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.

“Would I have to serve on any committees?”

“If in the process of recruiting surgeons you are asked such a question,” says Dr. Thomas Einhorn, Chairman of Orthopedic Surgery and Professor of Biomedical Engineering at Boston University, “your ESP meter should go off.”

An experienced recruiter, Dr. Einhorn knows that finding the right surgeon/department match is a multifaceted process that if handled incorrectly, could cost vital resources. Speaking of his own experience, he notes, “Individuals who want to work in my department need a strong desire to develop a practice and have a high level of intellectual fulfillment. They must also be driven to teach and do clinical and/or basic research. The fact that most departments require such commitments, and that the majority of orthopedic surgeons focus solely on patient care, means that the number of physicians who are eligible for departmental positions is in the single digits.”

So how does a department chair take that first dip into the applicant pool? “You should start by assessing your wants and needs,” advises Dr. Einhorn. “And be sure to do a reality check on what you can afford. I have seen too many instances where this isn’t done and results in bad outcomes. You also want to ensure that you have enough work for a newly recruited surgeon and that it is the right work for that person. Otherwise, weeks or months later you will discover that the surgeon is unhappy and bored because he or she is not busy and/or isn’t doing the work that he or she enjoys.”

After identifying the departmental needs, it’s time to reach out. “There are several reliable methods of locating new talent,” states Dr. Einhorn. “The American Academy of Orthopaedic Surgeons’ job posting website is one option, as well as the Journal of Bone and Joint Surgery and the Journal of the American Academy of Orthopedic Surgeons, both publications where physicians are known to place advertisements. One method I have found useful is to write to fellowship directors in the subspecialties. Then there is always word of mouth via colleagues. You can either pick up the phone or talk to physicians you meet up with at conferences. And while search firms would likely be helpful, as a rule we have not utilized them due to the added expense.”

A name and bio now in hand, a preliminary, screening phone call should be your next step. Dr. Einhorn: “First place a call to the applicant and try to assess whether your thoughts and goals are in alignment. If that goes well, follow it up with an interview so the surgeon can meet you, along with several other faculty members. Here at Boston I have identified three or four people whom all applicants must talk to during the first interview. They all spend time with the Vice Chair of Academic Affairs, the Vice Chair for Clinical Affairs, department administrators, and one or two faculty in their area of expertise. And, if the person is interested in basic science, he will then meet someone from the lab. Regarding the content of the meeting, I would recommend just getting a sense of whether or not you like the individual and if he or she would fit in. A week later I would do a phone ‘debriefing.’ That gives the person some time to think about things she may want to ask. On the second interview, the applicant will interview with the same people, in addition to others who might be involved in his or her career. For example, if the doctor might be spending time at the local VA hospital, we could arrange for him to meet with the Chief of Orthopedics at that institution. Or, if the applicant is a spine specialist, we could have him meet with the Chief of Neurosurgery because spine and neurosurgery are so intertwined. At this point I usually have the person invite his or her spouse to come up and I organize a meeting with a real estate agent.”

And then he holds his breath. “It may sound extreme,” says Dr. Einhorn, “but as a rule, if the spouse is not happy, the situation will not last. Even if you hire a well-rounded genius and all is perfection at work, if that person goes home to a spouse who hates the city/schools/neighbors, or just misses home, you will most likely lose that physician. I know of a surgeon who came from a small town and was newly married. His wife, a professional in her own right, moved, thinking that her ties here were strong, and that her parents would move to be near her. In the end, the parents chose not to move, and the relationships she did have here weren’t as strong as we all previously thought. It is critical to lay everything out on the table with applicants and their spouses. Otherwise everyone is wasting their time.”

While “forecasting” doesn’t usually appear on a department chair’s job description, when recruiting, it is most definitely part of the process. Dr. Einhorn: “Consciously and subconsciously you know the kind of reactions you are looking for from applicants. If you get questions along the lines of what they are not going to be expected to do, there’s a red flag…trouble ahead. Because, of course, you want someone who is going to be open to various options and experiences. Additionally, you want to think that the people you bring in will be ‘citizens’ of your department, i.e., sit on committees, serve as advisers to medical students, etc. It is important that this person eagerly take on such responsibilities. Another thing that helps me get a sense of someone is, perhaps oddly, how smoothly and efficiently the person can get here and get back. If, for example, my assistant tells me that she contacted Dr. X and that he didn’t return her calls, then that is a red flag. Or, someone might ask bizarre questions, such as, ‘Can I fly first class to the interview?’”

Proving there is no shortage of caution signals, Dr. Einhorn, the voice of experience, continues, “Watch out if it is hard for you to find references. For example, the person stumbles around and is ultimately unable or unwilling to give you information you need to proceed with the hiring process. Or, you can’t figure out exactly whom they have been associated with. As a general rule, if your gut says you’re becoming a private investigator, there is something wrong. My last comment on this is that one should beware the person who, at mid-career, has already left a trail of jobs behind him. If there has been a progression in responsibility, that’s one thing. Otherwise, ask a lot of questions.”

Dr. Einhorn continues, “As far as references, written ones are only of value if they are exceptionally strong or exceptionally weak. Anything in between is no good. You should most definitely call up the references.”

Prior to hiring new talent, one should take the financial temperature of the department. Explains Dr. Einhorn, “Here at Boston we share expenses, buy malpractice insurance together, and share secretaries and physician assistants. The hospital supplies some monies, as does the medical school, but the clinic revenue pays for the majority of expenses. If, for example, I am considering bringing another hand surgeon on board, before I hire I need to make sure we have a sufficient clinical volume for that person to support, grow, and sustain himself. Prior to hiring, we take a month to do a pro forma, taking into account how many cases we have now, where they are coming from, and the growth potential in those areas. In my department we have a core of ‘lieutenants’ who do the finance and strategic planning side of things. It is important to consider if you are getting pressure from the hospital administration to increase case volume. If there is an arrangement where the hospital administration is involved in making the faculty practice plan a success, then they will want the doctor to be profitable because they know they are responsible for the practice plans, too. How the Chief of Orthopedics ensures the department’s stability and financial growth is not the hospital’s problem, however.”

“Another important part of the financial picture is the ability to provide comprehensive care,” says Dr. Einhorn. “For example, the least well reimbursed subspecialty is pediatric orthopedics. Unfortunately, neither of the pediatric orthopedic surgeons we have on staff has been able to make expenses. Their income must be supplemented from the departmental coffers. Everyone on staff, and everyone I interview, knows that 10% of their salaries will be spent for the good of the department. They also know that from 3% to 7% is going into a reserve fund to support the salaries of people who are needed but don’t have the same payer mix as spine or sports medicine. To be fair, the numbers are retitrated every six months; that way, everyone knows the process is equitable and well managed.”

So when it comes to opening the door to new talent, information and intuition are powerful tools. “Using these criteria, I’ve made only one mistake over the years,” says Dr. Einhorn. “And that’s not bad given that I recruit on an ongoing basis.”