on a fee for services rendered. Exploring this concept of value in orthopedic care is a favorite topic of mine, succinctly summarized by Black and Warner2 in their 2013 article in  The American Journal of Orthopedics. Two papers in this current issue of The American Journal of Orthopedics make important points regarding value and the orthopedic surgeon.       

In “Orthopedic Implant Waste: Analysis and Quantification” (pages 554-560), Payne and colleagues examine the costs of wasted implants across 8 orthopedic subspecialties at  1 academic institution over the course of 12 months. The take-home points were these: wasted implants accounted for nearly 2% of the implant cost of the institution; the incidence of waste was related to surgeons with less experience (in practice less than 10 years) but not case volumes (ie, busier surgeons); and nearly two-thirds of the cost of wasted implants occurred in total joint and spine fusion cases.

At my institution, orthopedic implants represent one of the 3 major costs of inpatient hospital care (the other 2 being operating room time and length of stay). Hence, a 2% savings of total implant costs by minimizing waste can make a significant difference in an institution’s profit margin. Since the attending surgeon makes the intraoperative decision on implant type, the burden of minimizing implant waste falls primarily on the orthopedic surgeon. This is just one example of how the individual orthopedic surgeon can improve “value” by decreasing the “cost” of care.

In “Orthopedics in US Health Care” (pages 538-541), Yu and Zuckerman review 5 points on the evolving role orthopedic surgery plays in the changing landscape of US health care. Among many important topics reviewed, the authors raise  2 important issues specifically related to value and the orthopedic surgeon that I believe warrant special attention.

In point 2, “The Cost Equation,” Yu and Zuckerman state that new technology (always more expensive than existing technology!) must “clearly improve outcomes” prior to its introduction to the market. The adage “newer is better” is sometimes true, but new and more expensive technology (which increases the denominator of the “value” quotient) must afford even greater improvement in quality outcomes to justify its widespread use. Hence, as practicing orthopedic surgeons, we should resist the temptation to embrace new technology without clear evidence that said new technology actually improves the quality of care.

The second topic of interest to me is how we measure “outcomes” in this new value-driven health care world. While many important outcome metrics can be measured by hospital data systems, such as length of stay, unscheduled returns to the operating room, transfusion and infection rates, and 30-day readmissions, equally important clinical outcomes (eg, pain and function scores, joint range of motion and strength, and radiographic findings) are obtained primarily from office-based outpatient medical records. These clinically based quality metrics are far more difficult to obtain for individual practicing orthopedic surgeons and require an investment of time and staff to gather meaningful data. How to record and incorporate these clinical outcomes remains a challenge for the practicing orthopedic surgeon, especially in the nonacademic setting, but these clinical metrics must be a component in the “value equation.”

The concept of value in orthopedic surgery will be the primary driver of future health care financing and policies. To succeed in this changing world, orthopedic surgeons will need to not only understand this new paradigm  “value = quality/cost,” but be fundamentally involved in the process, institutionally and politically, that both defines and  rewards value.

Health care financing and the nature of orthopedic practice have changed dramatically in recent years and will continue to do so. Driving these changes is the emphasis on “value,” defined by Porter1 as the quality of care divided by the cost of care, as opposed to the traditional volume-based care, in which reimbursement is based on a fee for services rendered. Exploring this concept of value in orthopedic care is a favorite topic of mine, succinctly summarized by Black and Warner2 in their 2013 article in  The American Journal of Orthopedics. Two papers in this current issue of The American Journal of Orthopedics make important points regarding value and the orthopedic surgeon.       

In “Orthopedic Implant Waste: Analysis and Quantification” (pages 554-560), Payne and colleagues examine the costs of wasted implants across 8 orthopedic subspecialties at  1 academic institution over the course of 12 months. The take-home points were these: wasted implants accounted for nearly 2% of the implant cost of the institution; the incidence of waste was related to surgeons with less experience (in practice less than 10 years) but not case volumes (ie, busier surgeons); and nearly two-thirds of the cost of wasted implants occurred in total joint and spine fusion cases.

At my institution, orthopedic implants represent one of the 3 major costs of inpatient hospital care (the other 2 being operating room time and length of stay). Hence, a 2% savings of total implant costs by minimizing waste can make a significant difference in an institution’s profit margin. Since the attending surgeon makes the intraoperative decision on implant type, the burden of minimizing implant waste falls primarily on the orthopedic surgeon. This is just one example of how the individual orthopedic surgeon can improve “value” by decreasing the “cost” of care.

In “Orthopedics in US Health Care” (pages 538-541), Yu and Zuckerman review 5 points on the evolving role orthopedic surgery plays in the changing landscape of US health care. Among many important topics reviewed, the authors raise  2 important issues specifically related to value and the orthopedic surgeon that I believe warrant special attention.

In point 2, “The Cost Equation,” Yu and Zuckerman state that new technology (always more expensive than existing technology!) must “clearly improve outcomes” prior to its introduction to the market. The adage “newer is better” is sometimes true, but new and more expensive technology (which increases the denominator of the “value” quotient) must afford even greater improvement in quality outcomes to justify its widespread use. Hence, as practicing orthopedic surgeons, we should resist the temptation to embrace new technology without clear evidence that said new technology actually improves the quality of care.

The second topic of interest to me is how we measure “outcomes” in this new value-driven health care world. While many important outcome metrics can be measured by hospital data systems, such as length of stay, unscheduled returns to the operating room, transfusion and infection rates, and 30-day readmissions, equally important clinical outcomes (eg, pain and function scores, joint range of motion and strength, and radiographic findings) are obtained primarily from office-based outpatient medical records. These clinically based quality metrics are far more difficult to obtain for individual practicing orthopedic surgeons and require an investment of time and staff to gather meaningful data. How to record and incorporate these clinical outcomes remains a challenge for the practicing orthopedic surgeon, especially in the nonacademic setting, but these clinical metrics must be a component in the “value equation.”

The concept of value in orthopedic surgery will be the primary driver of future health care financing and policies. To succeed in this changing world, orthopedic surgeons will need to not only understand this new paradigm  “value = quality/cost,” but be fundamentally involved in the process, institutionally and politically, that both defines and  rewards value.

In this month’s issue of The American Journal of Orthopedics, Tannenbaum and colleagues present a “5 Points” article on “Measurement of Resource Utilization for Total and Reverse Shoulder Arthroplasty.” This is an excellent article that summarizes the authors’ methodology of determining not only the overall cost of hospital care for shoulder replacement but a detailed analysis of many components contributing to that cost.

The steps are fairly straightforward: identify the various components of the cost, gather the data contributing to those costs, and then analyze what are the major expenditures that contribute to the overall cost. Sounds simple, but, in practice, it is anything but!

As health care expenditures in the United States continue to increase and approach 20% of the gross domestic product, every sector of the health care industry is searching for ways to curtail and eventually decrease the cost of health care. However, one cannot control costs without accurate data that defines those costs. In this article, Tannenbaum and colleagues have provided a methodology to help both hospital administrators and surgeons determine the overall cost of shoulder arthroplasty, but their principles of analysis can be applied to all aspects of hospital care.

Such efforts are gaining the attention of many leaders of the health care industry. For example, in the September 8, 2015, edition of The New York Times, I was very interested to read the article “What are a Hospital’s Costs? Utah System Is Trying to Learn.”¹ The article reviewed the efforts of Dr. Vivian Lee, chief executive at University of Utah Health Care, to determine the actual cost of all care provided by the university hospital, the same goal as the present 5 Points article on shoulder arthroplasty but on a vastly greater scale. Analyzing those costs guided Dr. Lee and her colleagues to alter clinical programs, which led to a decrease of 30% in hospital expenditures and fewer complications.¹

We are all indebted to Mr. Tannenbaum and his coauthors for providing the journal’s readers with a clear map that we can use to both understand and navigate the current maze of hospital costs. Using such a guide, we will be able to gather information that not only saves money, but will improve care by directing resources to services that actually benefit our patients.

In this month’s issue of The American Journal of Orthopedics, Tannenbaum and colleagues present a “5 Points” article on “Measurement of Resource Utilization for Total and Reverse Shoulder Arthroplasty.” This is an excellent article that summarizes the authors’ methodology of determining not only the overall cost of hospital care for shoulder replacement but a detailed analysis of many components contributing to that cost.

The steps are fairly straightforward: identify the various components of the cost, gather the data contributing to those costs, and then analyze what are the major expenditures that contribute to the overall cost. Sounds simple, but, in practice, it is anything but!

As health care expenditures in the United States continue to increase and approach 20% of the gross domestic product, every sector of the health care industry is searching for ways to curtail and eventually decrease the cost of health care. However, one cannot control costs without accurate data that defines those costs. In this article, Tannenbaum and colleagues have provided a methodology to help both hospital administrators and surgeons determine the overall cost of shoulder arthroplasty, but their principles of analysis can be applied to all aspects of hospital care.

Such efforts are gaining the attention of many leaders of the health care industry. For example, in the September 8, 2015, edition of The New York Times, I was very interested to read the article “What are a Hospital’s Costs? Utah System Is Trying to Learn.”¹ The article reviewed the efforts of Dr. Vivian Lee, chief executive at University of Utah Health Care, to determine the actual cost of all care provided by the university hospital, the same goal as the present 5 Points article on shoulder arthroplasty but on a vastly greater scale. Analyzing those costs guided Dr. Lee and her colleagues to alter clinical programs, which led to a decrease of 30% in hospital expenditures and fewer complications.¹

We are all indebted to Mr. Tannenbaum and his coauthors for providing the journal’s readers with a clear map that we can use to both understand and navigate the current maze of hospital costs. Using such a guide, we will be able to gather information that not only saves money, but will improve care by directing resources to services that actually benefit our patients.

In this month’s issue of The American Journal of Orthopedics, Tannenbaum and colleagues present a “5 Points” article on “Measurement of Resource Utilization for Total and Reverse Shoulder Arthroplasty.” This is an excellent article that summarizes the authors’ methodology of determining not only the overall cost of hospital care for shoulder replacement but a detailed analysis of many components contributing to that cost.

The steps are fairly straightforward: identify the various components of the cost, gather the data contributing to those costs, and then analyze what are the major expenditures that contribute to the overall cost. Sounds simple, but, in practice, it is anything but!

As health care expenditures in the United States continue to increase and approach 20% of the gross domestic product, every sector of the health care industry is searching for ways to curtail and eventually decrease the cost of health care. However, one cannot control costs without accurate data that defines those costs. In this article, Tannenbaum and colleagues have provided a methodology to help both hospital administrators and surgeons determine the overall cost of shoulder arthroplasty, but their principles of analysis can be applied to all aspects of hospital care.

Such efforts are gaining the attention of many leaders of the health care industry. For example, in the September 8, 2015, edition of The New York Times, I was very interested to read the article “What are a Hospital’s Costs? Utah System Is Trying to Learn.”¹ The article reviewed the efforts of Dr. Vivian Lee, chief executive at University of Utah Health Care, to determine the actual cost of all care provided by the university hospital, the same goal as the present 5 Points article on shoulder arthroplasty but on a vastly greater scale. Analyzing those costs guided Dr. Lee and her colleagues to alter clinical programs, which led to a decrease of 30% in hospital expenditures and fewer complications.¹

We are all indebted to Mr. Tannenbaum and his coauthors for providing the journal’s readers with a clear map that we can use to both understand and navigate the current maze of hospital costs. Using such a guide, we will be able to gather information that not only saves money, but will improve care by directing resources to services that actually benefit our patients.

For the past 9 years, I have interviewed the president of the American Academy of Orthopaedic Surgeons (AAOS) to better understand the roles the AAOS and its president play in our professional lives.

At the 2015 AAOS Annual Meeting in Las Vegas this past March, David D. Teuscher, MD, assumed leadership of the AAOS as its 83rd president. Dr. Teuscher is a partner and past president of the Beaumont Bone & Joint Institute in Beaumont, Texas, and has had a broad experience in leadership positions in both Texas medical professional societies and the AAOS. Dr. Teuscher obtained his undergraduate degree from the University of Illinois at Champaign/Urbana and his medical degree from the University of Texas Medical School at San Antonio. He completed his orthopedic residency at the Brooke Army Medical Center, in Fort Sam Houston, and, following 13 years of military service, he entered private practice in 1993.

He has led numerous AAOS committees over the years, most notably the team that in 2014 completed a revision of the AAOS Strategic Plan, “Vision 20/20,” which outlines the Academy’s goals over the next 6 years, including the following elements:

• AAOS Mission: Serving our profession to provide the highest-quality musculoskeletal care.
• AAOS Vision: Keeping the world in motion through the prevention and treatment of musculoskeletal conditions.
• Core Values: Excellence, Professionalism, Leadership, Collegiality, Lifelong Learning.
• Strategic Domains: Advocacy, Education, Membership, Organizational Excellence, Quality and Patient Value.

Read more at: http://www.aaos.org/about/strategicplan.asp.

Dr. Teuscher explained that his role as president for the coming year is really that of spokesperson for a leadership group that has developed a 4-year presidential line and governance structure to ensure a solid platform for continuity and to achieve the goals of the AAOS Strategic Plan year after year. While the Academy president does not set his or her own agenda for the year, David has several priority goals during his tenure, which include ensuring that the rules governing the repeal and replacement of the Medicare Sustainable Growth Rate (SGR) formula treat our patients fairly, opening of the new digital and modular Orthopaedic Learning Center (OLC), preventing the harmful effects of unnecessary and premature ICD-10 (International Classification of Diseases, Tenth Revision) implementation, leading a cultural change in surgical patient safety, and advances in AAOS technology offerings in education and online lifelong learning.

Dr. Teuscher stated that the repeal of the SGR formula this year was a major step forward for orthopedic surgeons. Averting a 21% reduction in physician reimbursement in 2015, the new legislation will increase physician payments by 0.5% annually through 2019, at which time the Centers for Medicare and Medicaid Services (CMS) will begin a new payment system, based not on the traditional fee-for-service model, but on a new incentive: the quality and value of care.¹ David firmly believes that the AAOS has a major role to assist the practicing orthopedic surgeon manage this new payment system by:

• establishing standards of performance and quality that will drive payment for medical services.
• helping the practicing orthopedic surgeon report useful quality outcomes in a simple and accessible format.
• linking these new reporting measures to satisfy Maintenance of Certification (MOC) requirements.

David is especially proud of the recently opened OLC. This cutting-edge facility, sponsored by the AAOS and its equity partners (Arthroscopy Association of North America, American Orthopaedic Society for Sports Medicine, American Association of Hip and Knee Surgeons, OLC), is clear evidence of the Academy’s commitment to the highest quality of musculoskeletal care and lifelong learning for its members.

Dr. Teuscher is concerned that CMS may not be fully prepared for implementation of the new ICD-10 codes on October 1, 2015. In the spirit of advocacy for its members, the AAOS is actively engaged to recommend delay of ICD-10 implementation until reliable operating systems to process this new system can be ensured.

David and orthopedic patient safety experts are working with national perioperative stakeholders to plan and implement a National Surgical Patient Safety Summit in 2016. This will cause a cultural change in how we lead treatment teams to deliver a highly reliable and safe surgical experience for all our patients.

Finally, Dr. Teuscher is extremely excited about improvements in technology offered to Academy members. Many of us enjoyed the new AAOS My Academy app available this year at the Las Vegas meeting that enabled review of the 2015 program on your smartphone. Dr. Teuscher anticipates that upgrades to the AAOS Access app will provide the most comprehensive mobile platform for continuing medical education and educational videos available to all Academy members. The AAOS website is undergoing a complete update and expansion of offerings by the end of this year.

Over the years of interviewing current presidents of the AAOS, I have been impressed by consistent characteristics of our leaders: enormously energetic, engaging, articulate, and tirelessly committed to the Academy and its members. David Teuscher processes all these qualities. We are very fortunate to have someone of David’s organizational and leadership skills navigate our course through the turbulent health care waters that lie ahead of us in the coming years.◾

For the past 9 years, I have interviewed the president of the American Academy of Orthopaedic Surgeons (AAOS) to better understand the roles the AAOS and its president play in our professional lives.

At the 2015 AAOS Annual Meeting in Las Vegas this past March, David D. Teuscher, MD, assumed leadership of the AAOS as its 83rd president. Dr. Teuscher is a partner and past president of the Beaumont Bone & Joint Institute in Beaumont, Texas, and has had a broad experience in leadership positions in both Texas medical professional societies and the AAOS. Dr. Teuscher obtained his undergraduate degree from the University of Illinois at Champaign/Urbana and his medical degree from the University of Texas Medical School at San Antonio. He completed his orthopedic residency at the Brooke Army Medical Center, in Fort Sam Houston, and, following 13 years of military service, he entered private practice in 1993.

He has led numerous AAOS committees over the years, most notably the team that in 2014 completed a revision of the AAOS Strategic Plan, “Vision 20/20,” which outlines the Academy’s goals over the next 6 years, including the following elements:

• AAOS Mission: Serving our profession to provide the highest-quality musculoskeletal care.
• AAOS Vision: Keeping the world in motion through the prevention and treatment of musculoskeletal conditions.
• Core Values: Excellence, Professionalism, Leadership, Collegiality, Lifelong Learning.
• Strategic Domains: Advocacy, Education, Membership, Organizational Excellence, Quality and Patient Value.

Read more at: http://www.aaos.org/about/strategicplan.asp.

Dr. Teuscher explained that his role as president for the coming year is really that of spokesperson for a leadership group that has developed a 4-year presidential line and governance structure to ensure a solid platform for continuity and to achieve the goals of the AAOS Strategic Plan year after year. While the Academy president does not set his or her own agenda for the year, David has several priority goals during his tenure, which include ensuring that the rules governing the repeal and replacement of the Medicare Sustainable Growth Rate (SGR) formula treat our patients fairly, opening of the new digital and modular Orthopaedic Learning Center (OLC), preventing the harmful effects of unnecessary and premature ICD-10 (International Classification of Diseases, Tenth Revision) implementation, leading a cultural change in surgical patient safety, and advances in AAOS technology offerings in education and online lifelong learning.

Dr. Teuscher stated that the repeal of the SGR formula this year was a major step forward for orthopedic surgeons. Averting a 21% reduction in physician reimbursement in 2015, the new legislation will increase physician payments by 0.5% annually through 2019, at which time the Centers for Medicare and Medicaid Services (CMS) will begin a new payment system, based not on the traditional fee-for-service model, but on a new incentive: the quality and value of care.¹ David firmly believes that the AAOS has a major role to assist the practicing orthopedic surgeon manage this new payment system by:

• establishing standards of performance and quality that will drive payment for medical services.
• helping the practicing orthopedic surgeon report useful quality outcomes in a simple and accessible format.
• linking these new reporting measures to satisfy Maintenance of Certification (MOC) requirements.

David is especially proud of the recently opened OLC. This cutting-edge facility, sponsored by the AAOS and its equity partners (Arthroscopy Association of North America, American Orthopaedic Society for Sports Medicine, American Association of Hip and Knee Surgeons, OLC), is clear evidence of the Academy’s commitment to the highest quality of musculoskeletal care and lifelong learning for its members.

Dr. Teuscher is concerned that CMS may not be fully prepared for implementation of the new ICD-10 codes on October 1, 2015. In the spirit of advocacy for its members, the AAOS is actively engaged to recommend delay of ICD-10 implementation until reliable operating systems to process this new system can be ensured.

David and orthopedic patient safety experts are working with national perioperative stakeholders to plan and implement a National Surgical Patient Safety Summit in 2016. This will cause a cultural change in how we lead treatment teams to deliver a highly reliable and safe surgical experience for all our patients.

Finally, Dr. Teuscher is extremely excited about improvements in technology offered to Academy members. Many of us enjoyed the new AAOS My Academy app available this year at the Las Vegas meeting that enabled review of the 2015 program on your smartphone. Dr. Teuscher anticipates that upgrades to the AAOS Access app will provide the most comprehensive mobile platform for continuing medical education and educational videos available to all Academy members. The AAOS website is undergoing a complete update and expansion of offerings by the end of this year.

Over the years of interviewing current presidents of the AAOS, I have been impressed by consistent characteristics of our leaders: enormously energetic, engaging, articulate, and tirelessly committed to the Academy and its members. David Teuscher processes all these qualities. We are very fortunate to have someone of David’s organizational and leadership skills navigate our course through the turbulent health care waters that lie ahead of us in the coming years.◾

For the past 9 years, I have interviewed the president of the American Academy of Orthopaedic Surgeons (AAOS) to better understand the roles the AAOS and its president play in our professional lives.

At the 2015 AAOS Annual Meeting in Las Vegas this past March, David D. Teuscher, MD, assumed leadership of the AAOS as its 83rd president. Dr. Teuscher is a partner and past president of the Beaumont Bone & Joint Institute in Beaumont, Texas, and has had a broad experience in leadership positions in both Texas medical professional societies and the AAOS. Dr. Teuscher obtained his undergraduate degree from the University of Illinois at Champaign/Urbana and his medical degree from the University of Texas Medical School at San Antonio. He completed his orthopedic residency at the Brooke Army Medical Center, in Fort Sam Houston, and, following 13 years of military service, he entered private practice in 1993.

He has led numerous AAOS committees over the years, most notably the team that in 2014 completed a revision of the AAOS Strategic Plan, “Vision 20/20,” which outlines the Academy’s goals over the next 6 years, including the following elements:

• AAOS Mission: Serving our profession to provide the highest-quality musculoskeletal care.
• AAOS Vision: Keeping the world in motion through the prevention and treatment of musculoskeletal conditions.
• Core Values: Excellence, Professionalism, Leadership, Collegiality, Lifelong Learning.
• Strategic Domains: Advocacy, Education, Membership, Organizational Excellence, Quality and Patient Value.

Read more at: http://www.aaos.org/about/strategicplan.asp.

Dr. Teuscher explained that his role as president for the coming year is really that of spokesperson for a leadership group that has developed a 4-year presidential line and governance structure to ensure a solid platform for continuity and to achieve the goals of the AAOS Strategic Plan year after year. While the Academy president does not set his or her own agenda for the year, David has several priority goals during his tenure, which include ensuring that the rules governing the repeal and replacement of the Medicare Sustainable Growth Rate (SGR) formula treat our patients fairly, opening of the new digital and modular Orthopaedic Learning Center (OLC), preventing the harmful effects of unnecessary and premature ICD-10 (International Classification of Diseases, Tenth Revision) implementation, leading a cultural change in surgical patient safety, and advances in AAOS technology offerings in education and online lifelong learning.

Dr. Teuscher stated that the repeal of the SGR formula this year was a major step forward for orthopedic surgeons. Averting a 21% reduction in physician reimbursement in 2015, the new legislation will increase physician payments by 0.5% annually through 2019, at which time the Centers for Medicare and Medicaid Services (CMS) will begin a new payment system, based not on the traditional fee-for-service model, but on a new incentive: the quality and value of care.¹ David firmly believes that the AAOS has a major role to assist the practicing orthopedic surgeon manage this new payment system by:

• establishing standards of performance and quality that will drive payment for medical services.
• helping the practicing orthopedic surgeon report useful quality outcomes in a simple and accessible format.
• linking these new reporting measures to satisfy Maintenance of Certification (MOC) requirements.

David is especially proud of the recently opened OLC. This cutting-edge facility, sponsored by the AAOS and its equity partners (Arthroscopy Association of North America, American Orthopaedic Society for Sports Medicine, American Association of Hip and Knee Surgeons, OLC), is clear evidence of the Academy’s commitment to the highest quality of musculoskeletal care and lifelong learning for its members.

Dr. Teuscher is concerned that CMS may not be fully prepared for implementation of the new ICD-10 codes on October 1, 2015. In the spirit of advocacy for its members, the AAOS is actively engaged to recommend delay of ICD-10 implementation until reliable operating systems to process this new system can be ensured.

David and orthopedic patient safety experts are working with national perioperative stakeholders to plan and implement a National Surgical Patient Safety Summit in 2016. This will cause a cultural change in how we lead treatment teams to deliver a highly reliable and safe surgical experience for all our patients.

Finally, Dr. Teuscher is extremely excited about improvements in technology offered to Academy members. Many of us enjoyed the new AAOS My Academy app available this year at the Las Vegas meeting that enabled review of the 2015 program on your smartphone. Dr. Teuscher anticipates that upgrades to the AAOS Access app will provide the most comprehensive mobile platform for continuing medical education and educational videos available to all Academy members. The AAOS website is undergoing a complete update and expansion of offerings by the end of this year.

Over the years of interviewing current presidents of the AAOS, I have been impressed by consistent characteristics of our leaders: enormously energetic, engaging, articulate, and tirelessly committed to the Academy and its members. David Teuscher processes all these qualities. We are very fortunate to have someone of David’s organizational and leadership skills navigate our course through the turbulent health care waters that lie ahead of us in the coming years.◾

Gone are the days when, upon completion of training, the newly minted orthopedic surgeon would return to his or her hometown, raise a shingle, and begin a busy practice. Did these halcyon days ever exist? Who knows?

What I do know is that 75% of our shoulder fellowship graduates (my partner, Frances Cuomo, MD, and I offer an ACGME-accredited fellowship in shoulder surgery at Mount Sinai Beth Israel) in the past 10 years have accepted jobs as
employees of HMOs or hospital systems. They prefer the certainty of regular hours and incentive options offered by these institutions to the potential opportunities of greater (or lesser!) rewards as an entrepreneur in private practice.

I also know my local New York metropolitan orthopedic market, where the recent trend is towards consolidation among large medical centers. In September 2013, Mount Sinai Medical Center merged with the hospital where I work (full disclosure: I have been a full-time employee of my hospital since 1996), Continuum Health Partners, a consortium of 3 academic hospitals in Manhattan (Beth Israel Medical Center, St. Luke’s Roosevelt Hospital, and New York Eye and Ear Infirmary), to form the Mount Sinai Health System, currently the largest health care system in New York City. Other medical centers in the New York metropolitan region are actively recruiting physicians in private practice to join their respective institutions. Among the institutional goals, in addition to improving the scope, coordination, and efficiency of care, is to appoint as many practitioners as possible to increase the
number of patients treated by the particular medical center in certain geographic areas. Hence, the practice landscape in the New York metropolitan region is changing dramatically and reflects similar changes throughout the country.

While many practitioners of a certain generation, like mine, may lament the loss of those good old days as independent private practitioners, where self-reliance and experience dictated orthopedic practice, the reality is that today the business of medicine is the largest sector of our national economy, currently approaching 20% of the gross domestic product (GDP),¹ and that individual practitioners no longer
really control their practices. The number of independent physicians and surgeons is diminishing, and our practice environment is changing drastically. What’s an orthopedic surgeon to do?

Medical reports are abuzz with new terminology: accountable care organizations, population management, value-based care, etc.¹ They all reflect a fundamental shift in health care financing away from our current model of fee for services rendered to that of a global payment for groups of patients in which the outcome of treatment, not the number of procedures or interventions, is compensated. How such a bundled payment that covers the health care requirements for a population will be distributed among the various practitioners is extremely complicated and, to date, not widely embraced. However, these changes are coming.

To succeed in the future health care arena, I believe orthopedic surgeons must have 2 prerequisites. First, there must be reliable data that not only report accurate diagnoses, procedures, and outcomes of treatment (risk-adjusted by medical comorbidities and economic status) but also include the financial costs of treatment. Second, orthopedic surgeons must participate in the decision-making process and the development of treatment algorithms that will be ever-increasing elements of medical practice. Who better than practicing orthopedic surgeons should recommend treatment guidelines based on best practice and prudent
economics?

The new landscape of medical practice isn’t coming—it has already arrived. It behooves us practicing orthopedic surgeons to be involved in the decision-making process that will determine musculoskeletal care and to partner with our hospital and insurance administrators to establish the parameters that will deliver efficient and high-quality care to our patients. ◾

Reference
1. Black EM, Warner JJ. 5 points on value in orthopedic surgery. Am J
Orthop. 2013;42(1):22-25.

Gone are the days when, upon completion of training, the newly minted orthopedic surgeon would return to his or her hometown, raise a shingle, and begin a busy practice. Did these halcyon days ever exist? Who knows?

What I do know is that 75% of our shoulder fellowship graduates (my partner, Frances Cuomo, MD, and I offer an ACGME-accredited fellowship in shoulder surgery at Mount Sinai Beth Israel) in the past 10 years have accepted jobs as
employees of HMOs or hospital systems. They prefer the certainty of regular hours and incentive options offered by these institutions to the potential opportunities of greater (or lesser!) rewards as an entrepreneur in private practice.

I also know my local New York metropolitan orthopedic market, where the recent trend is towards consolidation among large medical centers. In September 2013, Mount Sinai Medical Center merged with the hospital where I work (full disclosure: I have been a full-time employee of my hospital since 1996), Continuum Health Partners, a consortium of 3 academic hospitals in Manhattan (Beth Israel Medical Center, St. Luke’s Roosevelt Hospital, and New York Eye and Ear Infirmary), to form the Mount Sinai Health System, currently the largest health care system in New York City. Other medical centers in the New York metropolitan region are actively recruiting physicians in private practice to join their respective institutions. Among the institutional goals, in addition to improving the scope, coordination, and efficiency of care, is to appoint as many practitioners as possible to increase the
number of patients treated by the particular medical center in certain geographic areas. Hence, the practice landscape in the New York metropolitan region is changing dramatically and reflects similar changes throughout the country.

While many practitioners of a certain generation, like mine, may lament the loss of those good old days as independent private practitioners, where self-reliance and experience dictated orthopedic practice, the reality is that today the business of medicine is the largest sector of our national economy, currently approaching 20% of the gross domestic product (GDP),¹ and that individual practitioners no longer
really control their practices. The number of independent physicians and surgeons is diminishing, and our practice environment is changing drastically. What’s an orthopedic surgeon to do?

Medical reports are abuzz with new terminology: accountable care organizations, population management, value-based care, etc.¹ They all reflect a fundamental shift in health care financing away from our current model of fee for services rendered to that of a global payment for groups of patients in which the outcome of treatment, not the number of procedures or interventions, is compensated. How such a bundled payment that covers the health care requirements for a population will be distributed among the various practitioners is extremely complicated and, to date, not widely embraced. However, these changes are coming.

To succeed in the future health care arena, I believe orthopedic surgeons must have 2 prerequisites. First, there must be reliable data that not only report accurate diagnoses, procedures, and outcomes of treatment (risk-adjusted by medical comorbidities and economic status) but also include the financial costs of treatment. Second, orthopedic surgeons must participate in the decision-making process and the development of treatment algorithms that will be ever-increasing elements of medical practice. Who better than practicing orthopedic surgeons should recommend treatment guidelines based on best practice and prudent
economics?

The new landscape of medical practice isn’t coming—it has already arrived. It behooves us practicing orthopedic surgeons to be involved in the decision-making process that will determine musculoskeletal care and to partner with our hospital and insurance administrators to establish the parameters that will deliver efficient and high-quality care to our patients. ◾

Reference
1. Black EM, Warner JJ. 5 points on value in orthopedic surgery. Am J
Orthop. 2013;42(1):22-25.

Gone are the days when, upon completion of training, the newly minted orthopedic surgeon would return to his or her hometown, raise a shingle, and begin a busy practice. Did these halcyon days ever exist? Who knows?

What I do know is that 75% of our shoulder fellowship graduates (my partner, Frances Cuomo, MD, and I offer an ACGME-accredited fellowship in shoulder surgery at Mount Sinai Beth Israel) in the past 10 years have accepted jobs as
employees of HMOs or hospital systems. They prefer the certainty of regular hours and incentive options offered by these institutions to the potential opportunities of greater (or lesser!) rewards as an entrepreneur in private practice.

I also know my local New York metropolitan orthopedic market, where the recent trend is towards consolidation among large medical centers. In September 2013, Mount Sinai Medical Center merged with the hospital where I work (full disclosure: I have been a full-time employee of my hospital since 1996), Continuum Health Partners, a consortium of 3 academic hospitals in Manhattan (Beth Israel Medical Center, St. Luke’s Roosevelt Hospital, and New York Eye and Ear Infirmary), to form the Mount Sinai Health System, currently the largest health care system in New York City. Other medical centers in the New York metropolitan region are actively recruiting physicians in private practice to join their respective institutions. Among the institutional goals, in addition to improving the scope, coordination, and efficiency of care, is to appoint as many practitioners as possible to increase the
number of patients treated by the particular medical center in certain geographic areas. Hence, the practice landscape in the New York metropolitan region is changing dramatically and reflects similar changes throughout the country.

While many practitioners of a certain generation, like mine, may lament the loss of those good old days as independent private practitioners, where self-reliance and experience dictated orthopedic practice, the reality is that today the business of medicine is the largest sector of our national economy, currently approaching 20% of the gross domestic product (GDP),¹ and that individual practitioners no longer
really control their practices. The number of independent physicians and surgeons is diminishing, and our practice environment is changing drastically. What’s an orthopedic surgeon to do?

Medical reports are abuzz with new terminology: accountable care organizations, population management, value-based care, etc.¹ They all reflect a fundamental shift in health care financing away from our current model of fee for services rendered to that of a global payment for groups of patients in which the outcome of treatment, not the number of procedures or interventions, is compensated. How such a bundled payment that covers the health care requirements for a population will be distributed among the various practitioners is extremely complicated and, to date, not widely embraced. However, these changes are coming.

To succeed in the future health care arena, I believe orthopedic surgeons must have 2 prerequisites. First, there must be reliable data that not only report accurate diagnoses, procedures, and outcomes of treatment (risk-adjusted by medical comorbidities and economic status) but also include the financial costs of treatment. Second, orthopedic surgeons must participate in the decision-making process and the development of treatment algorithms that will be ever-increasing elements of medical practice. Who better than practicing orthopedic surgeons should recommend treatment guidelines based on best practice and prudent
economics?

The new landscape of medical practice isn’t coming—it has already arrived. It behooves us practicing orthopedic surgeons to be involved in the decision-making process that will determine musculoskeletal care and to partner with our hospital and insurance administrators to establish the parameters that will deliver efficient and high-quality care to our patients. ◾

Reference
1. Black EM, Warner JJ. 5 points on value in orthopedic surgery. Am J
Orthop. 2013;42(1):22-25.

For the past 8 years, I have interviewed the president of the American Academy of Orthopaedic Surgeons (AAOS) to better understand the role the Academy plays in our professional lives in general and the contributions of the AAOS president in particular.

At the 2014 AAOS Annual Meeting this past March in New Orleans, Frederick M. Azar, MD, assumed leadership of the AAOS as its 82nd president. He brings a wide range of orthopedic experience to this role. He has been an Academy volunteer for the last 20 years, and is Chief of Staff at the Campbell Clinic as well as Professor of Orthopedic Surgery and Director of the Sports Medicine Fellowship at the University of Tennessee-Campbell Clinic. He is team physician for the NBA (National Basketball Association) Memphis Grizzlies (see Dr. Azar’s article in this issue of AJO, pages 267-271) and team physician for the University of Memphis and Christian Brothers University sports teams.

This year the Board of Directors of the Academy completed a revision of the AAOS Strategic Plan, last updated in 2010, under the leadership of David Teuscher, MD. The plan, dubbed “Vision 20/20,” includes the following essential elements:
◾ AAOS Mission: Serving our profession to provide the highest quality musculoskeletal care.
◾ AAOS Vision: Keeping the world in motion through the prevention and treatment of musculoskeletal conditions.
◾ Core Values: Excellence, Professionalism, Leadership, Collegiality, Lifelong Learning
◾ Strategic Domains: Advocacy, Education, Membership, Organizational Excellence, Quality and Patient Value

Fred explained that a fundamental aspect of this revised Strategic Plan is that the AAOS takes ownership of all aspects of musculoskeletal tear, not simply surgical management. (For further reading, please visit: www.aaos.org/about/strategicplan.asp.)

Dr. Azar views his role as president of the AAOS as a temporary steward furthering the goals of the organization and not as a proponent of a particular personal agenda. To that end, Fred hopes to focus on 2 areas during his tenure as captain of the orthopedic ship of state: education and communication.

Paradigm shifts are occurring in health care with the passage of the Affordable Care Act, access to medical information via the Internet, and changes in practice management with the near-universal implementation of electronic medical records. In an effort to address the educational needs of its members, the AAOS will expand its electronic media platform and develop mobile apps, ebooks, webinars, and webcasts. In addition, the new AAOS headquarters in Rosemont, Illinois, will house a state-of-the-art Orthopaedic Learning Center. These improvements in education will contribute to the Academy’s core value of lifelong learning.

Regarding communication, Dr. Azar believes that it is extremely important that we, orthopedic surgeons, share with our patients just how much orthopedic care contributes to their quality of life, thereby showcasing the great value orthopedic surgeons bring to millions of patients. Finally, communication with regulators and policymakers in Washington, DC, is equally important as is membership support
for the Orthopaedic Political Action Committee.

We are indeed fortunate to have someone of Dr. Azar’s caliber lead our organization. His extensive experience as an administrator, Academy volunteer, educator, and clinician makes him ideally suited to lead the AAOS during these
challenging times in health care. ◾

For the past 8 years, I have interviewed the president of the American Academy of Orthopaedic Surgeons (AAOS) to better understand the role the Academy plays in our professional lives in general and the contributions of the AAOS president in particular.

At the 2014 AAOS Annual Meeting this past March in New Orleans, Frederick M. Azar, MD, assumed leadership of the AAOS as its 82nd president. He brings a wide range of orthopedic experience to this role. He has been an Academy volunteer for the last 20 years, and is Chief of Staff at the Campbell Clinic as well as Professor of Orthopedic Surgery and Director of the Sports Medicine Fellowship at the University of Tennessee-Campbell Clinic. He is team physician for the NBA (National Basketball Association) Memphis Grizzlies (see Dr. Azar’s article in this issue of AJO, pages 267-271) and team physician for the University of Memphis and Christian Brothers University sports teams.

This year the Board of Directors of the Academy completed a revision of the AAOS Strategic Plan, last updated in 2010, under the leadership of David Teuscher, MD. The plan, dubbed “Vision 20/20,” includes the following essential elements:
◾ AAOS Mission: Serving our profession to provide the highest quality musculoskeletal care.
◾ AAOS Vision: Keeping the world in motion through the prevention and treatment of musculoskeletal conditions.
◾ Core Values: Excellence, Professionalism, Leadership, Collegiality, Lifelong Learning
◾ Strategic Domains: Advocacy, Education, Membership, Organizational Excellence, Quality and Patient Value

Fred explained that a fundamental aspect of this revised Strategic Plan is that the AAOS takes ownership of all aspects of musculoskeletal tear, not simply surgical management. (For further reading, please visit: www.aaos.org/about/strategicplan.asp.)

Dr. Azar views his role as president of the AAOS as a temporary steward furthering the goals of the organization and not as a proponent of a particular personal agenda. To that end, Fred hopes to focus on 2 areas during his tenure as captain of the orthopedic ship of state: education and communication.

Paradigm shifts are occurring in health care with the passage of the Affordable Care Act, access to medical information via the Internet, and changes in practice management with the near-universal implementation of electronic medical records. In an effort to address the educational needs of its members, the AAOS will expand its electronic media platform and develop mobile apps, ebooks, webinars, and webcasts. In addition, the new AAOS headquarters in Rosemont, Illinois, will house a state-of-the-art Orthopaedic Learning Center. These improvements in education will contribute to the Academy’s core value of lifelong learning.

Regarding communication, Dr. Azar believes that it is extremely important that we, orthopedic surgeons, share with our patients just how much orthopedic care contributes to their quality of life, thereby showcasing the great value orthopedic surgeons bring to millions of patients. Finally, communication with regulators and policymakers in Washington, DC, is equally important as is membership support
for the Orthopaedic Political Action Committee.

We are indeed fortunate to have someone of Dr. Azar’s caliber lead our organization. His extensive experience as an administrator, Academy volunteer, educator, and clinician makes him ideally suited to lead the AAOS during these
challenging times in health care. ◾

For the past 8 years, I have interviewed the president of the American Academy of Orthopaedic Surgeons (AAOS) to better understand the role the Academy plays in our professional lives in general and the contributions of the AAOS president in particular.

At the 2014 AAOS Annual Meeting this past March in New Orleans, Frederick M. Azar, MD, assumed leadership of the AAOS as its 82nd president. He brings a wide range of orthopedic experience to this role. He has been an Academy volunteer for the last 20 years, and is Chief of Staff at the Campbell Clinic as well as Professor of Orthopedic Surgery and Director of the Sports Medicine Fellowship at the University of Tennessee-Campbell Clinic. He is team physician for the NBA (National Basketball Association) Memphis Grizzlies (see Dr. Azar’s article in this issue of AJO, pages 267-271) and team physician for the University of Memphis and Christian Brothers University sports teams.

This year the Board of Directors of the Academy completed a revision of the AAOS Strategic Plan, last updated in 2010, under the leadership of David Teuscher, MD. The plan, dubbed “Vision 20/20,” includes the following essential elements:
◾ AAOS Mission: Serving our profession to provide the highest quality musculoskeletal care.
◾ AAOS Vision: Keeping the world in motion through the prevention and treatment of musculoskeletal conditions.
◾ Core Values: Excellence, Professionalism, Leadership, Collegiality, Lifelong Learning
◾ Strategic Domains: Advocacy, Education, Membership, Organizational Excellence, Quality and Patient Value

Fred explained that a fundamental aspect of this revised Strategic Plan is that the AAOS takes ownership of all aspects of musculoskeletal tear, not simply surgical management. (For further reading, please visit: www.aaos.org/about/strategicplan.asp.)

Dr. Azar views his role as president of the AAOS as a temporary steward furthering the goals of the organization and not as a proponent of a particular personal agenda. To that end, Fred hopes to focus on 2 areas during his tenure as captain of the orthopedic ship of state: education and communication.

Paradigm shifts are occurring in health care with the passage of the Affordable Care Act, access to medical information via the Internet, and changes in practice management with the near-universal implementation of electronic medical records. In an effort to address the educational needs of its members, the AAOS will expand its electronic media platform and develop mobile apps, ebooks, webinars, and webcasts. In addition, the new AAOS headquarters in Rosemont, Illinois, will house a state-of-the-art Orthopaedic Learning Center. These improvements in education will contribute to the Academy’s core value of lifelong learning.

Regarding communication, Dr. Azar believes that it is extremely important that we, orthopedic surgeons, share with our patients just how much orthopedic care contributes to their quality of life, thereby showcasing the great value orthopedic surgeons bring to millions of patients. Finally, communication with regulators and policymakers in Washington, DC, is equally important as is membership support
for the Orthopaedic Political Action Committee.

We are indeed fortunate to have someone of Dr. Azar’s caliber lead our organization. His extensive experience as an administrator, Academy volunteer, educator, and clinician makes him ideally suited to lead the AAOS during these
challenging times in health care. ◾

With their current report of “100 Most Cited Articles in Fracture Surgery,” which appeared in the December 2013 issue of The American Journal of Orthopedics, Baldwin and colleagues expand upon “classic citation” reviews that have been reported in recent years in orthopedic surgery and other fields including clinical care medicine and anesthesia.

I so enjoyed reviewing these top 100 articles which brought back fond (mostly!) memories of my orthopedic training in the early 1980s and my first reading of such classics as Neer’s 1970 article on displaced proximal humerus fractures, and Gustilo’s 1976 paper on open fractures, two of the most frequently cited authors in this list.

Several aspects of Baldwin’s paper are noteworthy. The first is how technology has fundamentally altered our access to information. Only with the aid of tools such as a computer could the vast amount of publications spanning nearly 60 years have been reviewed to formulate this top 100 list. The PubMed and Google Scholar search engines of today have transformed the formally tedious—and often incomplete—literature reviews of my residency days.

Second, nearly two-thirds of the clinical papers were evidence level IV case series reporting on the outcomes of patients treated with one method with neither comparison groups nor sensitivity analysis. It is truly astounding that so much of the foundation of orthopedic surgery is based on studies with so little scientific rigor. Of course, this is not to diminish enormous contributions of the early leaders of modern orthopedic surgery, whose keen powers of observation and vast clinical experience established principles of clinical practice still valuable today.

Lastly, the authors rightly state that the exercise of reviewing these most cited fracture articles offers "insight into the past and current trends … and provides the foundation for future investigations." Rigorous future scientific studies using modern techniques will either confirm or refute the work of our classic teachers. With continued research, we will discover "the truth" and determine which treatments really benefit our patients. In the end, that is what really matters.

Baldwin K, Namdari S, Donegan D, Kavatch K, Ahn J, Mehta S. 100 Most Cited Articles in Fracture Surgery. Am J Orthop. 2013;42(12):547-552.

With their current report of “100 Most Cited Articles in Fracture Surgery,” which appeared in the December 2013 issue of The American Journal of Orthopedics, Baldwin and colleagues expand upon “classic citation” reviews that have been reported in recent years in orthopedic surgery and other fields including clinical care medicine and anesthesia.

I so enjoyed reviewing these top 100 articles which brought back fond (mostly!) memories of my orthopedic training in the early 1980s and my first reading of such classics as Neer’s 1970 article on displaced proximal humerus fractures, and Gustilo’s 1976 paper on open fractures, two of the most frequently cited authors in this list.

Several aspects of Baldwin’s paper are noteworthy. The first is how technology has fundamentally altered our access to information. Only with the aid of tools such as a computer could the vast amount of publications spanning nearly 60 years have been reviewed to formulate this top 100 list. The PubMed and Google Scholar search engines of today have transformed the formally tedious—and often incomplete—literature reviews of my residency days.

Second, nearly two-thirds of the clinical papers were evidence level IV case series reporting on the outcomes of patients treated with one method with neither comparison groups nor sensitivity analysis. It is truly astounding that so much of the foundation of orthopedic surgery is based on studies with so little scientific rigor. Of course, this is not to diminish enormous contributions of the early leaders of modern orthopedic surgery, whose keen powers of observation and vast clinical experience established principles of clinical practice still valuable today.

Lastly, the authors rightly state that the exercise of reviewing these most cited fracture articles offers "insight into the past and current trends … and provides the foundation for future investigations." Rigorous future scientific studies using modern techniques will either confirm or refute the work of our classic teachers. With continued research, we will discover "the truth" and determine which treatments really benefit our patients. In the end, that is what really matters.

Baldwin K, Namdari S, Donegan D, Kavatch K, Ahn J, Mehta S. 100 Most Cited Articles in Fracture Surgery. Am J Orthop. 2013;42(12):547-552.

With their current report of “100 Most Cited Articles in Fracture Surgery,” which appeared in the December 2013 issue of The American Journal of Orthopedics, Baldwin and colleagues expand upon “classic citation” reviews that have been reported in recent years in orthopedic surgery and other fields including clinical care medicine and anesthesia.

I so enjoyed reviewing these top 100 articles which brought back fond (mostly!) memories of my orthopedic training in the early 1980s and my first reading of such classics as Neer’s 1970 article on displaced proximal humerus fractures, and Gustilo’s 1976 paper on open fractures, two of the most frequently cited authors in this list.

Several aspects of Baldwin’s paper are noteworthy. The first is how technology has fundamentally altered our access to information. Only with the aid of tools such as a computer could the vast amount of publications spanning nearly 60 years have been reviewed to formulate this top 100 list. The PubMed and Google Scholar search engines of today have transformed the formally tedious—and often incomplete—literature reviews of my residency days.

Second, nearly two-thirds of the clinical papers were evidence level IV case series reporting on the outcomes of patients treated with one method with neither comparison groups nor sensitivity analysis. It is truly astounding that so much of the foundation of orthopedic surgery is based on studies with so little scientific rigor. Of course, this is not to diminish enormous contributions of the early leaders of modern orthopedic surgery, whose keen powers of observation and vast clinical experience established principles of clinical practice still valuable today.

Lastly, the authors rightly state that the exercise of reviewing these most cited fracture articles offers "insight into the past and current trends … and provides the foundation for future investigations." Rigorous future scientific studies using modern techniques will either confirm or refute the work of our classic teachers. With continued research, we will discover "the truth" and determine which treatments really benefit our patients. In the end, that is what really matters.

Baldwin K, Namdari S, Donegan D, Kavatch K, Ahn J, Mehta S. 100 Most Cited Articles in Fracture Surgery. Am J Orthop. 2013;42(12):547-552.

For the past 7 years I have dedicated an annual editorial to a conversation with the current President of the American Academy of Orthopaedic Surgeons (AAOS). True to our collective orthopedic collegiality, these requests have never been declined, and I hope our AJO readers have benefited by gaining a better understanding of just how much the AAOS does for the practicing orthopedic surgeon and, in particular, a greater appreciation of the contributions of the AAOS President.

At the March 2013 meeting in Chicago, Joshua J. Jacobs, MD, assumed the Presidency of the AAOS. For many reasons, this was perfect timing. Josh has played an important role in many Academy committees and professional organizations over the past 20 years including President of the Orthopaedic Research Society as well as President of the US Bone and Joint Initiative. Chicago is Josh’s hometown where he is the William A. Hark, MD, Susanne G. Swift Professor and Chairman, Department of Orthopaedic Surgery, Rush Medical College. How appropriate to recognize a local star at our annual meeting!

This year, the Board of Directors of the AAOS are in the process of updating the Academy’s Strategic Plan, last updated in 2010, with specific goals designed to enhance its mission in education, advocacy, research, quality, communication, membership, diversity, unity, fiscal affairs, and structure and governance. A carefully crafted governance structure, with a clear line of presidential succession, provides a platform for continuity and a mechanism to achieve these goals. For example, Dr. Jacobs was positioned in line to the Presidency of the AAOS 3 years ago, giving him sufficient time to formulate his specific goals for his presidential year while at the same time maintaining continuity of current Academy goals (see the AAOS strategic plan, www.aaos.org/about/strategicplan.asp).

Josh outlined 3 important challenges for his Presidency. The first is that the Academy must be closely engaged in the implementation of the Patient Protection and Affordability Care Act, commonly referred to as Obamacare. He believes that our professional society must be a part of the solution to the nation’s healthcare crisis and a leader of the current reforms intended to address this crisis.

His second focus will be to implement programs that demonstrate our profession’s commitment to access of high quality orthopedic care. Integral to this effort is the emphasis on thorough, large-scale research projects demonstrating that orthopedic care improves quality of life and restores functional capacity to our patients. We know individually this to be the case based on our own clinical experience, but we need reliable independent data to prove this to third party payers and government agencies.

Finally, Josh’s third priority will be to actually communicate to patients, policy makers, and politicians the value and effectiveness of the services orthopedic surgeons provide. In the new healthcare arena, it will not be sufficient to simply demonstrate high quality in terms of clinical outcomes and patient’s satisfaction. We must prove that our care provides economic value to society as well. In a way, this approach can be viewed as a return on investment of the money spent on healthcare—a more complicated calculus the mere reports of clinical outcomes.

As an experienced clinician, educator, administrator, and researcher, Josh Jacobs is the ideal leader for our organization. In these uncertain and turbulent times in healthcare, we orthopedic surgeons will benefit from a leader who can clearly define our goals and guide our ship of state through treacherous seas of change. Healthcare delivery and financing will change dramatically in the years to come, and we are all so fortunate to have someone of Josh’s very extensive talents to navigate our course.

For the past 7 years I have dedicated an annual editorial to a conversation with the current President of the American Academy of Orthopaedic Surgeons (AAOS). True to our collective orthopedic collegiality, these requests have never been declined, and I hope our AJO readers have benefited by gaining a better understanding of just how much the AAOS does for the practicing orthopedic surgeon and, in particular, a greater appreciation of the contributions of the AAOS President.

At the March 2013 meeting in Chicago, Joshua J. Jacobs, MD, assumed the Presidency of the AAOS. For many reasons, this was perfect timing. Josh has played an important role in many Academy committees and professional organizations over the past 20 years including President of the Orthopaedic Research Society as well as President of the US Bone and Joint Initiative. Chicago is Josh’s hometown where he is the William A. Hark, MD, Susanne G. Swift Professor and Chairman, Department of Orthopaedic Surgery, Rush Medical College. How appropriate to recognize a local star at our annual meeting!

This year, the Board of Directors of the AAOS are in the process of updating the Academy’s Strategic Plan, last updated in 2010, with specific goals designed to enhance its mission in education, advocacy, research, quality, communication, membership, diversity, unity, fiscal affairs, and structure and governance. A carefully crafted governance structure, with a clear line of presidential succession, provides a platform for continuity and a mechanism to achieve these goals. For example, Dr. Jacobs was positioned in line to the Presidency of the AAOS 3 years ago, giving him sufficient time to formulate his specific goals for his presidential year while at the same time maintaining continuity of current Academy goals (see the AAOS strategic plan, www.aaos.org/about/strategicplan.asp).

Josh outlined 3 important challenges for his Presidency. The first is that the Academy must be closely engaged in the implementation of the Patient Protection and Affordability Care Act, commonly referred to as Obamacare. He believes that our professional society must be a part of the solution to the nation’s healthcare crisis and a leader of the current reforms intended to address this crisis.

His second focus will be to implement programs that demonstrate our profession’s commitment to access of high quality orthopedic care. Integral to this effort is the emphasis on thorough, large-scale research projects demonstrating that orthopedic care improves quality of life and restores functional capacity to our patients. We know individually this to be the case based on our own clinical experience, but we need reliable independent data to prove this to third party payers and government agencies.

Finally, Josh’s third priority will be to actually communicate to patients, policy makers, and politicians the value and effectiveness of the services orthopedic surgeons provide. In the new healthcare arena, it will not be sufficient to simply demonstrate high quality in terms of clinical outcomes and patient’s satisfaction. We must prove that our care provides economic value to society as well. In a way, this approach can be viewed as a return on investment of the money spent on healthcare—a more complicated calculus the mere reports of clinical outcomes.

As an experienced clinician, educator, administrator, and researcher, Josh Jacobs is the ideal leader for our organization. In these uncertain and turbulent times in healthcare, we orthopedic surgeons will benefit from a leader who can clearly define our goals and guide our ship of state through treacherous seas of change. Healthcare delivery and financing will change dramatically in the years to come, and we are all so fortunate to have someone of Josh’s very extensive talents to navigate our course.

For the past 7 years I have dedicated an annual editorial to a conversation with the current President of the American Academy of Orthopaedic Surgeons (AAOS). True to our collective orthopedic collegiality, these requests have never been declined, and I hope our AJO readers have benefited by gaining a better understanding of just how much the AAOS does for the practicing orthopedic surgeon and, in particular, a greater appreciation of the contributions of the AAOS President.

At the March 2013 meeting in Chicago, Joshua J. Jacobs, MD, assumed the Presidency of the AAOS. For many reasons, this was perfect timing. Josh has played an important role in many Academy committees and professional organizations over the past 20 years including President of the Orthopaedic Research Society as well as President of the US Bone and Joint Initiative. Chicago is Josh’s hometown where he is the William A. Hark, MD, Susanne G. Swift Professor and Chairman, Department of Orthopaedic Surgery, Rush Medical College. How appropriate to recognize a local star at our annual meeting!

This year, the Board of Directors of the AAOS are in the process of updating the Academy’s Strategic Plan, last updated in 2010, with specific goals designed to enhance its mission in education, advocacy, research, quality, communication, membership, diversity, unity, fiscal affairs, and structure and governance. A carefully crafted governance structure, with a clear line of presidential succession, provides a platform for continuity and a mechanism to achieve these goals. For example, Dr. Jacobs was positioned in line to the Presidency of the AAOS 3 years ago, giving him sufficient time to formulate his specific goals for his presidential year while at the same time maintaining continuity of current Academy goals (see the AAOS strategic plan, www.aaos.org/about/strategicplan.asp).

Josh outlined 3 important challenges for his Presidency. The first is that the Academy must be closely engaged in the implementation of the Patient Protection and Affordability Care Act, commonly referred to as Obamacare. He believes that our professional society must be a part of the solution to the nation’s healthcare crisis and a leader of the current reforms intended to address this crisis.

His second focus will be to implement programs that demonstrate our profession’s commitment to access of high quality orthopedic care. Integral to this effort is the emphasis on thorough, large-scale research projects demonstrating that orthopedic care improves quality of life and restores functional capacity to our patients. We know individually this to be the case based on our own clinical experience, but we need reliable independent data to prove this to third party payers and government agencies.

Finally, Josh’s third priority will be to actually communicate to patients, policy makers, and politicians the value and effectiveness of the services orthopedic surgeons provide. In the new healthcare arena, it will not be sufficient to simply demonstrate high quality in terms of clinical outcomes and patient’s satisfaction. We must prove that our care provides economic value to society as well. In a way, this approach can be viewed as a return on investment of the money spent on healthcare—a more complicated calculus the mere reports of clinical outcomes.

As an experienced clinician, educator, administrator, and researcher, Josh Jacobs is the ideal leader for our organization. In these uncertain and turbulent times in healthcare, we orthopedic surgeons will benefit from a leader who can clearly define our goals and guide our ship of state through treacherous seas of change. Healthcare delivery and financing will change dramatically in the years to come, and we are all so fortunate to have someone of Josh’s very extensive talents to navigate our course.