September 12, 2024 • 37 mins
Curious about how the future of orthopaedic surgery scholarly publications is shaping up? This episode features a deep dive with Marc F. Swiontkowski, MD, FAOA who provides an authoritative look at the challenges and opportunities facing the field. From the unintended consequences of open access mandates leading to a surge in subpar journals and paper mills, to the crucial rise in retracted manuscripts due to poor peer review, Dr. Swiontkowski explores every avenue. Also covered is the role of hybrid open access models and the complexities surrounding preprint servers, especially in the wake of the COVID-19 pandemic. This is an unmissable conversation that underscores the need for rigorous peer review and global cooperation to maintain the integrity of orthopaedic research.
In another compelling segment, the pitfalls and limitations of using large clinical databases and registries in medical research is assessed. Learn how missing data and skewed populations can skew your conclusions and why it’s crucial to approach these resources with a critical eye. The misuse of statistical methods by some researchers to chase positive associations without a clear research question, and how this can dilute scientific rigor is also discussed. Finally, how academic journals may inflate their impact factors and the transformative—and sometimes troubling—role of AI in academic publishing is explored. This episode is packed with invaluable insights for anyone vested in the future of orthopaedic surgery research and publications.
Mark as Played
Transcript
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 of
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 forthe podcast series.
Joining us today is Dr MarkSwinkowski.
Dr Swinkowski received hismedical degree from the
University of SouthernCalifornia School of Medicine.
(01:03):
He completed his internship andresidency training at the
University of Washington andthen went on to Davos,
switzerland, where he completeda research fellowship at the
Laboratory for ExperimentalSurgery.
He began his work as associateprofessor at the Vanderbilt
University, where he helpedestablish the state of
Tennessee's first level onetrauma center.
(01:24):
Dr Swierkowski then moved tothe University of Washington as
professor of orthopedic surgeryand chief of orthopedic surgery
at Harborview Medical Center inSeattle from 1988 to 1997.
From September of 1997 throughOctober of 2007, he held the
position of professor andchairman of the Department of
Orthopedic Surgery at theUniversity of Minnesota.
(01:46):
Dr Swinkowski has also beenpresident of the Orthopedic
Trauma Association, president ofthe Mid-American Orthopedic
Association and president of theAmerican Orthopedic Association
, in addition to serving on theboard of directors of the
American Board of OrthopedicSurgery.
So, dr Swankowski, welcome tothe podcast series, sir.
Speaker 3 (02:08):
Thank you, Dr Lundy.
Speaker 2 (02:09):
Happy to be here.
And then also, I did notmention that you also served in
the role as editor-in-chief ofthe Journal of Bone and Joint
Surgery until very recently.
Isn't that true that?
Speaker 3 (02:21):
is true, a 10-year term from 2014 to January 1,
2024, where I handed the reinsover to my esteemed colleague,
Dr Mohit Bhandari.
Speaker 2 (02:33):
Very good, so I can't think of anybody that would be
better suited to talk about thefuture of our academic journals
and the work that goes intothese journals and how this will
impact our profession.
So thank you for talking to usabout this.
Speaker 3 (02:51):
My pleasure.
Speaker 2 (02:52):
Now we had briefly discussed ahead of time.
A great way to probably startthis out is to talk about the
issues with open access, and Iknow we talked to him.
I heard you speak at theAmerican Orthopedic Association
meeting very recently and StLouis about this.
What are your thoughts on openaccess?
How has that affected ourprofession and where do you see
that going?
Speaker 3 (03:13):
That's a huge topic, one we could spend an entire
hour or two on it as a mandate,initially in Europe and then
across the pond in North Americaand Canada, from federal
governments who were trying tomake their funded research
(03:34):
accessible to all researchersworldwide.
In other words, if individualsdidn't have access, through a
paywall, to a specific journal,they couldn't access the
research.
So it became a funding mandatethat all of their publications
should be available freely andimmediately after publication,
(03:57):
to acknowledge the contributionsof their funded research, but
also to speed up the exchange ofinformation and make it more
fluid.
Unfortunately, the wholeconcept became hijacked, if you
will, as so many forwardthinking and good ideas do, by
(04:18):
nefarious motivations, and ithas resulted in a huge number of
journals that are really notproviding adequate peer review
or oversight and paper mills,and resulted in large batches of
published manuscripts beingretracted.
(04:38):
There's a group that's formedthat's called Retraction Watch,
and they provide charts whichshows the near 45-degree angle
escalation of the number ofmanuscripts being retracted on
an annual basis because offalsified information that
hasn't undergone peer review.
It's all about cash forpublication, and it has
(05:01):
contaminated the literature withfaulty information, and so the
whole open access initiative hasbeen sidelined and is under
extreme scrutiny now byknowledgeable individuals
worldwide who really are seeing,unfortunately, the downside
being higher than the upside.
(05:23):
Now all scholarly publicationsof reputation now have
opportunities where you can haveany article that's published in
so-called hybrid model where anarticle can be immediately
available.
So CORE and BJJ and JBJS we allhave mechanisms where an
(05:43):
individual, or particularly anindividual with sponsored
research, can pay an extracouple thousand dollars to have
it immediately available.
Hybrid open access be the modelfor open access, rather than
(06:08):
having specific open accessjournals that only have article
processing charges or APCs or anindividual pays to have the
manuscript be open access.
It would be a way to eliminatethese shadow journals and paper
mills etc.
But that's going to take nearglobal governmental support and
(06:31):
it's a slow process to educatepeople about the problems with
open access.
I know I'm taking a long time toanswer this first issue, but
the one thing that's possiblyworse than open access is the
phenomenon where manuscripts areput up prior to peer review and
(06:54):
they're citable and what thathas resulted in is dual copies
of manuscripts being availableto individuals worldwide.
Often these are called preprintservers.
Often the original posting on apreprint server, even though
(07:15):
proven in subsequent peer reviewto be fallacious or in error
are never taken down.
Oftentimes the most, I guess,outrageous and headline-grabbing
research findings are picked upby the lay press and then
brought out to the publicwithout appropriate peer review,
and it has resulted in allkinds of problems, the most
(07:39):
notable of which is in the areaof the early treatment paradigms
for COVID, where false researchclaims small cohort series are
picked up and published as truthand they're never really taken
down after exposed to rigorouspeer review and found out to be
false.
So it's a combination of theopen access plus preprint
(08:03):
servers which are reallydegrading the overall scholarly
publication world and are ofgrave importance to orthopedic
surgery and the future of ourspecialty.
Speaker 2 (08:16):
I was a little surprised when you brought this
up at AOA, in that I always sawthose solicitations from these
open access journals to bealmost like internet scams.
Almost it was like, hey, wewant you to publish in here and,
by the way, if you send thischeck, we'll publish anything.
It almost seemed like get awayfrom me.
This isn't legit.
But what you're saying is thisis a real threat.
(08:39):
That's actually.
A lot of people are submittingtheir work to yeah.
Absolutely.
Speaker 3 (08:46):
And you're an educated consumer of scholarly
work.
And there are many youngindividuals who are feeling
under pressure to have hugeincreases in the number of
citations in their CVs and theywill jump at these particularly
when they can get around areally rigorous peer review to
(09:09):
gain a publication.
And that leads us to perhapsanother topic and that's the
misappropriation of drivetowards having CVs that have
numbers count, the numbers kindof approaches, which is
unfortunately motivating a lotof our younger colleagues who
feel that's what matters, whenit really shouldn't be what
(09:33):
matters.
What should matter is theimpact of your work and
participating in high qualityresearch designs that can
actually favorably impact carein a way that undergoes the most
rigorous peer review.
And that's a hard thing to getthrough to our younger
(09:56):
colleagues that it's not aboutnumbers.
It should be about doingquality work with fewer numbers
that are actually going toimpact care work, the fewer
numbers that are actually goingto impact care.
Speaker 2 (10:11):
But are the committees that work on academic
advancement?
Are they contributing to thismotivation of the younger
physicians, or is this allintrinsic to them?
Speaker 3 (10:17):
I have been interested in this issue for a
long period of time and I serveon our medical school's
promotion and tenure committeeand I will point out that it is
a problem in most medicalschools around the United States
in having an adequate number ofsurgeons to serve on these
committees.
The fact of the matter is thatan academic orthopedic surgeon's
(10:40):
life is a very different lifethan an academic pediatrician's
life.
Many of the pediatricians Ihate to pick on those my
daughter is a pediatrician,she's a very good one happens to
be a Peds GI person but theiracademic life dominates over
their clinical productivity lifeand, as all of our listeners
(11:03):
know, that's not the case in ourspecialty.
All of us in our field arequite busy clinicians and it is
more difficult for us to produceadequate time to focus on
producing scholarly work.
So that's one thing.
The other thing is that a verypositive thing is I think our
(11:24):
field of orthopedic surgery hasadvanced the other surgical
fields in terms of the qualityof clinical research we publish
in terms of prospective trials,randomized trials, multi-center
trials, collaborative work, workresearch registries, etc.
(11:51):
And it is hard for other groupsof people practicing in other
fields to understand thedifficulty and the amount of
time that is involved withparticipating in a multi-center
trial, resulting in apublication that may have 24
authors to it.
So, all of this, I hope that myplea reaches some years of more
(12:12):
senior members of our communitythat will actually seek out
opportunities to participate inthe peer review process of these
dossiers that are comingforward and really serving to
protect and advance our surgicalcolleagues as they go through
the academic process, because itdoes really result in a numbers
(12:32):
game for particularly basicscience researchers and other
fields, when that's a totallydifferent world.
So you're right, some of thepromotion and tenure pressures
are contributing to this notionand we, as a community of
horsepeed leaders, need to helpdispel those misconceptions.
Speaker 2 (12:52):
That's very helpful.
Now, when we were at the AOAmeeting and you were presenting
this information, you alsobrought up the idea of these
large administrative databasesthat seem to be generating
significant and I think you usedthe word that these are
shortcuts to getting a lot ofmanuscripts submitted.
Can you talk about that alittle bit?
Speaker 3 (13:14):
I'd be delighted to, because in my decade as
editor-in-chief we saw from veryfew publications into massive
numbers of publications usingthese administrative databases,
to the point where we made itthe target of a retreat.
We did and we published asupplement which I think I have
(13:36):
back here on my desk.
It is Sorry, doug, that's notwhat I have written in my tongue
, but we produced in 2022, asupplement from a day and a half
symposium that we did at theAcademy's headquarters in
Chicago on the use of theseadministrative databases,
(13:57):
listing in a very detailedmanner the limitations of every
single one limitations of everysingle one as well as we listed
comprehensively all of theregistries around the world and
their individual limitations totry to inform the research
community about what thosedatabases can do and what they
(14:20):
should not attempt to do.
There are deficiencies acrossthe board in every single one
because of the lack ofspecificity on important
clinical characteristics of thepatients that are included in
those databases and registries,which limit the value of any
(14:42):
conclusion that they come to.
There is simply no way tocontrol for the factors that
influence clinical decisionmaking and unfortunately again,
I hate to bring up our youngermembers of our community, but
many members- see this as aquote quick and dirty unquote
(15:02):
unquote way of getting apublication because you can sit
in your barcode lounger andchurn through data to produce
some finding.
That is no way should it orcould it impact actual care For
anybody that's listening.
Please do not embark on suchwork unless you understand the
(15:27):
limitations of the database youare trying to use and what it
can and cannot do.
And please understand that ifyou try to submit these to
higher impact journals, you'regoing to be successful in the
case of JBGS, in single-digitpercentages because of these
(15:48):
deficiencies, and I believethat's true for the other more
higher-impact journals in ourfield.
Speaker 2 (15:55):
So this includes stuff like the ChemZeta, the
Medicare claims databases andthings like that.
Speaker 3 (16:00):
Correct, correct, they're.
Often.
What happens is a youngerinvestigator who has access to
these files will start aphishing expedition looking for
statistical associations andthen publish it as a so-called
finding.
Asked a focused question inadvance and started using
(16:25):
statistical methodology toliterally fish for positive
associations.
Speaker 2 (16:31):
And the registries like HARR and the other more
advanced registries could do thesame thing.
Speaker 3 (16:37):
Absolutely.
There are profound limitations,not only with lack of clinical
characteristics affectingdecision-making, but also
missing data, and many of thesedatabases do not have
information across allsocioeconomic groups, they do
not have information across allmodes of employment, et cetera,
(17:00):
et cetera.
They're skewed populations andit is risky to make any sort of
conclusion.
I would say that on the upside,they are reasonable ways to
generate hypotheses to be testedwith higher level research
design.
So it's not all bad.
Nothing is, or very few thingsare really all bad, but
(17:23):
unfortunately they're soattractive because it's so easy
to sit in the comfort of yourliving room next to a
refrigerator and do work insteadof doing the hard approach of
actually formulating a researchquestion, collecting pilot data
and testing a hypothesis, whichtakes much more work but has
(17:47):
much more profound impact on theprogress of our field.
Speaker 2 (17:51):
Now, as I've been more associated with our
journals you and I are both intrauma so we both read the same
things become more accustomed tothe whole concept of impact
factor.
How do you feel impact factoraffects our journals now and
then?
Where do you see this moving inthe future?
Speaker 3 (18:10):
Well, the impact factor is generated by a company
called Clarivate and it's asimple formula of you take a
published manuscript and youassess, you measure how many
times it's been cited over atwo-year period of time and then
you do the multiplication togenerate an impact factor.
You have to remember thatorthopedic surgery, even though
(18:35):
we're an influential group,we're a relatively small
percentage of the overallphysician community less than 3%
.
So there literally is no waythat any orthopedic journal is
going to generate an impactfactor that's going to come
close to a general medicaljournal like the New England
(18:57):
Journal or Lancet or DJJ, one ofthose we're.
Just we're too small a group.
So that's factor number one.
Factor number two is,unfortunately, many of our
colleagues in our field havelearned how to game the system,
(19:17):
and you can game the system bypublishing editorials that cite
the research that's published inyour journal, and that is one
thing that we never did at JBJSand I hope we would never do
that.
So you can artificially inflatean impact factor by
gamesmanship.
You can also inflate the impactfactor by limiting the number
(19:41):
of publications you have.
So if you're really interestedin producing a high number we
take the example of JBGS, whichI know the best would never
publish an ethics manuscript,because ethics manuscripts
simply do not get cited,similarly with educational
related manuscripts very rarelycited.
(20:03):
So you can game the system inmultiple ways to produce a
bigger number, but that reallydoes not favorably impact the
progress of our field by any way, shape or form.
Speaker 2 (20:15):
And so it is a fact of life.
Speaker 3 (20:18):
It is a calculation used to generate an age factor,
which those of our listeners whoare in academia will understand
that the dean's office in anymedical school knows your H
factor, which is basically acitation indice, and it is a
metric that is commonlyunderstood and used.
But I'm hopeful that perhaps bythis podcast we might educate
(20:43):
our community a little bit morethat it should never be the
end-all be-all, because it'sgameable, fungible if you will,
and it really doesn't tell thewhole story about how an
individual site, a publicmanuscript or a journal impacts
the progress of a field.
So I don't think it's going togo away anytime soon.
There's a lot of pressure onClarivate to innovate better
(21:05):
ways to measure the impact, butwe need to all understand a
little bit about how it's gainedand what it is and what it
isn't.
Speaker 2 (21:20):
And many times we hear from the pundits about the
issues with artificialintelligence and how they can be
used to mislead the public inwhat certain candidates may or
may not say or what they may ormay not have done.
We also know this isextensively pervading the
academic spaces as well, and Iknow that y'all wrote a
(21:42):
editorial you and Seth Leopoldand Mr Haddad, I believe, and
was there somebody else too?
I can't remember.
Speaker 3 (21:51):
Yeah, linda Sandel, from the Journal of Orthopedic
Research.
Yeah, that's right, I'm sorry.
Speaker 2 (21:56):
Wrote an article about, or an editorial about, ai
.
What are y'all's thoughts aboutwhere AI is?
Where's it going?
How's it impacting our journals?
Speaker 3 (22:07):
It was a rather straightforward and limited
editorial.
We basically agreed on twobasic principles One is that an
AI engine cannot be an author,and two was that when individual
authors use these tools largelanguage model tools being the
(22:28):
most prominent they need tostate in the manuscript where
and how it was used.
We did an experiment which youmay have heard me talk about,
where I worked with somecolleagues at Harvard and asked
them to generate a couple ofRCTs, which they did.
Each one took two minutes,using ChatGBT and unbeknownst to
(22:53):
our editorial board.
We sent them through theprocess and one of them got
through the peer review process,which was quite alarming to all
of us.
We used the opportunity at lastyear's editorial board meeting
to go through this and we havelearned some important issues
(23:13):
about the weaknesses of thesetools to date, being that they
do perseverate around,particularly the bibliography.
There can be journal nameswhich don't exist, the citations
are presented in nonsensicalways.
(23:34):
So we've not only educated oureditors, but we've educated our
staff to really comb through thebibliography to look for hints
that there may be somethinggoing on, so that we can direct
a query to the author askingthem to state whether or not
(23:55):
such a tool was used.
There is a arms race, if youwill, going on amongst the very
energetic and well-funded AIcommunity between those
generating new and innovativetools and those generating the
ways to identify the use ofthose tools, so it is a rapidly
(24:20):
evolving field.
I think there is potential forhuge positive impact in the use
of these tools Because, as I'msure our audience knows, where
the weak spot is what is theinformation being used to inform
(24:43):
the tool.
So, if you can inform an AIsearch engine with only high
quality, highly peer-reviewedinformation, you have tools that
can be used to be quite usefulat point-of-care decision-making
, etc.
But it's all about the datathat's being fed to the tool.
(25:07):
And if we can control thoseprocesses and have vetted
curated information being addedinto the tools.
I think there's a very bigupside, but myself and my
successor and those who also areeditors in the field, we're
really concerned about thepotential for just flat out
(25:29):
falsified information gettingthrough, about the potential for
just flat out falsifiedinformation getting through,
which has happened as you know,highly publicized cases in other
fields and I just hope and prayit never happens to us in
orthopedics.
Speaker 2 (25:42):
But you do see this as becoming a greater issue,
even though the policing effortsof this has increased.
On the flip side side of this,the penitence of ai into this
work is going to just only goget greater and greater correct.
Speaker 3 (25:58):
Both the negative and the positive are escalating at
a rapid race that's a bit gloomy.
Speaker 2 (26:05):
Now I do have my copy of jbjs.
I just got this morning here onthe desk and I know that y'all
and Journal of Orthopedic Trauma, jaos the big ones that I go
through all the time arestarting to move, or have moved
for quite a while, to more ofthe virtual format.
The paper edition has becomethinner.
I think I've heard y'all saythat the advertisements or the
(26:29):
marketing efforts within thejournal are becoming more
difficult.
Where do you see that headed?
Speaker 3 (26:35):
Yeah, that whole business of the print ad revenue
declining happened during mydecade as editor-in-chief.
We had a two-year period oftime where the revenue from the
print ads declined by two-thirds.
Revenue from the print adsdeclined by two-thirds and that
(26:57):
was a major revenue source forall scholarly publications.
And if you look now, there'svery few pages in any of the
print journals that you see.
So the thought was early on thatwe'll make it up on the ads on
the websites and that reallyhasn't turned out to be anywhere
close to replacing the revenueduring print ads.
(27:18):
And it's for multiple reasonsconsolidation among our
orthopedic vendors you know nowonly really five major implant
manufacturers, etc.
And the feeling of these groupsthe manufacturers that they
have direct access to theirsurgeons for innovation and
decision-making regarding what'sto be used, et cetera, so they
(27:40):
don't have to go throughjournals or scholarly societies
or whatever to have access tothe more limited number of
people making decisions aboutproducts the more limited number
of people making decisionsabout products so it places real
economic pressure on scholarlypublications to find ways to
break even.
(28:09):
Jbjs is sound fiscally throughthe hard work of the editorial
board and the trustees and theinnovative, creative people that
work at the journal outstandingyoung individuals who are
thinking every day about ways toimprove the product and find
ways to generate revenue.
So it is stable but thepressures are huge.
It has been long predicted thatthe print will go away, but yet
(28:32):
every time we've done surveys ofour readers.
The last time I saw data and Iknow we're serving again very
soon but the last time I sawdata would have been three years
ago and it was still.
The majority of surgeons underthe age of 45 preferred the
print version and that's becausethey can fold it up in their
(28:54):
lab coat and if they have fiveminutes while the patient is
getting the spinal, they canopen it up without logging on
and they can look at an articleand read an abstract in much
faster time than they can to logon and look something up.
I don't think it's going to becompletely gone in my
(29:16):
professional lifetime.
Could be wrong about that andmaybe AI tools will supplant
that.
Hard to know, but it's notgoing to be gone soon.
Speaker 2 (29:28):
Fascinating.
We've seen this big change inour career with any other
aspects that you see in the next10, 20 years or it's very
difficult to predict that farout in terms of where our
scholarly journals will beheaded or changes.
If we were to suddenly open ajournal in 20 years, what it may
look differently from today.
Any Any other thoughts?
Speaker 3 (29:51):
I think that the ability to integrate more
precise data collection effortsinto the electronic medical
record are going to increase inthe next five to 10 years so
that you will be able toprospectively include data
(30:16):
that's important for patientdecision making so you can deal
with the limitations of thecurrent administrative data sets
.
I think they're going toincrease making the use of huge
data sets of actual patient careinformation to be analyzable I
(30:38):
don't think that's a word To beable to be analyzed in a
positive way to get moredetailed information on huge
populations of patients.
So I think that is going toimpact our ability to advance
knowledge to a much greaterdegree.
There will always be a need forrandomized trials because that
(31:01):
is the most efficient way thatyou can deal with bias, and I
think that we are going to getsmarter about where we wish to
invest those precious dollars toanswer appropriate questions.
I've been involved, as havemany of my colleagues in
(31:29):
orthopedic trauma, in manymulti-center trials and, quite
(32:17):
frankly, the ones that we havehad funded I'm not sure they're
the ideal clinical questions to.
I believe that the leadershipof NIH and NIAMS, which is our
agency, would welcome processesto help focus topics which would
have greater clinical impactthan the way we do it now, which
is it's really about thequality of the clinical question
decided upon by a study sectionrather than a large group of
peers.
So expanded utility of actualpatient records.
Continued use of control trialsin a more focused area and I
think ways to add outcomes datato registries which should prove
to get patients incentivized toprovide dollars would be the
(32:41):
third one.
I have offered suggestionsabout how to get patients
incentivized, like if you'llprovide a validated survey to us
every year that we send to youvia text, you will get a 10% off
of your deductible.
Ways that you can incentivizepatients to give us that
(33:04):
information that would be thethird one.
Speaker 2 (33:08):
That's fantastic.
Lastly, on a personal note,I've heard you say this before
and you're, you've been held.
You've, your self-disciplinehas held you to this.
You were chair at Minnesota for10 years, right.
Speaker 3 (33:23):
Yes.
Speaker 2 (33:24):
And you were editor of JBJS for 10 years and I've
heard you say this before thatyou feel that a 10 year, 10, 10
year tenure is, in your and yourwisdom, was an adequate use of
your expertise and your energy.
And after 10 years you feltthat I'm putting words in your
mouth, that you felt that wouldwane and you should step aside
(33:46):
and let somebody else take over,that you've held down.
Did you say that?
But you've actually done that.
I remember hearing you say thatit's just inspiring to actually
you've actually said it andthen you actually did it.
I'm just opening the floor tothat.
Speaker 3 (34:00):
Yeah, it takes a lot of energy.
You've led big organizations.
You're no stranger to how muchenergy it takes to lead
physicians, and whenever you geta new position you get
resources I call them bulletsand you spend the bullets on
initiatives that are importantto you and I do not know of any
(34:23):
experience I've ever had whereyou can say after I think it's
actually eight years that youhave many bullets left.
You've spent the goodwill,you've driven the things that
are important to you and it isjust worked out in my experience
that at beginning, at eightyears, you ought to be trying to
help the organization selectyour successor, and
(34:45):
organizations are alwaysimproved by having a different
perspective and a new leader atthe table.
I think that many people hangon to these positions because
they're kind of afraid to leavesomething that they know and can
(35:05):
control and venture intosomething different.
But I myself and I know many ofus in orthopedic surgery I've
always felt the best part wastaking care of patients.
So I never had any fear ofactually going back and being
what I call a real doctor,because that's still the best
part.
You know, sitting around atable and listening to
(35:28):
colleagues whine about thedonuts in the doctor's lounge is
quite energy draining and it'salways been very reinforcing to
have the fallback position to bewhat I enjoy the most.
Yeah, I think that the 10-yearrule is good.
It's good for an individual.
(35:48):
It's also great for anorganization.
Many deans don't want to changeat that and I had to.
I actually had a signed letterwhen I took the position that I
wouldn't do it for more than 10years.
I made the dean sign it and Ihad to use it on the on that
dean successor to to get theprocess done.
But in many organizations areimproved by an internal
(36:13):
selection, which is number one,less expensive.
Number two the successor isgoing to get an infusion of
resources which benefitseverybody in the group and it's
low risk because everybody knowsthe person and they know what's
going to happen tomorrow.
So I'm a huge advocate of the10-year rule and I wish more
people in our field would jumpon board.
(36:36):
But I haven't seen too manypeople willing to do it, but for
me it's been very energizingevery time I did it.
Speaker 2 (36:46):
Wow.
Okay, it's been an absolutepleasure to discuss these issues
today with Dr Mark Swinkowski,who is the immediate past editor
of the Journal of Bone andJoint Surgery and past AOA
president.
Dr Swinkowski, thank you verymuch for being on the podcast
series, sir.
Speaker 3 (37:03):
Thank you very much, Dr Lundy, for the invitation.
I've enjoyed chatting with you.
Speaker 2 (37:06):
Yes, sir, and y'all look forward to future AOA,
future and orthopedic podcastseries episodes.
Thank you.
Welcome to the AOA Future in Orthopedic Surgery
podcast series.
This AOA podcast series willfocus on the future of
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 forthe podcast series.
Joining us today is Dr MarkSwinkowski.
Dr Swinkowski received hismedical degree from the
University of SouthernCalifornia School of Medicine.
(01:03):
He completed his internship andresidency training at the
University of Washington andthen went on to Davos,
switzerland, where he completeda research fellowship at the
Laboratory for ExperimentalSurgery.
He began his work as associateprofessor at the Vanderbilt
University, where he helpedestablish the state of
Tennessee's first level onetrauma center.
(01:24):
Dr Swierkowski then moved tothe University of Washington as
professor of orthopedic surgeryand chief of orthopedic surgery
at Harborview Medical Center inSeattle from 1988 to 1997.
From September of 1997 throughOctober of 2007, he held the
position of professor andchairman of the Department of
Orthopedic Surgery at theUniversity of Minnesota.
(01:46):
Dr Swinkowski has also beenpresident of the Orthopedic
Trauma Association, president ofthe Mid-American Orthopedic
Association and president of theAmerican Orthopedic Association
, in addition to serving on theboard of directors of the
American Board of OrthopedicSurgery.
So, dr Swankowski, welcome tothe podcast series, sir.
Speaker 3 (02:08):
Thank you, Dr Lundy.
Speaker 2 (02:09):
Happy to be here.
And then also, I did notmention that you also served in
the role as editor-in-chief ofthe Journal of Bone and Joint
Surgery until very recently.
Isn't that true that?
Speaker 3 (02:21):
is true, a 10-year term from 2014 to January 1,
2024, where I handed the reinsover to my esteemed colleague,
Dr Mohit Bhandari.
Speaker 2 (02:33):
Very good, so I can't think of anybody that would be
better suited to talk about thefuture of our academic journals
and the work that goes intothese journals and how this will
impact our profession.
So thank you for talking to usabout this.
Speaker 3 (02:51):
My pleasure.
Speaker 2 (02:52):
Now we had briefly discussed ahead of time.
A great way to probably startthis out is to talk about the
issues with open access, and Iknow we talked to him.
I heard you speak at theAmerican Orthopedic Association
meeting very recently and StLouis about this.
What are your thoughts on openaccess?
How has that affected ourprofession and where do you see
that going?
Speaker 3 (03:13):
That's a huge topic, one we could spend an entire
hour or two on it as a mandate,initially in Europe and then
across the pond in North Americaand Canada, from federal
governments who were trying tomake their funded research
(03:34):
accessible to all researchersworldwide.
In other words, if individualsdidn't have access, through a
paywall, to a specific journal,they couldn't access the
research.
So it became a funding mandatethat all of their publications
should be available freely andimmediately after publication,
(03:57):
to acknowledge the contributionsof their funded research, but
also to speed up the exchange ofinformation and make it more
fluid.
Unfortunately, the wholeconcept became hijacked, if you
will, as so many forwardthinking and good ideas do, by
(04:18):
nefarious motivations, and ithas resulted in a huge number of
journals that are really notproviding adequate peer review
or oversight and paper mills,and resulted in large batches of
published manuscripts beingretracted.
(04:38):
There's a group that's formedthat's called Retraction Watch,
and they provide charts whichshows the near 45-degree angle
escalation of the number ofmanuscripts being retracted on
an annual basis because offalsified information that
hasn't undergone peer review.
It's all about cash forpublication, and it has
(05:01):
contaminated the literature withfaulty information, and so the
whole open access initiative hasbeen sidelined and is under
extreme scrutiny now byknowledgeable individuals
worldwide who really are seeing,unfortunately, the downside
being higher than the upside.
(05:23):
Now all scholarly publicationsof reputation now have
opportunities where you can haveany article that's published in
so-called hybrid model where anarticle can be immediately
available.
So CORE and BJJ and JBJS we allhave mechanisms where an
(05:43):
individual, or particularly anindividual with sponsored
research, can pay an extracouple thousand dollars to have
it immediately available.
Hybrid open access be the modelfor open access, rather than
(06:08):
having specific open accessjournals that only have article
processing charges or APCs or anindividual pays to have the
manuscript be open access.
It would be a way to eliminatethese shadow journals and paper
mills etc.
But that's going to take nearglobal governmental support and
(06:31):
it's a slow process to educatepeople about the problems with
open access.
I know I'm taking a long time toanswer this first issue, but
the one thing that's possiblyworse than open access is the
phenomenon where manuscripts areput up prior to peer review and
(06:54):
they're citable and what thathas resulted in is dual copies
of manuscripts being availableto individuals worldwide.
Often these are called preprintservers.
Often the original posting on apreprint server, even though
(07:15):
proven in subsequent peer reviewto be fallacious or in error
are never taken down.
Oftentimes the most, I guess,outrageous and headline-grabbing
research findings are picked upby the lay press and then
brought out to the publicwithout appropriate peer review,
and it has resulted in allkinds of problems, the most
(07:39):
notable of which is in the areaof the early treatment paradigms
for COVID, where false researchclaims small cohort series are
picked up and published as truthand they're never really taken
down after exposed to rigorouspeer review and found out to be
false.
So it's a combination of theopen access plus preprint
(08:03):
servers which are reallydegrading the overall scholarly
publication world and are ofgrave importance to orthopedic
surgery and the future of ourspecialty.
Speaker 2 (08:16):
I was a little surprised when you brought this
up at AOA, in that I always sawthose solicitations from these
open access journals to bealmost like internet scams.
Almost it was like, hey, wewant you to publish in here and,
by the way, if you send thischeck, we'll publish anything.
It almost seemed like get awayfrom me.
This isn't legit.
But what you're saying is thisis a real threat.
(08:39):
That's actually.
A lot of people are submittingtheir work to yeah.
Absolutely.
Speaker 3 (08:46):
And you're an educated consumer of scholarly
work.
And there are many youngindividuals who are feeling
under pressure to have hugeincreases in the number of
citations in their CVs and theywill jump at these particularly
when they can get around areally rigorous peer review to
(09:09):
gain a publication.
And that leads us to perhapsanother topic and that's the
misappropriation of drivetowards having CVs that have
numbers count, the numbers kindof approaches, which is
unfortunately motivating a lotof our younger colleagues who
feel that's what matters, whenit really shouldn't be what
(09:33):
matters.
What should matter is theimpact of your work and
participating in high qualityresearch designs that can
actually favorably impact carein a way that undergoes the most
rigorous peer review.
And that's a hard thing to getthrough to our younger
(09:56):
colleagues that it's not aboutnumbers.
It should be about doingquality work with fewer numbers
that are actually going toimpact care work, the fewer
numbers that are actually goingto impact care.
Speaker 2 (10:11):
But are the committees that work on academic
advancement?
Are they contributing to thismotivation of the younger
physicians, or is this allintrinsic to them?
Speaker 3 (10:17):
I have been interested in this issue for a
long period of time and I serveon our medical school's
promotion and tenure committeeand I will point out that it is
a problem in most medicalschools around the United States
in having an adequate number ofsurgeons to serve on these
committees.
The fact of the matter is thatan academic orthopedic surgeon's
(10:40):
life is a very different lifethan an academic pediatrician's
life.
Many of the pediatricians Ihate to pick on those my
daughter is a pediatrician,she's a very good one happens to
be a Peds GI person but theiracademic life dominates over
their clinical productivity lifeand, as all of our listeners
(11:03):
know, that's not the case in ourspecialty.
All of us in our field arequite busy clinicians and it is
more difficult for us to produceadequate time to focus on
producing scholarly work.
So that's one thing.
The other thing is that a verypositive thing is I think our
(11:24):
field of orthopedic surgery hasadvanced the other surgical
fields in terms of the qualityof clinical research we publish
in terms of prospective trials,randomized trials, multi-center
trials, collaborative work, workresearch registries, etc.
(11:51):
And it is hard for other groupsof people practicing in other
fields to understand thedifficulty and the amount of
time that is involved withparticipating in a multi-center
trial, resulting in apublication that may have 24
authors to it.
So, all of this, I hope that myplea reaches some years of more
(12:12):
senior members of our communitythat will actually seek out
opportunities to participate inthe peer review process of these
dossiers that are comingforward and really serving to
protect and advance our surgicalcolleagues as they go through
the academic process, because itdoes really result in a numbers
(12:32):
game for particularly basicscience researchers and other
fields, when that's a totallydifferent world.
So you're right, some of thepromotion and tenure pressures
are contributing to this notionand we, as a community of
horsepeed leaders, need to helpdispel those misconceptions.
Speaker 2 (12:52):
That's very helpful.
Now, when we were at the AOAmeeting and you were presenting
this information, you alsobrought up the idea of these
large administrative databasesthat seem to be generating
significant and I think you usedthe word that these are
shortcuts to getting a lot ofmanuscripts submitted.
Can you talk about that alittle bit?
Speaker 3 (13:14):
I'd be delighted to, because in my decade as
editor-in-chief we saw from veryfew publications into massive
numbers of publications usingthese administrative databases,
to the point where we made itthe target of a retreat.
We did and we published asupplement which I think I have
(13:36):
back here on my desk.
It is Sorry, doug, that's notwhat I have written in my tongue
, but we produced in 2022, asupplement from a day and a half
symposium that we did at theAcademy's headquarters in
Chicago on the use of theseadministrative databases,
(13:57):
listing in a very detailedmanner the limitations of every
single one limitations of everysingle one as well as we listed
comprehensively all of theregistries around the world and
their individual limitations totry to inform the research
community about what thosedatabases can do and what they
(14:20):
should not attempt to do.
There are deficiencies acrossthe board in every single one
because of the lack ofspecificity on important
clinical characteristics of thepatients that are included in
those databases and registries,which limit the value of any
(14:42):
conclusion that they come to.
There is simply no way tocontrol for the factors that
influence clinical decisionmaking and unfortunately again,
I hate to bring up our youngermembers of our community, but
many members- see this as aquote quick and dirty unquote
(15:02):
unquote way of getting apublication because you can sit
in your barcode lounger andchurn through data to produce
some finding.
That is no way should it orcould it impact actual care For
anybody that's listening.
Please do not embark on suchwork unless you understand the
(15:27):
limitations of the database youare trying to use and what it
can and cannot do.
And please understand that ifyou try to submit these to
higher impact journals, you'regoing to be successful in the
case of JBGS, in single-digitpercentages because of these
(15:48):
deficiencies, and I believethat's true for the other more
higher-impact journals in ourfield.
Speaker 2 (15:55):
So this includes stuff like the ChemZeta, the
Medicare claims databases andthings like that.
Speaker 3 (16:00):
Correct, correct, they're.
Often.
What happens is a youngerinvestigator who has access to
these files will start aphishing expedition looking for
statistical associations andthen publish it as a so-called
finding.
Asked a focused question inadvance and started using
(16:25):
statistical methodology toliterally fish for positive
associations.
Speaker 2 (16:31):
And the registries like HARR and the other more
advanced registries could do thesame thing.
Speaker 3 (16:37):
Absolutely.
There are profound limitations,not only with lack of clinical
characteristics affectingdecision-making, but also
missing data, and many of thesedatabases do not have
information across allsocioeconomic groups, they do
not have information across allmodes of employment, et cetera,
(17:00):
et cetera.
They're skewed populations andit is risky to make any sort of
conclusion.
I would say that on the upside,they are reasonable ways to
generate hypotheses to be testedwith higher level research
design.
So it's not all bad.
Nothing is, or very few thingsare really all bad, but
(17:23):
unfortunately they're soattractive because it's so easy
to sit in the comfort of yourliving room next to a
refrigerator and do work insteadof doing the hard approach of
actually formulating a researchquestion, collecting pilot data
and testing a hypothesis, whichtakes much more work but has
(17:47):
much more profound impact on theprogress of our field.
Speaker 2 (17:51):
Now, as I've been more associated with our
journals you and I are both intrauma so we both read the same
things become more accustomed tothe whole concept of impact
factor.
How do you feel impact factoraffects our journals now and
then?
Where do you see this moving inthe future?
Speaker 3 (18:10):
Well, the impact factor is generated by a company
called Clarivate and it's asimple formula of you take a
published manuscript and youassess, you measure how many
times it's been cited over atwo-year period of time and then
you do the multiplication togenerate an impact factor.
You have to remember thatorthopedic surgery, even though
(18:35):
we're an influential group,we're a relatively small
percentage of the overallphysician community less than 3%
.
So there literally is no waythat any orthopedic journal is
going to generate an impactfactor that's going to come
close to a general medicaljournal like the New England
(18:57):
Journal or Lancet or DJJ, one ofthose we're.
Just we're too small a group.
So that's factor number one.
Factor number two is,unfortunately, many of our
colleagues in our field havelearned how to game the system,
(19:17):
and you can game the system bypublishing editorials that cite
the research that's published inyour journal, and that is one
thing that we never did at JBJSand I hope we would never do
that.
So you can artificially inflatean impact factor by
gamesmanship.
You can also inflate the impactfactor by limiting the number
(19:41):
of publications you have.
So if you're really interestedin producing a high number we
take the example of JBGS, whichI know the best would never
publish an ethics manuscript,because ethics manuscripts
simply do not get cited,similarly with educational
related manuscripts very rarelycited.
(20:03):
So you can game the system inmultiple ways to produce a
bigger number, but that reallydoes not favorably impact the
progress of our field by any way, shape or form.
Speaker 2 (20:15):
And so it is a fact of life.
Speaker 3 (20:18):
It is a calculation used to generate an age factor,
which those of our listeners whoare in academia will understand
that the dean's office in anymedical school knows your H
factor, which is basically acitation indice, and it is a
metric that is commonlyunderstood and used.
But I'm hopeful that perhaps bythis podcast we might educate
(20:43):
our community a little bit morethat it should never be the
end-all be-all, because it'sgameable, fungible if you will,
and it really doesn't tell thewhole story about how an
individual site, a publicmanuscript or a journal impacts
the progress of a field.
So I don't think it's going togo away anytime soon.
There's a lot of pressure onClarivate to innovate better
(21:05):
ways to measure the impact, butwe need to all understand a
little bit about how it's gainedand what it is and what it
isn't.
Speaker 2 (21:20):
And many times we hear from the pundits about the
issues with artificialintelligence and how they can be
used to mislead the public inwhat certain candidates may or
may not say or what they may ormay not have done.
We also know this isextensively pervading the
academic spaces as well, and Iknow that y'all wrote a
(21:42):
editorial you and Seth Leopoldand Mr Haddad, I believe, and
was there somebody else too?
I can't remember.
Speaker 3 (21:51):
Yeah, linda Sandel, from the Journal of Orthopedic
Research.
Yeah, that's right, I'm sorry.
Speaker 2 (21:56):
Wrote an article about, or an editorial about, ai
.
What are y'all's thoughts aboutwhere AI is?
Where's it going?
How's it impacting our journals?
Speaker 3 (22:07):
It was a rather straightforward and limited
editorial.
We basically agreed on twobasic principles One is that an
AI engine cannot be an author,and two was that when individual
authors use these tools largelanguage model tools being the
(22:28):
most prominent they need tostate in the manuscript where
and how it was used.
We did an experiment which youmay have heard me talk about,
where I worked with somecolleagues at Harvard and asked
them to generate a couple ofRCTs, which they did.
Each one took two minutes,using ChatGBT and unbeknownst to
(22:53):
our editorial board.
We sent them through theprocess and one of them got
through the peer review process,which was quite alarming to all
of us.
We used the opportunity at lastyear's editorial board meeting
to go through this and we havelearned some important issues
(23:13):
about the weaknesses of thesetools to date, being that they
do perseverate around,particularly the bibliography.
There can be journal nameswhich don't exist, the citations
are presented in nonsensicalways.
(23:34):
So we've not only educated oureditors, but we've educated our
staff to really comb through thebibliography to look for hints
that there may be somethinggoing on, so that we can direct
a query to the author askingthem to state whether or not
(23:55):
such a tool was used.
There is a arms race, if youwill, going on amongst the very
energetic and well-funded AIcommunity between those
generating new and innovativetools and those generating the
ways to identify the use ofthose tools, so it is a rapidly
(24:20):
evolving field.
I think there is potential forhuge positive impact in the use
of these tools Because, as I'msure our audience knows, where
the weak spot is what is theinformation being used to inform
(24:43):
the tool.
So, if you can inform an AIsearch engine with only high
quality, highly peer-reviewedinformation, you have tools that
can be used to be quite usefulat point-of-care decision-making
, etc.
But it's all about the datathat's being fed to the tool.
(25:07):
And if we can control thoseprocesses and have vetted
curated information being addedinto the tools.
I think there's a very bigupside, but myself and my
successor and those who also areeditors in the field, we're
really concerned about thepotential for just flat out
(25:29):
falsified information gettingthrough, about the potential for
just flat out falsifiedinformation getting through,
which has happened as you know,highly publicized cases in other
fields and I just hope and prayit never happens to us in
orthopedics.
Speaker 2 (25:42):
But you do see this as becoming a greater issue,
even though the policing effortsof this has increased.
On the flip side side of this,the penitence of ai into this
work is going to just only goget greater and greater correct.
Speaker 3 (25:58):
Both the negative and the positive are escalating at
a rapid race that's a bit gloomy.
Speaker 2 (26:05):
Now I do have my copy of jbjs.
I just got this morning here onthe desk and I know that y'all
and Journal of Orthopedic Trauma, jaos the big ones that I go
through all the time arestarting to move, or have moved
for quite a while, to more ofthe virtual format.
The paper edition has becomethinner.
I think I've heard y'all saythat the advertisements or the
(26:29):
marketing efforts within thejournal are becoming more
difficult.
Where do you see that headed?
Speaker 3 (26:35):
Yeah, that whole business of the print ad revenue
declining happened during mydecade as editor-in-chief.
We had a two-year period oftime where the revenue from the
print ads declined by two-thirds.
Revenue from the print adsdeclined by two-thirds and that
(26:57):
was a major revenue source forall scholarly publications.
And if you look now, there'svery few pages in any of the
print journals that you see.
So the thought was early on thatwe'll make it up on the ads on
the websites and that reallyhasn't turned out to be anywhere
close to replacing the revenueduring print ads.
(27:18):
And it's for multiple reasonsconsolidation among our
orthopedic vendors you know nowonly really five major implant
manufacturers, etc.
And the feeling of these groupsthe manufacturers that they
have direct access to theirsurgeons for innovation and
decision-making regarding what'sto be used, et cetera, so they
(27:40):
don't have to go throughjournals or scholarly societies
or whatever to have access tothe more limited number of
people making decisions aboutproducts the more limited number
of people making decisionsabout products so it places real
economic pressure on scholarlypublications to find ways to
break even.
(28:09):
Jbjs is sound fiscally throughthe hard work of the editorial
board and the trustees and theinnovative, creative people that
work at the journal outstandingyoung individuals who are
thinking every day about ways toimprove the product and find
ways to generate revenue.
So it is stable but thepressures are huge.
It has been long predicted thatthe print will go away, but yet
(28:32):
every time we've done surveys ofour readers.
The last time I saw data and Iknow we're serving again very
soon but the last time I sawdata would have been three years
ago and it was still.
The majority of surgeons underthe age of 45 preferred the
print version and that's becausethey can fold it up in their
(28:54):
lab coat and if they have fiveminutes while the patient is
getting the spinal, they canopen it up without logging on
and they can look at an articleand read an abstract in much
faster time than they can to logon and look something up.
I don't think it's going to becompletely gone in my
(29:16):
professional lifetime.
Could be wrong about that andmaybe AI tools will supplant
that.
Hard to know, but it's notgoing to be gone soon.
Speaker 2 (29:28):
Fascinating.
We've seen this big change inour career with any other
aspects that you see in the next10, 20 years or it's very
difficult to predict that farout in terms of where our
scholarly journals will beheaded or changes.
If we were to suddenly open ajournal in 20 years, what it may
look differently from today.
Any Any other thoughts?
Speaker 3 (29:51):
I think that the ability to integrate more
precise data collection effortsinto the electronic medical
record are going to increase inthe next five to 10 years so
that you will be able toprospectively include data
(30:16):
that's important for patientdecision making so you can deal
with the limitations of thecurrent administrative data sets
.
I think they're going toincrease making the use of huge
data sets of actual patient careinformation to be analyzable I
(30:38):
don't think that's a word To beable to be analyzed in a
positive way to get moredetailed information on huge
populations of patients.
So I think that is going toimpact our ability to advance
knowledge to a much greaterdegree.
There will always be a need forrandomized trials because that
(31:01):
is the most efficient way thatyou can deal with bias, and I
think that we are going to getsmarter about where we wish to
invest those precious dollars toanswer appropriate questions.
I've been involved, as havemany of my colleagues in
(31:29):
orthopedic trauma, in manymulti-center trials and, quite
(32:17):
frankly, the ones that we havehad funded I'm not sure they're
the ideal clinical questions to.
I believe that the leadershipof NIH and NIAMS, which is our
agency, would welcome processesto help focus topics which would
have greater clinical impactthan the way we do it now, which
is it's really about thequality of the clinical question
decided upon by a study sectionrather than a large group of
peers.
So expanded utility of actualpatient records.
Continued use of control trialsin a more focused area and I
think ways to add outcomes datato registries which should prove
to get patients incentivized toprovide dollars would be the
(32:41):
third one.
I have offered suggestionsabout how to get patients
incentivized, like if you'llprovide a validated survey to us
every year that we send to youvia text, you will get a 10% off
of your deductible.
Ways that you can incentivizepatients to give us that
(33:04):
information that would be thethird one.
Speaker 2 (33:08):
That's fantastic.
Lastly, on a personal note,I've heard you say this before
and you're, you've been held.
You've, your self-disciplinehas held you to this.
You were chair at Minnesota for10 years, right.
Speaker 3 (33:23):
Yes.
Speaker 2 (33:24):
And you were editor of JBJS for 10 years and I've
heard you say this before thatyou feel that a 10 year, 10, 10
year tenure is, in your and yourwisdom, was an adequate use of
your expertise and your energy.
And after 10 years you feltthat I'm putting words in your
mouth, that you felt that wouldwane and you should step aside
(33:46):
and let somebody else take over,that you've held down.
Did you say that?
But you've actually done that.
I remember hearing you say thatit's just inspiring to actually
you've actually said it andthen you actually did it.
I'm just opening the floor tothat.
Speaker 3 (34:00):
Yeah, it takes a lot of energy.
You've led big organizations.
You're no stranger to how muchenergy it takes to lead
physicians, and whenever you geta new position you get
resources I call them bulletsand you spend the bullets on
initiatives that are importantto you and I do not know of any
(34:23):
experience I've ever had whereyou can say after I think it's
actually eight years that youhave many bullets left.
You've spent the goodwill,you've driven the things that
are important to you and it isjust worked out in my experience
that at beginning, at eightyears, you ought to be trying to
help the organization selectyour successor, and
(34:45):
organizations are alwaysimproved by having a different
perspective and a new leader atthe table.
I think that many people hangon to these positions because
they're kind of afraid to leavesomething that they know and can
(35:05):
control and venture intosomething different.
But I myself and I know many ofus in orthopedic surgery I've
always felt the best part wastaking care of patients.
So I never had any fear ofactually going back and being
what I call a real doctor,because that's still the best
part.
You know, sitting around atable and listening to
(35:28):
colleagues whine about thedonuts in the doctor's lounge is
quite energy draining and it'salways been very reinforcing to
have the fallback position to bewhat I enjoy the most.
Yeah, I think that the 10-yearrule is good.
It's good for an individual.
(35:48):
It's also great for anorganization.
Many deans don't want to changeat that and I had to.
I actually had a signed letterwhen I took the position that I
wouldn't do it for more than 10years.
I made the dean sign it and Ihad to use it on the on that
dean successor to to get theprocess done.
But in many organizations areimproved by an internal
(36:13):
selection, which is number one,less expensive.
Number two the successor isgoing to get an infusion of
resources which benefitseverybody in the group and it's
low risk because everybody knowsthe person and they know what's
going to happen tomorrow.
So I'm a huge advocate of the10-year rule and I wish more
people in our field would jumpon board.
(36:36):
But I haven't seen too manypeople willing to do it, but for
me it's been very energizingevery time I did it.
Speaker 2 (36:46):
Wow.
Okay, it's been an absolutepleasure to discuss these issues
today with Dr Mark Swinkowski,who is the immediate past editor
of the Journal of Bone andJoint Surgery and past AOA
president.
Dr Swinkowski, thank you verymuch for being on the podcast
series, sir.
Speaker 3 (37:03):
Thank you very much, Dr Lundy, for the invitation.
I've enjoyed chatting with you.
Speaker 2 (37:06):
Yes, sir, and y'all look forward to future AOA,
future and orthopedic podcastseries episodes.
Thank you.
Popular Podcasts
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
The Joe Rogan Experience
The official podcast of comedian Joe Rogan.
24/7 News: The Latest
The latest news in 4 minutes updated every hour, every day.