In a previous column , I described four domains that all orthopaedic surgeons should consider before retirement: Charity, research, teaching, and leadership. Orthopaedic surgery is an amazing vocation, but without purposeful action, the private practicing orthopaedic surgeon can get lulled into the daily grind of maintaining a career in medicine. But some are left wondering: “Is that all there is?”
By stopping to consider these four domains, private practitioners can focus on activities that give back to others, which I believe offers both personal and professional satisfaction.
By taking part in any of the four domains, private practicing orthopaedic surgeons can:
(1) Expand their world (Charity). Our talents can help the poor and underprivileged anywhere and everywhere. Seek out opportunities abroad to help those in need now while you still can.
(2) Expand their knowledge (Research). Interested in an orthopaedic subspecialty? Partner with colleagues in academia on a research project you are interested in. Volunteer with residents at a nearby academic institution, or by conduct clinical studies through your own practice.
(3) Expand their reach (Teaching). There are often many opportunities for those of us in private practice to impart our experience on future generations as teachers or mentors. Physicians at my practice often teach nursing students and physician assistants in our offices.
(4) Expand their voice (Leadership). Given that we are busy private practitioners with personal hobbies, family commitments, and heavy clinical burdens, carving out time for a leadership role simply feels like extraneous work. But if we don’t fill organizational leadership positions, others will, and our voices will not be heard.
In thinking about this column, I kept returning to the leadership domain and the question: Why should we expect those in academia to champion private practitioners when we don’t champion ourselves?
A quick review of the chairpersons who lead our national organizations (American Academy of Orthopaedic Surgeons [AAOS], American Orthopaedic Association [AOA], and our specialty societies) suggests that academic surgeons are the predominant leaders of our specialty even though 72% of the workforce comes from outside academia . Are private-practicing orthopaedic surgeons being well-represented? And while I believe rank and file private-practicing orthopaedic surgeons should get more involved in leadership roles, we first need to discover: (1) Why we haven’t gotten more involved in the first place and (2) the ways we can get more involved.
What’s My Incentive?
At my own practice, there is little incentive to become more involved in organizational activities, and this is generally true across the entire private-practice spectrum. Those individuals willing to take on more responsibility and relinquish much of their free time are expected to do so without compensation or the possibility of promotion. In contrast, our colleagues in academia are generally encouraged to seek leadership roles and are often promoted when they become more involved in these activities. As a result, the representation of private practice orthopaedic surgeons in organizational leadership is woefully small. Despite the motivations to the contrary, we must encourage private practitioners to get involved so that our collective voice is heard effectively. Generally, the organizations seeking our leadership cannot afford to compensate us for the time and effort that we could have spent seeing and treating patients. The intangible reward of making the difference in society and positively affecting may be the only remuneration that you get. This is significant in that often we alone speak for our colleagues in the private world. The leadership we provide will make a difference in the delivery of private practice orthopaedic surgery, and ultimately, the care of our patients.
Getting Involved—Start Locally
For those who do want to get involved, state orthopaedic societies and medical associations are a great place to begin the leadership experience. Local- and state-level organizations generally offer more opportunities and openings for new leadership, as well as tolerance for the inevitable learning curve that it takes to be effective. Local-level issues can also be easier to grasp since you can more effectively engage with the stakeholders. For example, one of the main objectives of state orthopaedic societies is to mount effective opposition against harmful legislation at the state and local levels. When I was on the Board of the Georgia Orthopaedic Society, there were several legislative efforts that received our attention. Georgia was seeking to build a statewide trauma network, and the intense efforts of orthopaedic surgeons helped affect the final product. We stopped legislation that would make a physician criminally liable for failing to check the state database before prescribing opioids. Without our leadership and influence, patient care would be drastically, and negatively impacted in Georgia.
There are numerous community organizations that you can work within as well. I was in the Leadership Atlanta class of 2010 and the Leadership Cobb class of 2017. These community-based programs provide networking opportunities, and as you participate in other community events and organizations, your sphere of influence will inevitably grow. Business school curricula also offer leadership and management classes that can help you increase your abilities in this area.
Getting Involved—National Level
Some may bypass the local level and go straight to national organizations. The AAOS Leadership Fellows Program  is a year-long developmental program that takes a small group of orthopaedic surgeons under 45 years of age through an in-depth understanding of the Academy organization and culture as well as developing leadership ability. These fellows finish the program by becoming contributing members on an AAOS committee. The work our national organizations accomplish is largely driven by volunteers in committees varying from think-tanks to writing policies/papers to producing content for the membership. Seek out a committee that appeals to you and apply to be a member. Similar to the AAOS, the AOA offers an Emerging Leaders Program  that is available for those in their 5th year of residency up to the 13th year of clinical practice.
There are many opportunities for your talents in the AAOS, the specialty societies, or state and local organizations. Because of my advocacy efforts in the AAOS, I was included in the decision-making process for policy initiatives in the Orthopaedic Trauma Association and the AOA and helped the American Board of Orthopaedic Surgeons improve the board certification process.
By taking an active leadership role alongside like-minded individuals working toward the common goal of improving patient care, private practitioners can achieve personal growth and professional satisfaction, while making their voices heard.
1. American Academy of Orthopaedic Surgeons. The Leadership Fellows Program. Available at: https://www.aaos.org/lfp/
. Accessed February 13, 2018.
2. American Academy of Orthopaedic Surgeons Department of Research, Quality, and Scientific Affairs. Orthopaedic Practice in the U.S. 2016. Available at: www.aaos.org/2016OPUSReport/
. Accessed February 13, 2018.
3. American Orthopaedic Association. About the AOA's Emerging Leaders Program. Available at: http://www.aoassn.org/aoaimis/elp
. Accessed February 13, 2018.
4. Lundy DW. A Day at the Office: Smooth transitions-Setting up the next phase of a professional life. Clin Orthop Relat Res. 2017;475:1966–1968.