Can orthopaedic surgeons balance the demands of their profession while navigating complex healthcare systems? Join us as we explore this and more with our special guest, Felix H. “Buddy” Savoie, III, MD, FAOA. Dr. Savoie pulls back the curtain on the dedication required in orthopedic surgery, the challenges of maintaining high standards in patient care despite restrictive regulations, and how different operational models impact the quality of care provided. This isn't just about bones and joints—it's about the heart and soul surgeons pour into their work.
Learn more about global healthcare systems in Great Britain, South Africa, Canada, Australia, and New Zealand. Discover the strengths and pitfalls of national health services and why New Zealand's system stands out for its efficiency. Dr. Savoie sheds light on the significant delays in care in the UK and Canada, and underscores the critical importance of effective communication between physicians and administrators. His insights into rural healthcare challenges, medical training methodologies, and the role of budget constraints offer a well-rounded perspective on the global state of healthcare.
Looking ahead, we discuss the future landscape of orthopaedic surgery, from the evolution of Medicare reimbursements to the potential for employment models and unionization. Dr. Savoie emphasizes the urgent need for legislative changes to ensure sustainable medical practices, while also highlighting the importance of innovation and member engagement within professional healthcare organizations. Whether you're a medical professional or an enthusiast, this episode offers valuable insights into advocacy, the economics of practice, and the evolving field of orthopaedic surgery. Tune in to gain a comprehensive understanding of the future of healthcare from one of its leading voices.
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Episode Transcript
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Speaker 2 (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 self.
We will consider changes asthey occur in the domains of
(00:44):
culture, employment, technology,scope of practice, compensation
and other areas.
My name is Doug Lundy, host forthis podcast series.
Joining us today is Dr BuddySavoie.
Dr Savoie is an internationallyrenowned expert in areas of
shoulder and elbow surgery, aswell as sports medicine.
(01:05):
He's the chairman of theDepartment of Orthopedics at the
Tulane School of Medicine andthe Ray J Haddad Professor of
Orthopedic Surgery.
In 2022, dr Savoy became the90th president of the American
Academy of Orthopedic Surgeons.
He's also been president of theAmerican Shoulder and Elbow
(01:26):
Society, the ArthroscopyAssociation of North America,
the Orthopedic Learning Centerand the Louisiana Orthopedic
Association.
He served on the boards of ANA,the International Society of
Arthroscopy, knee Surgery andOrthopedic sports medicine.
He also serves as the sportsmedicine advisory committee of
(01:48):
the Louisiana High SchoolAthletic Association.
Dr Savoie is board certified inorthopedic surgery and sports
medicine.
He's a graduate of theLouisiana State University
School of Medicine in NewOrleans.
He completed his internship andresidency at the University of
Mississippi Medical Center inJackson Mississippi.
He added additional trainingand multiple fellowships in
(02:09):
sports medicine and arthroscopyat the Medical College of
Wisconsin, the Mayo Clinic, theAO International Fellowship in
Basel, switzerland, theOrthopedic Research at Richmond,
virginia, and at Fowler KennedySports Medicine in London,
ontario.
Dr Savoie, thank you andwelcome to the podcast series,
(02:29):
sir.
Speaker 3 (02:30):
Thank you, Dr Lindy.
It's an honor to be here.
Speaker 2 (02:33):
Well, buddy, you and I have known each other well.
You are one of my favoriteleaders in orthopedic surgery
and, as you know and as wediscussed on this series, we
specifically target ourdiscussions to areas that our
speakers are specifically expertin.
However, you have had a uniqueexperience that few members of
(02:55):
our profession have had, whereasyou have sat on the perch the
absolute pinnacle of arguablythe most powerful orthopedic
organization in the UnitedStates and in much of the world,
in terms of seeing the entirespectrum, the entire scope of
orthopedic surgery, both thegood and the bad.
So, instead of targeting in onespecific area, we like in this
(03:19):
podcast right here, just to lookinto the mind of Buddy Savoie.
What was your perception ofafter sitting in that incredible
position and now having alittle bit over a year to
reflect and consider what youlearned, what you did in the
middle of all that?
Plus, you know you had to dothe carousel afterwards.
Where are we going as aprofession?
You take this anywhere.
You need to take it, becauseyour insight is going to be
(03:41):
absolutely valuable.
Speaker 3 (03:43):
I think it's a great question and it's a wonderful
concept to think about andusually when people ask me, I
sort of ask if they want thegood or the bad or really what I
think, and so you sort ofseparate fact and impression.
I will tell you that the mostwonderful thing about serving
the academy and serving ourmembership and then actually
touring around the world is themany great physicians that we
(04:05):
have.
It's impressive how, across theworld, orthopedics is just it's
got to be the best medicalsubspecialty in the world and
the people are caring, theyreally care about their patients
, they want their patients to dowell and for most of us you and
I, doug, made the same waythere's nothing that we wouldn't
(04:25):
do for our patients.
I mean, it's the extra mile,whatever we do.
You know pay scale, all theseother things just goes out the
window with the joy of takingcare of our patients, and that's
refreshing.
I can tell you that when I waspresident of the academy, there
(04:46):
was a lot of passion amongst ourmembership about things that
prevent that from happening, andyou can argue right side, left
side, up or down, however youwant to do it, it doesn't make
any difference because we allcenter on this patient care
phenomenon and how to make surethat we can continue to do it.
That being said, there arestrong headwinds around the
(05:07):
world which are quite impressive, and I gave a talk at the
British Orthopedic Associationon how to maintain excellence in
a culture that demandsmediocrity, and I think one of
the things that the AOA isfamous for is leadership, and I
think that as we do these things, maintaining that focus on
(05:28):
excellence as surgeons,excellence in patient care is
going to be harder and harder.
To sort of maintain thatrequirement.
You have folks that are tryingto standardize everything we do
in our academies.
Cpgs, clinical practiceguidelines are really designed
to help, but as these get sortof utilized by insurance
(05:48):
companies and they use it todeny care rather than as a
mechanism to create better care,that's a problem.
The academy needs data.
The registries are important,but I think our colleagues
justifiably so, fear that thatdata could be used against them.
And you know, if you have atrauma registry and maybe
everybody doesn't treat a brokenfemur the same way maybe you're
(06:11):
held accountable, but in manyways it's good but threatening
at the same time.
So I think if we're going tohave the discussion, there's a
plethora of avenues to look at.
I think, if we focus on this,how do we maintain excellence,
how do we maintain excellence intraining?
How do we instill in our youngphysicians, who are residents or
fellows, that desire and needto get better, when people are
(06:35):
putting more and more rules inplay that prevent that?
So you know, I think that anyof those topics we'd be willing
to look at the reimbursementissues, the where you operate,
how you operate, venture capitalversus private groups, versus
academics but because the sameproblem is across the board when
you look at it.
Speaker 2 (06:57):
It's very refreshing to hear your initial comments on
the quality of our colleaguesacross the planet and their
motivations therein.
Speaker 3 (07:06):
Who, and then he and ann transitioned, and so wayne
and michelle were fabulous, andyou know the way the carousel
works you drop somebody everytime, so you just get to know a
(07:28):
couple, start to enjoy them andthen they drop off and then
somebody else comes on.
So we're losing wayne andmichelle.
We're thinking, well, thiscan't be as good.
And then ann and greg van he'scome on and we spent the year
with them and I just came to theAOA meeting in St Louis, really
mostly to see Greg and Ann.
The meeting was great and theseminars were great and I
(07:50):
enjoyed all that.
But even Amy said, and my wifesaid, why are we going to this
meeting?
I said we're going to see Annand Greg and our friends and she
said you never do that.
And I said, well, I'm doing itfor this couple because not only
is she a great leader andwonderful, but we had wonderful
times together.
So I admire her, I respect her,I think her opinions are
marvelous and I learn somethingevery time I talk to her.
But just having she and Gregand sitting and visiting with
(08:13):
Amy and I was one of the joyousexperiences of the year.
It was absolutely fantastic.
Speaker 2 (08:18):
That is fantastic, and Wayne's a sports guy like
you, so it's good to be with Annwho does something.
I mean she's, so that'scompletely different.
Speaker 3 (08:27):
Yeah, so it was great .
I mean, we had a wonderful time, the folks were terrific, as
always, and you know thedifference in perspective and
especially and when we would dotalks together.
She said, well, buddyrepresents just the regular
membership in the United Statesand I represent the leadership.
She said, well, buddyrepresents just the regular
membership in the United Statesand I represent the leadership,
and you know I don't disagree atall.
I think that's true and my jobas president of the academy is
(08:47):
to take care of our folks inpractice and let them be able to
take care of their patients andanything that interfered with
that.
I think that's the academy'srole to prevent that we're
incredibly lucky that we haveAdam Brueggemann and Wayne
Johnson heading up our lobbyinggroup.
Adam's head of the Council onAdvocacy and he's taking it in a
whole different direction andWayne's trying to get more money
(09:10):
in the PAC.
I mean we've got to build alobby, we've got to protect our
practice.
Everybody knows and this willgo to the pessimistic side if
you deal with this you know ourpay on CMS pay has been
decreasing every year and theysit down and they have to do it
and they cut budget based on ourdoctors.
If you look over the last 21years our pay scale has not just
(09:32):
stayed flat, it's actuallydeclined in terms of relative
value and spending power andeverything else where our
expenses have gone up.
And that was a deal cut 20something 25, 30 years ago where
they took physicians out of thecost of living increase.
So we should right now you getpaid on CMS about $32 in RVU.
(09:55):
If you simply factor in cost ofliving over the last 21 years,
that should be $68.
And it got traded off.
The AMA did that and they regretit as well.
So it's not like oh, they're theenemy or anything, but Adam has
been forging alliances withAmerican College of Surgeons,
like you and I did on the gunissue, so where we can lobby
(10:15):
together, and then you and I andthe OTA did that one, but it's
more like OK, where does thislook at With the AMA?
Prior authorization is a bigdeal for their doctors as well
as for surgeons, so that becomesa big deal.
And Adam has forged that pathforward and it's been really
good.
We're still hoping that thingslike that, where we can lobby
together, are very important.
So it's nice to see thatmechanism start to come into
(10:38):
play.
And then you know, traveling toalmost every state in the union
over the past few years andvisiting with the doctors again,
it's so reassuring how wellthey take care of folks.
At the same time, they need toknow that they have somebody
which is the American Academy ofOrthopedic Surgeons stressing
the importance of their abilityto take care of patients and to
get all these other factors outof the way.
(10:58):
So that makes you optimisticthat maybe altogether not apart,
but altogether we can moveforward and fix some of the
problems.
Speaker 2 (11:07):
So while you are on carousel and y'all go to England
, Australia, New, Zealand whatam I missing?
Canada?
Speaker 3 (11:15):
South.
Speaker 2 (11:15):
Africa, South Africa.
That's what I was missing.
You got to see, and it's notjust hearing about it or reading
about it, you're actually inthe culture, hanging out with
their leadership, going to theirmeeting with their surgeons.
Is there any insights that yougained on the future of
orthopedic surgery just fromthat incredibly broad exposure
across the English-speakingorthopedic associations?
Speaker 3 (11:36):
Yes, very interesting National Health Service.
It's quite interesting.
The doctors and even thepatients that were working in
that system and we in the USsort of downplayed a lot, but
they actually were verysupportive of their system.
They thought that providingcare across the board to
everyone somewhat equally wasgood.
They were very frustrated bythe delays in care, about the
(11:59):
ability to take care of folksbeing trumped sometimes by
budget issues, and so it's a bigdeal for the government at that
point.
Patients are simply budgetitems and so you can go back and
do that.
Now the flip of it comes back tous as physicians are do we
really need to be doing whatwe're doing, and are we doing
the most cost-effective butefficient and best way to do it?
(12:21):
So looking at the nationalhealth service in great britain,
south africa system is verydifferent.
Canada excuse me, it's muchlike great britain, australia
and new zealand very different.
They have different methods butin general everybody is insured
some way.
But they also have the optionexcept in great britain and
canada to have private insuranceand flip out of that system.
(12:44):
And I think New Zealand andAustralia's system, where you
have a base national healthsystem in this country, would
sort of be Medicare for all,because the base system pays a
decent amount.
But you can always opt out forprivate insurance, for private
insurance, and the thing Ireally liked about New Zealand
system is that you areautomatically in the national
(13:05):
health system.
At any given time you can optout and get private insurance
and the insurer has to give itto you.
So you have home insurance, youhave car insurance and you can
go to these people and say Iwant to buy health insurance.
You don't have to tell themit's because I just tore my
rotator cuff and I need to haveit fixed and I can't wait nine
months for the National HealthService to fix it.
I got to get back to work andthey have to take you, they have
(13:27):
to insure you, they have to payfor the whatever it is that you
need and then but you have tostay and you pay the extra
premium for a full year.
You can't opt in for a monthand opt out.
So it's.
I think it makes everything abit more efficient when you can
kind of go back and forth.
(13:48):
It makes both sides better.
So it's interesting looking ateveryone and how they handle
things.
Delays in Canada and GreatBritain are are in the UK are
almost insurmountable it's ayear to get a total hip or total
knee done.
And because it's a budget itemenough.
One of my favorite questions Ithink it was in Canada, because
we opened the carousel up forquestions and this gentleman
surgeon in the audience raisedhis hand.
He says well, my administratorand I are on exactly the same
(14:09):
page about patient care and howdo we make things happen.
And so he got kind of sort ofdiffuse answers from a few
people and I said you're not onthe same page, You're not
friends.
You have to learn to speak hislanguage To him.
You are a budget cost item.
Your patients are a budget costitem because at the end of the
day he has to balance aspreadsheet.
(14:31):
So to think that even though hemay talk to you and be a really
nice guy or girl and say, yeah,I'm really worried about your
patients, At the end of the dayhe has to make his spreadsheet
balance.
So it's your job, if you wantto take care of your patients,
to learn how to speakspreadsheet mentality.
Don't go to him and say I needthese 10 things without showing
(14:52):
him how it's going to beeffective.
If you can show him that if heinvests some money in your
patients or in your care, returnon investment is going to be X
and it'll fix a column in hisspreadsheet to look better.
Could be patient satisfaction,it could be efficiency of care.
But that cost of care episode,which is where physicians lose
(15:14):
out because we think of well, Ihave a broken bone, I'm going to
fix a broken bone and then mypart's done, I'm OK.
But the budget?
People are looking at it.
While they're coming in,they're getting x-rays.
This is an ER visit.
Now you are in a CT scan, Nowyou are in an MRI scan.
Then you do an operation andnow you send them to therapy and
anesthesia charged me a lot.
They did a block and nowthey're still in therapy.
(15:36):
My episode of care was veryexpensive and then you wonder
why we don't get paid enough orother people don't, because we
don't manage that whole episodeof care.
Orthopedics to win, we're goingto have to manage the episode of
care all of it.
So that part of it was veryintriguing and in every country
that system was a problem.
Rural health care is a problem.
(15:58):
People don't want to go topractice in small towns.
Australia.
That's a devastating problem.
How do you do emergency care inrural areas when you don't have
a hospital, because peopledon't want to go to hospitals?
Also another problem you knowtrainees.
Are we training them the waywe're supposed to train them,
and are they getting to learn alot?
Now that the breadth ofknowledge you need to learn in
(16:18):
orthopedics is so big, how do weteach them every part of this,
or should we be moving them intoa more specialized training
sooner?
You know, in most of the othercountries you finish med school
and you just basically dogeneral medical care for a
couple of years and then you dogeneral surgical care for a
couple of years and then youmove into your residency and
(16:39):
then fellowship.
So they're more experiencedwhen they start, but the
experience is not necessarilygreat.
So there's a million thingswhen you look around the world
that some places could do better, and, having said that, they
all look to the US to figure outwhere the path forward is, and
so it's quite interesting andit's an awesome responsibility
to know and to try to talk aboutthis, and it was fun to talk
(17:01):
about mistakes.
We've made things we've givenup that we shouldn't have and
where we've ceded control, wherewe should be taking it back and
how?
Speaker 2 (17:07):
to make it better.
Did you get a sense of optimism, bullishness or pessimistic
bearishness from the differentsocieties, the different leaders
in the carousels of thesocieties that you visited?
So it's interesting In terms ofthe future, in terms of where
we're going.
Speaker 3 (17:24):
No, it's great, so everybody's worried about it.
Everybody looks at the downside.
It's just like in our country,and we can talk about that in a
little bit, if you want but,everybody's trying to make sure
that we can take care ofpatients and they're concerned.
They're concerned that we're nottraining a younger group of
doctors like we should, that ouryounger colleagues don't
(17:44):
necessarily have the samecommitment that we did.
And the most common thing iscall.
Our younger docs want to getpaid for call.
That's not unreasonable.
But older folks are used tojust having to take calls part
of the job.
But in any other profession ifyou have to work extra you get
paid overtime.
That's not an unreasonablething for our young doctors to
(18:07):
want that.
I mean, work-life balancedoesn't really apply to
orthopedics very well and partof that is our own fault because
we love what we do.
But I will tell you that theseyounger doctors wanting Sundays
off is not necessarily a badthing.
I mean, I grew up going tomeetings, leaving on Friday
after a full day of work and afull week of work and going to a
meeting on Friday night,saturday, sunday, getting back
(18:29):
home by 1030 or 11 o'clock,going right back to work on
Monday, and it's kind of nice tobe home on Sunday.
So I think when you look atwhere people are thinking across
the board, they worry about thefuture.
They know that some of thechanges are good, some are not
as good, but in general, mostpeople think we're going to be
okay.
The biggest question everyonehas, and the biggest concern and
(18:52):
it should be in this countrytoo is how are we going to pay
for care?
Who's going to fund the bill totake care of folks?
Because you're getting bettertreatments but those treatments
are more expensive.
You're getting more people thatare retiring from the workforce
.
Who's going to take care ofthem?
Do we have enough doctors to dothat?
Do we have enough trainees todo that?
And most every country, justlike ours, is either woefully or
(19:17):
a little bit short on trainingand getting in the number of
people you need to take care offolks.
Speaker 2 (19:23):
Fascinating.
So that was the internationalside.
You said you had some insightson the US side as well from that
.
Speaker 3 (19:29):
So the pessimistic view of the US side is that by
2028, if nothing changes withCMS, and to our private practice
colleagues and to our VC folksand our academic folks,
everything ties into Medicare.
So if you have a commercialinsurance, you have Blue Cross,
you have United, they'rerestricting you more and more
(19:49):
but their payments are usuallytied to Medicare.
In 2028, if we can't changeanything, the reimbursement for
Medicare patients, thereimbursement for Medicare
patients, which will account forprobably 50% of our country by
then, is going to cross yourexpense line.
Our expenses stay the same andreimbursement continues to drop
(20:11):
Right around 2028, that's goingto cross and you will not be
able to make a living seeingpatients because the multiples
are going to happen.
So something has to changebefore then because there's no
way to decrease your overheadenough and still take care of
folks with that amount ofreimbursement.
(20:32):
So that's why the Academy andAdam are lobbying so hard to
make that not happen.
So the pessimistic view is thatwe can't get anything across.
Congress restricts this, theydecide doctors make too much
money anyway and everybody goesto an employment model.
Well, the plus side of anemployment model is, if 85
percent of us are employed, wecan unionize.
(20:54):
We can unionize and demand abetter wage, and we can tie it
in.
I'll take a couple of years Iwent 30 or 31 before that
happens, and hopefully with goodleadership.
The problem then is you holdthe government hostage to make a
better pay and guess whatthey'll do?
They'll outlaw the union, yeah,and then we're right back where
we were, which no leverage atall in how to do it.
(21:17):
More simple thing is geteverybody to contribute to the
PAC.
Start talking to yourcongressmen and your senators
and just explain this to them ina simple term that they can
understand that I'm not going tobe able to take care of your
constituents.
Your constituents are thepeople that vote for you.
I am their doctor, I'm yourdoctor.
If you can help me throw me abone here and help us out a
(21:38):
little bit, then we can keeptaking care of these people
because those people vote.
But if I start saying that mycongressman doesn't want me to
get paid to take care of you andI can't afford to take care of
you anymore, or I'd love to seeyou as a patient, but I can only
see X number of people a daybecause that's the only time
frame they let me do it.
You know it'll be six monthsbefore I can tend to be broken
(22:00):
ankle.
That's a problem.
So it'd be very interesting tosee.
I tend to be on the optimisticside.
I think orthopedic surgeonsespecially are very creative and
will figure out a way to takecare of people.
But it's not like we're notfighting headwinds.
That would be nice not to haveRight right.
Speaker 2 (22:17):
Now, a big function or purpose or mission of the
AAOS is education.
Where do you see academyeducation moving as we move into
the future?
Speaker 3 (22:29):
So what I hope to see , and I ended up dealing with
some crises when I was presidentof the academy.
But one of my goals was first.
One was patient care, to make iteasier for our guys and girls
to take care of patients.
But the second one was to tryto improve our educational
outlook, so to speak.
And I think the academy doesbest when we do things with our
(22:49):
specialist societies and I thinkthat that comes out the best
when we partner with.
If we want to do a shouldercourse, partner with shoulder
and elbow surgery, make it veryfair for them, don't just take
over the course and run it.
You know, do a give and takekind of thing where everybody,
if the course makes money, youmake a little bit of money, if
it loses money, you lose alittle bit of money.
But I think partnering with oursubspecialty societies to
(23:12):
provide education is going to becritically important.
The second thing is I think weneed to tailor those educational
offerings to the position wherethey are.
I think that in this day andage, you know you and I learn by
getting a cadaver and going anddissecting it out, figuring out
what's going on, going to thelibrary to read a book With our
young doctors it's at the palmof their hand.
(23:35):
You ask them a question, theycan look it up right there on
their phone and give you fivereferences in a minute, so that
part of it is quicker.
They also learn by video moreso than by anything else, and I
think, changing that educationalplatform into augmented reality
, virtual reality, where theyhave goggles and they have some
haptics in their hands, it's notlike going to find a simulator
(23:57):
to work with.
They're going to have it rightthere, just like you and I are
talking on the laptop.
It'll be the same thing.
They're going to be able to dothat and you'll do really well,
and I think education will gothat way.
I think you'll see a lot ofpartnerships.
I think you'll see a lot moreaugmented reality.
I think that that's going to,unfortunately, maybe allow some
standardization, but I do thinkthe people that are coming into
(24:18):
orthopedics will be just ascreative in how they design new
solutions for patients as wewere, you know, 40 years ago.
I think all this is going toget better and better because we
have great people.
They're very smart, they learnvery quickly and I think there's
more knowledge at theirfingertips and it's easier to
access.
So I think that increasingknowledge is going to be much
(24:39):
bigger.
My biggest fear is that westandardize it across the world,
and I would not like to seethat.
I want to see creativity.
I think creativity breeds newthings which the world and I
would not like to see that.
I want to see creativity.
I think creativity breeds newthings which help people, and I
think that's probably betterthan having everybody know the
same thing at the same time.
Speaker 2 (24:54):
Speaking of which and you kind of segued right into
that what about innovation?
I know the AOS has, I know,under the council on quality and
research, innovation is kind ofbaked in that to a degree.
What do you see innovationheaded in as we move into the
future?
Speaker 3 (25:10):
So innovation by definition is not going to be
with a big organization.
Innovation is one individualcoming up with a new solution.
You and I have done that formany years.
Where a patient comes in, theyhave a problem current stuff's
not available for it.
Let me design something that Ican use Now.
My problem is that I did thatfor probably 25 years and just
gave it away to companies sothat they could.
(25:31):
All I wanted to do is make me atoy.
I would say I need this, andthey would make it and not get
it, not make it work, and thatwould be fine.
And then next thing I see it'son a, on pamphlets or somebody.
They're doing all that stuff tomake it work.
(25:51):
So, but I think innovationdoesn't do that way.
Now, what the academy can do,what the arthroscopy association
is doing, I'm sure the traumaassociation is they'll have
areas where you can bring somean idea in.
I know with the arthroscopyassociation, ray thal has done
some of this for them, where youraise very creative he designed
uh, not the first, not the samecurve for for arthroscopy
Brilliant guy.
But you can bring an idea inand Ray can help you and maybe
they'll give you a little seedgrant to bring this up into
(26:13):
where it's available forcommercial use and you get to
keep your percentage, and theAcademy has an innovation lab
that will help you kind of atleast show you the ropes.
Nobody's trying to steal theideas.
We're just trying to createthat pathway.
We have an innovation area atTulane for the same thing.
So I think those kinds ofthings can happen if you already
have the idea and you see aneed.
So the creativity comes in andjust trying to take care of your
(26:36):
patients seeing something thatmaybe the current equipment,
technology, something doesn'tfit, that's always going to be
an individual person saying Ineed something better and that
person will make it happen andorganizations can help that.
Speaker 2 (26:53):
But I don't think as an organization you're going to
create new innovation in general, Speaking of organizations,
every organization I'm aware ofthe Academy, the Specialty
Societies, the State OrthopedicAssociations, the ACS put them
all together, it doesn't matter.
Every one of them are feelingthe impact of member apathy and
(27:17):
disengagement.
You and I are reading off thesame script in terms of what we
would say on that.
But what is the future?
And a lot of people blame itwith hospital employment.
Right, if I'm hospital, if I'memployed by the hospital, then
I'm insulated, they think, froma lot of the advocacy issues
(27:37):
that you, like you, talked aboutbefore, which you and I both
know they're not.
It's just there.
They are to a degree insulated,but the pain is going to be
just as real.
But getting back to the wholeidea of our professional
organizations, what's the futureof our professional
organizations and what can weexpect from the AOA, the AOS,
(27:58):
specialty societies, the stateorthopedic societies, in the
next 10 to 15 years?
I think they have to justifyrelevance.
Speaker 3 (28:05):
I think it's really difficult and you have to hit
home to that.
It's interesting travelingaround the States and with some
of the controversial issues thatusually started with someone
upset saying I'm gonna drop myacademy membership because of
this and on the one hand.
I'm saying thank you for calling, love, talking to you.
I appreciate your passion.
Let's go through this and seeif we can perhaps meet a common
(28:26):
ground Now.
I will tell you by the end ofthe year.
Having two or three callsalmost every night with someone
who is upset kind of wears youdown a bit.
So you're still trying to makethings work out for the best and
I think the hard part for everyorganization is going to be to
show relevance to where thatindividual practitioner is in
(28:48):
practice.
What can you do that makes themfeel that membership in your
organization is important?
We can talk all day abouthaving advocacy, and it's very
important, and you've got tohave a seat at the table or
you'll be the food on the table.
But by the same token, we'vegot to reach out to our guys and
girls.
You know, private practice orsomeone that's employed by a
(29:10):
hospital in Allentown,pennsylvania, may have something
totally different.
It's the job of the academy toreach out to him or her and have
things available that will helptheir practice, show them
what's going on, and that'sreally tough because how to
contact them and how to make itworthwhile and not just another
email to delete or another textmessage or another you know spam
(29:32):
phone call that you know investin timeshare.
That makes it really difficult,and so to get someone's
attention and keep it isimportant.
What the academy has done andmost societies have done is to
reach out to med students andstart talking to them early
about the importance of this andwhat you should do as a student
(29:52):
to help the profession that youhope to join.
So if you're a med student andyou want to do orthopedics, what
do you do as a med student tomake sure that when you're an
orthopedic resident, yourpractice is still going to be
good?
If you're a resident, what areyou going to do now to make sure
(30:13):
that your practice, whateverpractice it is, stays good?
So where's that importance?
And I think we do a poor job.
I'm sure you do a great job,but I think at Tulane we could
sure do a much better job ofteaching basic economics of
practice to our residents.
Now you could also argue thatpart of that is they're not
interested.
They're trying to learn how to,you know, learn the anatomy and
how to operate and how to dostuff.
By the same token, we seem tokeep it in play that this is
very important.
I think it's embarrassing that12 to 15 percent of our
(30:36):
membership across the countrycontribute to the PAC.
That's embarrassing, right.
I mean trial lawyers have 100percent commitment and
contribution and, having saidthat, we're the second largest
PAC on Capitol Hill.
Only anesthesiologists areabove us, and not by much.
So even with that smallpercentage, we still do a good
(30:57):
job.
But I think talking to thesepeople about and making it
personal, and making it personaland that's where our
organizations have got to hitthings, because that's where
we're going to run into trouble.
No matter what practice you'rein, if you're in a hospital
practice, what you get paid isgoing to be based on the private
guys out in town.
That's it.
(31:21):
And if those private guys goaway, you have nothing to base
your practice on other than whatthe hospital administrator
decides he wants to pay you.
And rest assured, they'll havenumbers, they'll have all the
data and they can say peopleacross the board do this.
You got to have that data too.
We you know if you belong tothe Academy, if you belong to
AOA, you belong to AOSSM.
Maybe you can get that data anduse it to argue your position.
I think that's criticallyimportant.
Speaker 2 (31:39):
John Gill did a phenomenal job as PAC chair,
following Stu.
I mean, he all, both of thoseguys were just absolutely
knocking it out of the park, andprobably the best person that I
can think of to follow eitherof the either one of them is
Wayne Johnson, who is continuingto carry the torch, so you're
pretty good yourself, though.
Yeah Well, thank you, but toyour point, adam reinvented the
(32:02):
whole council and has reallytaken it in a strong direction.
Speaker 3 (32:08):
He is truly brilliant .
I got to say Kevin Bozick gaveme his name and we appointed him
and he said it's a really smartguy.
And I talked to him I'm like,wow, this guy is sharp I mean
I'd like to be in practice withhim.
We went back into privatepractice and went away from this
.
He'd be a guy to work with.
Speaker 2 (32:22):
We actually interviewed him on this series
he'd be a guy to work with.
Speaker 3 (32:26):
We actually interviewed him on this series,
uh.
Speaker 2 (32:27):
So that's pretty great, brilliant guy and he's
truly amazing.
I think his will come outbefore this one.
If not, people will bewondering what I'm talking about
.
But two questions.
I'm gonna throw throughcurveballs they're not hardballs
with curveballs at you.
So you've done it all.
You have you've done it all ayoung buddy, savoie.
Let's do some kind of jujitsuthing and make you pop back out
(32:50):
when you're 30 years old, justfinishing your sports fellowship
and, if I recall, when yourfirst practice in private
practice in Mississippi yeah, Iactually went to University of
Mississippi in academics for acouple years and then I came to
Louisiana and then came, thenwent to Jackson and stayed there
25 years and then came down toNew Orleans after Hurricane
(33:10):
Katrina.
Speaker 3 (33:11):
That's right, that's right.
Speaker 2 (33:13):
So a brand new buddy Savoie coming out of sports
medicine fellowship.
Knowing what you know now, whatadvice would you give that
young buddy Savoie for hiscareer?
Speaker 3 (33:30):
that young buddy Savoie for his career.
Speaker 1 (33:31):
I think the best advice is what my dad told me
when you get when I got startedand he said you know, there's
always going to be smarter, morebrilliant.
Speaker 3 (33:36):
There'll be people out there that are just really
good at what they do.
But the one thing you cancontrol, you can control effort.
And so I, from my grandfather,from my great-grandfather
everybody we grew up on a farmFarmers know how to work hard
and you worry about things a lotand you worry about the weather
and things you can't control.
So I think if I was coming out,I would just say stay true to
(33:57):
yourself.
You know, take really good careof your patients.
Every patient is treat themlike your mom, your father.
You know, make sure that you'retaking care of them as best you
can and if there's somethingyou can do, don't say, well,
that's too hard or it's I'm tootired or I don't have enough
energy to do it.
You got to make it happen and Ithink if you do that,
everything else works out great.
I mean, I never started off tobe president of anything.
(34:19):
I just want to take care of myfolks and it seemed like
volunteering and doing thethings that we ended up doing
allowed that to happen.
And you know, I was incrediblyblessed and lucky where those
things that were important to mein patient care also were
important to other people, andso by doing the things I've done
(34:39):
, I've helped them take care ofmore people and made it easier
for them, and I think that's allwe can do.
All we can do is take care ofeach other.
So I would tell me, maybe don'tquite get so carried away with
how much fun you're havingoperating, doing from six in the
morning until midnight, threedays a week In as many cases.
Probably not reasonable in thisday and age anyway, but it was
(35:02):
then.
But I think that I think justmake sure you maintain your
focus on patient care.
Everybody gets sidetracked attimes, and the times I regret,
looking back over the last 40years, are the times where I
went in a different direction,where taking care of my patients
didn't come first.
Family didn't come first.
You know, my church and my Goddidn't come first and they have
(35:22):
to come first, and then afterthat, you know, the rest of the
stuff can happen.
Speaker 2 (35:27):
Very, very well said.
Everybody needs to listen tothat.
Well, Dr Savoie, thank you somuch.
It's been an absolute pleasuretalking with you about the
future in orthopedic surgeryfrom a position that very few
people ever get to sit at.
It's a hard earned position,it's well-deserved, but y'all
being very close to thepresidential line when I was on
(35:48):
the council on advocacy y'allwork tirelessly hard and get
beat up pretty good in thatposition.
So appreciate your efforts asAcademy president and we
appreciate you being on thepodcast series today, sir.
Well, it's been my honor.
Doug, thank you so much andy'all stay tuned for other
editions of the future andorthopedic surgery podcast
(36:09):
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 self.
We will consider changes asthey occur in the domains of
(00:44):
culture, employment, technology,scope of practice, compensation
and other areas.
My name is Doug Lundy, host forthis podcast series.
Joining us today is Dr BuddySavoie.
Dr Savoie is an internationallyrenowned expert in areas of
shoulder and elbow surgery, aswell as sports medicine.
(01:05):
He's the chairman of theDepartment of Orthopedics at the
Tulane School of Medicine andthe Ray J Haddad Professor of
Orthopedic Surgery.
In 2022, dr Savoy became the90th president of the American
Academy of Orthopedic Surgeons.
He's also been president of theAmerican Shoulder and Elbow
(01:26):
Society, the ArthroscopyAssociation of North America,
the Orthopedic Learning Centerand the Louisiana Orthopedic
Association.
He served on the boards of ANA,the International Society of
Arthroscopy, knee Surgery andOrthopedic sports medicine.
He also serves as the sportsmedicine advisory committee of
(01:48):
the Louisiana High SchoolAthletic Association.
Dr Savoie is board certified inorthopedic surgery and sports
medicine.
He's a graduate of theLouisiana State University
School of Medicine in NewOrleans.
He completed his internship andresidency at the University of
Mississippi Medical Center inJackson Mississippi.
He added additional trainingand multiple fellowships in
(02:09):
sports medicine and arthroscopyat the Medical College of
Wisconsin, the Mayo Clinic, theAO International Fellowship in
Basel, switzerland, theOrthopedic Research at Richmond,
virginia, and at Fowler KennedySports Medicine in London,
ontario.
Dr Savoie, thank you andwelcome to the podcast series,
(02:29):
sir.
Speaker 3 (02:30):
Thank you, Dr Lindy.
It's an honor to be here.
Speaker 2 (02:33):
Well, buddy, you and I have known each other well.
You are one of my favoriteleaders in orthopedic surgery
and, as you know and as wediscussed on this series, we
specifically target ourdiscussions to areas that our
speakers are specifically expertin.
However, you have had a uniqueexperience that few members of
(02:55):
our profession have had, whereasyou have sat on the perch the
absolute pinnacle of arguablythe most powerful orthopedic
organization in the UnitedStates and in much of the world,
in terms of seeing the entirespectrum, the entire scope of
orthopedic surgery, both thegood and the bad.
So, instead of targeting in onespecific area, we like in this
(03:19):
podcast right here, just to lookinto the mind of Buddy Savoie.
What was your perception ofafter sitting in that incredible
position and now having alittle bit over a year to
reflect and consider what youlearned, what you did in the
middle of all that?
Plus, you know you had to dothe carousel afterwards.
Where are we going as aprofession?
You take this anywhere.
You need to take it, becauseyour insight is going to be
(03:41):
absolutely valuable.
Speaker 3 (03:43):
I think it's a great question and it's a wonderful
concept to think about andusually when people ask me, I
sort of ask if they want thegood or the bad or really what I
think, and so you sort ofseparate fact and impression.
I will tell you that the mostwonderful thing about serving
the academy and serving ourmembership and then actually
touring around the world is themany great physicians that we
(04:05):
have.
It's impressive how, across theworld, orthopedics is just it's
got to be the best medicalsubspecialty in the world and
the people are caring, theyreally care about their patients
, they want their patients to dowell and for most of us you and
I, doug, made the same waythere's nothing that we wouldn't
(04:25):
do for our patients.
I mean, it's the extra mile,whatever we do.
You know pay scale, all theseother things just goes out the
window with the joy of takingcare of our patients, and that's
refreshing.
I can tell you that when I waspresident of the academy, there
(04:46):
was a lot of passion amongst ourmembership about things that
prevent that from happening, andyou can argue right side, left
side, up or down, however youwant to do it, it doesn't make
any difference because we allcenter on this patient care
phenomenon and how to make surethat we can continue to do it.
That being said, there arestrong headwinds around the
(05:07):
world which are quite impressive, and I gave a talk at the
British Orthopedic Associationon how to maintain excellence in
a culture that demandsmediocrity, and I think one of
the things that the AOA isfamous for is leadership, and I
think that as we do these things, maintaining that focus on
(05:28):
excellence as surgeons,excellence in patient care is
going to be harder and harder.
To sort of maintain thatrequirement.
You have folks that are tryingto standardize everything we do
in our academies.
Cpgs, clinical practiceguidelines are really designed
to help, but as these get sortof utilized by insurance
(05:48):
companies and they use it todeny care rather than as a
mechanism to create better care,that's a problem.
The academy needs data.
The registries are important,but I think our colleagues
justifiably so, fear that thatdata could be used against them.
And you know, if you have atrauma registry and maybe
everybody doesn't treat a brokenfemur the same way maybe you're
(06:11):
held accountable, but in manyways it's good but threatening
at the same time.
So I think if we're going tohave the discussion, there's a
plethora of avenues to look at.
I think, if we focus on this,how do we maintain excellence,
how do we maintain excellence intraining?
How do we instill in our youngphysicians, who are residents or
fellows, that desire and needto get better, when people are
(06:35):
putting more and more rules inplay that prevent that?
So you know, I think that anyof those topics we'd be willing
to look at the reimbursementissues, the where you operate,
how you operate, venture capitalversus private groups, versus
academics but because the sameproblem is across the board when
you look at it.
Speaker 2 (06:57):
It's very refreshing to hear your initial comments on
the quality of our colleaguesacross the planet and their
motivations therein.
Speaker 3 (07:06):
Who, and then he and ann transitioned, and so wayne
and michelle were fabulous, andyou know the way the carousel
works you drop somebody everytime, so you just get to know a
(07:28):
couple, start to enjoy them andthen they drop off and then
somebody else comes on.
So we're losing wayne andmichelle.
We're thinking, well, thiscan't be as good.
And then ann and greg van he'scome on and we spent the year
with them and I just came to theAOA meeting in St Louis, really
mostly to see Greg and Ann.
The meeting was great and theseminars were great and I
(07:50):
enjoyed all that.
But even Amy said, and my wifesaid, why are we going to this
meeting?
I said we're going to see Annand Greg and our friends and she
said you never do that.
And I said, well, I'm doing itfor this couple because not only
is she a great leader andwonderful, but we had wonderful
times together.
So I admire her, I respect her,I think her opinions are
marvelous and I learn somethingevery time I talk to her.
But just having she and Gregand sitting and visiting with
(08:13):
Amy and I was one of the joyousexperiences of the year.
It was absolutely fantastic.
Speaker 2 (08:18):
That is fantastic, and Wayne's a sports guy like
you, so it's good to be with Annwho does something.
I mean she's, so that'scompletely different.
Speaker 3 (08:27):
Yeah, so it was great .
I mean, we had a wonderful time, the folks were terrific, as
always, and you know thedifference in perspective and
especially and when we would dotalks together.
She said, well, buddyrepresents just the regular
membership in the United Statesand I represent the leadership.
She said, well, buddyrepresents just the regular
membership in the United Statesand I represent the leadership,
and you know I don't disagree atall.
I think that's true and my jobas president of the academy is
(08:47):
to take care of our folks inpractice and let them be able to
take care of their patients andanything that interfered with
that.
I think that's the academy'srole to prevent that we're
incredibly lucky that we haveAdam Brueggemann and Wayne
Johnson heading up our lobbyinggroup.
Adam's head of the Council onAdvocacy and he's taking it in a
whole different direction andWayne's trying to get more money
(09:10):
in the PAC.
I mean we've got to build alobby, we've got to protect our
practice.
Everybody knows and this willgo to the pessimistic side if
you deal with this you know ourpay on CMS pay has been
decreasing every year and theysit down and they have to do it
and they cut budget based on ourdoctors.
If you look over the last 21years our pay scale has not just
(09:32):
stayed flat, it's actuallydeclined in terms of relative
value and spending power andeverything else where our
expenses have gone up.
And that was a deal cut 20something 25, 30 years ago where
they took physicians out of thecost of living increase.
So we should right now you getpaid on CMS about $32 in RVU.
(09:55):
If you simply factor in cost ofliving over the last 21 years,
that should be $68.
And it got traded off.
The AMA did that and they regretit as well.
So it's not like oh, they're theenemy or anything, but Adam has
been forging alliances withAmerican College of Surgeons,
like you and I did on the gunissue, so where we can lobby
(10:15):
together, and then you and I andthe OTA did that one, but it's
more like OK, where does thislook at With the AMA?
Prior authorization is a bigdeal for their doctors as well
as for surgeons, so that becomesa big deal.
And Adam has forged that pathforward and it's been really
good.
We're still hoping that thingslike that, where we can lobby
together, are very important.
So it's nice to see thatmechanism start to come into
(10:38):
play.
And then you know, traveling toalmost every state in the union
over the past few years andvisiting with the doctors again,
it's so reassuring how wellthey take care of folks.
At the same time, they need toknow that they have somebody
which is the American Academy ofOrthopedic Surgeons stressing
the importance of their abilityto take care of patients and to
get all these other factors outof the way.
(10:58):
So that makes you optimisticthat maybe altogether not apart,
but altogether we can moveforward and fix some of the
problems.
Speaker 2 (11:07):
So while you are on carousel and y'all go to England
, Australia, New, Zealand whatam I missing?
Canada?
Speaker 3 (11:15):
South.
Speaker 2 (11:15):
Africa, South Africa.
That's what I was missing.
You got to see, and it's notjust hearing about it or reading
about it, you're actually inthe culture, hanging out with
their leadership, going to theirmeeting with their surgeons.
Is there any insights that yougained on the future of
orthopedic surgery just fromthat incredibly broad exposure
across the English-speakingorthopedic associations?
Speaker 3 (11:36):
Yes, very interesting National Health Service.
It's quite interesting.
The doctors and even thepatients that were working in
that system and we in the USsort of downplayed a lot, but
they actually were verysupportive of their system.
They thought that providingcare across the board to
everyone somewhat equally wasgood.
They were very frustrated bythe delays in care, about the
(11:59):
ability to take care of folksbeing trumped sometimes by
budget issues, and so it's a bigdeal for the government at that
point.
Patients are simply budgetitems and so you can go back and
do that.
Now the flip of it comes back tous as physicians are do we
really need to be doing whatwe're doing, and are we doing
the most cost-effective butefficient and best way to do it?
(12:21):
So looking at the nationalhealth service in great britain,
south africa system is verydifferent.
Canada excuse me, it's muchlike great britain, australia
and new zealand very different.
They have different methods butin general everybody is insured
some way.
But they also have the optionexcept in great britain and
canada to have private insuranceand flip out of that system.
(12:44):
And I think New Zealand andAustralia's system, where you
have a base national healthsystem in this country, would
sort of be Medicare for all,because the base system pays a
decent amount.
But you can always opt out forprivate insurance, for private
insurance, and the thing Ireally liked about New Zealand
system is that you areautomatically in the national
(13:05):
health system.
At any given time you can optout and get private insurance
and the insurer has to give itto you.
So you have home insurance, youhave car insurance and you can
go to these people and say Iwant to buy health insurance.
You don't have to tell themit's because I just tore my
rotator cuff and I need to haveit fixed and I can't wait nine
months for the National HealthService to fix it.
I got to get back to work andthey have to take you, they have
(13:27):
to insure you, they have to payfor the whatever it is that you
need and then but you have tostay and you pay the extra
premium for a full year.
You can't opt in for a monthand opt out.
So it's.
I think it makes everything abit more efficient when you can
kind of go back and forth.
(13:48):
It makes both sides better.
So it's interesting looking ateveryone and how they handle
things.
Delays in Canada and GreatBritain are are in the UK are
almost insurmountable it's ayear to get a total hip or total
knee done.
And because it's a budget itemenough.
One of my favorite questions Ithink it was in Canada, because
we opened the carousel up forquestions and this gentleman
surgeon in the audience raisedhis hand.
He says well, my administratorand I are on exactly the same
(14:09):
page about patient care and howdo we make things happen.
And so he got kind of sort ofdiffuse answers from a few
people and I said you're not onthe same page, You're not
friends.
You have to learn to speak hislanguage To him.
You are a budget cost item.
Your patients are a budget costitem because at the end of the
day he has to balance aspreadsheet.
(14:31):
So to think that even though hemay talk to you and be a really
nice guy or girl and say, yeah,I'm really worried about your
patients, At the end of the dayhe has to make his spreadsheet
balance.
So it's your job, if you wantto take care of your patients,
to learn how to speakspreadsheet mentality.
Don't go to him and say I needthese 10 things without showing
(14:52):
him how it's going to beeffective.
If you can show him that if heinvests some money in your
patients or in your care, returnon investment is going to be X
and it'll fix a column in hisspreadsheet to look better.
Could be patient satisfaction,it could be efficiency of care.
But that cost of care episode,which is where physicians lose
(15:14):
out because we think of well, Ihave a broken bone, I'm going to
fix a broken bone and then mypart's done, I'm OK.
But the budget?
People are looking at it.
While they're coming in,they're getting x-rays.
This is an ER visit.
Now you are in a CT scan, Nowyou are in an MRI scan.
Then you do an operation andnow you send them to therapy and
anesthesia charged me a lot.
They did a block and nowthey're still in therapy.
(15:36):
My episode of care was veryexpensive and then you wonder
why we don't get paid enough orother people don't, because we
don't manage that whole episodeof care.
Orthopedics to win, we're goingto have to manage the episode of
care all of it.
So that part of it was veryintriguing and in every country
that system was a problem.
Rural health care is a problem.
(15:58):
People don't want to go topractice in small towns.
Australia.
That's a devastating problem.
How do you do emergency care inrural areas when you don't have
a hospital, because peopledon't want to go to hospitals?
Also another problem you knowtrainees.
Are we training them the waywe're supposed to train them,
and are they getting to learn alot?
Now that the breadth ofknowledge you need to learn in
(16:18):
orthopedics is so big, how do weteach them every part of this,
or should we be moving them intoa more specialized training
sooner?
You know, in most of the othercountries you finish med school
and you just basically dogeneral medical care for a
couple of years and then you dogeneral surgical care for a
couple of years and then youmove into your residency and
(16:39):
then fellowship.
So they're more experiencedwhen they start, but the
experience is not necessarilygreat.
So there's a million thingswhen you look around the world
that some places could do better, and, having said that, they
all look to the US to figure outwhere the path forward is, and
so it's quite interesting andit's an awesome responsibility
to know and to try to talk aboutthis, and it was fun to talk
(17:01):
about mistakes.
We've made things we've givenup that we shouldn't have and
where we've ceded control, wherewe should be taking it back and
how?
Speaker 2 (17:07):
to make it better.
Did you get a sense of optimism, bullishness or pessimistic
bearishness from the differentsocieties, the different leaders
in the carousels of thesocieties that you visited?
So it's interesting In terms ofthe future, in terms of where
we're going.
Speaker 3 (17:24):
No, it's great, so everybody's worried about it.
Everybody looks at the downside.
It's just like in our country,and we can talk about that in a
little bit, if you want but,everybody's trying to make sure
that we can take care ofpatients and they're concerned.
They're concerned that we're nottraining a younger group of
doctors like we should, that ouryounger colleagues don't
(17:44):
necessarily have the samecommitment that we did.
And the most common thing iscall.
Our younger docs want to getpaid for call.
That's not unreasonable.
But older folks are used tojust having to take calls part
of the job.
But in any other profession ifyou have to work extra you get
paid overtime.
That's not an unreasonablething for our young doctors to
(18:07):
want that.
I mean, work-life balancedoesn't really apply to
orthopedics very well and partof that is our own fault because
we love what we do.
But I will tell you that theseyounger doctors wanting Sundays
off is not necessarily a badthing.
I mean, I grew up going tomeetings, leaving on Friday
after a full day of work and afull week of work and going to a
meeting on Friday night,saturday, sunday, getting back
(18:29):
home by 1030 or 11 o'clock,going right back to work on
Monday, and it's kind of nice tobe home on Sunday.
So I think when you look atwhere people are thinking across
the board, they worry about thefuture.
They know that some of thechanges are good, some are not
as good, but in general, mostpeople think we're going to be
okay.
The biggest question everyonehas, and the biggest concern and
(18:52):
it should be in this countrytoo is how are we going to pay
for care?
Who's going to fund the bill totake care of folks?
Because you're getting bettertreatments but those treatments
are more expensive.
You're getting more people thatare retiring from the workforce
.
Who's going to take care ofthem?
Do we have enough doctors to dothat?
Do we have enough trainees todo that?
And most every country, justlike ours, is either woefully or
(19:17):
a little bit short on trainingand getting in the number of
people you need to take care offolks.
Speaker 2 (19:23):
Fascinating.
So that was the internationalside.
You said you had some insightson the US side as well from that
.
Speaker 3 (19:29):
So the pessimistic view of the US side is that by
2028, if nothing changes withCMS, and to our private practice
colleagues and to our VC folksand our academic folks,
everything ties into Medicare.
So if you have a commercialinsurance, you have Blue Cross,
you have United, they'rerestricting you more and more
(19:49):
but their payments are usuallytied to Medicare.
In 2028, if we can't changeanything, the reimbursement for
Medicare patients, thereimbursement for Medicare
patients, which will account forprobably 50% of our country by
then, is going to cross yourexpense line.
Our expenses stay the same andreimbursement continues to drop
(20:11):
Right around 2028, that's goingto cross and you will not be
able to make a living seeingpatients because the multiples
are going to happen.
So something has to changebefore then because there's no
way to decrease your overheadenough and still take care of
folks with that amount ofreimbursement.
(20:32):
So that's why the Academy andAdam are lobbying so hard to
make that not happen.
So the pessimistic view is thatwe can't get anything across.
Congress restricts this, theydecide doctors make too much
money anyway and everybody goesto an employment model.
Well, the plus side of anemployment model is, if 85
percent of us are employed, wecan unionize.
(20:54):
We can unionize and demand abetter wage, and we can tie it
in.
I'll take a couple of years Iwent 30 or 31 before that
happens, and hopefully with goodleadership.
The problem then is you holdthe government hostage to make a
better pay and guess whatthey'll do?
They'll outlaw the union, yeah,and then we're right back where
we were, which no leverage atall in how to do it.
(21:17):
More simple thing is geteverybody to contribute to the
PAC.
Start talking to yourcongressmen and your senators
and just explain this to them ina simple term that they can
understand that I'm not going tobe able to take care of your
constituents.
Your constituents are thepeople that vote for you.
I am their doctor, I'm yourdoctor.
If you can help me throw me abone here and help us out a
(21:38):
little bit, then we can keeptaking care of these people
because those people vote.
But if I start saying that mycongressman doesn't want me to
get paid to take care of you andI can't afford to take care of
you anymore, or I'd love to seeyou as a patient, but I can only
see X number of people a daybecause that's the only time
frame they let me do it.
You know it'll be six monthsbefore I can tend to be broken
(22:00):
ankle.
That's a problem.
So it'd be very interesting tosee.
I tend to be on the optimisticside.
I think orthopedic surgeonsespecially are very creative and
will figure out a way to takecare of people.
But it's not like we're notfighting headwinds.
That would be nice not to haveRight right.
Speaker 2 (22:17):
Now, a big function or purpose or mission of the
AAOS is education.
Where do you see academyeducation moving as we move into
the future?
Speaker 3 (22:29):
So what I hope to see , and I ended up dealing with
some crises when I was presidentof the academy.
But one of my goals was first.
One was patient care, to make iteasier for our guys and girls
to take care of patients.
But the second one was to tryto improve our educational
outlook, so to speak.
And I think the academy doesbest when we do things with our
(22:49):
specialist societies and I thinkthat that comes out the best
when we partner with.
If we want to do a shouldercourse, partner with shoulder
and elbow surgery, make it veryfair for them, don't just take
over the course and run it.
You know, do a give and takekind of thing where everybody,
if the course makes money, youmake a little bit of money, if
it loses money, you lose alittle bit of money.
But I think partnering with oursubspecialty societies to
(23:12):
provide education is going to becritically important.
The second thing is I think weneed to tailor those educational
offerings to the position wherethey are.
I think that in this day andage, you know you and I learn by
getting a cadaver and going anddissecting it out, figuring out
what's going on, going to thelibrary to read a book With our
young doctors it's at the palmof their hand.
(23:35):
You ask them a question, theycan look it up right there on
their phone and give you fivereferences in a minute, so that
part of it is quicker.
They also learn by video moreso than by anything else, and I
think, changing that educationalplatform into augmented reality
, virtual reality, where theyhave goggles and they have some
haptics in their hands, it's notlike going to find a simulator
(23:57):
to work with.
They're going to have it rightthere, just like you and I are
talking on the laptop.
It'll be the same thing.
They're going to be able to dothat and you'll do really well,
and I think education will gothat way.
I think you'll see a lot ofpartnerships.
I think you'll see a lot moreaugmented reality.
I think that that's going to,unfortunately, maybe allow some
standardization, but I do thinkthe people that are coming into
(24:18):
orthopedics will be just ascreative in how they design new
solutions for patients as wewere, you know, 40 years ago.
I think all this is going toget better and better because we
have great people.
They're very smart, they learnvery quickly and I think there's
more knowledge at theirfingertips and it's easier to
access.
So I think that increasingknowledge is going to be much
(24:39):
bigger.
My biggest fear is that westandardize it across the world,
and I would not like to seethat.
I want to see creativity.
I think creativity breeds newthings which the world and I
would not like to see that.
I want to see creativity.
I think creativity breeds newthings which help people, and I
think that's probably betterthan having everybody know the
same thing at the same time.
Speaker 2 (24:54):
Speaking of which and you kind of segued right into
that what about innovation?
I know the AOS has, I know,under the council on quality and
research, innovation is kind ofbaked in that to a degree.
What do you see innovationheaded in as we move into the
future?
Speaker 3 (25:10):
So innovation by definition is not going to be
with a big organization.
Innovation is one individualcoming up with a new solution.
You and I have done that formany years.
Where a patient comes in, theyhave a problem current stuff's
not available for it.
Let me design something that Ican use Now.
My problem is that I did thatfor probably 25 years and just
gave it away to companies sothat they could.
(25:31):
All I wanted to do is make me atoy.
I would say I need this, andthey would make it and not get
it, not make it work, and thatwould be fine.
And then next thing I see it'son a, on pamphlets or somebody.
They're doing all that stuff tomake it work.
(25:51):
So, but I think innovationdoesn't do that way.
Now, what the academy can do,what the arthroscopy association
is doing, I'm sure the traumaassociation is they'll have
areas where you can bring somean idea in.
I know with the arthroscopyassociation, ray thal has done
some of this for them, where youraise very creative he designed
uh, not the first, not the samecurve for for arthroscopy
Brilliant guy.
But you can bring an idea inand Ray can help you and maybe
they'll give you a little seedgrant to bring this up into
(26:13):
where it's available forcommercial use and you get to
keep your percentage, and theAcademy has an innovation lab
that will help you kind of atleast show you the ropes.
Nobody's trying to steal theideas.
We're just trying to createthat pathway.
We have an innovation area atTulane for the same thing.
So I think those kinds ofthings can happen if you already
have the idea and you see aneed.
So the creativity comes in andjust trying to take care of your
(26:36):
patients seeing something thatmaybe the current equipment,
technology, something doesn'tfit, that's always going to be
an individual person saying Ineed something better and that
person will make it happen andorganizations can help that.
Speaker 2 (26:53):
But I don't think as an organization you're going to
create new innovation in general, Speaking of organizations,
every organization I'm aware ofthe Academy, the Specialty
Societies, the State OrthopedicAssociations, the ACS put them
all together, it doesn't matter.
Every one of them are feelingthe impact of member apathy and
(27:17):
disengagement.
You and I are reading off thesame script in terms of what we
would say on that.
But what is the future?
And a lot of people blame itwith hospital employment.
Right, if I'm hospital, if I'memployed by the hospital, then
I'm insulated, they think, froma lot of the advocacy issues
(27:37):
that you, like you, talked aboutbefore, which you and I both
know they're not.
It's just there.
They are to a degree insulated,but the pain is going to be
just as real.
But getting back to the wholeidea of our professional
organizations, what's the futureof our professional
organizations and what can weexpect from the AOA, the AOS,
(27:58):
specialty societies, the stateorthopedic societies, in the
next 10 to 15 years?
I think they have to justifyrelevance.
Speaker 3 (28:05):
I think it's really difficult and you have to hit
home to that.
It's interesting travelingaround the States and with some
of the controversial issues thatusually started with someone
upset saying I'm gonna drop myacademy membership because of
this and on the one hand.
I'm saying thank you for calling, love, talking to you.
I appreciate your passion.
Let's go through this and seeif we can perhaps meet a common
(28:26):
ground Now.
I will tell you by the end ofthe year.
Having two or three callsalmost every night with someone
who is upset kind of wears youdown a bit.
So you're still trying to makethings work out for the best and
I think the hard part for everyorganization is going to be to
show relevance to where thatindividual practitioner is in
(28:48):
practice.
What can you do that makes themfeel that membership in your
organization is important?
We can talk all day abouthaving advocacy, and it's very
important, and you've got tohave a seat at the table or
you'll be the food on the table.
But by the same token, we'vegot to reach out to our guys and
girls.
You know, private practice orsomeone that's employed by a
(29:10):
hospital in Allentown,pennsylvania, may have something
totally different.
It's the job of the academy toreach out to him or her and have
things available that will helptheir practice, show them
what's going on, and that'sreally tough because how to
contact them and how to make itworthwhile and not just another
email to delete or another textmessage or another you know spam
(29:32):
phone call that you know investin timeshare.
That makes it really difficult,and so to get someone's
attention and keep it isimportant.
What the academy has done andmost societies have done is to
reach out to med students andstart talking to them early
about the importance of this andwhat you should do as a student
(29:52):
to help the profession that youhope to join.
So if you're a med student andyou want to do orthopedics, what
do you do as a med student tomake sure that when you're an
orthopedic resident, yourpractice is still going to be
good?
If you're a resident, what areyou going to do now to make sure
(30:13):
that your practice, whateverpractice it is, stays good?
So where's that importance?
And I think we do a poor job.
I'm sure you do a great job,but I think at Tulane we could
sure do a much better job ofteaching basic economics of
practice to our residents.
Now you could also argue thatpart of that is they're not
interested.
They're trying to learn how to,you know, learn the anatomy and
how to operate and how to dostuff.
By the same token, we seem tokeep it in play that this is
very important.
I think it's embarrassing that12 to 15 percent of our
(30:36):
membership across the countrycontribute to the PAC.
That's embarrassing, right.
I mean trial lawyers have 100percent commitment and
contribution and, having saidthat, we're the second largest
PAC on Capitol Hill.
Only anesthesiologists areabove us, and not by much.
So even with that smallpercentage, we still do a good
(30:57):
job.
But I think talking to thesepeople about and making it
personal, and making it personaland that's where our
organizations have got to hitthings, because that's where
we're going to run into trouble.
No matter what practice you'rein, if you're in a hospital
practice, what you get paid isgoing to be based on the private
guys out in town.
That's it.
(31:21):
And if those private guys goaway, you have nothing to base
your practice on other than whatthe hospital administrator
decides he wants to pay you.
And rest assured, they'll havenumbers, they'll have all the
data and they can say peopleacross the board do this.
You got to have that data too.
We you know if you belong tothe Academy, if you belong to
AOA, you belong to AOSSM.
Maybe you can get that data anduse it to argue your position.
I think that's criticallyimportant.
Speaker 2 (31:39):
John Gill did a phenomenal job as PAC chair,
following Stu.
I mean, he all, both of thoseguys were just absolutely
knocking it out of the park, andprobably the best person that I
can think of to follow eitherof the either one of them is
Wayne Johnson, who is continuingto carry the torch, so you're
pretty good yourself, though.
Yeah Well, thank you, but toyour point, adam reinvented the
(32:02):
whole council and has reallytaken it in a strong direction.
Speaker 3 (32:08):
He is truly brilliant .
I got to say Kevin Bozick gaveme his name and we appointed him
and he said it's a really smartguy.
And I talked to him I'm like,wow, this guy is sharp I mean
I'd like to be in practice withhim.
We went back into privatepractice and went away from this
.
He'd be a guy to work with.
Speaker 2 (32:22):
We actually interviewed him on this series
he'd be a guy to work with.
Speaker 3 (32:26):
We actually interviewed him on this series,
uh.
Speaker 2 (32:27):
So that's pretty great, brilliant guy and he's
truly amazing.
I think his will come outbefore this one.
If not, people will bewondering what I'm talking about
.
But two questions.
I'm gonna throw throughcurveballs they're not hardballs
with curveballs at you.
So you've done it all.
You have you've done it all ayoung buddy, savoie.
Let's do some kind of jujitsuthing and make you pop back out
(32:50):
when you're 30 years old, justfinishing your sports fellowship
and, if I recall, when yourfirst practice in private
practice in Mississippi yeah, Iactually went to University of
Mississippi in academics for acouple years and then I came to
Louisiana and then came, thenwent to Jackson and stayed there
25 years and then came down toNew Orleans after Hurricane
(33:10):
Katrina.
Speaker 3 (33:11):
That's right, that's right.
Speaker 2 (33:13):
So a brand new buddy Savoie coming out of sports
medicine fellowship.
Knowing what you know now, whatadvice would you give that
young buddy Savoie for hiscareer?
Speaker 3 (33:30):
that young buddy Savoie for his career.
Speaker 1 (33:31):
I think the best advice is what my dad told me
when you get when I got startedand he said you know, there's
always going to be smarter, morebrilliant.
Speaker 3 (33:36):
There'll be people out there that are just really
good at what they do.
But the one thing you cancontrol, you can control effort.
And so I, from my grandfather,from my great-grandfather
everybody we grew up on a farmFarmers know how to work hard
and you worry about things a lotand you worry about the weather
and things you can't control.
So I think if I was coming out,I would just say stay true to
(33:57):
yourself.
You know, take really good careof your patients.
Every patient is treat themlike your mom, your father.
You know, make sure that you'retaking care of them as best you
can and if there's somethingyou can do, don't say, well,
that's too hard or it's I'm tootired or I don't have enough
energy to do it.
You got to make it happen and Ithink if you do that,
everything else works out great.
I mean, I never started off tobe president of anything.
(34:19):
I just want to take care of myfolks and it seemed like
volunteering and doing thethings that we ended up doing
allowed that to happen.
And you know, I was incrediblyblessed and lucky where those
things that were important to mein patient care also were
important to other people, andso by doing the things I've done
(34:39):
, I've helped them take care ofmore people and made it easier
for them, and I think that's allwe can do.
All we can do is take care ofeach other.
So I would tell me, maybe don'tquite get so carried away with
how much fun you're havingoperating, doing from six in the
morning until midnight, threedays a week In as many cases.
Probably not reasonable in thisday and age anyway, but it was
(35:02):
then.
But I think that I think justmake sure you maintain your
focus on patient care.
Everybody gets sidetracked attimes, and the times I regret,
looking back over the last 40years, are the times where I
went in a different direction,where taking care of my patients
didn't come first.
Family didn't come first.
You know, my church and my Goddidn't come first and they have
(35:22):
to come first, and then afterthat, you know, the rest of the
stuff can happen.
Speaker 2 (35:27):
Very, very well said.
Everybody needs to listen tothat.
Well, Dr Savoie, thank you somuch.
It's been an absolute pleasuretalking with you about the
future in orthopedic surgeryfrom a position that very few
people ever get to sit at.
It's a hard earned position,it's well-deserved, but y'all
being very close to thepresidential line when I was on
(35:48):
the council on advocacy y'allwork tirelessly hard and get
beat up pretty good in thatposition.
So appreciate your efforts asAcademy president and we
appreciate you being on thepodcast series today, sir.
Well, it's been my honor.
Doug, thank you so much andy'all stay tuned for other
editions of the future andorthopedic surgery podcast
(36:09):
series.
Thank you.
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