Other Articles

AAOS Political Action Committee
Active players in the orthopedic field know the importance of the AAOS Political Action Committee (PAC). On the cusp of hot topics affecting physicians and patients, the AAOS PAC works diligently to provide data to members of Congress and improve the present and future of orthopedics.

Who ARE These Guys?
Every 60 seconds or so a surgeon tears the cover off an Integra LifeSciences package. Quietly, this company has become the seventh largest medical implant manufacturer serving orthopedic surgeons in the world. Where to now? Would you believe $1 billion in two years? How about $2 billion by 2015?

Redemption in a Mechanism of Failure: The TOPS™ Story
Impliant’s TOPS™ System had a “squeaker” in its clinical study. After a voluntary suspension of the study by the company and finding the mechanism of failure, the FDA has approved a resumption of the study. What insider lessons were learned? Class starts here.

Who is Numero Uno in the PearlDiver Database!! Are You Surprised?
The answer may surprise you. Is it sore backs, aching hips, sore knees, fingers? PearlDiver details 3.8 million spine related complaints—complete with demographic information and charging information. But that’s not #1. PearlDiver also lists 3.5 million large joint complaints. Sorry, still not #1. What could the most common orthopedic complaint possibly be? To get the surprising answer…read on.

What the Knees Need: Baby Boomers and Their Options
Knee patients often show up at the doctor’s office with recurrent mechanical symptoms. It is up to the orthopedist, says Dr. Giles R. Scuderi, Director and orthopedic surgeon with the Insall, Scott & Kelly Institute in Manhattan, to thoroughly assess the patient and then determine if nonoperative treatment will do, or if the person needs a unicompartmental or total knee procedure.

Physician: Report Thyself
The government says its healthcare anti-fraud efforts are working and it wants to encourage physicians to self-report possible fraud. How well did the government do in 2007 and what about those deferred-prosecution deals with undisclosed evidence? Read about it here.

Revising the Statistics
The word that orthopedic patients least want to hear is “revision.” Who, in the universe of large joint patients, do we expect to see on the receiving end of this news? If you guessed “the elderly” you would have been wrong. The reality of who is hearing “revision” may come as a surprise. Read what we found when probing PearlDiver’s database.

Where Is Ben Now? Trends in Venture Capital
What is being funded by VCs and why? First of all, spine is having to share the spotlight, says Gary Stevenson, Managing Partner at MB Venture Partners, LLC. Here Stevenson outlines what constitutes an attractive investment…he also highlights issues that are affecting the distribution of VC funding.

The Hounds of Wall Street
Conventional wisdom on Wall Street is that ArthroCare is in a bare-knuckle fight to the finish with short sellers. Which leaves us with the dominating question: If ArthroCare is essentially a “lame duck” growth stock, then why are sales, earnings, and the stock price contradicting the short seller’s dire predictions and even outperforming consensus analyst forecasts? We have the answer.

The Era of “Tell Me Right Now” Dawns at FDA
The FDA wants the next phase of post-market oversight to change from self reporting to proactive surveillance. How? Through the Sentinel Initiative. Read what it means to device manufacturers here.

The Day After Tomorrow: Complication Rates and Instrumentation Trends in Posterior Lumbar Fusion
Could PearlDiver be the Nostradamus of spinal instrumentation? This most commonly performed surgery on the lumbar region of the spine increases fusion rates and improves spinal stability—but what about complications? Using PearlDiver’s database we find the answers. Are you ready for some quatrains about what happens next?

You Try It. No You Try It First: New Technology Adoption
What are the forces working for and against new technology adoption? Youth versus age, risk taking versus conservatism, and the economic realities of the day, says Dr. Rick Guyer, President of the Texas Back Institute.

Cheaper, Thinner, Faster, Stronger
In this, the second of our series of three articles on innovation, we tackle the question: How do you measure medical technology innovation? While difficult, measuring innovation is NOT impossible. Why? Well to start, and in the immortal words of Supreme Court Justice Potter Stewart, “We know it when we see it.”

SAS Crosses the Rubicon in Miami Beach
The SAS 8th Annual Global Symposium in Miami Beach may have crossed the Rubicon. How? Read about the Society’s opportunities for growth and collaboration as its new President lays out a vision for the future.

Arthroscopic Treatment for Tennis Elbow: Coming on Strong
“Tennis elbow” or lateral epicondylitis is, according to our PearlDiver database, one of the most reported diagnosis for problems with the elbow. Lately clinical evidence has shown that arthroscopic treatment for tennis elbow can provide long-term stability and, in most cases, return of the elbow to its optimal function. Check out the data from PearlDiver.

Do Republicans Make Better Orthopedic Surgeons?
A recent Nature Neuroscience journal study of the decision making differences between liberals and conservatives appears to argue in favor of Republican surgeons! Which, frankly, explains a lot—to BOTH sides and, to stretch an analogy almost to its breaking point, it may also explain why McCain’s health care plan is different from Obama’s. Read OUR take here.

"Sound of Music" Turns to Greek Tragedy for Smith & Nephew
Smith & Nephew’s Swiss (mis)adventure with Plus Orthopaedics is turning into a Greek Tragedy. The company’s whole acquisition strategy is being called into question. Read how CEO Illingworth explained it to the brutal British press.

“Dear John Letter” for Hip Resurfacing?
“Dear John H. Resurfacing: I hope this little note finds you well. We certainly have had some great times and, gosh, I’ll never forget those wonderful moments when the FDA approved your PMA. We’ve just celebrated our second anniversary together and, well, I’m just not feeling the magic anymore….” Two years after FDA approval, how happy are orthopedists with hip resurfacing? Read our analysis here.

In the Beginning, There Was the End: Manuscripts 101
Dr. Paul Manske, Professor of Orthopaedic Surgery at Washington University School of Medicine in St. Louis and Editor-in-Chief of The Journal of Hand Surgery, shares his thoughts and experience on the details of shepherding a manuscript through publication.

Did ConMed Get Re-Wired?
Ever hear about the neurosurgeon who used an $80 Bosch power drill to do brain surgery? It really happened. Surgeons like their power tools. Increasingly they also like a particular line of sterilizeable power tools from ConMed’s Linvatec unit. Did ConMed get re-wired? We have the details here.

Once a year medical students across the country come together and let out a cacophony of whoops and hollers. The orthopedists-to-be among them, future serious clinicians all, surely leapt into the fray on March 20, 2008…match day.

“What a relief that it’s over,” sighs Matt Popa, a fourth-year medical student at Case Western Reserve University School of Medicine in Cleveland. “Over the last seven months there have been periods of great activity and periods of thumb twiddling. Now I can breathe easily.”

As the pages on the calendar approached March 20, Popa spent the last weeks in deep thought about his options and preferences. “At the beginning of the entire process, my first choice was to remain in Ohio where my wife and I could be close to family. I did interview at Grand Rapids Medical Education and Research Center, however, and was tempted by several aspects of their program and the city. My wife and I both liked Grand Rapids a lot and started to balance our desire to be near family with the economic realities of our situation. We could see that there were insurance benefits and program perks in Grand Rapids that were lacking in Cleveland. While programs in Ohio had impressive training, we had to consider whether my wife could stay at home with our three children, something that meant a lot to us. Grand Rapids offered that, along with great training and affordable housing that is close to the hospital. They were top on my list.”

And evidently, he was on theirs. Matt Popa will be entering the residency program at Grand Rapids Medical Education and Research Center (GRMERC) in 2009. “I am thrilled to be entering the Grand Rapids program,” says Popa. “The program is a community-based affair where people know each other, and cover for each other. During my visit to the program I could see how closely they interacted and got a real feel for the atmosphere of the program. I was drawn to their focus on teaching and developing the residents. And the attendings go out of their way to make teaching points and include residents in all of the discussions. It was a relaxed atmosphere with congenial people…I knew I would have a great experience there.”

Speaking to the feel of the last two months, Matt says, “It just crawled. You submit your list on February 29 to the National Residency Matching Program and the programs submit their lists…then you cool your heels for a month. After that was March 17, the day we all found out whether we matched or not. The Sunday before the 17th, it hit me that there was a chance that I wouldn’t match. Several anxiety-ridden hours later I received an email with a subject line saying, ‘Did I match?’ I opened it and got a great gift—a ‘yes.’”

And on March 20, even men who say they don’t dance could be caught doing, well, something like dancing. Matt Popa: “Our school had the envelopes spread out on a table, which was roped off until the big moment. We nervously mingled until noon and then listened to a few words from the Dean, who then cut the ribbon and let people ‘have at it.’ It was generally a free-for-all, with some people lunging for the table and others waiting in the back like we did. People were dancing around and screaming…it was a really happy time for most of us.”

And for those whose plans went awry? Explains Popa, “Some who don’t match participate in what we call ‘the scramble,’ where there is a rush to get into another specialty. You get a list of all unfilled residency spots in all specialties. Then the program directors have two days to decide whom they will be accepting. Another option that some people take is to do a preliminary year, essentially an intern year. Then they reapply next year for a first- or second-year spot in orthopedics. Lastly, someone who doesn’t match can do a year of orthopedics research, which is often helpful in matching in the following year.”

Reflecting on the months of work, wondering, and waiting, Popa says, “If I had to do it over I would have gotten things done sooner. In particular I would have had my application in earlier because as the deadline approaches it is stressful to wait for letters of recommendation. On the personal side, if my wife were not pregnant, I would have done away rotations. In the end, however, I am very pleased with how things evolved.”

And if he were in charge of the process? “Having to wait until March is very stressful. While I understand the process needs to be long so that everyone can make it to interviews, I would think there is some way to shorten things a bit.”

In hindsight, says Popa, the value of the process can be found in what it confirmed for him. “Going through the match process allowed me to get a feel for the high quality of programs and orthopedists that exist across the country. They are doing a lot of interesting, beneficial work and generally speaking are a great group of people with whom I would be proud to work. The orthopedists I have met are smart, hardworking, fun, and seem happy in their lives. It’s good to know I’m on the right track.”

As for our other orthopedist-to-be, Scott Tucker, fourth-year medical student at Tulane University School of Medicine in New Orleans, you could say he married the girl next door. “I got exactly what I wanted,” exclaims Tucker. “I matched at Tulane. In the end I found it ironic as I had expended so much energy on my away rotations. No matter, of course. Those experiences greatly expanded my sense of the field.”

Commenting on the last two months, Tucker says, “I had a couple of last-minute interviews, one of which was at Dartmouth, where I had done an away rotation. Some of the interviews there involved eight applicants meeting with six or seven people. They were at least 25 minutes each, thus giving us a better interview experience. Some places I went allowed only 10 minutes for an interview. In late February I interviewed in South Carolina. They had higher than expected acceptance rates for interviews, so they opened another day for more interviews. I admire that they were willing to give up another day of practice to meet with interviewees.”

Hardly noticing the raucous Mardi Gras festivities this year, Scott Tucker hunkered down and worked on his program list. “My wife and I decided that we wanted to nail down my list at least three or four days before it was due. We were hoping that would alleviate some of the stress. We reached a consensus on my first choices and then went back and forth on my middle choices. Fortunately, I had gotten positive feedback that if I ranked high enough to get a spot at Tulane, there would be room for me. As for my preferences, I could see that programs are fairly comparable…they’re not accredited for no reason. For us, it was a matter of location. Our family is here and over the past few years I’ve truly become attached to the New Orleans rebuilding effort, so I’m ecstatic about spending another five years here!”

On March 17 Tucker watched the clock until 11 a.m. “It’s such a nerve-wracking day because orthopedics is so competitive. Even people who you think have a lock on it may actually not match. I was on high alert and then at 11 a.m., when they post the thumbs up or down information, I went online and got the news I wanted. It was just gravy from there.”

As for the day itself, Tucker says, “You think you can play it cool, but that’s a joke. All of us nervous students crowded into the Sheraton ballroom downtown with our families and friends in tow. There was a slide show at 10 a.m. showing us progressing through the years, followed by remarks from the Dean of the medical school (who knew he had to keep it short as we were on the edge of our seats). Then they randomly started handing out the envelopes, at which point most of us brought them to our seats to open them up with family members. The final thing was a really nice touch. Tulane did a slide show displaying information on where everyone would be going. It was a fun, happy day.”

Now that he has perspective on the process, Tucker is in a position to see what could be changed. “It would be helpful if programs had fewer applicants per day so that we could spend more time in the interviews. Also, the best programs are those that are well coordinated and where things run on time. There was one program where it was as if some people didn’t even realize it was an interview day. They had to get residents and attendings out of surgery. I realize they’re losing money by not operating, but getting good applicants is integral to their whole program. There was another program where I spent an entire morning talking to other applicants because there was no one else to talk to. Another issue was that programs are supposed to contact applicants one way or another. There are some programs that never contacted me to say, ‘Sorry, you’re not a good fit.’ Another improvement I would make to the process would be that programs have second- or third-year residents doing more interviews. They are the ones who will be training us. There are too many programs with upper-level residents conducting the interviews. Lastly, it would be helpful if programs would not call back for interviews those people who had rotated there. If we were there for a month or two it would seem that they know us and would not have to interview us. It would save resources all around.”

With the match process behind him Scott Tucker reflects, “In retrospect I would have put more emphasis on my grades and board scores because these influence whether you get an interview. In the end, however, it is a long, convoluted process that eventually works to the applicants’ benefit.”

Best wishes to Matt and Scott as they embark on their orthopedic residency adventures!