How is artificial intelligence revolutionizing orthopaedic surgery, and what can big data teach us about improving patient outcomes across different healthcare systems? In our latest episode, we feature insights from Dr. Wayne Sebastianelli, a leading expert in orthopaedics, as he discusses the transformative role of AI and big data in advancing orthopaedic care. Dr. Sebastianelli provides a comparative analysis of international big data registries, highlighting the differences between systems in the United Kingdom, New Zealand, and the United States, and the impact these systems have on patient care. We also explore the challenges of managing extensive data and the implications of different healthcare models on orthopaedic practices.
Leadership development and emotional intelligence are pivotal in ensuring the future success of orthopaedists. Listen as Dr. Sebastianelli shares his vision on balancing manpower and honing leadership skills within the field of orthopaedics. We dive into the collaborative efforts of the AOA, AAOS, and ABOS in addressing key issues like compensation and advocacy while emphasizing the critical role of AI in reducing administrative burdens. Dr. Sebastianelli's rich experiences and leadership roles offer valuable perspectives on preparing the next generation of practitioners. Join us for an enlightening conversation that celebrates Dr. Sebastianelli's contributions and looks ahead to the evolving landscape of orthopedic surgery.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Dr. Lundy (00:22):
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 onthe vast spectrum of change that
will occur as the futurereveals itself.
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 WayneSebastianelli.
Dr Sebastionelli is the KalanickProfessor in Orthopedics,
medical Director of Penn StateSports Medicine, associate Chief
(01:03):
Medical Officer of Center ofPenn State Sports Medicine,
associate chief medical officerof Center County, penn State
Health and the associate deanfor clinical affairs at the
University Park Regional Campus.
He went to medical school atthe University of Rochester, did
his residency at Rochester andthen did his fellowship at the
Milton Hershey Medical Centerand then went on to become, and
(01:25):
eventually become, the teamdoctor for Penn State University
.
He's currently a director ofthe American Board of Orthopedic
Surgery and the immediate pastpresident, which is the 135th
president of the AmericanOrthopedic Association, dr
Sebastian Nelly.
Thank you and welcome to thepodcast, sir.
Dr. Sebastianelli (01:44):
Happy to be here, Douglas.
Very, very good to be with youand spend some time trying to
hash out some of these issues.
Dr. Lundy (01:50):
And so Wayne and I have known each other for quite
a while through the ABOS andthrough the AOA and absolutely
love Wayne and his company andhis lovely wife and just being
friends and talking throughdifferent and complex things
with them.
And Wayne's got a very uniqueperspective because as the past
president of the AmericanOrthopedic Association he sat in
(02:11):
a very specific and uniqueposition to view the future of
orthopedic surgery that few ofus will ever have and certainly
didn't have last year as he waspresident, certainly through the
American Orthopedic Association, then also through Carousel and
dealing with the otherpresidents of the
English-speaking orthopedicorganization.
So, Wayne, based on yourperspective from that, can you
(02:34):
tell us, sir, what your thoughtsare on the future in
orthopedics, either short-termor long-term, how you see it?
Dr. Sebastianelli (02:40):
Sure, doug, you know it's obviously not
something that is going to be.
Sure Doug, you know it'sobviously not something that is
going to be settled by one man'sthoughts or one man's opinion,
but there are multiple thingsthat need to be considered, as
(03:02):
we we need to somehow blendeverything together with the
power of artificial intelligenceand the power of computer
systems to try to generate thebest possible solutions from big
data.
As I was working through someof this over the presidential
line and ultimately through thetravel of the carousel, you can
(03:26):
see that the problems are pretty, you know, consistent
throughout every country that wevisited, and training certainly
is an issue in the sense of howwe best train our residents and
our successors to sort ofbecome the stewards of
orthopedic care in the next 30to 40 years to become the
(03:46):
stewards of orthopedic care inthe next 30 to 40 years.
Dr. Lundy (03:51):
So thank you for that .
Now, as you interacted with thepresidents of the other
orthopedic organizations acrossthe English-speaking world, did
you see anything unique orinnovative that one of the other
organizations was doing thatperhaps we should consider?
Or did anything come up whereyou were like, wow, that's a
really good idea, we should dothat at Penn State and hopefully
across the US.
Dr. Sebastianelli (04:08):
Yeah, I think you know the big data
acquisition that England has iscertainly powerful and you know
their registries are reallyreally quite sophisticated and
New Zealand has really benefitedfrom that connection with the
United Kingdom and how they'veincorporated their registries as
well.
But when you put it into thescope of what you know they're
(04:31):
dealing with and what we'redealing with and the size
differences, you can understandwhy it's a little bit easier for
a country like New Zealand inparticular to sort of organize
things in a very, veryregimented way.
There's not as many sort ofbodies of influence than you
know in a country of New Zealandsize as there would be in the
United States.
So it's a little bit easier tomanage some of the opinions and,
(04:54):
again, some of thepersonalities that we're doing,
what needs to be in the registry, how to manage it, how to fund
it.
You know those kind of thingsare very, very important.
Dr. Lundy (05:04):
Are Great Britain's registries as comprehensive as
ours, or more so, or how doesthat look?
Dr. Sebastianelli (05:11):
Well, I think it's been done for a lot longer
period of time and I do thinkthat you know their control of
the primary care system and thespecialty system is a little bit
more sophisticated in ways thatI think.
You know the American model isa little bit different and not a
lot of practitioners want tohave that necessarily national
control over their practice.
(05:32):
So it's sort of like looking atannual wellness visits today
for our primary care docs andwhat has to go into you know,
the documentation of that visitand how it gets categorized.
Well, you know England's beendoing that for you know, a lot
longer than we have and from theperspective of managing
orthopedic maladies, wecertainly have done it for, you
(05:53):
know, an extended period of timerelatively speaking to us.
Dr. Lundy (05:57):
So the Academy has not only got the AJRR, but it's
also shoulder and elbow traumatumor.
I'm probably missing somethingin there.
Does the great Britain systemcapture all that, or are they
just limited to joints?
Dr. Sebastianelli (06:09):
No, I think they're doing it for just about
everything.
You know.
Pediatric data is really strong.
I do think that they'reprobably not as sub-specialized
in ways as we are, like the ninesub-specialties of orthopedics
probably aren't as deeplytraveled as they are in the
United States.
They just don't have the samevolume of providers that we have
.
So we tend to have a little bitmore manpower in areas where
(06:33):
you know you can get strongerdata based on the fact that you
have, you know, four or fivetimes the number of providers
dealing with a particular partof orthopedics.
Dr. Lundy (06:42):
Right right, you and I were recently at the 90th
anniversary of the AmericanBoard of Orthopedic Surgery.
It seems kind of crazy thatthat organization's only 90
years old and as I go back tothe history, of course I can
point out to where the AOAactually formed, the AAOS and
the ABOS.
But as we were at the ABOS 90thanniversary, you and I both
(07:06):
heard about the futures of boardcertification and how AI and
big data will be eventuallybrought into that.
How do you feel that big data,artificial intelligence, machine
learning and such is going toimpact us in the near and the
far future, in your opinion?
Dr. Sebastianelli (07:23):
You know, I think it's a great question and
it's clearly something that hasmultiple avenues of analysis.
Dr. Lundy (07:28):
While you're at it, I'll ask you to boil the ocean.
Dr. Sebastianelli (07:31):
I understand that's like you know tell me
about the universe.
Dr. Lundy (07:34):
Yeah, there you go.
Dr. Sebastianelli (07:36):
You know, I think what we really need to
factor in, that we haven't yetfully understood is, you know,
the transition of manpower overthe last 20 years and what the
full-time equivalent in 2025will use, say, or 2024 now, is
what that full-time equivalentis relatively speaking to what
(07:57):
it was in 2015, 2000,.
So forth.
Going back, you know thebalance of work that is being
sort of sought after, the holygrail of what makes a good
career versus what makes a, youknow, a bad career in the sense
of time and effort and thosekind of things, and it's a very
delicate balance.
(08:17):
So you know, what a provideryou know in 2025 is going to be
like remains to be seen andthey're beyond right.
So residencies are you know,they're beholden to ACGME
criteria in the sense of dutyhours and so forth.
And things change and you know,you look at not that we're doing
it wrong, it's just that it'schanging.
(08:38):
And the population, mygeneration, is sort of skewing
things to the right in a senseof you know, disease-related
problems such as hip fracture,hip osteoarthritis and knee
osteoarthritis, and they'regoing to just multiply the
number of cases by factors oftwo or three over the next 25 to
(08:58):
30 years.
Well, we're not certainlytraining a whole bunch of more
people and we're certainly nottraining a whole bunch of people
that are going to work at 1.0relative to what it was in 2000.
So there's a different balancehere that we have to figure out.
And then we're dealing withsort of the aging population and
(09:19):
what's happening there and howwe assess, you know, individuals
like myself or those older thanme in the future.
You know there's obviously thatconcern about discrimination
and how to manage that, and so Ithink we need to come up with
some form of board recognitionof, in the sense of maintenance
(09:40):
of certification, how we come upwith the ability to assess a
surgeon's skills over time andas they go from you know, their
third decade to their fourthdecade, to the fifth decade,
what is changing.
You know, cognitively, what'schanging physically and
physiologically that allows themto maintain their productivity.
You know some industries mandateretirement.
(10:02):
You know healthcare should notmandate retirement but needs to
somehow come up with the rightkind of way to assess
individuals before they get tothose ages where now you can
sort of you have to confrontthat discrimination based on the
fact that somebody has moregray hair and so forth.
So it's a fine balance right.
(10:22):
We need to recognize ourmanpower is going to be stressed
because the volume is going tobe higher and we need to
recognize that our manpower willbe stressed because some
physicians are going to workinto a longer career than some.
And we need to be able toassess everybody, whether it's
in their first decade of theircareer or their fourth decade of
their career.
And we need to be able toassess everybody, whether it's
in their first decade of theircareer or their fourth decade of
(10:44):
their career.
And we need to make it fair andwe need to make it just and
equitable and recognize that amandated retirement because of
age 70 is really not appropriate.
Dr. Lundy (10:55):
Right, yeah, I was about to ask you about workforce
issues.
Are there other futuristicideas that you have in terms of
workforce?
You covered it prettyextensively there, but are there
other things in terms of theworkforce itself?
Dr. Sebastianelli (11:08):
Well, I think you know we have.
We did have the need to creategender equity in our specialty,
despite the fact that we'restill, you know, heavily leaning
towards one demographic, whitemale.
The last five years inparticular, we've escalated the
number of women significantly inthe residency programs and now
(11:32):
are graduating into boardcertification.
So that's a really encouragingstatistic and it sort of still
needs a ton of work, right.
We still need to get intominorities and so forth so that
we get a better diversity andtry to minimize the social
determinants of health ordisease that we miss because
(11:53):
we're not identifyingnecessarily with our patients as
well as we should.
We're not getting, you know,black and brown individuals into
orthopedics as frequently as weshould.
We're not getting, you knowblack and brown individuals into
orthopedics as frequently as weshould.
So you know, we've done a goodjob with women, but we need to
get better with minorities inother ways as well, and those
kinds of things will help createbetter balance to healthcare
(12:14):
and create better identification, you know, with physicians and
patients' relationships thaneven though the best intentions
sometimes create misconceptionsbecause you're not quite
identified with the individualyou're treating.
So very important to recognizethat and again, the balance of
work-life balance and thosekinds of issues.
(12:36):
You know, I think I saw astatistic where 40% of the women
in medicine don't workfull-time and about 20% of the
males in medicine don't workfull-time as of 2024.
Well, that skips back to thatworkforce issue that I alluded
to earlier.
We need to figure out what thefull-time equivalent is for 2025
(12:59):
and beyond, because we haven'tdone a good job with that and in
order to maintain that balancebetween what is perceived as the
right work-life balance versusoverworking needs to be defined,
and we haven't defined that yet.
Dr. Lundy (13:15):
What you say just leads directly into scope of
practice issues, right?
I mean, if I remember, a fewyears ago there was the question
that orthopedic surgeons numberone did not want to take call
but number two did not wantanybody else fixing fractures
and it's like, look y'all, it'sone or the other.
We either fix the fractures orwe let somebody else do it.
What's it going to be?
So?
(13:36):
Do you have any thoughts on asworkforce matures, as the future
rolls out, is there going to beloosening a scope of practice?
There are certain physiciansthat may have a big crunch.
I firmly believe that radiologyand pathology are highly at
risk with AI to being replacedby computers and they may find
(14:01):
radiologists can do some reallycool things and they might be
able to do what I do.
Any thoughts on scope ofpractice?
Dr. Sebastianelli (14:06):
Yeah, you know, and I've actually floated
this by you know, fellow boardmembers, sort of in a very
informal way.
You know I've mentioned it evenas far back as Shep Hurwitz
when he was the executivedirector.
Certainly, david Martin, youknow we spend a lot of time
training our graduates.
You know our residents havefive years, probably four and a
(14:29):
half, of doing orthopedicsurgery and then they become
board certified and as soon asthey sort of get that big
certificate, all of a suddenthey migrate towards those
things that they like to do andthings that they don't like to
do.
Right, and the one thing that Isort of maybe we can consider
is that until they get past thatfirst 10 years, sort of as a
(14:52):
pay it forward kind of processor proposition, you know,
certain types of cases shouldcontinue to be done by
orthopedic surgeons in its basicfracture care and community
support and a sense of coveringan ER and those kind of things.
It's really hard to sort ofthink that everybody's going to
(15:14):
come out and do nothing.
But you know, outpatientsurgery after being trained for
five, you know, for five yearsand maybe six years or seven
years if they've done one or twofellowships.
So it's hard, it's hard againto sort of create that manpower
balance and I'm not saying thatpeople aren't entitled to sort
of develop social specialties Idon't want this to be taken the
(15:34):
wrong way but in the sense ofutilizing your manpower as most
productively, efficiently and asskillfully as possible, if
you've been trained to do someof these things, you should do
it and you should continue to doit until you get past a certain
point in your career where nowthose behind you can now bring
up the energy that starts todwindle as we get a little bit
(15:55):
grayer and longer in the tooth.
Dr. Lundy (15:57):
Right.
One thing that I've alwaysadmired and enjoyed about the
AOA is that it was in dramatic,conscious distinction to most of
the activities that I did overon the academy side, because in
the advocacy realm I dealt witha lot of scope of practice,
compensation, a lot of moreprotection kind of things,
whereas AOA is kind of lookingat more.
(16:18):
I'm not being critical becausethose are very important things,
but they're very lofty things.
But acknowledging that the AOAdoesn't focus on a lot of those
things, do you have any thoughtson the future in terms of
compensation of the workforce?
Certainly it's.
You know we got to becompensated for what we do and
(16:40):
how the changes in the entirefuture will affect that.
Dr. Sebastianelli (16:45):
Yeah, and you know I actually mentioned this.
You know my presidential address, you know, two years ago in
June, where all three arms oforthopedics are crucial to work
together in a way, in a sense ofsort of assessing critical
issues, trying to incorporateeducation into leadership
development and the criticalissues that are in front of us.
(17:08):
You know the ABOS needs to sortof develop that minimum sort of
expectation of what it needs tobe a certified orthopedic
surgeon so we protect the public.
And then the advocacy effortsand the scope of size of the AOS
is just, they're just so muchbigger right that you know we
need all three arms to sort oflobby in ways that we stick to
(17:31):
our lanes and use our strength.
And certainly AOS has a muchmore influential, you know,
presence in Washington and statecapitals and so forth than AOA
or ABOS will ever have.
Nor should necessarily thosetwo organizations be involved
the same way as AOS is.
But all three need to worktogether and clearly, you know,
(17:53):
with resources being squeezedand revenue being tightened and
you know margins being sort oftrimmed up to the bare minimum,
unfortunately, we need to havemore direct influence on what's
happening in Washington at afederal level, so that that's
where the AOS is going to bereally, really important.
Dr. Lundy (18:30):
Right, yeah, and that was the center of my lane
through my stuff over there.
I agree, 100% may be in thefuture, do you?
And understanding to what yousaid earlier, with the changes
in workforce and what does theorthopedic surgeon 25, 30 years
from now look like?
We're kind of making thosefolks now.
So what should we be lookingfor?
Dr. Sebastianelli (18:52):
Well, I think , I think you know it all comes
down to, I think, emotionalintelligence and really picking.
Well, I think we need to pickbetter before we ever get them
into the orthopedic residency.
So it really starts way back incollege and getting into
medical school and making surewe're picking the right people
to go into medicine, because itreally, you know, we can all
(19:13):
talk about work-life balance buthealthcare is, it's a calling,
it's not a job, and you sort ofhave to have a little bit of
that sort of that ingrained inyour thought process.
You know it's hard to sort ofwalk away from something in the
middle of, you know, a disastermedically.
You know you want to have thatsort of that ability, that
(19:35):
innate care, to sort of stickaround and try to see it through
.
So I think we need to be betterat judging emotional
intelligence, picking ourcandidates better, but, more
importantly, when we do findthat we've had a problem, we
need to somehow either remediateit or identify a way to sort of
release that individual intoanother pathway, because if it's
(19:57):
not going to work, it's notgoing to work, whether it's
failure at year two or failureat year five and after they've
been certified.
In practice.
We all saw that, you know, as,as board members, doing our
credentials work and so forth,where we, where we just you know
what.
Where did this fall off thetrack and probably should have
been picked up in medical school?
(20:18):
And so we sort of need torealize that we again have to
develop fair assessments and becareful and obviously not
over-assess or over-penalizesituations.
But if we can't remediatethings early on, it just
continues to develop in theircareer.
But you know, with that said, wecan use things like artificial
(20:40):
intelligence to take away someof the administrative burden or
the regulatory required to do.
Now, whether it's ACGME relatedor even, you know, medical
health system related, there arethings that all of us have to
(21:13):
do every year to sort of meetcorporate compliance and this
compliance and that compliance.
Well, that all takes time, andso we can't dilute the necessary
development of the clinicalskills by having time taken away
by other things.
So I think we need to be alittle bit more efficient, a
little bit more dependent onsome of the automated things
(21:33):
that we not every health systemhas developed yet.
You know, some of the biggersystems probably have it, you
know, like Mayo and so forth,but we're just not in that realm
right now unanimously acrosshealthcare.
Dr. Lundy (21:45):
Right, absolutely Well, my friend, everything we
have talked about matters fornothing, not one bit, if we fail
in what the AOA does best,which is the development of
leadership.
Everything we've talked aboutin the future doesn't matter,
and as former chair of thecouncil on advocacy, I can see
(22:06):
how the government would love totake over what we do as a
profession.
And if we're going to maintainourselves as a profession and
continue to develop our uniquespecialty as we move into the
future, it is absolutelyrequisite that we have high
levels of efficient and capableorthopedic surgeon leaders.
So, with that, how are wedeveloping the leaders for the
(22:28):
future in orthopedics,especially through the AOA?
Dr. Sebastianelli (22:31):
I think you know we have come to the
realization that in order for usto do that, we need to get back
into the C-suite, and so weneed to identify segments of our
specialty.
Certain percentage of us need tosort of not only utilize the
skills we have clinically butalso utilize some of the skills
(22:54):
we have politically andadministratively and start to
train those individuals anddevelop coursework.
You know, through the AOA andthe critical issues, to maybe
try to get some of oursymposiums that specifically
embellish our younger leaders tosort of take an interest in
this and to sort of recognizethat those that get to the top
(23:19):
do have a skill set that noteverybody has.
They need to use that to sortof help embellish the
development of the specialtyitself in general.
You know they're not only sortof getting there individually
and becoming successful, butalso utilizing that knowledge
and database to sort of take theentire department or the entire
(23:40):
health systems division oragain department of whatever
specialty maybe, but orthopedicsin general and specifically.
You know, as we're speakinghere, it needs to sort of get
more people into the C-suite, nodoubt about it.
Dr. Lundy (23:54):
Very good Any specific programs within the AOI
you see as beingtransformational as we move into
the future here.
Dr. Sebastianelli (24:01):
I think we've developed, you know, the APEX
program.
We try to get you knowindividuals even earlier with
the resident leaderships forumand try to get you know those
PGY-4s and 5s that get into thatprogram, interested in
understanding that.
You know patient care is theNorth Star, the patient's the
North Star, but that North Starhas rays that go off in the
(24:22):
different directions andadministration is one of those
directions and leadership inthat area by a clinician means
more when they understand whatis involved to take care of a
patient with a difficult problem.
You know the patient has adiagnosis but they're not the
disease, they're a patient thatstill has needs and wants and
(24:43):
sort of family issues.
Only a clinician reallyunderstands that.
Administrators don't understandthat and so having more
clinicians in that space andperforming in those areas is
really, really important.
So whether it's the ELF or, youknow, the Emerging Leaders
Forum or the Resident LeadersForum or APEX, those areas
(25:05):
really hone in on having youngphysicians and developing
physicians understand howimportant that is to their
career and sort of moving thespecialty forward.
Dr. Lundy (25:16):
Very good.
Well, we've covered a whole lotof things.
Is there any other insight intothe future of orthopedics that
you've gleaned in your time inleadership in the AOA?
Dr. Sebastianelli (25:43):
something.
We should also recognize thateven though, again, we may, we
may not necessarily havesucceeded in the way we wanted
to, we own the outcome.
We should analyze the outcomeand we should find value in the
outcome.
And every situation has value,whether, whether you've
succeeded or whether you did notsucceed.
I won't use the word failure,but you know, you learn from it
and and you and you move on andyou analyze how it could have
(26:03):
been done differently or how itcould have been, even though you
may have achieved the goal,done it better, with less sort
of pain to others or lessexpense.
You know and sort of analyzethe true value, what it was and
how to get there, and sort ofreserve the resources so that it
could be again moved into thefuture and help others.
(26:26):
So we don't want to succeed andsort of exhaust our resources.
We want to succeed and preserveresources and utilize them for
other goals in the future.
Dr. Lundy (26:36):
Well, thank you very much and I'd just like to, if
y'all don't know, wayneSpassionelli, he is an
absolutely fantastic gentleman.
I've always been impressed byyour graciousness, both when you
first met my wife and yougraciously dealt with her very
aggressive University of Georgiafootball taunting you as the
Penn State doctor.
(26:57):
You handled her with absolutefinesse and grace.
And then, after your teampounded my Auburn Tigers, both
in Happy Valley and down inAlabama, you were such a
gracious winner after that.
So I can't emphasize enoughwhat a pro you are and how lucky
we were to have you as ourpresident of the AOA.
So, dr Spacinelli, thank youvery much for being on the
podcast, sir, and appreciateyour time.
Dr. Sebastianelli (27:28):
Thank you so much for the invitation and
certainly want to identify yoursignificant role in orthopedics,
not only as a physician leaderin your large group in Georgia,
but what you did for the stateof Georgia and your leadership
there, and ultimately as anAmerican Board of Orthopedic
Surgery member and for AOS andnow working with us in the AOA.
We look forward to great thingsin the future.
Dr. Lundy (27:42):
Well, thank you very much.
My friend Appreciate you and Ihope that y'all will join us
again for more additions in thefuture of orthopedic surgery
podcast series.
Thank you,
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 onthe vast spectrum of change that
will occur as the futurereveals itself.
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 WayneSebastianelli.
Dr Sebastionelli is the KalanickProfessor in Orthopedics,
medical Director of Penn StateSports Medicine, associate Chief
(01:03):
Medical Officer of Center ofPenn State Sports Medicine,
associate chief medical officerof Center County, penn State
Health and the associate deanfor clinical affairs at the
University Park Regional Campus.
He went to medical school atthe University of Rochester, did
his residency at Rochester andthen did his fellowship at the
Milton Hershey Medical Centerand then went on to become, and
(01:25):
eventually become, the teamdoctor for Penn State University
.
He's currently a director ofthe American Board of Orthopedic
Surgery and the immediate pastpresident, which is the 135th
president of the AmericanOrthopedic Association, dr
Sebastian Nelly.
Thank you and welcome to thepodcast, sir.
Dr. Sebastianelli (01:44):
Happy to be here, Douglas.
Very, very good to be with youand spend some time trying to
hash out some of these issues.
Dr. Lundy (01:50):
And so Wayne and I have known each other for quite
a while through the ABOS andthrough the AOA and absolutely
love Wayne and his company andhis lovely wife and just being
friends and talking throughdifferent and complex things
with them.
And Wayne's got a very uniqueperspective because as the past
president of the AmericanOrthopedic Association he sat in
(02:11):
a very specific and uniqueposition to view the future of
orthopedic surgery that few ofus will ever have and certainly
didn't have last year as he waspresident, certainly through the
American Orthopedic Association, then also through Carousel and
dealing with the otherpresidents of the
English-speaking orthopedicorganization.
So, Wayne, based on yourperspective from that, can you
(02:34):
tell us, sir, what your thoughtsare on the future in
orthopedics, either short-termor long-term, how you see it?
Dr. Sebastianelli (02:40):
Sure, doug, you know it's obviously not
something that is going to be.
Sure Doug, you know it'sobviously not something that is
going to be settled by one man'sthoughts or one man's opinion,
but there are multiple thingsthat need to be considered, as
(03:02):
we we need to somehow blendeverything together with the
power of artificial intelligenceand the power of computer
systems to try to generate thebest possible solutions from big
data.
As I was working through someof this over the presidential
line and ultimately through thetravel of the carousel, you can
(03:26):
see that the problems are pretty, you know, consistent
throughout every country that wevisited, and training certainly
is an issue in the sense of howwe best train our residents and
our successors to sort ofbecome the stewards of
orthopedic care in the next 30to 40 years to become the
(03:46):
stewards of orthopedic care inthe next 30 to 40 years.
Dr. Lundy (03:51):
So thank you for that .
Now, as you interacted with thepresidents of the other
orthopedic organizations acrossthe English-speaking world, did
you see anything unique orinnovative that one of the other
organizations was doing thatperhaps we should consider?
Or did anything come up whereyou were like, wow, that's a
really good idea, we should dothat at Penn State and hopefully
across the US.
Dr. Sebastianelli (04:08):
Yeah, I think you know the big data
acquisition that England has iscertainly powerful and you know
their registries are reallyreally quite sophisticated and
New Zealand has really benefitedfrom that connection with the
United Kingdom and how they'veincorporated their registries as
well.
But when you put it into thescope of what you know they're
(04:31):
dealing with and what we'redealing with and the size
differences, you can understandwhy it's a little bit easier for
a country like New Zealand inparticular to sort of organize
things in a very, veryregimented way.
There's not as many sort ofbodies of influence than you
know in a country of New Zealandsize as there would be in the
United States.
So it's a little bit easier tomanage some of the opinions and,
(04:54):
again, some of thepersonalities that we're doing,
what needs to be in the registry, how to manage it, how to fund
it.
You know those kind of thingsare very, very important.
Dr. Lundy (05:04):
Are Great Britain's registries as comprehensive as
ours, or more so, or how doesthat look?
Dr. Sebastianelli (05:11):
Well, I think it's been done for a lot longer
period of time and I do thinkthat you know their control of
the primary care system and thespecialty system is a little bit
more sophisticated in ways thatI think.
You know the American model isa little bit different and not a
lot of practitioners want tohave that necessarily national
control over their practice.
(05:32):
So it's sort of like looking atannual wellness visits today
for our primary care docs andwhat has to go into you know,
the documentation of that visitand how it gets categorized.
Well, you know England's beendoing that for you know, a lot
longer than we have and from theperspective of managing
orthopedic maladies, wecertainly have done it for, you
(05:53):
know, an extended period of timerelatively speaking to us.
Dr. Lundy (05:57):
So the Academy has not only got the AJRR, but it's
also shoulder and elbow traumatumor.
I'm probably missing somethingin there.
Does the great Britain systemcapture all that, or are they
just limited to joints?
Dr. Sebastianelli (06:09):
No, I think they're doing it for just about
everything.
You know.
Pediatric data is really strong.
I do think that they'reprobably not as sub-specialized
in ways as we are, like the ninesub-specialties of orthopedics
probably aren't as deeplytraveled as they are in the
United States.
They just don't have the samevolume of providers that we have
.
So we tend to have a little bitmore manpower in areas where
(06:33):
you know you can get strongerdata based on the fact that you
have, you know, four or fivetimes the number of providers
dealing with a particular partof orthopedics.
Dr. Lundy (06:42):
Right right, you and I were recently at the 90th
anniversary of the AmericanBoard of Orthopedic Surgery.
It seems kind of crazy thatthat organization's only 90
years old and as I go back tothe history, of course I can
point out to where the AOAactually formed, the AAOS and
the ABOS.
But as we were at the ABOS 90thanniversary, you and I both
(07:06):
heard about the futures of boardcertification and how AI and
big data will be eventuallybrought into that.
How do you feel that big data,artificial intelligence, machine
learning and such is going toimpact us in the near and the
far future, in your opinion?
Dr. Sebastianelli (07:23):
You know, I think it's a great question and
it's clearly something that hasmultiple avenues of analysis.
Dr. Lundy (07:28):
While you're at it, I'll ask you to boil the ocean.
Dr. Sebastianelli (07:31):
I understand that's like you know tell me
about the universe.
Dr. Lundy (07:34):
Yeah, there you go.
Dr. Sebastianelli (07:36):
You know, I think what we really need to
factor in, that we haven't yetfully understood is, you know,
the transition of manpower overthe last 20 years and what the
full-time equivalent in 2025will use, say, or 2024 now, is
what that full-time equivalentis relatively speaking to what
(07:57):
it was in 2015, 2000,.
So forth.
Going back, you know thebalance of work that is being
sort of sought after, the holygrail of what makes a good
career versus what makes a, youknow, a bad career in the sense
of time and effort and thosekind of things, and it's a very
delicate balance.
(08:17):
So you know, what a provideryou know in 2025 is going to be
like remains to be seen andthey're beyond right.
So residencies are you know,they're beholden to ACGME
criteria in the sense of dutyhours and so forth.
And things change and you know,you look at not that we're doing
it wrong, it's just that it'schanging.
(08:38):
And the population, mygeneration, is sort of skewing
things to the right in a senseof you know, disease-related
problems such as hip fracture,hip osteoarthritis and knee
osteoarthritis, and they'regoing to just multiply the
number of cases by factors oftwo or three over the next 25 to
(08:58):
30 years.
Well, we're not certainlytraining a whole bunch of more
people and we're certainly nottraining a whole bunch of people
that are going to work at 1.0relative to what it was in 2000.
So there's a different balancehere that we have to figure out.
And then we're dealing withsort of the aging population and
(09:19):
what's happening there and howwe assess, you know, individuals
like myself or those older thanme in the future.
You know there's obviously thatconcern about discrimination
and how to manage that, and so Ithink we need to come up with
some form of board recognitionof, in the sense of maintenance
(09:40):
of certification, how we come upwith the ability to assess a
surgeon's skills over time andas they go from you know, their
third decade to their fourthdecade, to the fifth decade,
what is changing.
You know, cognitively, what'schanging physically and
physiologically that allows themto maintain their productivity.
You know some industries mandateretirement.
(10:02):
You know healthcare should notmandate retirement but needs to
somehow come up with the rightkind of way to assess
individuals before they get tothose ages where now you can
sort of you have to confrontthat discrimination based on the
fact that somebody has moregray hair and so forth.
So it's a fine balance right.
(10:22):
We need to recognize ourmanpower is going to be stressed
because the volume is going tobe higher and we need to
recognize that our manpower willbe stressed because some
physicians are going to workinto a longer career than some.
And we need to be able toassess everybody, whether it's
in their first decade of theircareer or their fourth decade of
their career.
And we need to be able toassess everybody, whether it's
in their first decade of theircareer or their fourth decade of
(10:44):
their career.
And we need to make it fair andwe need to make it just and
equitable and recognize that amandated retirement because of
age 70 is really not appropriate.
Dr. Lundy (10:55):
Right, yeah, I was about to ask you about workforce
issues.
Are there other futuristicideas that you have in terms of
workforce?
You covered it prettyextensively there, but are there
other things in terms of theworkforce itself?
Dr. Sebastianelli (11:08):
Well, I think you know we have.
We did have the need to creategender equity in our specialty,
despite the fact that we'restill, you know, heavily leaning
towards one demographic, whitemale.
The last five years inparticular, we've escalated the
number of women significantly inthe residency programs and now
(11:32):
are graduating into boardcertification.
So that's a really encouragingstatistic and it sort of still
needs a ton of work, right.
We still need to get intominorities and so forth so that
we get a better diversity andtry to minimize the social
determinants of health ordisease that we miss because
(11:53):
we're not identifyingnecessarily with our patients as
well as we should.
We're not getting, you know,black and brown individuals into
orthopedics as frequently as weshould.
We're not getting, you knowblack and brown individuals into
orthopedics as frequently as weshould.
So you know, we've done a goodjob with women, but we need to
get better with minorities inother ways as well, and those
kinds of things will help createbetter balance to healthcare
(12:14):
and create better identification, you know, with physicians and
patients' relationships thaneven though the best intentions
sometimes create misconceptionsbecause you're not quite
identified with the individualyou're treating.
So very important to recognizethat and again, the balance of
work-life balance and thosekinds of issues.
(12:36):
You know, I think I saw astatistic where 40% of the women
in medicine don't workfull-time and about 20% of the
males in medicine don't workfull-time as of 2024.
Well, that skips back to thatworkforce issue that I alluded
to earlier.
We need to figure out what thefull-time equivalent is for 2025
(12:59):
and beyond, because we haven'tdone a good job with that and in
order to maintain that balancebetween what is perceived as the
right work-life balance versusoverworking needs to be defined,
and we haven't defined that yet.
Dr. Lundy (13:15):
What you say just leads directly into scope of
practice issues, right?
I mean, if I remember, a fewyears ago there was the question
that orthopedic surgeons numberone did not want to take call
but number two did not wantanybody else fixing fractures
and it's like, look y'all, it'sone or the other.
We either fix the fractures orwe let somebody else do it.
What's it going to be?
So?
(13:36):
Do you have any thoughts on asworkforce matures, as the future
rolls out, is there going to beloosening a scope of practice?
There are certain physiciansthat may have a big crunch.
I firmly believe that radiologyand pathology are highly at
risk with AI to being replacedby computers and they may find
(14:01):
radiologists can do some reallycool things and they might be
able to do what I do.
Any thoughts on scope ofpractice?
Dr. Sebastianelli (14:06):
Yeah, you know, and I've actually floated
this by you know, fellow boardmembers, sort of in a very
informal way.
You know I've mentioned it evenas far back as Shep Hurwitz
when he was the executivedirector.
Certainly, david Martin, youknow we spend a lot of time
training our graduates.
You know our residents havefive years, probably four and a
(14:29):
half, of doing orthopedicsurgery and then they become
board certified and as soon asthey sort of get that big
certificate, all of a suddenthey migrate towards those
things that they like to do andthings that they don't like to
do.
Right, and the one thing that Isort of maybe we can consider
is that until they get past thatfirst 10 years, sort of as a
(14:52):
pay it forward kind of processor proposition, you know,
certain types of cases shouldcontinue to be done by
orthopedic surgeons in its basicfracture care and community
support and a sense of coveringan ER and those kind of things.
It's really hard to sort ofthink that everybody's going to
(15:14):
come out and do nothing.
But you know, outpatientsurgery after being trained for
five, you know, for five yearsand maybe six years or seven
years if they've done one or twofellowships.
So it's hard, it's hard againto sort of create that manpower
balance and I'm not saying thatpeople aren't entitled to sort
of develop social specialties Idon't want this to be taken the
(15:34):
wrong way but in the sense ofutilizing your manpower as most
productively, efficiently and asskillfully as possible, if
you've been trained to do someof these things, you should do
it and you should continue to doit until you get past a certain
point in your career where nowthose behind you can now bring
up the energy that starts todwindle as we get a little bit
(15:55):
grayer and longer in the tooth.
Dr. Lundy (15:57):
Right.
One thing that I've alwaysadmired and enjoyed about the
AOA is that it was in dramatic,conscious distinction to most of
the activities that I did overon the academy side, because in
the advocacy realm I dealt witha lot of scope of practice,
compensation, a lot of moreprotection kind of things,
whereas AOA is kind of lookingat more.
(16:18):
I'm not being critical becausethose are very important things,
but they're very lofty things.
But acknowledging that the AOAdoesn't focus on a lot of those
things, do you have any thoughtson the future in terms of
compensation of the workforce?
Certainly it's.
You know we got to becompensated for what we do and
(16:40):
how the changes in the entirefuture will affect that.
Dr. Sebastianelli (16:45):
Yeah, and you know I actually mentioned this.
You know my presidential address, you know, two years ago in
June, where all three arms oforthopedics are crucial to work
together in a way, in a sense ofsort of assessing critical
issues, trying to incorporateeducation into leadership
development and the criticalissues that are in front of us.
(17:08):
You know the ABOS needs to sortof develop that minimum sort of
expectation of what it needs tobe a certified orthopedic
surgeon so we protect the public.
And then the advocacy effortsand the scope of size of the AOS
is just, they're just so muchbigger right that you know we
need all three arms to sort oflobby in ways that we stick to
(17:31):
our lanes and use our strength.
And certainly AOS has a muchmore influential, you know,
presence in Washington and statecapitals and so forth than AOA
or ABOS will ever have.
Nor should necessarily thosetwo organizations be involved
the same way as AOS is.
But all three need to worktogether and clearly, you know,
(17:53):
with resources being squeezedand revenue being tightened and
you know margins being sort oftrimmed up to the bare minimum,
unfortunately, we need to havemore direct influence on what's
happening in Washington at afederal level, so that that's
where the AOS is going to bereally, really important.
Dr. Lundy (18:30):
Right, yeah, and that was the center of my lane
through my stuff over there.
I agree, 100% may be in thefuture, do you?
And understanding to what yousaid earlier, with the changes
in workforce and what does theorthopedic surgeon 25, 30 years
from now look like?
We're kind of making thosefolks now.
So what should we be lookingfor?
Dr. Sebastianelli (18:52):
Well, I think , I think you know it all comes
down to, I think, emotionalintelligence and really picking.
Well, I think we need to pickbetter before we ever get them
into the orthopedic residency.
So it really starts way back incollege and getting into
medical school and making surewe're picking the right people
to go into medicine, because itreally, you know, we can all
(19:13):
talk about work-life balance buthealthcare is, it's a calling,
it's not a job, and you sort ofhave to have a little bit of
that sort of that ingrained inyour thought process.
You know it's hard to sort ofwalk away from something in the
middle of, you know, a disastermedically.
You know you want to have thatsort of that ability, that
(19:35):
innate care, to sort of stickaround and try to see it through
.
So I think we need to be betterat judging emotional
intelligence, picking ourcandidates better, but, more
importantly, when we do findthat we've had a problem, we
need to somehow either remediateit or identify a way to sort of
release that individual intoanother pathway, because if it's
(19:57):
not going to work, it's notgoing to work, whether it's
failure at year two or failureat year five and after they've
been certified.
In practice.
We all saw that, you know, as,as board members, doing our
credentials work and so forth,where we, where we just you know
what.
Where did this fall off thetrack and probably should have
been picked up in medical school?
(20:18):
And so we sort of need torealize that we again have to
develop fair assessments and becareful and obviously not
over-assess or over-penalizesituations.
But if we can't remediatethings early on, it just
continues to develop in theircareer.
But you know, with that said, wecan use things like artificial
(20:40):
intelligence to take away someof the administrative burden or
the regulatory required to do.
Now, whether it's ACGME relatedor even, you know, medical
health system related, there arethings that all of us have to
(21:13):
do every year to sort of meetcorporate compliance and this
compliance and that compliance.
Well, that all takes time, andso we can't dilute the necessary
development of the clinicalskills by having time taken away
by other things.
So I think we need to be alittle bit more efficient, a
little bit more dependent onsome of the automated things
(21:33):
that we not every health systemhas developed yet.
You know, some of the biggersystems probably have it, you
know, like Mayo and so forth,but we're just not in that realm
right now unanimously acrosshealthcare.
Dr. Lundy (21:45):
Right, absolutely Well, my friend, everything we
have talked about matters fornothing, not one bit, if we fail
in what the AOA does best,which is the development of
leadership.
Everything we've talked aboutin the future doesn't matter,
and as former chair of thecouncil on advocacy, I can see
(22:06):
how the government would love totake over what we do as a
profession.
And if we're going to maintainourselves as a profession and
continue to develop our uniquespecialty as we move into the
future, it is absolutelyrequisite that we have high
levels of efficient and capableorthopedic surgeon leaders.
So, with that, how are wedeveloping the leaders for the
(22:28):
future in orthopedics,especially through the AOA?
Dr. Sebastianelli (22:31):
I think you know we have come to the
realization that in order for usto do that, we need to get back
into the C-suite, and so weneed to identify segments of our
specialty.
Certain percentage of us need tosort of not only utilize the
skills we have clinically butalso utilize some of the skills
(22:54):
we have politically andadministratively and start to
train those individuals anddevelop coursework.
You know, through the AOA andthe critical issues, to maybe
try to get some of oursymposiums that specifically
embellish our younger leaders tosort of take an interest in
this and to sort of recognizethat those that get to the top
(23:19):
do have a skill set that noteverybody has.
They need to use that to sortof help embellish the
development of the specialtyitself in general.
You know they're not only sortof getting there individually
and becoming successful, butalso utilizing that knowledge
and database to sort of take theentire department or the entire
(23:40):
health systems division oragain department of whatever
specialty maybe, but orthopedicsin general and specifically.
You know, as we're speakinghere, it needs to sort of get
more people into the C-suite, nodoubt about it.
Dr. Lundy (23:54):
Very good Any specific programs within the AOI
you see as beingtransformational as we move into
the future here.
Dr. Sebastianelli (24:01):
I think we've developed, you know, the APEX
program.
We try to get you knowindividuals even earlier with
the resident leaderships forumand try to get you know those
PGY-4s and 5s that get into thatprogram, interested in
understanding that.
You know patient care is theNorth Star, the patient's the
North Star, but that North Starhas rays that go off in the
(24:22):
different directions andadministration is one of those
directions and leadership inthat area by a clinician means
more when they understand whatis involved to take care of a
patient with a difficult problem.
You know the patient has adiagnosis but they're not the
disease, they're a patient thatstill has needs and wants and
(24:43):
sort of family issues.
Only a clinician reallyunderstands that.
Administrators don't understandthat and so having more
clinicians in that space andperforming in those areas is
really, really important.
So whether it's the ELF or, youknow, the Emerging Leaders
Forum or the Resident LeadersForum or APEX, those areas
(25:05):
really hone in on having youngphysicians and developing
physicians understand howimportant that is to their
career and sort of moving thespecialty forward.
Dr. Lundy (25:16):
Very good.
Well, we've covered a whole lotof things.
Is there any other insight intothe future of orthopedics that
you've gleaned in your time inleadership in the AOA?
Dr. Sebastianelli (25:43):
something.
We should also recognize thateven though, again, we may, we
may not necessarily havesucceeded in the way we wanted
to, we own the outcome.
We should analyze the outcomeand we should find value in the
outcome.
And every situation has value,whether, whether you've
succeeded or whether you did notsucceed.
I won't use the word failure,but you know, you learn from it
and and you and you move on andyou analyze how it could have
(26:03):
been done differently or how itcould have been, even though you
may have achieved the goal,done it better, with less sort
of pain to others or lessexpense.
You know and sort of analyzethe true value, what it was and
how to get there, and sort ofreserve the resources so that it
could be again moved into thefuture and help others.
(26:26):
So we don't want to succeed andsort of exhaust our resources.
We want to succeed and preserveresources and utilize them for
other goals in the future.
Dr. Lundy (26:36):
Well, thank you very much and I'd just like to, if
y'all don't know, wayneSpassionelli, he is an
absolutely fantastic gentleman.
I've always been impressed byyour graciousness, both when you
first met my wife and yougraciously dealt with her very
aggressive University of Georgiafootball taunting you as the
Penn State doctor.
(26:57):
You handled her with absolutefinesse and grace.
And then, after your teampounded my Auburn Tigers, both
in Happy Valley and down inAlabama, you were such a
gracious winner after that.
So I can't emphasize enoughwhat a pro you are and how lucky
we were to have you as ourpresident of the AOA.
So, dr Spacinelli, thank youvery much for being on the
podcast, sir, and appreciateyour time.
Dr. Sebastianelli (27:28):
Thank you so much for the invitation and
certainly want to identify yoursignificant role in orthopedics,
not only as a physician leaderin your large group in Georgia,
but what you did for the stateof Georgia and your leadership
there, and ultimately as anAmerican Board of Orthopedic
Surgery member and for AOS andnow working with us in the AOA.
We look forward to great thingsin the future.
Dr. Lundy (27:42):
Well, thank you very much.
My friend Appreciate you and Ihope that y'all will join us
again for more additions in thefuture of orthopedic surgery
podcast series.
Thank you,
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