Reporter's Notebook

Dear OTW Reader:

The Great Recession is affecting residents and fellows. “I may not be able to get a job!” Dr. James Herndon, former head of the American Academy of Orthopaedic Surgeons, told OTW that for the first time in his career, he is hearing the following from residents and fellows: Dr. Herndon: “Older orthopedists are probably concerned about the economic outlook, and may be making the decision to remain in practice longer. I have even heard of surgeons who have secured offers from practices, only to have those offers withdrawn. We may eventually have a situation where people may begin to shy away from our specialty.”

Disclosure rules not clear enough. When you say “financial disclosure” what do you mean?…A leader in the orthopedic field told OTW, “When I listen to a presentation and hear a researcher say; ‘I or member of my family has received more than $10K’…I want to know how much more! Most doctors will not sell their favorite pen for $10K…we’ve got to get better at transparency.”

Sound familiar? “Medicine is the only field where you tell the payor what something’s worth and they turn around and say, ‘We’ll pay you this. We couldn’t have said it better ourselves…the eminent Dr. Claudia Thomas gets credit for that truism. She continued; “Insurance companies brag because they pay 80% of what Medicare pays…hello…the system is not working. Take the multiple tiers out of the private insurance companies and then there will more resources available to those of us who do the hard work to keep people healthy.”

Economic dissing? “Orthopedics is increasingly being looked at as a commodity because it is often the leading breadwinner for the hospital. When cardiothoracic surgery was in that position it received tremendous support; nowadays orthopedics is making around 50% of the OR revenue, but we don’t have the same support and/or ‘PR’ because we are not usually dealing with life or death situations. That is not smart on the part of hospitals.”—a voice in the trenches.

“Sports medicine is flourishing, with a third of all orthopedic residents seeking sports medicine fellowships. The issue is funding. My hope is that the medical profession, the federal government and industry will work together and seek appropriate guidelines to help support all post-graduate education.”—Dr. Peter Indelicato, president of the American Orthopaedic Society of Sports Medicine (AOSSM) to OTW.

Chris Harner M.D. to succeed Peter Indelicato, M.D. as president of AOSSM. Lisa Weisenberger of AOSSM tells OTW that the new presidential line has been announced…Chris Harner, M.D. of the University of Pittsburgh will be taking the helm after the current president, Peter Indelicato, M.D., steps down in July 2012. Then, AOSSM will have its first-ever female president…Jo Hannafin, M.D., Ph.D., of Hospital for Special Surgery.

Hospitals cracking down on social media postings. Some residents have gotten in hot water with their bosses after complaining about patient experiences on social media sites like Facebook. OTW hears: “Because of this, some hospitals are reworking their social media policies.” Worries about HIPPA violations spurring new rules. But will they stick?

Disappointing board scores. “I hope residents are not getting dumber!” says a seasoned academic …“We (orthopedics) had a 19% failure rate on the first part of the board exam this year—the highest ever. Is the shorter workweek to blame? Residents are probably not studying when they’re at home, and are not following through on case studies. I know the orthopedic knowledge base has exploded, so maybe that can explain this ‘red flag’ failure rate.”  OTW wonders if Facebook is part of the problem. 

Work hour restrictions may bleed into orthopedics. OTW hears: “In general surgery some attendings are actually at home when they are called for a nighttime consult. They are telling the ER either, ‘Call my resident or send the patient to the office.’ So, will academic orthopedists begin to think, ‘Is it worth it if I am doing what private practitioners are doing but they are earning much more?’” Worries about income disparity and the gap between private practice and academic centers have always been a problem.

Former Pioneer Surgical exec and Mandarin speaking Chip Bao is new Bonovo CEO. Chinese orthopedics company—Bonovo Orthopedics—has a new CEO. Exec Peter Slate says to OTW…“Bonovo is doing well and growing rapidly in the China market. Because our business is focused primarily in Asia, we have always felt that eventually it would be best to have a Mandarin-speaking CEO located in China full time.”Translation…Mandarin speaking Chip Bao is the new chief at Bonovo. Slate will remain on the Board of Directors.

ACOs are on the march in Massachusetts and are headed to an orthopedic practice near you…Dr. Charles Day of Beth Israel Deaconess Medical Center and Harvard Medical School tells OTW: “Massachusetts is the first state to try accountable care organizations (ACOs)…and insurance companies are leading the charge. They are saying to primary care groups, ‘Here is this amount of money for XYZ diagnosis.’ In some cases, insurance companies are seeking bids, saying, ‘Take XYZ diagnosis…how much could you treat it for?’ We don’t know how this will affect orthopedists…but it will…and we had better be ready—countrywide—to see things like a one lump sum payout for treating a given diagnosis.”

Sterling Bunnell Traveling Fellowship awarded to Dr. Charles Day of Beth Israel Deaconess Medical Center and Harvard Medical School. This award is granted annually by the American Society for Surgery of the Hand (ASSH) so that a young hand surgeon can development of national and international relationships which contribute to his/her pursuit of higher learning and which foster the principles of scholarship of the ASSH.

Dr. Steve K. Lee joining the Hospital for Special Surgery (HSS) Hand and Upper Extremity Service. Dr. Lee will also be the research director of the HSS Center for Brachial Plexus and Complex Nerve Injury. Dr. Lee comes from the NYU Hospital for Joint Diseases Orthopaedic Institute where he was associate professor of the Department of Orthopaedic Surgery and served as associate chief of the Division of Hand Surgery.

Texas Medical Board…thumbs up to autologous stem cell treatment? Since Presidential Candidate Rick Perry was treated with his own stem cells, the Texas Medical Board met (at the governor’s direction) to discuss how to regulate this stem cell harvesting and processing procedure. Gov. Perry urged the Medical Board to consider the economic and life-altering potential of adult stem cells and recognize the “the sound science and good work that it is already being done.” OTW hears that the Board is expected to support this approach to stem cell treatment. We wonder…if performed in the clinic, with the patient’s own cells, in a manner supported by the Texas Medical Board, does the FDA have the right to weigh in?

Stem cell system used on Gov. Perry was the RNL BIO system. RNL Bio is an 11-year old Korean biotechnology company—founded by three professors of Seoul National University. The company went public on the Korean stock exchange in 2005. This system uses the patient’s own adipose tissue and then cultures those cells up to an optimum number…cells are then injected back into the patient. The Texas physician who administered the stem cells to Gov. Perry was Dr. Stanley Jones. Dr. Jones goes “live” on YouTube and describes the RNL BIO system:

In the Yuan family, inventing is in the DNA. Dr. Philip S. Yuan, oldest son of Dr. Hansen Yuan (former president of NASS, ISSAS, editor of the SAS Journal, legendary surgeon and inventor) was just issued a new patent for a novel device to treat vertebral compression fractures. This father and son have kept the U.S. patent office busy—the office has issued more than 100 patents to these two gentlemen. Turns out Dr. Philip Yuan, who did his residency under Dr. Steven Garfin and his fellowship with Drs. Todd Albert and Alex Vaccaro, eventually joined the practice of Dr. Hansen Yuan’s mentors, Dr. Leon Wiltse and Dr. Douglas Jackson. The younger Dr. Yuan practices at Long Beach Memorial. He and his wife, Ruth, who is a nurse anesthetist, live in Long Beach with their two boys.