January 22, 2025 • 30 mins
Douglas W. Lundy, MD, MBA, FACS, FAOA, sits down with Hassan R. Mir, MD, MBA, FACS, FAOA to discuss the ethical dynamics and transformative potential of physician-industry relationships. Through his wealth of experience in leadership roles, Dr. Mir guides us through the intricacies of aligning personal passion with professional commitments in the medical field. He opens up about maintaining integrity through transparent, fair market value agreements, and how the "front page test" can serve as a guiding principle for ethical business interactions. Prioritizing patient care while cultivating meaningful industry partnerships stands at the forefront of our discussion, offering a blueprint for those navigating this complex landscape.
As we delve into the evolving roles of physicians as educators, advisors, and innovators within the industry, Dr. Mir sheds light on the balance needed for those aspiring to leadership positions. We explore how younger physicians can effectively engage with the industry through teaching, networking, and research, while also addressing ethical considerations and the importance of transparent disclosure practices. This episode is packed with insights on navigating the rewarding world of physician-industry engagement, the challenges national organizations face in maintaining funding, and the mutual benefits that arise from these vital partnerships. Join us in this compelling conversation to learn strategies for harnessing the potential of physician-industry collaborations.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 2 (00:21):
Welcome to the AOA Future in Orthopedic Surgery
podcast series.
This AOA podcast series willfocus on the future in
orthopedic surgery and theimpact on leaders in our
profession.
These podcasts will focus on avast spectrum of change that
will occur as the future revealsitself.
We will consider changes asthey occur in the domains of
(00:43):
culture, employment, technology,scope of practice, compensation
and other areas.
My name is Doug Lundy, host forthis podcast series.
Joining us today is Dr HassanMir Meir is a professor of
orthopedic surgery and medicaleducation and associate dean of
(01:05):
cultural enrichment andenvironment at the University of
South Florida and director ofthe orthopedic trauma research
at Florida Orthopedic Institute.
He's previously served asresidency program director.
Dr Meir completed his orthopedicsurgery residency at the
Campbell Clinic in Memphis,tennessee, and then went on to
(01:26):
do his fellowship in orthopedictrauma at Tampa General Hospital
.
He also obtained his Master ofBusiness Administration degree
at Auburn University.
Dr Mears' clinical interestsinclude care of polytraumatized
patients, pelvic and acetabularfractures and complex
periarticular fractures.
He also has interest inclinical and health policy
(01:48):
research, medical education andinvolvement with multiple
national orthopedicorganizations.
He served as the chieffinancial officer for the
Orthopedic Trauma Association.
He was on the AmericanAssociation of Orthopedic
Surgery Diversity Advisory Boardand the Council on Advocacy,
and on the American Orth ofOrthopedic Surgery Diversity
Advisory Board and the Councilon Advocacy, and on the American
Orthopedic Association Board ofDirectors.
(02:09):
And on the American College ofSurgeons Committee on Trauma.
As a consultant reviewer formultiple journals, he also
consults with multiple industrypartners on innovative projects
to improve patient care,projects to improve patient care
.
So Dr Mir is with us today totalk about the future of
(02:31):
physician engagement withindustry.
Hassan, welcome to the podcastmy friend.
Thank you for having me Doug,Really happy to be here with you
, and if y'all hadn't picked up,hassan and I go way back.
We also did our MBAs togetherat Auburn University, warrior
Eagle.
Speaker 3 (02:48):
I learned a lot from you back then and continue to
Not much left.
Speaker 2 (02:52):
So there you go, appreciate you.
Well, hassan, you've done atremendous amount.
So you, after you did yourfellowship at Tampa General, you
did quite a stint at Vanderbiltand the trauma service there,
and there's, you know,vanderbilt is just covered with
strong leaders in the orthopedicdepartment there, especially in
the trauma division, and fromthere you went back to Tampa to
(03:16):
do many great things.
There You've been, you've donethe JOA fellowship and what was
the?
You did ABC.
I think it was, is that right?
Yeah, I didc as well, abcfellowship.
You've done a tremendous amountof leadership development and
leadership activities in yourcareer very, very respectable cv
in terms of your involvement inthese organizations.
(03:36):
On this, do you have any pearlsof wisdom or anything that
you've learned along the waythat has inspired you or made
you a better leader?
Speaker 3 (03:44):
Yeah, so a few different things that I've kind
of noticed along the way andpicked up from people that I
look up to, like yourself andseveral people in the AOA, and I
think the first thing is youknow to show up.
You got to be there and bepresent, to be actively engaged
and then you kind of truly theorganizations that interest you
(04:05):
and inspire you are the onesthat you want to commit yourself
to, because, as we know, thereare several organizations you
can get involved in, but youkind of want to, early on,
figure out what you'repassionate about.
And then, I think, early in yourcareer, you get offered
opportunities and you want toreally sign up for what you can
deliver.
And then, if you deliver,people will then ask you to do
(04:28):
more and more.
And then you at some point haveto learn when your bandwidth is
met.
You sometimes have to turnthings down because you don't
want to keep saying yes and notbe able to deliver on something
that you promise.
So those are just some of thethings I've learned along the
way.
And then people that I think of, that I've worked with, who
really, you know, have inspiredme to continue doing this stuff,
(04:49):
are those who are selfless, whocare more about the profession
and the organization beyond justwhat can enrich them and try to
make things better for ourfield and our colleagues, and
those who treat others withkindness and open doors for them
are really those who I try toemulate.
Speaker 2 (05:07):
Very good, and I would attest, as being a good
friend of yours for many years,that you certainly do live up to
those things and you'vecertainly emulated them yourself
.
So we've talked about a numberof things on the series in the
future in orthopedic surgery,and one of the ones that I was
inspired to talk about was whereare we headed with engagement
(05:29):
with industry?
So what's currently?
What's your philosophy BecauseI know you've done some stuff
with the industry what is yourphilosophy for ethical
involvement in orthopedicsurgery, orthopedic surgeons,
with our industry partners?
Speaker 3 (05:45):
Yeah.
So it goes back to my kind ofearly training in Memphis and
had some of our faculty andmentors there, and I remember
Jim Beatty specifically sayingthat you know you never want to
do anything in when it comes tobusiness or industry relations
that doesn't pass the front pagetest, and so I've kind of stuck
(06:06):
by that mantra.
But with that in mind I workeda lot with Tony Russell, who has
done a lot with industry andsaw the way he did things and
how it was all about passion forimproving patient care and
making things more efficient forour colleagues.
And then you know, as long asyou have those overarching goals
(06:30):
in mind, then how you do the.
You set up your structure ofthe relationship contractual
relationship you have with yourindustry partners.
That should just follow suitand that it's ethical, it's
above board, it's all fairmarket value.
There's clear delineation ofthe services you're providing
(06:51):
and how you're being remuneratedfor those services.
That would stand up to musterin any format.
So that's kind of where itstarted and kind of where we're
at present day with all thosethings.
The types of projects aresomewhat changing as we go
forward, though.
How so Well, whereas early oneverything and still there are a
(07:12):
lot of things in orthopedicsthat are about implants and
implant-related technology andinstruments, and that's been the
dominant force and, frankly,where a lot of the money is in
the industry, where they gettheir shareholder value and they
need surgeon input to developthose things.
But now there's a lot moretechnological advancement on
(07:35):
enabling technology such asimage guidance, such as robotics
, and then also on the biologicside, to try to get patients to
improve without necessarilyundergoing surgery.
Then there's other avenues thatrelate to orthopedics, such as
patient engagement andmonitoring and various other
(07:58):
related technologies and fieldsthat certainly need surgeon
input and input of those of uswho are in active practice so
the engineers and businesspeople can can get it right for
us and, for, most importantly,for our patients very good.
Speaker 2 (08:16):
Yeah, that's intriguing how that that all
seems to work out with us.
So I've known and we've heardpeople do this from the podium
right where they would say Ihave no conflicts.
If anybody would like to get mesome, I'd appreciate it, trying
to make a joke and things likethat.
Um, and so sometimes you, youfeel that some of these folks
are just in it for the money.
Other people are in it formaking you know they have great
(08:39):
ideas they want to see getbrought to fruition.
Other people seem to be muchmore altruistic on it.
What's your take on the currenttrends in industry?
Because not too many years agothere was a big reset.
In the early 2000s there was ahuge reset among the big
companies about some of thequestionable behaviors and
(09:01):
intents that were going on.
Speaker 3 (09:03):
Right.
I mean, I think, like a lot ofthings, with time things evolved
and some early contracts andrelationships probably were
based more upon surgeon usageand volume and, as we learned in
back in at Auburn, anytime,there there's healthcare
services going in one directionand remuneration going in the
(09:26):
opposite direction and they'reproportional and related.
That's not legal or shouldn'thappen.
You can't just have surgeonsinvolved on teams to get
royalties who aren't actuallycontributing and are getting
(09:49):
exorbitant amounts of royaltieswithout truly helping to improve
product.
So I think that now there'sstill to this day.
There are certain scenarios thatwill pop up in the media and
the press where that a usuallywith smaller companies or
players and not with the majorindustry partners who are very
(10:09):
much by the book.
But I think that, you know, withany of these relationships,
there has to be a justifiablereason why surgeons are picked
for the teams that they're on.
You know, usually people's CVsare scrutinized and case mix is
scrutinized to see hey, are yougoing to be a valuable
(10:30):
contributor to what we're tryingto do here, especially when
it's part of a design team thatis partnering with engineers and
industry executives.
Now, when it comes to havingyour own original idea and
starting it up and really,really going from scratch.
That's, that's a whole, youknow different ball game and
different scenario and there,truly, it is out of out of
(10:53):
interest and innovation andbecause that's going to be a
very difficult path to take butbut still can be done and is
being done so it's maybe alittle late to the conversation,
but I think we both agree thatphysician involvement with
industry and the development andrefinement of products is
(11:14):
absolutely integral.
Speaker 2 (11:15):
The practicing physician who's actually
touching the implants, or thetechnology or whatever the
biologics, whatever you'retalking about?
You really can't do it withoutus, right.
Speaker 3 (11:27):
No, it's absolutely critical.
It's absolutely critical.
When you meet the engineers,they're brilliant, but many,
especially junior engineers,have never been to an operating
room and even some seniorengineers have limited
experience.
Right, they're not surgeons.
They don't have the experienceof operating on human beings,
even if they've participatedsometimes in cadaveric labs or
(11:49):
something.
It's very different than doinglive surgery and then seeing
patients long-term and seeingtheir outcomes.
And then even on the tech side,you know we are the end user,
or our patients are the endusers, and we can certainly give
the perspective of what isclinically relevant, what's
feasible, what's easy and whatactually adds value to our
(12:12):
practices and to our patients'outcomes.
Speaker 2 (12:15):
So if physicians are going to continue being involved
with industry and indevelopment and refinement of
products, where do you seethings going over the next 5, 10
, 20, whatever years you'recomfortable pushing it out five,
10, 20, however many yearsyou're comfortable pushing it
out Because we've had a rockypast and I'm not exactly sure
the current state, where is it?
(12:35):
Where are we headed?
Speaker 3 (12:37):
Yeah.
So I think that positions arestill going to have to be
involved, you know, and where.
Where it's going with a lot ofthe bigger companies, for some
of their R&D and innovation isreally being outsourced to
startups, right, rather thanspend a lot of time, energy,
(12:58):
effort and money developingstuff in-house, they're actually
letting a lot of the trulyinnovative stuff happen at
startup companies and then justacquiring those startups,
whether it's for their wholeportfolio or really mainly for
their IP, and then they can takeit from there because it's
already been vetted, tried andtrue and there's some traction
gain.
So I think that that change isalready happening, that a lot of
(13:21):
the truly differentiatingtechnologies and innovation has
moved to the startup side, butthat still definitely involves
physicians.
And when you see thoseacquisitions happen, though,
when it comes to the back end onthe business, it makes it a
little cleaner sometimes forthose companies and acquisitions
(13:42):
to do things on an equity basisrather than on a royalty basis.
So that gets a little bit intothe weeds.
On the contractual negotiationsthat happen, but they're still
completely done above board andwithin, you know, within federal
guidelines on those issues.
Speaker 2 (14:02):
Okay, so we've got startups and smaller companies
taking on a lot of the R&D anddevelopment stuff.
What opportunities do you stillthink will?
What will the current state ofthe opportunities be with the
big companies, the big, big,huge ones that we all know about
?
Speaker 3 (14:18):
Yeah, the big ones still are doing some right, but
it's more you know they aredoing some truly unique
technologies but for the mostpart, for the stuff that's
really out there, that's goingto be at the smaller scale.
But the bigger companies arestill, you know, coming out with
newer generations of all oftheir existing technologies and
platforms and implants andinstruments and they need
(14:41):
surgeon input and design teamsto help push those things
forward.
And you know the days of peoplegetting huge royalties for
those are probably done, butthey're, you know.
But there still is a fairmarket value of royalties given
to surgeons who are working aspart of those project teams with
those engineers to improvetheir systems for the next
(15:03):
generation.
Speaker 2 (15:05):
So, with the big reset that occurred back in the
early 2000s, when all the bigcompanies had to go through all
the compliance agreements and doall those regulatory things to
keep themselves out of hot water, is this going to be just a
continual revolution back andforth of the pendulum to where
(15:27):
industry pushes it, pushes it,it pushes it?
The government comes in andsays enough too far, we're going
to put you on complianceagreements, push everybody back,
and then the the momentum willcome back the other way.
Or do you think we're justgoing to figure it out finally
and industry and the physicianswill run in a happy state
without this cyclical mess thatwe had in the past?
Speaker 3 (15:57):
I think it's going to stay in this in in the current
state.
I don't know.
You know it's relatively happy,right, and I think that
everybody is still making neatinnovative products and coming
out with new types oftechnologies to help us.
Every year.
If you just go to any of ourmajor meetings, you know for you
know combined or subspecialtymeetings there's new stuff every
(16:18):
year that is being done withpartnerships with industry and
physicians.
So I think that you know, Idon't know and I personally am
not aware of anybody.
I don't know and I personallyam not aware of anybody signing
(16:46):
it and talk to you know folkswho are my generation doing it
or folks who are starting outand want to get involved in on
how to do that Cause I don'tthink it's a shameful thing now
within, you know, but you haveto understand that it can
potentially bias you.
It, it, it, it does right,because if you really believe in
something that you're workingon, you're going to be biased
(17:08):
towards that.
Otherwise, why are you doing itif you don't believe in it?
And because of that, sometimesyou do give up potentially
opportunities and organizationsfor major leadership roles that
require you to recuse yourselfof all these sorts of
relationships and things.
So there are.
There is there's somewhat of anopportunity cost with it,
depending on where your interestlies, if it's more on the
(17:28):
higher end leadership side withcertain organizations, or if
it's more on hey, I want tocontinue to work with the
partnerships and relationshipsit took me several years to
develop and I don't want to goon a hiatus from those for a few
years and risk not being ableto get back in yeah, we've
talked about that before interms of the significant
opportunity cost to a lot ofthese folks that do this
(18:07):
consulting agreements.
Now some of the organizationsstill allow royalty agreements
but don't allow consultingagreements, which to me doesn't
pass the front page testpersonally, but those
organizations have felt that itdoes.
But there are certainly timeswhere, if you are nominated or
considering participating at thehigher level, that you may have
to give some of these things up.
Speaker 2 (18:25):
What are some of the current relationships or roles
that physicians can play inindustry in current times now?
Speaker 3 (18:33):
So there's various roles you can.
Clearly you can teach right.
That's one of the easiest waysto do things.
Industry runs a lot of greateducational events and courses
and I think frankly thatorthopedic education needs
industry partners.
Now many of us who work atuniversities have seen our
(18:54):
budgets cut that allow ourtrainees to go to events or to
do cadaver labs or to do skillslabs and having industry
partners help.
So working as faculty and someof those things can can you know
be a way to partner withindustry without doing stuff.
On the design side.
There's obviously then thebeing part of evaluating teams
where you're at a site that's anearly release site, or you go
(19:15):
and do labs so you can be partof the design process there.
With some of the smallercompanies you can be on the
scientific advisory board or themedical advisory board, and
typically those relationshipswith smaller companies may
involve hourly consulting butalso could involve some equity
if you're giving your time toreally advise them on their
(19:36):
strategy on a more global scalethan just the one particular
small project, and then reallyyou can be a founder right.
You can do your own startup.
You got your own idea, youfound your own company and take
it the whole way there.
Speaker 2 (19:50):
We know folks that have done that.
That's a big risk and a lot ofengagement there, because it's
not as easy and as romantic, Ithink, as people think it is.
Speaker 3 (19:59):
No, it's really challenging and I've talked to a
lot of people who have done itand they're happy at the end,
but it can be a very difficultroad to travel.
Speaker 2 (20:12):
How do you see these relationships changing in the
years ahead?
Is there a happier state thatindustry or the physician
workforce or the federalgovernment would like to have
and influencing people in acertain direction?
Speaker 3 (20:23):
Yeah, no, I mean, I think that for the surgeons who
do it right, I think that mostof the surgeons I talk to who do
this truly have an interest ininnovating and improving patient
care, improving search,workflow, and so I think the
surgeons will always be involved.
Would they like to be, you know, continue to be compensated for
(20:44):
it, of course, but I betthere's several who would do it
even if there was nothing in itfor them.
But I don't think that's fair.
I think it's fair to compensatepeople for work they've done,
especially if they're on theindustry side.
They're going to monetize it,which they will, and most of our
industry partners also, right,they're ultimately private
companies that are responsibleto their shareholders, but they
(21:06):
can't do what they do without us, and they get it.
And I think the government'srole is just to make sure that
things are done above board andfairly and that there's again
sticking with federalregulations, that people are not
doing things for unethicalreasons.
Speaker 2 (21:25):
So if somebody, a younger physician, was
interested in starting to engagewith industry and partner up to
some of these things, whatwould you recommend folks do to
become more involved in this?
Speaker 3 (21:38):
yeah.
So I have a lot of my formerresidents and fellows who have
asked me about it over time andnow you know are doing some of
these things and so so I thinkit's you know, first be good at
what you do and be a goodphysician, be a good surgeon,
get your practice taken care ofand then, as you do those things
and you can talk to yourmentors about getting involved
(22:01):
in teaching and courses andintroducing you to people that
way.
I think that's a really goodway to do it.
And at the various meetingsthat we have to get to get to
know people.
And then, once you've kind ofgotten in through the education
route or through letting peopleknow that, hey, you're willing
to do labs, so to think that dayone graduating from fellowship,
that I'm going to be put on amajor team to redesign a major
(22:32):
system and get a bunch ofroyalties isn't really practical
right.
So you got to kind of work yourway into it and show that
you've got a passion for ourfield, show that you've got
knowledge base, show that youhave respect amongst your peers,
that you're someone who canthen present and talk about the
work that you're doing and thatthen, based upon your volume and
(22:56):
your knowledge and yourexperience that you can then
innovate in that space.
I think that's typically whatour industry partners are
looking for.
One additional way that peoplecan get involved with industry
is through academic productivity, and research found the same
(23:33):
thing that those surgeons whohave greater involvement with
industry and more industryfunding and compensation have a
direct correlation with howproductive they've been
academically when you look attheir H index and M index, which
are different available metricsto look at and see how much
they have published, and also ifyou look at their grant funding
(23:53):
.
So while you do these academicpursuits not necessarily for the
purpose of engaging withindustry they do tend to make
you more visible and someone whoindustry may be more likely to
engage with, because it showsthat you have a good knowledge
(24:15):
base, experience and also aresomeone who is at the podium and
in the journals and can conveyyour message about what you
believe and how you can improvepatient care.
Speaker 2 (24:28):
So many times in the different organizations that
I've been involved, especiallyat the national level, there's
been there's no secret about itthere's been a slow, progressive
shrinking of the amount offunds and the investment that
industry is making into ournational organizations that you
and I both belong to several ofthe same.
(24:49):
On that, Any thoughts on?
Because obviously clearlybottom line motives or the value
paradigm is affecting that.
They just don't feel there'svalue in it.
They may say one thing buttheir checkbooks are heading a
different direction.
And if that's the case, howdoes that somehow impact on the
surgeons who are then loyalmembers of these organizations,
(25:11):
who are also engaged in thespeaking and consulting areas?
Speaker 3 (25:29):
organizational perspective and organizational
leaders.
We obviously need industrysupport to help carry on our
meetings and carry on ourfunctions and serve our members.
But from the industry side theykind of want to see that their
investment towards research,education and the organizations
is getting the maximum value fortheir dollar.
So in talking to some of themover the years you were the CFO
(25:52):
before, I was the CFO at the OTAand now you're in the PL there
that we engage with our industrypartners to support that
organization, amongst others anda lot of their feedback is like
look, we love the organization,we need the organization to
succeed and we'll continue tosupport it.
But on the other hand, when youtalk to them separately, they
(26:14):
also have their own educationalevents that they put on separate
from our meetings and they seesometimes that they get more
value out of those becausethey're not competing with other
companies there, they're theonly show and they feel
sometimes that their return oninvestment is better on those
events.
So it's kind of tricky becauseyou kind of can see their side
(26:35):
of it too and if you were intheir seat it might be hard to
justify one versus the other.
But I would hope from being amember of the AOA and other
organizations, that our industrypartners still continue to see
value and can help us to improvethe value that they're getting
for their donations to us, so wecan continue those partnerships
(26:57):
.
Speaker 2 (27:00):
So, Hassan, you know, when we go to the OTA, the
academy, different meetings thatyou and I attend and you see
the guys up there with their,the men and women up there with
their disclosures, and there'sall different ways of doing it
right.
It's on the AOS website.
I make a joke about a slide.
It's got you know 30 things onthere in a size eight font that
(27:24):
nobody can read.
What's the current state ofdisclosures, how relevant is it
and where do you see thingsgoing in the future to a better
state, if there is one.
Speaker 3 (27:36):
Yeah.
So you know, when we see theslide pop up for literally even
if it's 10 seconds, right,sometimes it's really easy to
read I have no disclosures.
And sometimes you're like, wow,I, there's no way I can take
all that in.
So is it really valuable tohave us have them on the
Academy's app available toanyone who wants to look them up
(28:13):
?
I think that that's probablythe best way to go about it just
saying, hey, I do have somerelevant disclosures, they're
here.
And then, in particular, though,if you're given a talk where
there is a really pertinentdisclosure really relevant to
that talk, I think that shouldbe highlighted separately.
I think that if I'm giving atalk on a product that I've
designed and used on a series ofpatients, I probably should
(28:35):
disclose that specificallyrather than saying all my
disclosures are on the app.
And then I think that thequestion then is, what is
relevant and what is not, gets alittle gray and a little tricky
.
But I think that there are somethat are clear, like the
example I gave, like that's veryrelevant, and there's others
that may not be so relevant andclear.
(28:56):
So having them all listedsomewhere centrally can help
others to discern what'srelevant or not.
I think that future state Idon't know that it'll really be
much different.
I think that there is a lotmore, you know potential
scrutiny, especially when youget up to the higher level
organizational leadership, whereyou may own stock in different
(29:18):
company, and things like thatthat you don't necessarily think
as much about when people are,you know, just giving a talk or
something that come into play.
But I think that all thesethings are relevant and should
be listed somewhere.
Speaker 2 (29:33):
Very well said.
It's been a real pleasuretalking with my friend Ahsan Mir
, who's an orthopedic traumasurgeon at the Florida
Orthopedic Institute at TampaGeneral and very well known
throughout our profession inmultiple fields.
From the very well knownthroughout our profession in
multiple fields, from the AOAthrough the academy through the
(29:58):
OTA and many others.
Speaker 3 (29:59):
So, hassan, thank you so much for being on the
podcast, sir.
Speaker 2 (30:02):
Thanks for having me, doug.
It's always great chatting withyou and hope to see you again
soon.
Yes, sir, me too, and y'allstay tuned for future in
orthopedic surgery on thispodcast channel.
Welcome to the AOA Future in Orthopedic Surgery
podcast series.
This AOA podcast series willfocus on the future in
orthopedic surgery and theimpact on leaders in our
profession.
These podcasts will focus on avast spectrum of change that
will occur as the future revealsitself.
We will consider changes asthey occur in the domains of
(00:43):
culture, employment, technology,scope of practice, compensation
and other areas.
My name is Doug Lundy, host forthis podcast series.
Joining us today is Dr HassanMir Meir is a professor of
orthopedic surgery and medicaleducation and associate dean of
(01:05):
cultural enrichment andenvironment at the University of
South Florida and director ofthe orthopedic trauma research
at Florida Orthopedic Institute.
He's previously served asresidency program director.
Dr Meir completed his orthopedicsurgery residency at the
Campbell Clinic in Memphis,tennessee, and then went on to
(01:26):
do his fellowship in orthopedictrauma at Tampa General Hospital
.
He also obtained his Master ofBusiness Administration degree
at Auburn University.
Dr Mears' clinical interestsinclude care of polytraumatized
patients, pelvic and acetabularfractures and complex
periarticular fractures.
He also has interest inclinical and health policy
(01:48):
research, medical education andinvolvement with multiple
national orthopedicorganizations.
He served as the chieffinancial officer for the
Orthopedic Trauma Association.
He was on the AmericanAssociation of Orthopedic
Surgery Diversity Advisory Boardand the Council on Advocacy,
and on the American Orth ofOrthopedic Surgery Diversity
Advisory Board and the Councilon Advocacy, and on the American
Orthopedic Association Board ofDirectors.
(02:09):
And on the American College ofSurgeons Committee on Trauma.
As a consultant reviewer formultiple journals, he also
consults with multiple industrypartners on innovative projects
to improve patient care,projects to improve patient care
.
So Dr Mir is with us today totalk about the future of
(02:31):
physician engagement withindustry.
Hassan, welcome to the podcastmy friend.
Thank you for having me Doug,Really happy to be here with you
, and if y'all hadn't picked up,hassan and I go way back.
We also did our MBAs togetherat Auburn University, warrior
Eagle.
Speaker 3 (02:48):
I learned a lot from you back then and continue to
Not much left.
Speaker 2 (02:52):
So there you go, appreciate you.
Well, hassan, you've done atremendous amount.
So you, after you did yourfellowship at Tampa General, you
did quite a stint at Vanderbiltand the trauma service there,
and there's, you know,vanderbilt is just covered with
strong leaders in the orthopedicdepartment there, especially in
the trauma division, and fromthere you went back to Tampa to
(03:16):
do many great things.
There You've been, you've donethe JOA fellowship and what was
the?
You did ABC.
I think it was, is that right?
Yeah, I didc as well, abcfellowship.
You've done a tremendous amountof leadership development and
leadership activities in yourcareer very, very respectable cv
in terms of your involvement inthese organizations.
(03:36):
On this, do you have any pearlsof wisdom or anything that
you've learned along the waythat has inspired you or made
you a better leader?
Speaker 3 (03:44):
Yeah, so a few different things that I've kind
of noticed along the way andpicked up from people that I
look up to, like yourself andseveral people in the AOA, and I
think the first thing is youknow to show up.
You got to be there and bepresent, to be actively engaged
and then you kind of truly theorganizations that interest you
(04:05):
and inspire you are the onesthat you want to commit yourself
to, because, as we know, thereare several organizations you
can get involved in, but youkind of want to, early on,
figure out what you'repassionate about.
And then, I think, early in yourcareer, you get offered
opportunities and you want toreally sign up for what you can
deliver.
And then, if you deliver,people will then ask you to do
(04:28):
more and more.
And then you at some point haveto learn when your bandwidth is
met.
You sometimes have to turnthings down because you don't
want to keep saying yes and notbe able to deliver on something
that you promise.
So those are just some of thethings I've learned along the
way.
And then people that I think of, that I've worked with, who
really, you know, have inspiredme to continue doing this stuff,
(04:49):
are those who are selfless, whocare more about the profession
and the organization beyond justwhat can enrich them and try to
make things better for ourfield and our colleagues, and
those who treat others withkindness and open doors for them
are really those who I try toemulate.
Speaker 2 (05:07):
Very good, and I would attest, as being a good
friend of yours for many years,that you certainly do live up to
those things and you'vecertainly emulated them yourself
.
So we've talked about a numberof things on the series in the
future in orthopedic surgery,and one of the ones that I was
inspired to talk about was whereare we headed with engagement
(05:29):
with industry?
So what's currently?
What's your philosophy BecauseI know you've done some stuff
with the industry what is yourphilosophy for ethical
involvement in orthopedicsurgery, orthopedic surgeons,
with our industry partners?
Speaker 3 (05:45):
Yeah.
So it goes back to my kind ofearly training in Memphis and
had some of our faculty andmentors there, and I remember
Jim Beatty specifically sayingthat you know you never want to
do anything in when it comes tobusiness or industry relations
that doesn't pass the front pagetest, and so I've kind of stuck
(06:06):
by that mantra.
But with that in mind I workeda lot with Tony Russell, who has
done a lot with industry andsaw the way he did things and
how it was all about passion forimproving patient care and
making things more efficient forour colleagues.
And then you know, as long asyou have those overarching goals
(06:30):
in mind, then how you do the.
You set up your structure ofthe relationship contractual
relationship you have with yourindustry partners.
That should just follow suitand that it's ethical, it's
above board, it's all fairmarket value.
There's clear delineation ofthe services you're providing
(06:51):
and how you're being remuneratedfor those services.
That would stand up to musterin any format.
So that's kind of where itstarted and kind of where we're
at present day with all thosethings.
The types of projects aresomewhat changing as we go
forward, though.
How so Well, whereas early oneverything and still there are a
(07:12):
lot of things in orthopedicsthat are about implants and
implant-related technology andinstruments, and that's been the
dominant force and, frankly,where a lot of the money is in
the industry, where they gettheir shareholder value and they
need surgeon input to developthose things.
But now there's a lot moretechnological advancement on
(07:35):
enabling technology such asimage guidance, such as robotics
, and then also on the biologicside, to try to get patients to
improve without necessarilyundergoing surgery.
Then there's other avenues thatrelate to orthopedics, such as
patient engagement andmonitoring and various other
(07:58):
related technologies and fieldsthat certainly need surgeon
input and input of those of uswho are in active practice so
the engineers and businesspeople can can get it right for
us and, for, most importantly,for our patients very good.
Speaker 2 (08:16):
Yeah, that's intriguing how that that all
seems to work out with us.
So I've known and we've heardpeople do this from the podium
right where they would say Ihave no conflicts.
If anybody would like to get mesome, I'd appreciate it, trying
to make a joke and things likethat.
Um, and so sometimes you, youfeel that some of these folks
are just in it for the money.
Other people are in it formaking you know they have great
(08:39):
ideas they want to see getbrought to fruition.
Other people seem to be muchmore altruistic on it.
What's your take on the currenttrends in industry?
Because not too many years agothere was a big reset.
In the early 2000s there was ahuge reset among the big
companies about some of thequestionable behaviors and
(09:01):
intents that were going on.
Speaker 3 (09:03):
Right.
I mean, I think, like a lot ofthings, with time things evolved
and some early contracts andrelationships probably were
based more upon surgeon usageand volume and, as we learned in
back in at Auburn, anytime,there there's healthcare
services going in one directionand remuneration going in the
(09:26):
opposite direction and they'reproportional and related.
That's not legal or shouldn'thappen.
You can't just have surgeonsinvolved on teams to get
royalties who aren't actuallycontributing and are getting
(09:49):
exorbitant amounts of royaltieswithout truly helping to improve
product.
So I think that now there'sstill to this day.
There are certain scenarios thatwill pop up in the media and
the press where that a usuallywith smaller companies or
players and not with the majorindustry partners who are very
(10:09):
much by the book.
But I think that, you know, withany of these relationships,
there has to be a justifiablereason why surgeons are picked
for the teams that they're on.
You know, usually people's CVsare scrutinized and case mix is
scrutinized to see hey, are yougoing to be a valuable
(10:30):
contributor to what we're tryingto do here, especially when
it's part of a design team thatis partnering with engineers and
industry executives.
Now, when it comes to havingyour own original idea and
starting it up and really,really going from scratch.
That's, that's a whole, youknow different ball game and
different scenario and there,truly, it is out of out of
(10:53):
interest and innovation andbecause that's going to be a
very difficult path to take butbut still can be done and is
being done so it's maybe alittle late to the conversation,
but I think we both agree thatphysician involvement with
industry and the development andrefinement of products is
(11:14):
absolutely integral.
Speaker 2 (11:15):
The practicing physician who's actually
touching the implants, or thetechnology or whatever the
biologics, whatever you'retalking about?
You really can't do it withoutus, right.
Speaker 3 (11:27):
No, it's absolutely critical.
It's absolutely critical.
When you meet the engineers,they're brilliant, but many,
especially junior engineers,have never been to an operating
room and even some seniorengineers have limited
experience.
Right, they're not surgeons.
They don't have the experienceof operating on human beings,
even if they've participatedsometimes in cadaveric labs or
(11:49):
something.
It's very different than doinglive surgery and then seeing
patients long-term and seeingtheir outcomes.
And then even on the tech side,you know we are the end user,
or our patients are the endusers, and we can certainly give
the perspective of what isclinically relevant, what's
feasible, what's easy and whatactually adds value to our
(12:12):
practices and to our patients'outcomes.
Speaker 2 (12:15):
So if physicians are going to continue being involved
with industry and indevelopment and refinement of
products, where do you seethings going over the next 5, 10
, 20, whatever years you'recomfortable pushing it out five,
10, 20, however many yearsyou're comfortable pushing it
out Because we've had a rockypast and I'm not exactly sure
the current state, where is it?
(12:35):
Where are we headed?
Speaker 3 (12:37):
Yeah.
So I think that positions arestill going to have to be
involved, you know, and where.
Where it's going with a lot ofthe bigger companies, for some
of their R&D and innovation isreally being outsourced to
startups, right, rather thanspend a lot of time, energy,
(12:58):
effort and money developingstuff in-house, they're actually
letting a lot of the trulyinnovative stuff happen at
startup companies and then justacquiring those startups,
whether it's for their wholeportfolio or really mainly for
their IP, and then they can takeit from there because it's
already been vetted, tried andtrue and there's some traction
gain.
So I think that that change isalready happening, that a lot of
(13:21):
the truly differentiatingtechnologies and innovation has
moved to the startup side, butthat still definitely involves
physicians.
And when you see thoseacquisitions happen, though,
when it comes to the back end onthe business, it makes it a
little cleaner sometimes forthose companies and acquisitions
(13:42):
to do things on an equity basisrather than on a royalty basis.
So that gets a little bit intothe weeds.
On the contractual negotiationsthat happen, but they're still
completely done above board andwithin, you know, within federal
guidelines on those issues.
Speaker 2 (14:02):
Okay, so we've got startups and smaller companies
taking on a lot of the R&D anddevelopment stuff.
What opportunities do you stillthink will?
What will the current state ofthe opportunities be with the
big companies, the big, big,huge ones that we all know about
?
Speaker 3 (14:18):
Yeah, the big ones still are doing some right, but
it's more you know they aredoing some truly unique
technologies but for the mostpart, for the stuff that's
really out there, that's goingto be at the smaller scale.
But the bigger companies arestill, you know, coming out with
newer generations of all oftheir existing technologies and
platforms and implants andinstruments and they need
(14:41):
surgeon input and design teamsto help push those things
forward.
And you know the days of peoplegetting huge royalties for
those are probably done, butthey're, you know.
But there still is a fairmarket value of royalties given
to surgeons who are working aspart of those project teams with
those engineers to improvetheir systems for the next
(15:03):
generation.
Speaker 2 (15:05):
So, with the big reset that occurred back in the
early 2000s, when all the bigcompanies had to go through all
the compliance agreements and doall those regulatory things to
keep themselves out of hot water, is this going to be just a
continual revolution back andforth of the pendulum to where
(15:27):
industry pushes it, pushes it,it pushes it?
The government comes in andsays enough too far, we're going
to put you on complianceagreements, push everybody back,
and then the the momentum willcome back the other way.
Or do you think we're justgoing to figure it out finally
and industry and the physicianswill run in a happy state
without this cyclical mess thatwe had in the past?
Speaker 3 (15:57):
I think it's going to stay in this in in the current
state.
I don't know.
You know it's relatively happy,right, and I think that
everybody is still making neatinnovative products and coming
out with new types oftechnologies to help us.
Every year.
If you just go to any of ourmajor meetings, you know for you
know combined or subspecialtymeetings there's new stuff every
(16:18):
year that is being done withpartnerships with industry and
physicians.
So I think that you know, Idon't know and I personally am
not aware of anybody.
I don't know and I personallyam not aware of anybody signing
(16:46):
it and talk to you know folkswho are my generation doing it
or folks who are starting outand want to get involved in on
how to do that Cause I don'tthink it's a shameful thing now
within, you know, but you haveto understand that it can
potentially bias you.
It, it, it, it does right,because if you really believe in
something that you're workingon, you're going to be biased
(17:08):
towards that.
Otherwise, why are you doing itif you don't believe in it?
And because of that, sometimesyou do give up potentially
opportunities and organizationsfor major leadership roles that
require you to recuse yourselfof all these sorts of
relationships and things.
So there are.
There is there's somewhat of anopportunity cost with it,
depending on where your interestlies, if it's more on the
(17:28):
higher end leadership side withcertain organizations, or if
it's more on hey, I want tocontinue to work with the
partnerships and relationshipsit took me several years to
develop and I don't want to goon a hiatus from those for a few
years and risk not being ableto get back in yeah, we've
talked about that before interms of the significant
opportunity cost to a lot ofthese folks that do this
(18:07):
consulting agreements.
Now some of the organizationsstill allow royalty agreements
but don't allow consultingagreements, which to me doesn't
pass the front page testpersonally, but those
organizations have felt that itdoes.
But there are certainly timeswhere, if you are nominated or
considering participating at thehigher level, that you may have
to give some of these things up.
Speaker 2 (18:25):
What are some of the current relationships or roles
that physicians can play inindustry in current times now?
Speaker 3 (18:33):
So there's various roles you can.
Clearly you can teach right.
That's one of the easiest waysto do things.
Industry runs a lot of greateducational events and courses
and I think frankly thatorthopedic education needs
industry partners.
Now many of us who work atuniversities have seen our
(18:54):
budgets cut that allow ourtrainees to go to events or to
do cadaver labs or to do skillslabs and having industry
partners help.
So working as faculty and someof those things can can you know
be a way to partner withindustry without doing stuff.
On the design side.
There's obviously then thebeing part of evaluating teams
where you're at a site that's anearly release site, or you go
(19:15):
and do labs so you can be partof the design process there.
With some of the smallercompanies you can be on the
scientific advisory board or themedical advisory board, and
typically those relationshipswith smaller companies may
involve hourly consulting butalso could involve some equity
if you're giving your time toreally advise them on their
(19:36):
strategy on a more global scalethan just the one particular
small project, and then reallyyou can be a founder right.
You can do your own startup.
You got your own idea, youfound your own company and take
it the whole way there.
Speaker 2 (19:50):
We know folks that have done that.
That's a big risk and a lot ofengagement there, because it's
not as easy and as romantic, Ithink, as people think it is.
Speaker 3 (19:59):
No, it's really challenging and I've talked to a
lot of people who have done itand they're happy at the end,
but it can be a very difficultroad to travel.
Speaker 2 (20:12):
How do you see these relationships changing in the
years ahead?
Is there a happier state thatindustry or the physician
workforce or the federalgovernment would like to have
and influencing people in acertain direction?
Speaker 3 (20:23):
Yeah, no, I mean, I think that for the surgeons who
do it right, I think that mostof the surgeons I talk to who do
this truly have an interest ininnovating and improving patient
care, improving search,workflow, and so I think the
surgeons will always be involved.
Would they like to be, you know, continue to be compensated for
(20:44):
it, of course, but I betthere's several who would do it
even if there was nothing in itfor them.
But I don't think that's fair.
I think it's fair to compensatepeople for work they've done,
especially if they're on theindustry side.
They're going to monetize it,which they will, and most of our
industry partners also, right,they're ultimately private
companies that are responsibleto their shareholders, but they
(21:06):
can't do what they do without us, and they get it.
And I think the government'srole is just to make sure that
things are done above board andfairly and that there's again
sticking with federalregulations, that people are not
doing things for unethicalreasons.
Speaker 2 (21:25):
So if somebody, a younger physician, was
interested in starting to engagewith industry and partner up to
some of these things, whatwould you recommend folks do to
become more involved in this?
Speaker 3 (21:38):
yeah.
So I have a lot of my formerresidents and fellows who have
asked me about it over time andnow you know are doing some of
these things and so so I thinkit's you know, first be good at
what you do and be a goodphysician, be a good surgeon,
get your practice taken care ofand then, as you do those things
and you can talk to yourmentors about getting involved
(22:01):
in teaching and courses andintroducing you to people that
way.
I think that's a really goodway to do it.
And at the various meetingsthat we have to get to get to
know people.
And then, once you've kind ofgotten in through the education
route or through letting peopleknow that, hey, you're willing
to do labs, so to think that dayone graduating from fellowship,
that I'm going to be put on amajor team to redesign a major
(22:32):
system and get a bunch ofroyalties isn't really practical
right.
So you got to kind of work yourway into it and show that
you've got a passion for ourfield, show that you've got
knowledge base, show that youhave respect amongst your peers,
that you're someone who canthen present and talk about the
work that you're doing and thatthen, based upon your volume and
(22:56):
your knowledge and yourexperience that you can then
innovate in that space.
I think that's typically whatour industry partners are
looking for.
One additional way that peoplecan get involved with industry
is through academic productivity, and research found the same
(23:33):
thing that those surgeons whohave greater involvement with
industry and more industryfunding and compensation have a
direct correlation with howproductive they've been
academically when you look attheir H index and M index, which
are different available metricsto look at and see how much
they have published, and also ifyou look at their grant funding
(23:53):
.
So while you do these academicpursuits not necessarily for the
purpose of engaging withindustry they do tend to make
you more visible and someone whoindustry may be more likely to
engage with, because it showsthat you have a good knowledge
(24:15):
base, experience and also aresomeone who is at the podium and
in the journals and can conveyyour message about what you
believe and how you can improvepatient care.
Speaker 2 (24:28):
So many times in the different organizations that
I've been involved, especiallyat the national level, there's
been there's no secret about itthere's been a slow, progressive
shrinking of the amount offunds and the investment that
industry is making into ournational organizations that you
and I both belong to several ofthe same.
(24:49):
On that, Any thoughts on?
Because obviously clearlybottom line motives or the value
paradigm is affecting that.
They just don't feel there'svalue in it.
They may say one thing buttheir checkbooks are heading a
different direction.
And if that's the case, howdoes that somehow impact on the
surgeons who are then loyalmembers of these organizations,
(25:11):
who are also engaged in thespeaking and consulting areas?
Speaker 3 (25:29):
organizational perspective and organizational
leaders.
We obviously need industrysupport to help carry on our
meetings and carry on ourfunctions and serve our members.
But from the industry side theykind of want to see that their
investment towards research,education and the organizations
is getting the maximum value fortheir dollar.
So in talking to some of themover the years you were the CFO
(25:52):
before, I was the CFO at the OTAand now you're in the PL there
that we engage with our industrypartners to support that
organization, amongst others anda lot of their feedback is like
look, we love the organization,we need the organization to
succeed and we'll continue tosupport it.
But on the other hand, when youtalk to them separately, they
(26:14):
also have their own educationalevents that they put on separate
from our meetings and they seesometimes that they get more
value out of those becausethey're not competing with other
companies there, they're theonly show and they feel
sometimes that their return oninvestment is better on those
events.
So it's kind of tricky becauseyou kind of can see their side
(26:35):
of it too and if you were intheir seat it might be hard to
justify one versus the other.
But I would hope from being amember of the AOA and other
organizations, that our industrypartners still continue to see
value and can help us to improvethe value that they're getting
for their donations to us, so wecan continue those partnerships
(26:57):
.
Speaker 2 (27:00):
So, Hassan, you know, when we go to the OTA, the
academy, different meetings thatyou and I attend and you see
the guys up there with their,the men and women up there with
their disclosures, and there'sall different ways of doing it
right.
It's on the AOS website.
I make a joke about a slide.
It's got you know 30 things onthere in a size eight font that
(27:24):
nobody can read.
What's the current state ofdisclosures, how relevant is it
and where do you see thingsgoing in the future to a better
state, if there is one.
Speaker 3 (27:36):
Yeah.
So you know, when we see theslide pop up for literally even
if it's 10 seconds, right,sometimes it's really easy to
read I have no disclosures.
And sometimes you're like, wow,I, there's no way I can take
all that in.
So is it really valuable tohave us have them on the
Academy's app available toanyone who wants to look them up
(28:13):
?
I think that that's probablythe best way to go about it just
saying, hey, I do have somerelevant disclosures, they're
here.
And then, in particular, though,if you're given a talk where
there is a really pertinentdisclosure really relevant to
that talk, I think that shouldbe highlighted separately.
I think that if I'm giving atalk on a product that I've
designed and used on a series ofpatients, I probably should
(28:35):
disclose that specificallyrather than saying all my
disclosures are on the app.
And then I think that thequestion then is, what is
relevant and what is not, gets alittle gray and a little tricky
.
But I think that there are somethat are clear, like the
example I gave, like that's veryrelevant, and there's others
that may not be so relevant andclear.
(28:56):
So having them all listedsomewhere centrally can help
others to discern what'srelevant or not.
I think that future state Idon't know that it'll really be
much different.
I think that there is a lotmore, you know potential
scrutiny, especially when youget up to the higher level
organizational leadership, whereyou may own stock in different
(29:18):
company, and things like thatthat you don't necessarily think
as much about when people are,you know, just giving a talk or
something that come into play.
But I think that all thesethings are relevant and should
be listed somewhere.
Speaker 2 (29:33):
Very well said.
It's been a real pleasuretalking with my friend Ahsan Mir
, who's an orthopedic traumasurgeon at the Florida
Orthopedic Institute at TampaGeneral and very well known
throughout our profession inmultiple fields.
From the very well knownthroughout our profession in
multiple fields, from the AOAthrough the academy through the
(29:58):
OTA and many others.
Speaker 3 (29:59):
So, hassan, thank you so much for being on the
podcast, sir.
Speaker 2 (30:02):
Thanks for having me, doug.
It's always great chatting withyou and hope to see you again
soon.
Yes, sir, me too, and y'allstay tuned for future in
orthopedic surgery on thispodcast channel.
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