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Building a Practice In The Largest, Most Neglected Orthopedic Market
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By Billie Young,
Contributing Writer |
April 8, 2008
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Of her residency experience Dr. Switzer remembers that “there was no suggestion that I could not do what I had set out to do. No one actively discouraged me in any way but there was a bit of benign neglect. Perhaps the faculty was not comfortable mentoring or bringing along someone like me. It was a difficult time in terms of not knowing where to fit in.” A close relationship with her grandparents and an affinity for older people—she founded an “Adopt-A-Grandparent” program while a student at Stanford University—influenced Dr. Switzer’s selection of a specialty—geriatric orthopedic trauma. Again breaking new ground, Dr. Switzer has dedicated herself to elevating this sub-specialty from its present status as a preoccupation of a relatively few doctors to a recognized specialty in orthopedics. She, and her colleagues at Regions Hospital, hope to accomplish this by focusing on a five-pronged approach (1) urging orthopedic surgeons to accept additional responsibility for their patients’ peri-operative care, (2) recommending the use of implants better suited to osteoporotic bone than traditional implants now in use, (3) a revolutionary program of hospital-based surgeons providing surgical and diagnostic services to nursing homes and senior residences, (4) patient rooms in hospitals designed for the special needs of geriatric patients and (5) an annual geriatric orthopedic summit conference. Dr. Switzer points out that, because of the decrease in bone density of older patients, the screws conventionally used to hold implants in place often pull out of osteoporotic bone. These problems can be avoided with the use of new devices such as locked plating where the screws lock the plate into place instead of gripping onto the bone—much as a butterfly device anchors a screw on a plaster wall.
Through their Health Partners affiliation, Dr. Switzer, along with a physician’s assistant and a nurse practitioner, have established the Geriatric Orthopedic Trauma Service, a unique program that brings orthopedic services to approximately 140 nursing homes, senior living and assisted care facilities in the Twin Cities. As Dr. Switzer explains it, “If a nursing home has a patient with a musculoskeletal problem such as a fall, or an individual stops using her arm, or has a swelling—something that is not right indicating that a fracture might have been sustained—the nursing home staff will order an X-ray from a portable X-ray company and have it sent to us over the Internet.” She receives approximately 15 such cases each week. Dr. Switzer diagnoses the problem, (“Yes, that is a hip fracture.”) and then consults with the provider at the health care facility. Some patients may be in hospice care or in late stage dementia. By talking with Dr. Switzer first, the patient, if she is to be admitted to the hospital, does not have to go to the emergency room where she may languish for a period of time, but can be admitted directly to the floor. (In other cases the patient may not be admitted if the family and care providers decide that undergoing treatment is not in the patient’s best interest.) In cases less critical than hip fractures, such as distal radius fractures, Dr. Switzer sends her PA or nurse practitioner to the facility to apply the necessary splints or casts—thus obviating the necessity of having to transport the elderly patients into the hospital. Even in cases of surgery where Dr. Switzer asks her patients to come in for check-ups two, four, and six weeks following the surgery , if the patients are older and would require transportation by ambulance, she or her staff goes out to them. “That changes the way we practice medicine in this population,” she admits. “But it is the right way to go.” Dr. Switzer and Dr. Peter Cole, Chief of Orthopedic Surgery, are campaigning to establish a geriatric-focused unit in a new wing of Regions Hospital, due to open in 2009. They want the beds in this unit to be able to be lowered to only a few inches above the floor so patients won’t fall, better lighting because older eyes need more light in order to be able to see well, quieter spaces to reduce the likely hood that patients with dementia will develop post-operative delirium—a common occurrence. “I looked back at our hip fracture population and over 40% had some form of dementia,” Dr. Switzer notes. Dr. Switzer is the director and primary organizer of the country’s only geriatric orthopedic summit. Past keynote speakers have been Dr. Joe Lane, of Cornell Medical School, Dr. Joe Zuckerman, chairman of New York University’s orthopedic surgery department, the president-elect of the American Academy of Orthopedic Surgery, and the individual who initiated the first hip fracture study group more than 20 years ago. Hundreds of surgeons and health care providers have come from all over the United States and Canada to attend the three-day conferences. Speakers at this year’s summit, to be held October 9 – 11 at River Center in Saint Paul, include Dr. Ken Koval, a Professor of Orthopedic Surgery at Dartmouth Medical Center and thought leader in the field of geriatric orthopedic trauma, and Senator David Durenberger. Since she graduated in 1999, more women have followed Dr. Switzer into the orthopedic residency program at the University of Washington. And more orthopedic surgeons are paying attention to the special needs of the growing population of aging patients. Whether it is promoting new devices and instrumentation or testing new methods of delivering service, Dr. Switzer is making her mark on her chosen specialty.
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Petite orthopedic surgeon Julie Switzer is accustomed to breaking new ground. She was the only female in her orthopedic residency program when she began at the University of Washington, at Seattle, as there had been no women residents in the program during the six years preceding her. Moreover, of the 41 faculty members in the specialty, only one was a woman. At Health Partners Regions Hospital in Saint Paul, Minnesota, a 400 bed level one trauma center where she now practices, she continues to be the only woman orthopedic surgeon in a group of ten. According to Dr. Switzer, while women represent up to 40% of doctors in general surgery, they make up only 7% of doctors training in orthopedic surgery.
“One of the things we know as a profession,” Dr. Switzer says, “is that orthopedic surgeons have neglected something important which is taking responsibility for bone health beyond fracture. A patient comes in with a hip fracture. We fix the fracture. Because it looks good on the table, we say, when we see the patient afterward, that the surgery was a success. We do not even think about preventing a second fracture – which is actually more likely to occur in this individual, who has already sustained a hip fracture than in an individuals, who is of the same age and has the same bone density, but who has not already broken a hip.” Switzer wants surgeons to do assessments of their patients’ bone health and make sure they do not have vitamin D deficiencies or, failing that, assure themselves that the primary care physicians are aware and committed to doing the work-ups.
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