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AAOS pioneers fostered unity in the specialty, focused efforts on patient care
Forces and events, particularly World War II, shaped the American Academy of Orthopaedic Surgeons over 8 decades and prepared it to address future challenges.
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During its 79-year history, the American Academy of Orthopaedic Surgeons has evolved from a concept forged by a small group of early U.S. orthopedic surgeons into the largest orthopedic society in the world, keenly focused on advancing musculoskeletal care and boasting more than 36,000 members.
A host of forces and events have shaped the course of the American Academy of Orthopaedic Surgeons (AAOS) during the past 8 decades, making it the organization that it is today, those individuals affiliated with the AAOS who spoke with Orthopedics Today said.
One outside influence that had a profound effect on orthopedics as a specialty and perhaps changed the face of AAOS as a pioneering medical society more than anything else was the treatment of war injuries, AAOS President John J. Callaghan, MD, said.
 War was a catalyst for many changes that the AAOS and its members weathered. 1999 AAOS President Robert D. D’Ambrosia, pictured, was a U.S. Air Force flight surgeon, 1965 to 1967 and during the Vietnam War consulted at a Thai orphanage for refugees. Image: D’Ambrosia RD |
However, worldwide technological advances, the emergence of managed care, the need for increased advocacy for the orthopedic specialty, specialization trends and the current push for health care reform, have also played key roles in molding and changing the AAOS.
Founded in 1931
Established in 1933, the beginnings of the AAOS can be traced back to October, 1931, when seven surgeons gathered at a meeting of the Clinical Orthopaedic Society and drew up a charter for a national organization that would welcome all practicing orthopedic surgeons from across the United States. When the first AAOS meeting was held 2 years later in 1933, orthopedics was still in its infancy in many ways, noted AAOS Chief Executive Officer Karen L. Hackett, FACHE, CAE.
Not until after World War II did orthopedics really expand as a specialty, as the knowledge gained from treating war injuries was brought back to the home front. In fact, a great deal of orthopedic innovations and advancements have stemmed from treatment of injuries sustained during wars throughout history, according to Callaghan and others.
“With each of the wars, starting especially with World War II, the things that were learned from war combat injuries actually helped us advance the field,” Callaghan told Orthopedics Today. “Whether it was World War II, somewhat Vietnam also, and even now as we get into Afghanistan and Iraq, the injuries have all changed, yet the injuries that were seen and the way we took care of those combat injuries has been brought over to civilian life,” he said.
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The AAOS held its ninth meeting, a 5-day gathering in New Orleans, just prior to the United States’ involvement in World War II, a conflict that would eventually change the face of orthopedic medicine forever. Image: The American Academy of Orthopaedic Surgeons |
As World War II ended, the world’s first computer became operational ushering in an era of technological advancements. Similar advances occurred at about the same time in the practice of medicine, including orthopedics, which advanced the field tremendously. In particular, as the knowledge of disease processes and injuries of the musculoskeletal system expanded, so did the orthopedist’s ability to treat patients and return them to normal or near-normal function much more quickly than in the past, Callaghan said.
1990s: Challenges
In the 1990s, the face of health care began to change as the shift to managed care occurred. Concerns regarding physician reimbursement and government regulation were in the forefront, all of which had an effect on the AAOS. At the same time, the lawsuits regarding pedicle screws were instituted, with the AAOS and several medical societies named as defendants.
“There was a lot of negativity that was going on in the ’90s,” Robert D. D’Ambrosia, MD, AAOS president in 1999 and editor-in-chief of Orthopedics, said.
“I think the real turning point, though, was the academy started thinking that if we really consider what is best for our patients and put the patient first, in view of all the negativity that was going on with the government and managed care ... putting the patient first is the best way to put ourselves first,” he said.
A new era, better image
According to Hackett, to counteract the negativity of the ‘90s and further its efforts at putting patients first, the AAOS started building playgrounds in the cities where its annual meetings were held in 2000.
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Image: The American Academy of Orthopaedic Surgeons |
In addition, it started campaigns for safety and prevention of orthopedic injuries, all of which “gave us a better light in the academy,” D’Ambrosia said.
Callaghan said another crucial event that helped shape the organization occurred in 1997, when the AAOS formed a second and separate C6 organization, the American Association of Orthopaedic Surgeons, allowing them to spend funds on advocacy and further its efforts in that area.
“We really have tried to educate our members and have them actively involved in the advocacy effort in this country in order to push through the legislation that we feel is important for our patients and for patient access to us as orthopedic surgeons,” Callaghan said.
He noted the Political Action Committee (PAC) of the American Association of Orthopaedic Surgeons was the number-one PAC in medicine as of last year, “which we think is tremendous when you consider that less than 3% of all physicians are orthopedic surgeons.”
Influence of specialization
Hackett told Orthopedics Today that one long-term, ongoing concern faced by the AAOS in recent decades has been specialization within orthopedics. Specialization gradually started to emerge in the 1950s and 1960s; however by the early 1980s the number of orthopedic specialties had grown so substantially that Charles Rockwood Jr., MD, titled his first vice-president’s address at the 1984 AAOS annual meeting, “Keep the Family Together.”
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Image: Callaghan JJ |
“It really is our goal to work with the orthopedic specialty societies and in a way that suits them the best,” Hackett said. “The orthopedic specialty societies are different in terms of their size and their sophistication, if you will, as a society. So we have learned over time that we cannot have a cookie-cutter approach to working with them,” she explained.
As a result, the AAOS has worked in recent years to make unity a priority and to partner with the specialty societies on different projects as well as on education. It provides management services for 11 specialty societies and also houses some of the societies in its headquarters building in Rosemont, Ill. The Board of Specialty Societies, created in 1984 as the Council of Orthopaedic Musculoskeletal Societies, represents 22 musculoskeletal specialty societies. In addition, the Board of Specialty Societies holds three voting seats on the AAOS Board.
The latest challenge facing AAOS is health care reform and determining what the implementation of the Patient Protection and Affordable Care Act will mean to orthopedics, according to Callaghan. Although the regulations supported by the act have yet to be finalized, AAOS officials like Callaghan and Hackett expect its effects on the academy will be felt throughout the decade and beyond. – by Mary L. Jerrell, ELS
- John J. Callaghan, MD, can be reached at University of Iowa Hospital, Department of Orthopaedics, 200 Hawkins Drive, Iowa City, IA 52242; 319-356-3110; e-mail: john-callaghan@uiowa.edu.
- Robert D. D’Ambrosia, MD, can be reached at 12631 East 17th Ave., Academic Office 1, Room 4602, Aurora, CO 80045; 303-724-2955.
- Karen L. Hackett, FACHE, CAE, Chief Executive Officer AAOS, can be reached at 6300 North River Road, Rosemont, IL 60018-4262; 847-384-4042; e-mail: hackett@aaos.org.