Looking Ahead to Toronto

OTA specialty day in Dallas went off without a hitch. It was a jam-packed program of "Current and practical techniques in orthopaedic trauma care" with everything from cervical spine clearance in the multiply injured patient to what to do with failed internal fixation. The hospitality was great; however, the overall attendance at the AAOS meeting was a bit of a disappointment.

Is the practice of orthopaedic traumatology science or service? Be sure to have a look at the results of the EMTALA survey in this issue. We had one of the best responses ever to a survey so the topic seems to be on everyone's mind. The higher response rate is probably also a result of electronic distribution. Continuing the theme of how the practice of orthopaedic traumatology affects the individual, please be sure to fill out the new survey on "Career Longevity in Orthopaedic Traumatology: Is Burnout a Real Problem?" Also in this issue, see the update on the upcoming annual meeting in Toronto, together with a preliminary schedule of hands-on workshops and mini-symposium.

Who is to say that things are not looking up for orthopaedic traumatology? The US Trauma market grew by almost 10% in 2001 with an anticipated 11% annual growth over the next 5 years. Nearly half of the surgical cases in residency training programs (from which residents-in-training learn the principles and practice of orthopaedic surgery) are trauma cases. Of course, balancing these facts are the 5.4% Medicare reduction and new ECFMG guidelines about J-I clinical visas and ACGME accredited fellowships.

Keep your eyes open for the ballot for a ByLaws revision creating a new membership category for residents and fellows. Spearheaded by Membership Committee Chair Bob Probe, this concept makes a lot of sense because it will foster interest in orthopaedic traumatology among residents and fellows.

Please help get the word out about the annual meeting in Toronto and the Regional course in Nashville. I look forward to hearing from you.

Craig S. Roberts, M.D.
craig.roberts@louisville.edu

Actions Taken
· Minutes of the October 17, 2001 BOD meeting in San Diego were approved unanimously.
· The Board decided to increase the booth fee charged to commercial exhibitors at the annual meeting from $1500 to $3000 for next year.
· The Board decided to forego the industry luncheon at next year's annual meeting in favor of an afternoon cocktail reception for OTA leaders and donors.
· The Board decided by consensus that the OTA mailing list should not be sold or given to commercial entities, but should only be made available to members for approved research or educational activities.
· The Board decided to continue the policy of restricting OTA research grants to North American members of the OTA for now, but to periodically review it in the future.
· The Board unanimously approved a Bylaws change creating a new category of membership ("candidate member"), for residents and fellows, which will have a reduced fee structure.
· The Board approved the list of acceptable qualifying publications submitted by the Membership Committee, with the addition of JBJS-Br.

To Do
1. Officer Assignments
A. Board
The Board will read the management contract with the AAOS as included in the agenda book and contact CFO Pollak with any concerns or questions.
The Board and committee chairmen will make efforts to promote and publicize the OTA Update course in Nashville and the Resident's Course in Toronto.
The Board and Committee chairmen will send suggestions for keynote speakers and symposium topics to Dr. Tornetta for the annual meeting in Toronto.
B. President
Dr. Russell will invite OREF staff to meet with the Board in Toronto to discuss fundraising and /or fund management options, after receiving the recommendation of Dr. Pollak in March. Dr. Russell will appoint one new member to the Archives Committee and one to the Research Committee.
C. Past President
Dr. Wiss will contact Dr. James Beaty to discuss coordination of the AAOS-OTA jointly sponsored course on trauma for future years.
D. CFO
Dr. Pollak will amend the agreement with JBJS for publication of annual meeting abstracts to give OTA the right to remove specific abstracts after they have been published.
Dr. Pollak will meet with Drs. Swiontkowski, Miclau, and Jones in Washington in March to discuss merits and details of an agreement with OREF to provide fundraising and/or management services.
E. Secretary
Dr. Anglen will check into, and report back on, the possibility of making the full membership directory on the web into a password protected section, while keeping a geographic listing of member names open.
2. Staff Assignments
Ms Franzon and Ms. Garrett will explore options to increase vendor exhibit space in Toronto, such as changing the poster display arrangement (different site, all E-posters, posters put out in a book or CD-ROM, decreasing the size of posters).
The annual meeting abstract form will be revised to include permission to publish abstracts on the web - both OTA's website and JBJS's. This information will be added to acceptance letters for this year.
Staff will send out a mail ballot for approval of the Bylaws change creating a candidate member category. (See text below under Membership Committee report)
Staff will explore these additions or changes to the website: addition of front page moving banners for courses and meetings, adding the approved journal list to the membership page, adding interactive surveys from the newsletter, addition of password protection to the full membership directory, while keeping the geographic listing open to the public.
3. Committee Chair Assignments None made.
4. Other
An ad hoc committee composed of Drs. Wiss, Russell, Sanders, Moed, Anglen and Nepola will work out the details of the Howard Rosen award.
Dr. Riemer will work with AAOS committee on trauma to set up the details of course chair rotation for the annual joint AAOS-OTA course on trauma.

Action Items/ Reminders:
· Minutes from the October 19, 2001 meeting were approved.
· The following OTA members were nominated to serve on the nominating committee: Bone, Koval, Leighton, Gruen, Teague, Stevens, Sirkin, and Lange.
· Ideas for trauma-related symposia or panels for the 2003 AAOS meeting should be sent to Dr. Russell ASAP, as the deadline for submission is soon.
· Suggestions for Keynote Speakers, symposium topics and labs for the annual meeting should be sent to Dr. Tornetta or Dr. Templeman.
· Any members interested in participating in the multicenter research study on delayed versus immediate closure of open tibia fractures should contact Dr. Bosse.
· Every member should promote OTA courses in their local community. Brochures are available from Headquarters. Please mention the courses, especially the Providence Course, at every opportunity to address other orthopaedic surgeons.

Meeting:

1. Call to Order. President Wiss called the meeting to order at noon in the Dallas Convention Center.
2. Approval of the Minutes. Secretary Anglen presented minutes of the OTA business meeting of October 19, 2001. A motion for approval was made, seconded and passed unanimously.
3. Report of the CFO. Dr. Alan Jones gave the CFO report for Dr. Pollak, who was unable to attend. He reported an operating fund deficit of approximately $2000 in 2001, primarily due to increased costs and decreased revenue associated with the annual meeting, which resulted from the events of September 11. The 2002 budget was presented, which included an increase in the management fees charged by AAOS of 8.5%. He noted that strategies were under development to offset increased costs by increasing revenues, primarily by raising the fees charged to exhibitors at the annual meeting. With regard to the financial success of our events, last year's Specialty Day program was profitable by about $17,000 and the annual meeting by about $13,000. Smaller programs such as the Resident's course and Update Course essentially broke even. The Research Fund balance at year's end was approximately $1.7 million, with 2001 revenues of $300K in contributions, $52K in investment income, and $36K in miscellaneous source income. For the future, the Board is looking at a proposal from OREF to assist with fund raising campaigns in a way that has been very successful for other specialty societies.
4. New Business
A. Nominating Committee. President Wiss opened the floor for nominations to the nominating committee. He reminded everyone that only members who had not served on the committee in the previous 3 years were eligible, and presented the list of members who are ineligible. The following OTA members were nominated: Bone, Koval, Leighton, Gruen, Teague, Steven, Sirkin and Lange. A motion was made, seconded and passed to close nominations.
B. RUC Dr. Wiss reviewed the disappointing performance of the OTA in the most recent RUC 5 year review of CPT RVUs. He suggested that we develop a new mechanism for collecting the requisite data, because despite the fact that lots of members agreed in writing to fill out the work value surveys, few actually did, leading to inadequate data to support RVU increases. Several members rose to attest to the importance of this process.
C. Symposia topics requested for 2003 AAOS meeting. Dr. Wiss noted that there is a very short deadline for development of symposia for the annual AAOS meeting, and suggested that anyone with ideas should communicate them to Dr. Russell ASAP.
5. Committee Reports.
A. Membership Committee Dr. Probe noted that the committee had presented a suggested ByLaws revision to the Board creating a new category of membership for residents and fellows. The Board approved it, and it will be sent out to the membership for a mail-in vote. The committee has also developed a list of approved qualifying journals that will be used to evaluate the publication requirement for membership. This list has been endorsed by the Board and will be available on the website. He also noted that the committee and Board are considering using certain presentations as qualifying "publications" now that Orthopaedic Transactions is not a hard copy publication.
The following new members were welcomed into membership: Active Robert H. Blotter, Henry M. Broekhuyse, Jens R. Chapman, Kevin J. Coupe, William Creevy, Dolfi Herscovici Jr, Allan S. Liew, J. Spence Reid, Michael C. Tucker, David A. Volgas. Associate to Active Daniel Altman, Paul Gregory, Daniel S. Horwitz, Gregory Konrath, Gerald J. Lang, Dean Lorich, Theodore Miclau III, Brent L. Norris, Michael J. Prayson, Mark C. Reilly, Matthew Weresh. Associate Carlo Bellabarba, Gregory A. Brown, Timothy A. Burd, Thomas J. Ellis, Thomas F. Higgins, Theodore T. Le, R. Scott Meyer, David Ring. Research Hossein K. Elgafy. International Reto H. Babst, Andreas Seekamp, Annelie-Martina Weinberg, Kyu Hyun Yang, Kazuhiko Yokoyama
B. Coding, Classification and Outcomes Committee. Dr. Webb reported on progress in getting the OTA fracture coding system incorporated into the AAAM coding system, so that it would be entered by professional coders at all trauma centers and thus searchable via TRACS and other databases. He also noted that the committee will be surveying the membership about the use and history of the OTA database program, as they are trying to evaluate the future direction of that program.
C. Education committee. Dr Anglen reported on the success and progress of the Resident's Basic Fracture Course, and thanked the membership of the OTA for all the hard work involved in the course. The organizing committee for the course consisted of the following members: Sanders, Ricci, Baumgaertner, Pugh, Kregor, France, Hak and Ruch. The next Update Course will be in Nashville at the Loew's Vanderbilt Plaza on November 22-24, 2003. Course Chairmen are Drs. Borrelli and Probe.
D. Program Committee. Dr. Tornetta reported that 440 abstracts had been received and that they will now begin the hard work of reviewing and grading them in a blinded fashion. Specialty reviews would be outsourced beyond the committee as in previous years. He solicited the membership for suggestions for Keynote Speakers, as well as topics for symposia and labs.
E. Research. Dr. Swiontkowski reviewed the most recent grant cycle, and noted 47 pre-proposals submitted, 14 full proposals requested and 8 projects funded for a total of $212,500. The deadline for proposal submission this year is April 1. The new chair of the committee will be Dr. Miclau. The Multicenter study on immediate versus delayed closure for open tibial fractures is doing well, and has received OREF funding. We need additional centers to sign on, those interested should contact Dr. Bosse. An additional OTA sponsored multicenter study on reamed versus unreamed nails has been funded by OREF and may be funded by NIH.
F. Health Policy and Planning. Dr. Anglen noted that the AAOS is interested in the members experience with EMTALA regulations, and particularly any specific problems that have resulted in patient care issues. He also announced that the AAOS committee on Injury Prevention is looking for new members, so anyone interested should contact him.
6. Announcements. Dr. Michael Chapman announced that JBJS is continuing to publish Orthopaedic Transactions, although only in electronic format. He reported that Dr. Heckman is trying to make JBJS more relevant for the practicing general orthopaedic surgeon, and including more articles with summary type information. They are also using the JBJS website to provide supporting data from the papers.

The program committee met on April 8 here at OTA headquarters in Rosemont. We reviewed a list of possible case presentations, hands-on labs, symposia, and Dr. Russell's Presidential speech title "Innovation & Invention: Catalyst for Change."

We received 420 abstract applications (20 received via courier and the rest received online). Blinded author and institutional grading by the committee is now in process. Pediatric and Spine papers were outsourced to additional experts in those sub-specialty areas of trauma. Also about 10 papers were outsourced to former program committee chairs to grade for current committee member submissions.

Paul Tornetta and Dave Templeman are working on details, such as moderators, faculty and keynote speakers. The first day of the meeting will overlap with the last day of the ISFR meeting and the first session will be symposia and basic science papers. Emil Schemitsch is the local host for Toronto for both OTA and ISFR. The Friday evening reception will be at the Hockey Hall of Fame and will be CASUAL--with interactive virtual reality hockey games and hockey history quizzes. It is a "walk to" location -- no lengthy bus rides for 2002!

Book your hotel rooms now! Westin Harbour Castle is the OTA host hotel and the meeting location. Call them at 416 869-1600. The Hotel reservation form will be available on-line at www.ota.org. Rooms will be assigned on a First-come First-served Basis. Reservations made after September 9, 2002 will be accommodated on a space and rate available basis only. Convention Rates will not be available if booked after September 9, 2002. Convention rates apply from October 6 - 15, 2002. Guests who depart prior to their scheduled check-out date will be charged a $50.00 CDN Early Departure Fee.

Fly to Toronto Pearson Airport: Air Canada is the "official airline." The United code for Specialty Societies is 552 KC; 179027A for Delta; CV 694031 for Air Canada (for Specialty Society meetings in Canada only).

The Membership Committee is continuing to focus on the mission of bringing Orthopaedic Trauma talent within our ranks. We have introduced two initiatives. The Board of Directors has approved the concept of a "Resident" class of membership. The details of this membership category have to be worked out but the objective is to provide residents with OTA exposure and benefits at a reasonable cost. The committee is hopeful that this timely contact will influence career choices and grow the discipline of Orthopaedic Traumatology. We anticipate a formal note at the annual meeting in order to make the appropriate Bylaw changes. The second initiative endorsed by the Board is the creation of an OTA specific list of journals that qualify candidates for membership. Traditionally the committee has relied upon the list of "peer-reviewed" journals provided by the American Orthopaedic Association. This list has proven to be deficient. Our current list is available for review on the OTA web site. We envision periodic review of this list. If one of your preferred journals is not there, please let us know. By being more inclusive of these quality journals, we hope to promote membership applications from an expanded group of committed individuals.

As we look forward to 2003, there are a number of initiatives that we plan to explore. The first is to reexamine to role of international members. Currently there are only sixty international members within the OTA. Despite the extensive academic contributions of this group, they are not afforded voting rights or other privileges of active OTA membership. While there are potential negatives to consider, international expansion appears to be impeded by the existing Bylaws. Perhaps the OTA should be a part of the globalization process and become a truly international organization? Another group to consider is the active community orthopaedic trauma surgeon. Publication requirements have traditionally been the most arduous task to complete for this group. Lowering publication requirements has repeatedly been considered and rejected by the OTA membership over the years. Another strategy may be to facilitate research contributions from this group by coordinating multicenter clinical trials for them to participate in.

The membership committee is interested in your thoughts on these initiatives and any other tactics that would expand membership.

Friday Choices
Hands-on Skills Workshops
1)Calcaneus Fractures
2)Percutaneous Plating
3)Proximal Humeral Fractures

Mini-Symposia:
4)Complex elbow injuries
5)Clinical Research Advice
6)Coding and Billing Issues
7)What's New in Common Fractures?

Saturday choices
Hands-on Skills Workshops
1)Pilon Fracture-ORIF
2)Distal Radius Fractures
3)Periprosthetic Fracture

Mini-Symposia
4)Techniques in tibial nailing
5)Tibial Plateau Fractures
6)Crisis & Trauma Delivery

Saturday Case Presentations (bring problem cases)
1)Foot and Ankle
2)Upper Extremity
3)Pelvis and Acetabulum

Sunday morning Case Presentations
1)Distal Radius Fractures
2)Hindfoot
3)Management of Infections
4)Pilon
5)Soft Tissue Coverage
6)Deformity Correction
7)Pediatric Trauma
8)Spine

Do you take orthopaedic trauma emergency room call at a Level I or Level II trauma center?
Yes [94%] · No[6%]

Do you receive a supplementary income from the hospital for "talking call"?
Yes[32%] · No[68%]

If you answered "yes," what is the form of this compensation?
[59%] Stipend per night
[5%] Guaranteed payment for uninsured patients
[36%] Other: contract, supplement, annual

Should orthopaedic surgeons be paid specifically for taking orthopaedic trauma emergency room call?
Yes[88%] · No[9%] Abstain[3%]

Which medical staff members' incomes are supplemented for taking emergency room trauma call? (check all that apply)
[49%] General Surgeons
[25%] Anesthesiologists
[31%] Neurosurgeons
[32%] Orthopaedic Surgeons
[16%] Other: OB/GYN, Plastic, ER, Cardiac
[29%] None [9%] Don't Know
(note: % of all respondents; total does not add up to 100%)

Which medical staff members are required to take call "in-house"?
[65%] General Surgeons
[71%] Anesthesiologists
[7%] Neurosurgeons
[10%] Orthopaedic Surgeons
[10%] Other: OB/GYN, ER, Radiology
[1%] None [13%] Don't Know
(note: % of all respondents; total does not add up to 100%)

Is it getting more difficult to get orthopaedic surgeons in your institution to "take call"?
Yes[66%] · No[34%]

Do you anticipate personally taking less orthopaedic trauma emergency room call in the future?
Yes[44%] · No[56%]

RELATED REFERENCES:
"Problems of EMTALA and Emergency Call Discussed." Councilor's Report AAOS, vol 6, no.2, November 2001.

The next topic we have chosen for discussion is:
Career Longevity in Orthopaedic Traumatology: Is "Burnout" a Real issue?

How many years post-residency are you in your career?

1-5 · 6-10 · 11-15 · 16-20 · 21-25 · >25

Did you do fellowship training in orthopaedic trauma?

Yes · No

For how many years have you regularly taken level I or Level II orthopaedic trauma call?

0 · 1-5 · 6-10 · 11-15 · 16-20 · 21-25 · >25

What percentage of your practice is orthopaedic trauma?

<25% · 26-50% · 51-74% · >75%

How many years has your practice included

Academics (teaching and/or research)?_______years
Private practice?________years
Other?_______years

At what age do you plan to retire from clinical practice?

41-45 · 46-50 · 51-55 · 56-60 · 61-65 · >65

What factors contributed most to a decline in your participation in orthopaedic trauma?

Decreased reimbursement · Litigation · Managed care · Bad hours · Lifestyle
Others:_________________________

What factors have contributed most to the maintenance of your participation in orthopaedic trauma?

Please list: __________________________________
___________________________________________

Membership deadline: Encourage colleagues and send recommendations by July 1. Membership forms available in 2001 program book and/or on the website.

Hotel Reservations for annual meeting: September 9, 2002
Annual meeting registration deadline: September 9, 2002

Board Agenda items due by September 1, 2002.

Announcements:

· Kyle Dickson, M.D. has been appointed Archives Committee Chair.
· Robert Ostrum, M.D. has been appointed as a new member to the Archives committee.
· Three OTA members are on the AAOS Board-James Herndon, M.D., Robert Bucholz, M.D. in the presidential line; Maureen Finnegan, M.D. as BOC Chair-Elect