Weinstein reviews year as AAOS president, looks ahead

Issue: February 2006

Outgoing President of the American Academy of Orthopaedic Surgeons, Stuart L. Weinstein, MD, reflects below on his year in office. In this interview with Orthopedics Today, he notes that academy officials have cast new mission and vision statements that reposition the organization to better meet member needs and become more patient-focused. The academy also sought to become more achievement-focused and has begun working more closely with the many orthopedic specialty societies.
Weinstein also discusses several burning issues, including Medicare reimbursement and liability reform. Regarding the latter: “We have to keep the pressure on,” or risk giving back the hard-won gains that came out of the 2004 election, he said.
Weinstein is the Ignacio V. Ponseti Chair and professor of orthopedic surgery at the University of Iowa Hospital, Iowa City. He specializes in pediatric orthopedics and in treating spinal deformities, and is chair of Doctors for Medical Liability Reform, the largest coalition of physicians fighting for federal medical liability reform.
Susan M. Rapp
Staff Writer

ORTHOPEDICS TODAY: What were your main accomplishments as American Academy of Orthopaedic Surgeons (AAOS) president this past year? Which ones made you most proud and why?

Stuart L. Weinstein, MD: Well, I would first like to emphasize that the accomplishments are not my accomplishments. You know the president has the ability to steer the ship some, but these are accomplishments by the Board of Directors. This is an organization which is run by a board and which is responsive to the needs of the members. So, I think that’s important to emphasize, that we’re beyond the point of having a president’s agenda. So, it’s an organizational agenda, which is basically to increase the value of the organization to the members and provide members with the programs, products and services that they need.

Stuart L. Weinstein, MD [photo]
Stuart L. Weinstein

So, when you ask what are the things that we accomplished, I think we have first of all changed our mission and vision statements to ones that are very contemporary and that really emphasize strongly the interests of patients. Our new mission is “to serve the profession, champion the interest of patients and advance the highest quality musculoskeletal health.” Our new vision statement is that, “the AAOS will be the authoritative source of knowledge and leadership in musculoskeletal health.” I think that these are significant changes in our direction — emphasizing our patients. I think that as physicians, if we always take the high ground and argue for what’s in the best interest of patients, we’ll always be on solid footing.

“I can say with great certainty that we are, without a doubt, the best organized advocacy unit of medical specialty organizations.”
— Stuart L. Weinstein

The second accomplishment is that we’ve changed our whole paradigm for goals. The strategic plan in the past had a number of goals, which were prioritized, say for example, one through 12, with No. 1 the most important and No. 12 the least important. We have changed the paradigm so that all of our goals are equal. There’s no one goal that’s more important. Some structural aspects of the organization are geared to achieving specific goals, but there are two overarching goals, which all aspects of academy life — be it a cabinet, a council, a committee — must achieve diversity and culturally competent care, and orthopedic unity.

We have also changed the way we do business. We’re becoming an achievement-focused organization as opposed to activity-focused. All activities must be geared to achievements; what are we trying to achieve by an activity? So, our culture will become an achievement-oriented culture as opposed to an activity-oriented culture.

Our strategic planning program was called “AAOS in 2010,” but in actuality, the horizon for planning for organizations can’t be that far out. It has to be the immediate horizon for the next two years. You can try and visualize beyond that point in time, but, in reality, you need to be focused on the next two years. We’re also very proud of the fact that as background for our strategic planning efforts, we’ve been able to accomplish the first true member needs assessment that was the foundation for our new mission and vision. On the basis of this needs assessment, we’ve totally oriented the AAOS to providing the programs, the products and the services that members want and need. And we will assess this on a continuous basis going forward.

We’ve also changed to a much more contemporary governance structure. This was just approved in December, and it will allow the organization to be much more nimble, to be able to change direction at a moment’s notice, to again meet member needs and enhance value to the organization.

The other initiative that I’m extremely happy we were able to get going, and we’ve been working on this for three years, is the initiative of patient-centered care. This ties in with our mission and vision, but I’m very proud to say that the academy is one of the leading organizations that is focused on this issue. This is a paradigm that’s been changing in health care. President Bush talks about it. Congress speaks about it. Every health care unit, whether it’s governmental or private, talks about the importance of patient-centered care. We’re changing the orientation of care from physician-centered to patient-centered. And I think this is critical as far as the future of medicine is concerned.

OT: One of your goals coming into the position of AAOS president was to meet the needs of the academy members. Looking back over the year, how would you define the membership’s current and most urgent needs as you’ve come to understand them?

Weinstein: We have about 15 prioritizations of members’ needs. The No. 1 need of members is medical liability reform. No. 2 is Medicare reimbursement. No. 3 is expert witness monitoring, and there are a whole host of others, but those are the top three.

OT: What inroads have been made under your direction for giving orthopedic surgeons a stronger voice in Washington? What’s happened in that area?

Weinstein: The academy is a strong advocacy organization. With our new governance structure, we are going to be focusing on a unified advocacy agenda. In my experience over the last three or four years of working with our Washington staff and working in Washington with various initiatives with the academy, I can say with great certainty that we are, without a doubt, the best organized advocacy unit of medical specialty organizations. Our leadership in the formation of Doctors for Medical Liability Reform (DMLR), The Alliance for Specialty Medicine and other coalitions to deal with the important issues of the day show we are indeed a leadership organization in Washington.

Another important aspect of academy life is enhancing our advocacy efforts on behalf of specialty societies. This has been an extremely important initiative. Advocacy issues are very important to some of our specialty societies, and we have enhanced our Washington office by adding a position for our specialty societies that are interested in advocacy so they have some representation and a voice in Washington. This has really enhanced the specialty societies’ ability to advocate along side of the academy and have an official presence in Washington, which is critical to effective advocacy.

OT: Medical liability reform remains a hot issue and the DMLR group has worked hard on federal liability reform and states are slowly making progress in this area, one step at a time.

How long do you personally predict it will take to pass a national liability reform act and what would be the main steps required to do that?

Weinstein: I think that’s a very difficult question to answer, but I’m very optimistic about our effectiveness thus far. The DMLR was extremely effective in the last election cycle. We spent more than $10 million on getting five new “yes” votes for medical liability reform in the Senate. Our efforts contributed, as well as the academy’s efforts contributed, to getting significant liability reform on many state levels.

As to the future: I think a lot of it really depends on the President and his popularity, which at the moment is a little bit down. For us to get meaningful liability on the federal level will take 100% of academy members stepping forward to be part of the initiative. We need everybody to step forward and contribute to our DMLR campaign. If we don’t have that I think that we’ll have difficulty achieving our goal. We need to have 19,000 actively practicing orthopedic surgeons contributing both financially and by getting on the phone to their elected representatives. We need 100% effort of our members and also the members of the other high-risk specialty societies, which are the ones most affected by the current liability crisis.

“For us to get meaningful liability on the federal level is going to take 100% of academy members stepping forward to be part of the initiative.”
— Stuart L. Weinstein

We need each and every member of the academy, regardless of whether they live in a so-called “safe state” or not, to step up to the plate and contribute to the medical liability reform campaign. Now as far as the Senate’s concerned, it’s very difficult to say. We may have to wait until the next election cycle. It’s hard to know exactly when we’ll be able to achieve the successes that we’re hoping for as so much really depends on the President’s ability to get things done. We know it’s a high priority for him and it’s just a question of whether he and the Senate leadership can move the conversation forward on this issue. We must keep the pressure on because the problem is not getting any better. And I think that this issue continues to threaten the American public’s access to health care.

OT: Apart from tort reform, what do you view as the top political and practice management challenges and issues for the AAOS and orthopedic surgeons in general, for the future?

Weinstein: Well, I think the key issue on our plate besides medical liability reform is Medicare reimbursement and how that’s going to be tied to pay for performance. Other issues that are on the table include the issue of gainsharing and specialty hospitals; those are the top issues currently.

But I will say, and the readers should note, that the academy is on top of all of this. We’re on top of every issue. We’re actually prospectively planning as opposed to reacting to both the pay for performance and gainsharing, etc.

I thought the academy was a wonderful organization before I was in the presidential line. I’m even more convinced now that it is the best medical organization around. I don’t know if members can really appreciate how excellent it is and how caring the Board of Directors is toward member needs. The AAOS is not about the Board of Directors; it’s not about us. It’s about the members and doing everything we possibly can to enhance value and make sure we serve the needs of the members.

OT: Orthopedics continues to be a more specialized field. At Orthopedics Today, we are seeing that orthopedic surgeons are finding the annual academy meeting — because it has to meet the needs of so many people — is meeting fewer of the orthopedic surgeons’ specialized medical education needs. Some are turning to smaller, more specialized meetings to get the information they need.

Do you agree that this trend exists, and if so, how does the academy plan to address that?

Weinstein: Well, I don’t agree with this. A third of the members identify themselves as specialists, a third of them are generalists with specialty interests, and a third are generalists. The attendance at the academy meeting really hasn’t changed for a number of years as far as the number of members who attend. The AAOS has addressed this important issue in many ways through its Unity initiative. First, we have changed the Council of Musculoskeletal Specialty Societies (COMSS) organization, completely changing its focus. It will now become the Board of Specialty Societies. Second, we’re incorporating the specialty societies very heavily into the planning of the annual meeting program, so that … specialty societies will have an ever-increasing role in the annual meeting to make it more relevant to the members. Maintaining relevance is a tough task. The interests of orthopedic surgeons are so broad that it is hard to appeal to everybody, but I think we do a varied enough program to appeal to the varied interests of our members.

In my opinion, the AAOS annual meeting is the best educational value in orthopedic surgery. It’s a free meeting for members, no registration fee. No other medical specialty society provides a free annual meeting. And when you look at the offerings at the AAOS annual meeting, all you can say is “Wow.”

OT: In the movie, “The Graduate,” a man approaches Dustin Hoffman’s character at his college graduation party and gives him one word of advice: “Plastics.” What would be your one word or short piece of advice to Dr. Kyle as he moves up to the AAOS presidency?

Weinstein: We don’t have a “president’s issue;” instead, the entire presidential line is in complete agreement that we are focusing on issues which add value and enhance the relevance of the organization to members.

So, my advice to Dr. Kyle would be to stay focused on the horizon. We need to be continually looking ahead over the next two to three years.

OT: Prior to being the academy president, you focused a lot on the Bone and Joint Decade (BJD) 2000-2010. What role, if any, do you expect to play in the rest of the progress that the U.S. National Action Network makes during the last half of the decade?

Weinstein: The BJD is a movement very close to my heart, and I would be happy to support the BJD in any way that the leadership of that Decade now, which doesn’t include me, would like to see. I think it’s very important that the fundamental purpose of the Decade, to raise the awareness of the burden of musculoskeletal disease to the public and to people who make health care decisions, must be attained by the end of the decade. The appropriate resources need to be invested into research and also into patient care for patients with musculoskeletal conditions, and it’s through the efforts of the BJD that awareness will be achieved.

OT: How do you plan to continue assisting the academy’s leadership in the near future?

Weinstein: I’ll continue as chairman of DMLR through the 2006 election cycle. And as far as the academy is concerned, I will serve in whatever role Dick Kyle, MD, would like me to serve in the year to come.

OT: After an extremely busy year, what do look forward to most that might be rejuvenative on a personal level for you when you step down?

Weinstein: I can honestly tell you that I don’t need any rejuvenation. Being in the leadership of the academy has been, I would say, the most energizing and exhilarating experience of my life. It’s really been a privilege to serve on behalf of the membership and work for the membership.

OT: We recently polled members of our Editorial Board and asked them this question. What do you think was the biggest news in orthopedics in 2005 and why?

Weinstein: Well I think that the biggest news to me, and it wasn’t big news, but it was a little bit disheartening: The investigation by the U.S. Department of Justice of implant manufacturers and their relationship with orthopedic surgeons. And the reason for this is that I think that anything that damages the patient/physician relationship would be very detrimental to orthopedic surgery. I’ve heard nothing about it since that time, but I think that as an orthopedic academy and its members, we have to always maintain the public trust. And anything that threatens public trust i s a problem. So I hope these investigations won’t turn up anything.

OT: Do you have any final comments to add?

Weinstein: It’s been a real privilege for me to serve the members in this capacity. It’s been a labor of love, and I leave my post really energized and totally enamored with the AAOS. I just can’t tell you how wonderful I think the AAOS is both from the volunteer and the staff perspective.

We have a dedicated staff and really dedicated volunteers in so many different areas that we are really a model organization in medical specialty societies. I just hope that our membership will continue to want to be engaged to keep making the organization better.