Stuart Weinstein braces for a busy year as AAOS president

Issue: February 2005

Stuart Weinstein [photo] This month, Stuart L. Weinstein, MD, will become president of the American Academy of Orthopaedic Surgeons at the annual meeting in Washington.

Weinstein, who is the Ignacio V. Ponseti Chair and professor of orthopedic surgery at the University of Iowa Hospital, took time to talk to Orthopedics Today about his new appointment with the AAOS and the goals he has for the academy in 2005. Among his aspirations: attaining medical liability reform and creating a more patient-centered culture within the AAOS.

Orthopedics Today: Dr. Weinstein, how did you get started in orthopedics? Where did you receive your education and where have you practiced medicine?

Stuart L. Weinstein, MD: I received my undergraduate education at the University of Illinois, where I majored in political science and history. I went to medical school at the University of Iowa and did a brief stint in internal medicine at the University of California–San Francisco. I came back to the University of Iowa to do my orthopedic training. I joined the faculty at the University of Iowa in 1976. I have been in practice in Iowa City ever since then.

My practice is mostly confined to pediatric orthopedics and spinal deformity in children, but I also take regular trauma call on rotation and spine trauma call.

OT: How have your experiences prepared you to be the AAOS president?

Weinstein: I have been fortunate to have the opportunity to play a leadership position in many orthopedic organizations, including the Pediatric Orthopaedic Society of North America, the American Orthopaedic Association and the American Board of Orthopaedic Surgery. I also had the privilege of serving in many capacities while working for the academy over the past 25 years, including serving on the Council in Education and the Examinations Committee, and being given the opportunity to organize U.S. efforts to launch the Bone and Joint Decade.

In 1998, Bob D’Ambrosia, who was then the president of the AAOS, asked me if I would head a project that would get the academy up and running in developing the Bone and Joint Decade initiative. I also had the secondary task of getting it organized here in the United States. So I was the first chairman of the U.S. Bone and Joint Decade. That has been a very valuable experience.

OT: What goals do you have for the academy in 2005?

Weinstein: My goals are very ambitious. The No. 1 thing that the academy needs to do is add value to the membership. We want to enhance the value of everyone’s membership in the AAOS and make sure we are meeting the needs of our members.

I also think that the most pressing issue for our members is medical liability reform. This is the No. 1 issue affecting our members’ ability to practice. We have already made significant financial contributions and a total organizational commitment to this effort, so my goal for this year — with the help of the AAOS and through the new coalition Doctors for Medical Liability Reform (DMLR) — is to achieve federal medical liability reform.

The academy has already been a leader among medical specialty societies in the effort to achieve reform. We were the founders, along with the American Association of Neurologic Surgeons, in establishing DMLR, a 230,000-member physician coalition representing 11 specialty societies that is totally geared to achieving federal medical liability reform. [Editor’s note: Please refer to the article on the new coalition, which appears on page 82 of the February 2005 issue].

The other thing we’ve done at the AAOS in that regard is provide funds for state orthopedic societies that are [on the verge] of achieving meaningful liability reform at the state level. During the last election cycle, we provided grants to state orthopedic societies in 10 of the 20 so-called crisis states. The efforts of our members at the state level were able to achieve significant victories in four of those states, including Texas and Mississippi, and some gains in Florida and Nevada, with inroads in others.

OT: What other things do you hope to accomplish during your term as AAOS president?

Weinstein: Another goal I have is the establishment of a patient-centered culture within the academy and, indirectly, within our individual practices. It’s a commitment to improve the care we provide to our patients. I would define patient-centered orthopedic care as safe, effective musculoskeletal treatment provided through a partnership among the orthopedic surgeon, an informed and respected patient and family, when appropriate, and a coordinated health care team.

When you talk about patient-centered care, you’re talking about care that responds to the individual patient’s needs and preferences, where the patient’s input is solicited. We also provide the educational support they need to make important decisions about their care. The patient’s values guide our decisions.

This is a changing paradigm in health care, and I think the academy has laid the groundwork to be a leader in patient-centered health care through its efforts over the past 15 years, even prior to the so-called “quality movement” in health care. This is our opportunity to put this [concept] together and play a leadership role among the medical specialty societies.

OT: The AAOS places a high priority on its role as an advocate for orthopedic surgeons, especially concerning legislation that affects surgeons’ medical practice and reimbursement. Besides medical liability reform, what other areas will you target in your advocacy efforts?

Weinstein: The importance of advocacy can’t be overestimated because musculoskeletal diseases and conditions are underappreciated, undervalued and under-resourced by people who pay for health care, by people who regulate health care and by those who allocate research funding.

We have created another position in our Washington office to enhance our advocacy and regulatory agenda and help the orthopedic specialty societies who list advocacy as part of their mission take advantage of this new resource.

We are also focusing on building orthopedic unity. Specialization is good for orthopedics as long as we don’t become fragmented, because fragmentation in orthopedics will result in fragmentation of patient care and a loss of hard-won political capital. Specialization has improved many aspects of orthopedic care, and it’s been largely technology driven, but I think we want to avoid achieving specialization at the expense of unity in orthopedics as a discipline, because otherwise we will ultimately lose.

We also need to provide further burden-of-disease information that substantiates how musculoskeletal conditions are undervalued and under-resourced throughout the country. This has been the foundation of the Bone and Joint Decade, and the academy played a key role in convincing President Bush that it was necessary to create a Bone and Joint Decade to build awareness of the burden of musculoskeletal conditions.

So, we need to continue developing information about this increasing burden of disease and further our work in decreasing disparities in health care.

OT: One of the AAOS’ major functions is coordinating continuing medical education. What efforts will you be making this year to ensure that that mission continues?

Weinstein: Medical education is our No. 1 mission, and the academy continues to devote considerable resources and efforts to maintain a strong educational effort. We want to strengthen our relationships with specialty societies and look for mutually beneficial ways to work together with regard to our educational efforts.

Today, the public places great value on certification and the maintenance of that certification. In response to the public’s demand for physician accountability, the American Board of Medical Specialties started a program called the Maintenance of Certification (MOC). The [MOC] has essentially four components: cognitive expertise, lifelong learning, professional standing and practice performance.

One of our education goals is to assure our members that we’ll help them meet the commitment to lifelong learning and periodic self-assessment that’s mandated by the Maintenance of Certification process. We’ll do so through a variety of programs and formats that suits every preferred learning style. It will be an evolving process.

OT: What aspect of the AAOS are you most proud of?

Weinstein: In my experience in working with the Bone and Joint Decade and then helping to build the Doctors for Medical Liability Reform coalition, which I now chair, I have been extremely impressed with the academy and how it is run. It is a wonderful organization that is admired by other medical specialty societies because of our members’ commitment, our staff’s dedication and the actual value that our members receive from their dues.

To me, it is the premier medical specialty society. I am extremely proud of all aspects of the academy. We’re always trying to be better and respond to our members’ needs. I feel privileged to have the opportunity to lead the organization this year on behalf of the 27,000 members of the academy.

OT: Last year, AAOS President Robert Bucholz cited his concern over the diminishing supply of dedicated orthopedic clinical scientists performing clinical research. As a researcher, you can appreciate the challenges of engaging in ambitious clinical investigations while sustaining a strong practice. Do you foresee a change in this downward trend?

Weinstein: We’re all worried about the future of clinical scientists. Likewise, very few of our residents are going into pediatric orthopedics, and we’re seeing very few of our residents accept trauma fellowships. So, we have some manpower issues that we really need to address.

With respect to the researchers, as long as we are in this time of decreasing reimbursement and increasing pressures associated with medical liability, those who want to do clinical research are hard-pressed to find the time because it takes away from revenue-generating activities. Physicians need to spend more time seeing more patients and do more surgeries to generate the same income they used to get. Also, the availability of research dollars is an issue. Clinical research is extremely expensive, and I don’t expect to see much change in National Institutes of Health funding in the next few years.

However, that being said, I think it’s incumbent on all of us who can to organize clinical trials and work with specialty societies to develop studies, because without these trials, it is hard for our specialty to advance. We have to make the most out of the funding we do have, yet work collectively through our Washington office on strategies to increase research funding.

OT: What areas within orthopedic medicine do you predict will experience the most change in the next few years?

Weinstein: I think we are approaching a very significant manpower shortage in pediatric orthopedics and trauma care. Pediatric orthopedics is already in a shortage situation, and trauma care is following close behind.

In a survey done by POSNA, the reasons residents are not going into pediatric orthopedics include low reimbursement and prolonged liability. You could treat a child who is one year old and he or she could still bring a suit against you 23 years later in many states.

With trauma, there are liability and lifestyle issues; it is an uncontrolled practice with high liability risk. The academy must address these important manpower and patient care issues.