Vision, leadership mark 110-year history of orthopedics at Washington University

Clinical care, education and research grew after orthopedic department was created in 1995.

Leadership has been the hallmark of the orthopedic pioneers at Washington University in St. Louis who helped create the well-respected 31-physician academic practice there today.

The tradition of leadership started with Aaron J. Steele, MD, who was already a national leader in the field when he became the first professor and chairman of orthopedic surgery in 1899. It continued with the nine chairmen who succeeded him and acted on their visions of success.

Current Chairman Richard H. Gelberman, MD, was president of the American Academy of Orthopaedic Surgeons (AAOS) in 2001. Last year, he led the department to increase its volume by 17%, including a 9.5% increase for procedures and 7.5% for patient visits, according to Ronald J. Faulbaum, MBA, CMPE, executive director of business affairs.

Clinical service

“Washington University orthopedics is a model academic orthopedic surgery department. It has been guided by principled leadership and has grown into a leader in all areas of clinical service, research and education,” said Herbert S. Schwartz, MD, chair of Vanderbilt Orthopaedic Institute in Nashville, Tenn.

Department members have consistently advanced the specialty in spine treatments, hand surgery, pediatric orthopedics and sports medicine and recently improved their tumor, foot and ankle, total joint reconstruction, trauma and upper extremity care.

“It is rare that you have an orthopedic department where there are six or seven subspecialties that are unquestionably of a national caliber,” said Robert L. Barrack, MD, chief of adult reconstruction.

Steele helped organize the American Orthopaedic Association (AOA) and was AOA president in 1893. Nathaniel Allison, MD, became the second chairman in 1912. He was elected AOA president in 1922, and served as dean of the medical school and orthopedic surgery chairman from 1920 to 1923. He was co-editor of the American Journal of Orthopaedic Surgery, the forerunner of The Journal of Bone & Joint Surgery.

Other chairmen enhanced the department’s national reputation through leadership and clinical, educational and research contributions, including J. Albert Key, MD, and Fred C. Reynolds, MD. Key and Leroy Abbott, MD, who preceded Key as chairman, were AOA presidents. Reynolds, twice the department chairman, was AAOS president in 1965 and a National Football League (NFL) Physician’s Society founder and president. H.R. McCarroll, MD, team physician for the NFL’s former St. Louis Cardinals, was AAOS president in 1958.

“Most people think of this as a unit that just began in 1995. However, it has a rich history,” Gelberman said.

Top hospitals

Early in its development, the university affiliated with Barnes Hospital, which merged with Jewish Hospital, and then with St. Louis Children’s Hospital, located on the same downtown campus. Both hospitals now serve as the main teaching hospitals for the school of medicine. The department is affiliated with the Veterans Affairs Medical Center and St. Louis Shriner’s Hospital for Children, which provide added clinical and educational exposure for the subspecialties.

Barrack found this juxtaposition of clinical opportunities rare and appealing enough to make a mid-career change, joining the faculty in 2004.

“It is a unique setup here, where you have a hospital that is always ranked among the top U.S. hospitals and a medical school and children’s hospital that are always ranked in the top five. There are not many places in the country where you have that combination of resources,” he told Orthopedics Today.

J. Albert Key, MD, was orthopedic surgery chairman at Washington University from 1930 to 1955. One innovative practice of his was fusing the joints of skeletally immature patients to fight infection.

Resident education and advancing sports medicine as a subspecialty were some areas Fred C. Reynolds, MD, championed as department chairman. He was president of the American Academy of Orthopaedic Surgeons in 1965.

Washington University’s first orthopedic chairman, Aaron Steele, MD, was a surgeon during the Civil War. He was reportedly one of the first to practice orthopedic surgery west of the Allegheny Mountains. Images: Washington University

New department

It was not until 1995 that a formal department of orthopedic surgery was established at Washington University School of Medicine: the idea of Dean William A. Peck, MD. He envisioned the department being led by a top-flight individual, according to Faulbaum.

“Peck helped marshal the resources from the hospital to make that possible,” he said, which paved the way for Gelberman to become chairman in 1995.

Gelberman soon recruited some new members with the ability to make his vision of department-wide quality results and growth a reality.

Recruiting excellence

One recruit, hand surgeon Martin I. Boyer, MD, called Gelberman a leader who strives for excellence and recruits like-minded people.

“Everybody he hires for both clinical and nonclinical functions within the department knows his mission is singular: To build the best orthopedic department in the world,” he said.

Gelberman’s strategy has produced some positive results, moving the practice from not even being among the orthopedic departments ranked in U.S. News & World Report in 1995 to a ranking among the nation’s elite departments in recent years.

“We like where we are because our goal is to continue to improve,” Gelberman said.

According to Daniel J. Berry, MD, chairman of orthopedics at the Mayo Clinic, “The Washington University Department of Orthopedic Surgery stands out for having phenomenal departmental leadership with a clear sense of direction and priorities. That great leadership, in turn, has attracted exceptionally talented individuals with great clinical, surgical and academic talent.”

Members of the Washington University Orthopedic Surgery Department see adult patients at The Center for Advanced Medicine on the Washington University Medical Center campus in St. Louis, which includes 18 treatment centers.

Getting better

Soon after being hired, Gelberman devised the “Just Say Yes” program to foster departmental growth and improvement. It focused on rapidly addressing all clinical requests from referring physicians or patients and directed everyone’s efforts toward meeting patient needs.

“That attitude still runs through the veins of this department and is a top priority for us,” Gelberman noted.

The program afforded the department greater opportunities to excel in training, research and clinical endeavors and set it on its current course for success, he said.

Education strategy

Education of residents, fellows and medical students has always been a department priority.

Before serving 25 years as department chairman, Key developed formal surgeon training programs at Barnes Hospital, later introducing clinical and basic science orthopedic research at the university.

In 1945, the department instituted an orthopedic residency program. Today’s residency program involves six residents per year for 5 years.

“The strengths are a broad clinical experience covering all the subspecialties, backed by a very strong didactic curriculum,” said residency director Rick W. Wright, MD, who specializes in sports medicine and is team physician for St. Louis Blues and Rams.

Core curriculum

Program features include a regularly updated syllabus, core curriculum lectures supplemented with essential readings and a 360· evaluation process for residents to assess attending surgeons’ teaching ability.

“We place an incredibly strong emphasis on the well-being of our residents, their happiness and their education,” said K. Daniel Riew, MD, member of the resident education committee.

One-year fellowships are offered in all major subspecialties.

Nathaniel Allison, MD, is seen operating around 1911 (third from right). The department’s second chairman, he had a reputation as a leader from his work with national orthopedic societies and publications.

Educating med students

To provide thorough education in musculoskeletal medicine, Boyer, who coordinates orthopedic training for 3rd and 4th year medical students, developed one of the nation’s first month-long musculoskeletal courses for medical students. Students’ test scores show how successful it has been. In fact, many now rank orthopedics as one of the best rotations, according to Riew.

“There is a significant positive effect of this new course that our institution has pioneered in the education of medical students in musculoskeletal surgery and medicine,” Boyer said, noting the department’s reputation for teaching other surgeons nationally has been equally good.

Paul Manske, MD; Keith Bridwell, MD; and Perry L. Shoenecker, MD, are all well-known figures in hand, spine and pediatrics, respectively, he said.

Research

The research department includes six individuals with PhD degrees, most of whom are partnered with a leading clinician.

“We are more of a traditional research-oriented medical school department,” Gelberman said. “Everybody on this faculty is engaged in innovation, development and advancing the field. … It is really part of our fabric. It is part of our mission.”

Examples of the emphasis placed on high-level musculoskeletal research at the university include five department members who received AAOS Kappa Delta Awards and departmental work currently supported by 11 National Institutes of Health (NIH) R01 grants.

“We have outstanding spine, total joint, shoulder, hand and sports research programs going on here. In addition, our department is third among orthopedic departments in the country in NIH funding,” Wright said.

Three clinicians — Gelberman; Bridwell, who is chief of the spine service; and shoulder specialist Ken Yamaguchi, MD — have NIH grants.

“To have not just one but three surgeons in the department have separate NIH grants is very unusual,” Riew added.

Challenges

“I think one of the strengths of the program … is there is no weak link,” Boyer said, noting the department is among the “healthiest” in the nation.

It is a leader in some areas with a clinical total joint implant registry, an electronic health records system and a 60,000-sq. ft. orthopedic outpatient facility built in suburban St. Louis in 2007 as part of a business plan seeking greater growth and patient access.

“We are very proud of that achievement, but I think we are going to continue to have other challenges,” Gelberman said.

“If anything, we seek to take advantage of what exists here and are creating something I hope will last for many years as an example of effective care and teaching and research.”

For more information:

• Robert L. Barrack, MD, 314-747-2562; e-mail: barrackrl@wustl.edu.
• Martin I. Boyer, MD, 314-747-2813; e-mail: boyerm@wustl.edu.
• Ronald J. Faulbaum, MBA, CMPE, 314-747-2520; e-mail: faulbaumr@ wustl.edu.
• Richard H. Gelberman, MD, 314-747-2531; e-mail: gelbermanr@wustl.edu.
• K. Daniel Riew, MD, 314-747-2565; e-mail: riewd@wustl.edu.
• Rick W. Wright, MD, 314-747-2639; e-mail: wright@wustl.edu. Barrack, Boyer, Faulbaum, Gelberman, Riew and Wright can be reached at 660 S. Euclid Ave., Campus Box 8233, St. Louis MO 63110.
• Daniel J. Berry, MD, can be reached at Mayo Clinic, 200 1st St. SW, Rochester, MN 55905; 507-284-4204; e-mail: mundt.norma@mayo.edu.
• Herbert S. Schwartz, MD, can be reached at Vanderbilt Orthopaedic Institute, Medical Center East, South Tower, Suite 4200, Nashville, TN 37232; 615-322-8890; e-mail: herbert.s.schwartz@vanderbilt.edu.

Reference:

• ortho.wustl.edu