Lessons in Orthopaedic Leadership: An AOA Podcast

Douglas W. Lundy, MD, MBA, FAOA, interviewed Jim Barber, MD who is an accomplished orthopaedic surgeon who practices in Douglas, Georgia. Dr. Barber shares his compelling journey, the various leadership roles he has embraced, and his experiences enriching a close-knit community despite the geographical limitations of a small town. His story illuminates the challenges and rewards of rural healthcare, showing how one dedicated individual can make a significant impact both locally and nationally.
 
Drs. Lundy and Barber tackle the evolving landscape of rural solo private practice, touching on the mounting pressures from insurance companies, the complexities of electronic medical records, and the growing need for larger teams. Dr. Barber offers his thoughts on state support programs, value-based care, and the pressures of consolidation, while reflecting on the changing dynamics of physician collegiality and scope of practice. Through innovative collaboration with local hospitals and Medicare shared savings programs, various pathways are explored for sustainability and the importance of staying positive and proactive in this challenging environment.

Aaron Brandt, MD, spoke with Anthony Catanzano, MD, a Pediatric Spine and Neuromuscular Surgeon at Duke University, and Erin Honcharuk, MD, a Pediatric Deformity Surgeon at Johns Hopkins University, to discuss the Board Certification Process and their methods for preparation.

While the boards can be a stressful process, all three orthopaedic surgeons emphasized that the examiners want to make sure that you are practicing safe medicine. Drs. Brandt, Honcharuk, and Catanzano highlighted the importance of using proper documentation, redacting all identifying data, and thoroughly reviewing the ABOS guidelines. Using proper documentation will set you and your patient up for future success. Throughout the conversation, they share valuable insights and personal stories about how mentors and colleagues played pivotal roles in their board preparation. Tune in for essential tips and advice to help you navigate this challenging process with confidence. 

Douglas W. Lundy, MD, MBA, FAOA, interviewed Karl Koenig, MD, FAOA, Executive Director and Adult Reconstruction Surgeon at Musculoskeletal Institute for the University of Texas at Austin, to discuss Shifts in Medicare. 

Dr. Koenig touched on the different views for Medicare shifting payment systems and managing budget issues. While America has spent large amounts of money on healthcare, Dr. Koenig believes the payment system needs to be adjusted to improve patient outcomes. It is discussed how Medicare is trying to move in a different direction by creating relationships between the specialists and Accountable Care Organizations (ACOs), so they can work together and achieve the same goals. Drs. Lundy and Koenig transitioned to a discussion on bundle payments; and explained the pros and cons for both physicians and patients. Overall, Dr. Koenig stated there are different views on Medicare, but the goal is to have the surgeons’ incentives be more aligned with the patients, to give them the best care possible.  

Alexander Aleem, MD, FAOA, interviewed Dr. Danny P. Goel, CEO of PrecisionOS, who currently practices in Vancouver, B.C. and is a Clinical Professor in the Department of Orthopedic Surgery at the University of British Columbia, to discuss the role of virtual reality training and surgical simulation in orthopaedics.

Virtual Reality (VR) training is impacting orthopaedics for both residents and educators. The ease of access and affordability of virtual reality education allows residents to practice and be better prepared in the OR, while also allowing the educators to assess the resident’s performance and teach them the best habits and actions to operate at the highest level. While typical training methods give haptic feedback to residents, virtual reality allows both haptic and real data feedback to assess competency. In addition to the different types of feedback that VR provides, it also can help foster mentorship both live or on demand, which helps promote a synchronous learning experience for the mentor and mentee. Dr. Goel expresses his excitement and optimism about the future role that VR and AI will play in the world of orthopaedics to provide the best training to future orthopaedic surgeons.

Dr. Aaron Brandt sat down with James R. Ficke, MD, FACS, FAOA, Department Chair of Johns Hopkins, and Joseph R. Hsu, MD, FAOA, Trauma and Deformity Surgeon at Carolinas Medical Center in Atrium Health in Charlotte, to discuss meaningful mentorship during early career. 

This conversation focuses on what they believe led them on a path to success, and how they have gotten the most out of both experiences – being a mentor and as a mentee. Their discussion communicates the importance of honesty and vulnerability when making relationships, and how this gives both parties the ability to trust one another. Throughout their chat, Drs. Brandt, Ficke, and Hsu, share numerous stories on how their relationships began, and the ways they were able to capitalize on being their genuine selves.  

Douglas W. Lundy, MD, MBA, FAOA, discussed generational shifts and worldview changes in orthopaedics with Lisa Lattanza, MD, FAOA, Chair of Department of Orthopaedics and Rehabilitation at Yale School of Medicine. 

Dr. Lattanza sees a lot of similarities between the residents of today, and those during her time of residency. Although there are generational differences in technology and practices, there are many positive changes that allow orthopaedic surgeons to become competent and successful in their practice. Young faculty prefers to have a culture that supports their professional and personal lives, allowing them to develop their leadership skills and become a working member of society. 

Some of the major differences between generations are the faster adaptation to technology and the increased effort to support diversity amongst the orthopaedic profession. Both factors allow for orthopaedic surgeons to become better poised to solve issues in medicine, use more forward thinking, and expand their leadership to a more inclusive culture. 

Douglas W. Lundy, MD, MBA, FAOA, spoke with Scott Porter, MD, FAOA, Orthopaedic Oncologist and Vice Chair of Operations in the Department of Orthopaedics at Prisma Health, Greenville, South Carolina, to discuss how changes in compensation will affect access to patient care in the future. 

Throughout the discussion, the concepts of rationing healthcare, bundling, and the future of compensation models are evaluated. Dr. Porter explains that compensation affects physician behavior which directly impacts access to patient care. The limitation or creation of access to patient care is created by the physician, while rationing healthcare is only due to overconsumption.

Dr. Porter describes his ideal situation for future patient care, which involves a way to fund a healthcare account owned by the patient. This can be used as a means to pay for healthcare in the future, which can also be gifted and transferred to others. 

In conclusion, Dr. Porter states that it is not a matter of whether changes in compensation will affect access to patient care, but how it will influence access.

Deana Mercer, MD, FAOA, Professor at the University of New Mexico at Albuquerque and Hand and Upper Extremity Surgeon, spoke with Douglas W. Lundy MD, MBA, FAOA, to discuss the misogynistic culture of the orthopaedic specialty. Dr. Mercer explains the changing norms of society and how young orthopaedic surgeons can adjust their views to succeed. Rather than focusing on diversity, biases, and difficulties, orthopaedic departments need to give women the tools to succeed, build their confidence, and empower them to be successful orthopaedic surgeons. Dr. Mercer believes that all prospective orthopaedic surgeons need to engage, challenge others, and be a part of the discussion. 

Dr. Alex Jahangir, MD, FAOA, an Orthopaedic Trauma Surgeon at Vanderbilt University Medical Center, spoke with Dr. Douglas W. Lundy, MD, MBA, FAOA, about the governmental influence on change of culture in orthopaedics.

Dr. Jahangir shared his experience as the Chair of the Board of Health and the COVID-19 Taskforce, during the global pandemic. Taking on this government position allowed Dr. Jahangir to see what matters most to the community of Nashville regarding Health and Safety. He found that physicians need to build relationships with patients so they can have trust in the methods that doctors advocate for. A sense of trust and transparency between government officials and the community are also a necessity to address everyone’s issues. Dr. Jahangir is optimistic about the future of orthopaedics and believes that establishing good relationships and civil discourse are an investment in the successful future of the orthopaedic profession.  

Drs. Douglas W. Lundy, MD, MBA, FAOA and Aaron Brandt, MD, sat down with Dr. Matthew R. Schmitz, MD, FAOA to discuss the development of two new Lessons in Leadership Podcast Series. Dr. Lundy discussed his intention to interview different leaders on the topic of the future in orthopaedics. This primarily involves changes in culture, employment, and technology—factors that have a major effect on the careers of orthopaedic surgeons. Dr. Brandt indicates that different leaders will be interviewed on the best ways to develop skills early in their practice. This includes addressing the importance of meaningful mentorships, finding success at your first job, and being as productive and efficient as possible. By interviewing these leaders about their early career best practices, Dr. Brandt’s goal is to give young orthopaedic surgeons valuable and relevant information as they evolve in their practice.