March 6, 2025 • 34 mins
Charlie Saltzman, MD, a leader in foot and ankle surgery and former chair of the University of Utah’s Department of Orthopaedics, joins Douglas W. Lundy, MD, MBA, FACS, FAOA, to discuss the future of orthopaedic surgery. Dr. Saltzman shares insights on leadership, collective vision, and community engagement to create thriving teams and advance medical programs.
Join us as we discuss transformative innovations, from potential osteoarthritis treatments to trauma reduction via self-driving cars. Discover how advancements in bone healing and ankle replacements are shaping patient care and redefining the future of orthopaedics.
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Episode Transcript
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Speaker 2 (00:23):
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 itself.
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 CharlieSaltzman.
Dr Saltzman is the LS PearyPresidential Endowed Professor
(01:05):
of Orthopedic Surgery at theUniversity of Utah and also the
Editor-in-Chief of Foot AnkleInternational and Foot Ankle
Orthopedics.
Dr Salzman did his undergraduatework in pre-medical sciences at
Brown University.
He went to medical school atthe University of North Carolina
(01:32):
and then did his internship andresidency at the University of
Michigan, followed by hisfellowship in foot and ankle
surgery at the Mayo Clinic.
As I said, he serves on thefield of orthopedics as
editor-in-chief of Foot andAnkle International and Foot and
Ankle Orthopedics.
He's co-editor of Man's Surgeryof Foot and Ankle and past
president of the AmericanOrthopedic Foot and Ankle
Society.
Past president of theInternational Federation of Foot
and Ankle Societies.
Past president of theAssociation of Bone and Joint
(01:55):
Surgeons and past vice presidentof the American Board of
Orthopedic Surgery, and servedas the chair at the University
of Utah Department ofOrthopedics from 2005 to 2021.
Dr Salzman, welcome to thepodcast, sir.
Nice to be with you, doug, andit's always good to see you
again.
Charlie and Charlie and I havebeen friends for a long time and
(02:17):
it's really great to talk toCharlie because Charlie is going
to give us insight into thefuture in foot and ankle surgery
and all the things that aregoing to be coming down the pike
in terms of that, and I wouldargue that Charlie knows that as
well or better than anybody.
But, charlie, before we go intothat, you served for quite a
lot I guess 16, 17 years as thechair at the University of Utah
(02:42):
and you have a wealth ofexperience in leadership.
What was your philosophy whileyou were chair at Utah and what
were the key takeaway learningsthat you took from that position
and that experience?
Speaker 3 (02:53):
Thanks, doug.
I had a great opportunity atUtah when they brought me on as
chair to create an environmentand a program in a direction
that I thought that programshould move, and my philosophy
for doing that pretty simple,actually.
The first was to see my jobprimarily as a person who was
(03:18):
tasked with resourcing otherpeople and giving others an
opportunity to grow, to moveinto the shadows and not be in
the limelight so that otherscould shine and I could
basically rejoice in thereflected glow of others.
And so my role I saw it as afiduciary role to one extent,
(03:40):
which is to make sure there wasenough resources to share and to
help everyone become the personthey wanted to become within
the department.
I do think it's very importantfor a chair or a person in
leadership to help pick theright people and to get the
wrong people basically, as iscommonly referred to, off the
(04:02):
bus, and I took that veryseriously and we were able to
recruit wonderful people.
We did remove a few people andthe environment flourished as a
result.
I think it's very important toset a North Star for the group
and to have this done mutually,but to make sure it's consistent
with the leader's vision and,for us, the North Star was like
(04:25):
it should be for most orthopedicprograms excellence in patient
care, excellent in education,concern about our community and
trying to improve orthopedics bybeing engaged in the
progression of the science ofthe field, as well as the
national organizations oforthopedics, and we try to do
(04:47):
that and involve everyone insome aspect of that so that
everyone felt that they achievedtheir personal goals.
And, as a leader, I think it'spretty simple.
Actually, it's not about youever If you take that job, it's
never about you.
It's about serving the otherpeople.
It's almost an upside downtriangle, surprisingly, and
(05:09):
that's what works.
And I do think it's importantto set a vision.
I do think you should have acommon set of ethical principles
that you enforce and holdeveryone to, or at least ask
everyone to pay attention to it,and when they don't pay
attention, that you act on those, on that.
(05:30):
And I think it's that simple andit is not unique to say this,
but I've heard this from othersand I think it rings true and
I'm just going to read you thisGood people plant trees the
shade of which they will neversit under, and that's the whole
point of leadership.
I do take my work veryseriously.
I don't take myself thatseriously, but I love taking the
(05:54):
work seriously and I'm enthusedabout the work.
I've always been enthused aboutorthopedics.
I think we are the mostfortunate people in medicine and
we have maybe the mostfortunate people in anything,
because we have this great joband we're able to help so many
people.
And I think that level ofenthusiasm in a leader is also
(06:16):
helpful to the esprit de corpsof the group.
So I'll leave it at that.
Speaker 2 (06:21):
We can close right here and thank you for being on
the podcast.
That was fantastic.
Thank can close right here andthank you for being on the
podcast.
That was fantastic.
Thank you, my friend, and Ithink people can clearly see why
we were looking so forward tohaving you on the podcast and
talking with you about that, andI know a lot of folks at Utah.
Y'all developed a tremendousprogram there.
It was a very historic programanyway, and so that would have
(06:44):
been easy to be in a low and youpicked it up and took it along
and the facilities that y'allbuilt out there the Orthopedic
Institute is spectacular.
Speaker 3 (06:53):
Yeah, I think it's fair to say I was very fortunate
, and I'll just make two points.
One is that I moved into anarea where the population was
growing and so the economy isgood and the population is
growing.
You got to be pretty bad toscrew that up, okay, because
(07:13):
businesses do well when thingsare growing.
And the other point is when Ilooked at this job I didn't
understand what I understand nowat all, but I do think if it
had been an A-plus program Iprobably would have driven it
down If it had been a D program.
(07:34):
I may never gotten out of thehole, but I was fortunate to
come into a program that wasvery well managed and had a
great trajectory, first reallyunder unbelievable previous
leadership here, including apast president of the AOA who
(07:55):
was Dr Sherm Coleman, who is theperson who first announced to
the AOA that he thought thefuture of orthopedics was
subspecialization, for which hegot roundly criticized, and then
by Harold Dunn, who was ahistoric and amazing chair.
So I was very lucky to come inafter tremendous leadership.
(08:15):
So I think all that theenvironment helped.
There are three things thatmatter in life in my view of
things.
Whether it's right or wrong,this is my view.
One is preparation and theother two are luck and timing,
and I had a lot of luck andgreat timing.
Speaker 2 (08:33):
That's fantastic, fantastic.
Now, through your role you'vehad many roles in orthopedics,
of course, within your specialty, and then also being editor of
the big journal you can see alot of the trends of the future.
And I get it, brother, you andI were talking about it earlier.
That predicting the future is,and you had a great yogi bear
(08:56):
quote you threw in there.
It's impossible, but to thebest of your ability, with the
tremendous knowledge base thatyou have, where's foot and ankle
go and in the future, and youcan define whatever that is in
terms of 5, 10, 20, 100 years.
I'm kidding.
Okay, you're both thanks.
Speaker 3 (09:15):
Yeah, so I did bring up joe grieber's quote, which is
the future ain't what it usedto be, which is on the surface,
just just humorous, but, as you,if you think about it, he's
absolutely right.
None of us really, or very fewof us really, can see very far
into the future because there'sso many changes.
The tectonic plates ofengineering and science and
(09:39):
geopolitical activity is arealways moving and none of us can
really us can really computewhere we're going.
And to give my perspective,which is one person's
perspective, number one, I knowI was incredibly lucky to grow
up in the United States at atime where we were the dominant
(10:00):
country and I was a white male.
So there I start and I look outacross my universe.
At that time, the world andwhen I was starting my residency
, I was no.
I would not believe if you toldme that the USSR would collapse,
the wall between East and WestBerlin would come down, they
(10:23):
would become unified.
I wouldn't believe that.
Nor could I imagine in any waythe internet.
I could not have imagined itbeing real.
I could not have imaginedhaving an iPhone that works like
a computer and not using a.
I used a slide rule when I wasin school to give you a sense of
(10:43):
where it came from, and I don'tthink any of us, even 15 years
ago or 10 years ago, couldimagine what artificial
intelligence is.
So to give you some perspectiveon looking forward, the one
thing you know is things aregoing to change and you don't
(11:04):
know where that change is comingfrom.
So I'll take this a littledifferently.
I'll first start with a patientperspective.
One thing that's not going tochange is patients, like
consumers, want something easy,want it quick, want it reliable
and patient.
And those features of medicine,those don't exactly fit with
(11:29):
what our current medicine is.
I guess.
For foot and ankle patients,first of all, it's not so easy
to get into the office.
Then you have a surgery that'snot necessarily reliable.
It's got a 10% non-union rateacross the foot for any fusion
let's start with that.
So you get one out of 10patients who aren't going to
heal and you're telling them tostay off their foot for three
(11:52):
months, four months and theymight have to have the surgery
done again.
So all those things aredissatisfiers to patients.
So that's a concept thateveryone should keep in mind.
It's the same concept of Icould go out and buy Christmas
(12:14):
presents at five differentstores, not have what's in place
.
Come back finally, get it,bring it home, wrap them up, put
them under a tree or somethinglike that, or a Hanukkah bush in
my case.
Wrap them up, put them under atree or something like that, or
a Hanukkah bush in my case.
Or I can now go on Amazon andorder it all wrapped and it'll
be delivered.
(12:34):
It's probably less costlyactually to the world because of
the system that they have forfulfillment.
It's probably less pollutionbecause I'm not driving all over
the place three times.
It takes no time for me, so Idon't have to invest my time.
So how is medicine going to movetowards Amazon?
(12:54):
And I would say we're not goingto move quickly.
We're a slow moving huge vesselwith a lot of tugboats around
us pulling in oppositedirections.
But those who figure out how tomove in that direction will be
rewarded and the patients willdo better and will have a better
(13:15):
experience.
So for foot and anklespecifically, if I was to look
at it, I say my biggest problemis I put patients out of work.
I put patients who are 70 yearsold on crutches routinely and
have them not in weight-bearingfor a prolonged period of time
(13:35):
and somebody's got to figure outhow to avoid that, how to
change that.
So where is that going tohappen?
It could happen in bone biology, it could happen in bone
mechanics, it could happen inboot mechanics.
It could happen in ways I can'timagine, but it will happen.
It will happen and it willshorten their recovery.
So from the patient'sperspective and I think that's
(14:04):
what all of us should keep inmind as we look to the future
what is going to make it betterfor them?
And it may be that if we canmake the surgeries more reliable
, if we can get them recoveringquicker, any of that stuff is
going to make our world better.
So if you look at what's goingon now, mis surgery is booming
in the foot and ankle world incertain areas of Europe, in
certain parts of South America.
It's coming to the UnitedStates and most of it tends to
(14:28):
work and the patients have lesspain, they recover quicker.
They recover, say, in six weeksinstead of 12 weeks, and to the
surgeon it doesn't seem tomatter that much, because you're
going to see the patient backat 6 and 12.
You're going to have to haveyour clinic full of the patients
anyway, but to the patient itmatters a lot, and so I think
(14:50):
the field will move towards inthat direction.
Now all of us see robotics, someof us see AI coming in, and I
am sure that for foot and ankle,either robotics or navigation
will come in.
Ai will help predict things.
So where will it help us in thenear future?
Well, if AI gets smart enoughto look at two orthogonal planes
(15:13):
of plane x-rays and build a 3Dmodel, then they can direct
surgery.
You can do all your planningoff those x-rays in a reliable
manner, and I think that'slow-lying fruit, probably right
now for AI, but eventually youcan see where it's going.
I think you can see where it'sgoing, which is okay.
(15:35):
Now you got the plan, now thetools.
Now the tools relate to theplan and relate to the AI
intraoperatively, and basicallyyour job is to make sure you put
the tools on correctly.
But maybe it's even better thanthat.
It already knows how to put thetools on correctly, and then
you make your cuts perfectly.
Your screws are allpredetermined.
You've done it in a third ofthe time because you don't have
(15:57):
to think.
Actually, all you have to do isset it up and it's more
reliable.
The basic for all of orthopedicsapproach.
The other thing I'd say is wedon't know what the future
pathologies will be.
Okay, so what we do know iswhat today's pathologies are.
And to give you a broader sortof long review sense, I want to
(16:17):
just take a moment and justexplain this perspective.
In 1900, orthopedic surgeonshad trauma.
They had syphilis to take careof because of the tabes dorsalis
and the joints being destroyed.
And then, if you take from thatpoint forward and think about
what has not, has gone away fromorthopedics.
(16:39):
So syphilis went away, poliowent away, leprosy has mostly
gone, at least in the world thatwe all live in.
Hansen's disease 1900, hansen'sdisease was prevalent in Europe.
It's called Hansen becauseHansen was a scientist in Norway
(17:02):
that determined the organismthat caused the disease, to give
you a sense of the prevalenceof this disease.
So it was across the world.
You don't see leprosy in theUnited States.
We don't take care of it now,but there was a huge need for
that, especially in hand andfoot and ankle to do tendon
(17:23):
transfers.
We don't do any of that anymore.
We don't take care of polio andpolio was a big disease for
foot and ankle surgeons Triplearthrodesis at University of
Iowa, where I was at, drPonsetti did 400 triples for
polio alone.
And then so we don't see that,so that's gone okay.
(17:44):
Rheumatoid arthritis when Istarted in 1992, I was doing one
out of 10 operations was on arheumatoid forefoot.
Now probably one in a hundred,maybe less.
So it's gone okay.
So what's the next disease togo?
I'm guessing that somebody'sgonna figure out how to slow
(18:07):
down the progression ofosteoarthritis pharmacologically
.
It can't be that hard to figureout, and it's such a big market
, right?
Somebody's going to get there.
And just like GLPs, right?
Glps never heard of that threeyears ago, five years ago.
Glps are killing it right nowand they're helping a lot of
(18:29):
patients and beauty stars andGLPs.
Imagine a GLP forosteoarthritis.
Okay, that all of a suddenyou've gone from rapidly
progressing to half the speed ofprogression of your
osteoarthritis.
Well, that'll cut out half ofthe total joints, probably.
And then so imagine that.
(18:50):
But also imagine self-drivingcars.
Self-driving cars that areactually 10 times as safe as
driving cars, so that thegovernment says no more driving,
you can't drive yourself unlessyou're under these
circumstances and where there'sno self-driving, because they're
10 times safer.
Well, that'll get rid of 85% ofour trauma here or 75% of our
(19:15):
trauma here.
So there's a lot of changesthat we can't see, but we know
one thing.
We know one thing which is thatif we focus on what making the
patient experience better, wethink deeply about that We'll
make a difference and we'llembrace the changes that are
coming towards us, because weknow that's our goal, that's our
(19:38):
North Star.
Now I did talk before, just totake it a little further.
I did talk a little bit abouton the tissue level and on the
anatomic level, and there's afew things maybe worth saying.
One is, on a tissue level, bonehealing.
Bones love to heal incompression.
Okay, if they could decompress,they'll heal.
Okay, and that's just how itworks.
(19:58):
I think of it in my mind andI've seen a very high resolution
EM that confirms this view,which actually I can't remember
if I thought of it, or I bet Ijust saw it on the image and
decided I thought of it.
But the view that it's thereare stalactites and stalagmites
(20:19):
coming together and merging okay, icicles, you can think of
coming up and coming down andmerging, and compression doesn't
hurt that.
But shear kills it, tensionkills it, okay.
So anything we can do that cancompress bone better is good in
my mind, until a point wherecertainly at some level bone is
(20:41):
gonna crush okay.
So we don't actually know wherethat point is.
That sounds crazy, but I don'tthink anyone really knows has
defined that.
Maybe I'm wrong.
I've looked.
But so some level ofcompression is better than no
compression and continuouscompression, which we see now
with continuous compressionstaples, appear to be helpful.
(21:02):
Certainly are easy to use,certainly are easier for the
patients because less hard work.
But so I think that's adirection.
You know I'm talking aboutnon-biological direction.
Another just great big fatpaintbrush stroke is biology.
Can we have adjuvant biologythat works?
I don't think we really havemuch now.
(21:23):
We got the beginnings of it.
But if we had adjuvant biologythat worked for cartilage,
tendon, old tendons and bone,we'd be in a much better place.
You can expect that eventuallyto emerge.
You can also expect a lot.
(21:54):
Subtail and joint can bepartially incompatible.
It's almost vertical.
So anytime you step downthey're trying to slide, they're
trying to shear.
And the foot we do a lot offusions because we think it
should be stable and we don'thave a lot of options for
(22:15):
replacement because the FDA onlyhas ankle replacements, so as a
lot of ankle replacements sofar.
So we have to fuse, so we needto figure out a better way of
converting the forces ofdistraction, the forces of shear
, or at least resisting thoseforces to get people up and
walking early after these fusionprocedures.
(22:37):
So that's a direction.
And finally, I think, totalankles.
I've been on this total anklebang wagon for too long so I'm
almost believing myself, but Ido think we've already breached
the top and now we're on thedownhill slide and people are
seeing total ankles as a primaryoption for many patients with
(22:58):
ankle arthritis.
And the field has got to getbetter.
We've got to get smaller anklereplacements, meaning we've got
to take out less bone and getthe same results or better
results.
And once we get there, then Ithink the younger patients will
be able to have anklereplacements and be more active.
So that's how I sort of see thefuture.
(23:18):
But again, I can't see thefuture because something is
going to come along that's goingto just completely change how
we look at everything, just likearthroscopy did, just like John
Charnley did with figuring outlow friction arthroplasty.
That guy was unbelievable.
And what does it take to beJohn Charnley?
(23:40):
What it takes and I just liketo leave with this to be John,
charlie or my hero IgnacioPansetti, who I got to know, who
changed clubfoot treatmentaround the world.
It takes a few things.
One is incredible curiosity.
So orthopedic surgeons can benon-curious people, they can
(24:04):
just learn a recipe and you knowall the recipe.
But for those who have naturalcuriosity and tremendous
perseverance, I think, and noconsideration of money, neither
of those guys cared a bit aboutmoney, not anything about money,
neither of them.
They wanted to make the worldbetter and they found it
(24:27):
interesting and I hope that thislittle conversation will
stimulate others to realize thatcan be part of their life, that
can be a fun part of their life, that doesn't have to be their
whole life and they can make abig impact broader than
themselves.
It can make in the opera, onone by one page, one patient at
time, as charlie and ponsettidid right, that's absolutely
(24:53):
spectacular on that.
Speaker 2 (24:54):
so you think that it was interesting hearing what you
were saying so I could see ademographic shift in the
specialties that the residentsare going into, based on the
changes in diseasecharacteristics as the future
continues to roll out.
I mean my beloved traumasurgery.
We're going to become to yourpoint, if motor vehicle road
(25:18):
traffic accidents go way downwith AI, then we are now
becoming more fragility fracturesurgeons, because that's really
the only yeah we're not seeingtrue iss over 16 trauma patients
, but older folks, utterlypeople with proximal femoral
fractures yeah, no, I thinkthat's it.
Speaker 3 (25:37):
Yeah, I, your skill set is very important for the
world.
Let me just make you and theaging population is where you
can make a big difference andthere's not a.
All right, I'm going to go offscript here.
The way it works seems to workOkay.
The way it seems to work to meis that the big companies in
(25:58):
trauma go to the big traumacenters and get the big names to
do big trials or to supporttheir big products, but guess
what?
There's a lot of old people notgoing to the big trauma centers
.
This is the massive amount andit's probably much bigger than
(26:19):
who's going to the traumacenters, but for some reason the
companies haven't figured thatout.
Once the companies figure outthat and this is my take, like,
say, for LC1 fractures, get themup early, get them moving.
Why not put a couple of screwsin transacral screws in to get
them moving?
What is it about the world?
(26:39):
That's ageist, that says theydon't deserve the screws where
they have the worst bone andsome young guy deserves the
screws.
Okay, so that's how I look atthings, okay, so I think
there'll be work, but it willchange.
It could change when I was aresident and it's a little bit
before you, doug, because I knowyour age and you know mine,
because we were on the boardtogether and it's about a decade
(27:01):
before, when I was a resident,almost every night I was on call
, somebody came in dead onarrival, right right, why?
Well, because there wereseatbelts who just started and
there were no airbags.
There were some airbags, butthey were terrible and I think
in my senior year I saw threePILONs.
Why?
(27:22):
Because the patients werekilled Once the airbags popped
up.
Pilons popped up, wow.
So the point is is, if cars getsafer, if transportation gets
safer, and what?
Who's to think it's not goingto get safer?
Because certainly withseatbelts, which was basically
pushed through by a New Yorkstate orthopedic surgeon and
(27:46):
made a law in that state, by theway, and then became a national
law, if seatbelts changedeverything and then airbags
changed everything, I am surethat there'll be another level
that'll change everything fordriving accidents Not going to
get rid of everything, but it'sgoing to change the demographics
.
And it's going to be true forus too, in the foot and ankle
(28:07):
world, because we take care of alot of post-traumatic Ankle
work is basically post-traumaticand we do a lot of trauma in
the foot and ankle area, sowe'll probably see a diminished
volume there.
But there's always going to bework for good people and it's
just a matter of realizing thatthe population is getting bigger
(28:28):
.
They're going to need to betaken care of.
You just have to adapt with thechange.
Speaker 2 (28:32):
Well, so much of your stuff is done in the inpatient
sector.
I would imagine that you'rewell above 80% is outpatient.
Speaker 3 (28:40):
Oh yeah, we don't want to walk in a hospital.
Speaker 2 (28:44):
So what would you guess?
Speaker 3 (28:47):
In Charlie Seltzman's .
Well, in my world it's 90something percent, and that
includes children and adults,not babies, because I don't take
care of babies, but childrenand adults.
And yeah, so there's a group ofpatients who are comorbid
enough that they reallyshouldn't have any surgery done
(29:10):
in an ASC.
They just, you know, you can'ttell, it's just rolling the dice
when they're going to have aproblem in the operating room,
and so they're done at a mainhospital which has all the
resources nearby, you still havethe hospital outpatient
department.
Speaker 2 (29:24):
You can still treat them that way within the
hospital and still let them gohome.
Speaker 3 (29:29):
Yeah, that's what, yeah, and that's what we do.
Yeah, and that's the.
That's the standard I.
Utah is an interesting place towork that people here are
really fit and they don't smoke.
Well, some do, but very fewsmoke or drink.
Diabetes is a lower prevalencein this population because they
really focus on being fit and ifwe had a large diabetic
(29:50):
population it would change thatcalculus a little bit because of
their needs for inpatient care.
Speaker 2 (29:59):
It's been absolutely fascinating because you've gone
into the effect that a lot offolks have not done to this
point that as the pathologychanges because I think that's
one of the first times I'veheard that come up.
But to your point, especiallywith road traffic accidents,
motor vehicle collisions, withAI and then with biologic
(30:19):
advances to mute the progressionof osteoarthritis and to your
to your point earlier, thatwould be, oh my gosh, any drug
company that got a hold of thatwould cease market share and the
return on investment will bespectacular for them.
But the combinations of allthose will change demographics
of our specialty, what we do,who we are and what disease
(30:41):
processes we're taking care of.
And I haven't heard that reallyelaborated to the degree and to
the eloquence that you just did.
Speaker 3 (30:49):
Well, I think my view is embrace change, okay, right,
you asked me about being chairhere earlier and I came out for
an interview, and so part of theinterview process was to sit in
front of the faculty.
At the time there were probably12 or 15 people in the room Now
we're 60, to give a sense andone of the persons asked me
(31:13):
something, and my response wasand I believed this then and I
believe it now my response wasif you don't like change, don't
hire me.
Don't hire me.
I think too much of the worldwas scared of change.
I think too much of the worldis scared of risk, right, just
(31:35):
in general.
And I believe the work that youknow I think it's Kahneman Danny
Kahneman got the Nobel Prizefor on risk avoidance behavior
is a real thing and Traverskyand Conneman got the Nobel Prize
for it.
And I think that this is justfor the members of the AOA
(31:56):
Embrace change.
It's coming.
You can't avoid it.
You know that the world will beinherited by those who embrace
change and everybody else willbe left behind.
And so I think being agile ispart of being a leader, and I
think being willing to engageand keep up is required for all
(32:21):
of us, and I just think that'sthe way the world is and it's
foolish to think you can go back.
Speaker 2 (32:33):
Yeah, yeah.
If nothing else, those changesin technology are going to force
everything else on us because,to your point, it makes
everything much, much differentthan it was earlier.
As you made the shoppinganalogy, yeah, yeah, and I think
it wouldn't make thingsdifferent than it was earlier.
Speaker 3 (32:45):
As you made the shopping analogy, yeah, yeah,
and I think it.
It wouldn't make thingsdifferent if it, if it didn't
make things better.
So temporarily you'll see theselittle blips in technology that
actually hurt patients, andthen they disappear and you try
to trace down what happened andwho published on it.
You can't find a trace, likethe company folded the docs,
(33:06):
going on to another promotinganother product for another
company.
That's probably a terribleproduct, and so you see that all
the time in this field.
So don't embrace all the changeyou see, but these big trends,
the overall trend is things aregoing to have to change in both,
in every direction, and you'rebringing up changes in
technology.
That's out of our control andthat's a good thing, because
(33:30):
there are a lot of smart peoplearound the world figuring out
how to make things better for us.
You know, just to take somethingsimple, like when I started, we
were using all the tools wereplugged in.
All the tools were most of themwere on air compressor controls
.
That was horrible.
I didn't know it.
Then I thought it was great wedidn't have a mini CRM.
We had at the University ofMichigan.
(33:51):
I was excited when they got aCRM and then we got this.
Now I wouldn't use a CRM for90%.
I want to use a mini and I getupset if I don't get the right
mini.
Like so we all love this stuff,admit it, okay, and just
embrace it as it comes along andtest it be skeptical but
(34:11):
embrace it.
Speaker 2 (34:12):
And what a great conversation and I think you hit
directly on what we're lookingfor and we certainly have
discussed the future.
So, dr Charlie Salzman, thankyou very much for being on the
podcast series.
Sir, my pleasure.
Always good to see him again,my friend and for all our
listeners.
Y'all please stay tuned forfuture AOA and future orthopedic
(34:33):
surgery podcasts on thischannel.
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 itself.
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 CharlieSaltzman.
Dr Saltzman is the LS PearyPresidential Endowed Professor
(01:05):
of Orthopedic Surgery at theUniversity of Utah and also the
Editor-in-Chief of Foot AnkleInternational and Foot Ankle
Orthopedics.
Dr Salzman did his undergraduatework in pre-medical sciences at
Brown University.
He went to medical school atthe University of North Carolina
(01:32):
and then did his internship andresidency at the University of
Michigan, followed by hisfellowship in foot and ankle
surgery at the Mayo Clinic.
As I said, he serves on thefield of orthopedics as
editor-in-chief of Foot andAnkle International and Foot and
Ankle Orthopedics.
He's co-editor of Man's Surgeryof Foot and Ankle and past
president of the AmericanOrthopedic Foot and Ankle
Society.
Past president of theInternational Federation of Foot
and Ankle Societies.
Past president of theAssociation of Bone and Joint
(01:55):
Surgeons and past vice presidentof the American Board of
Orthopedic Surgery, and servedas the chair at the University
of Utah Department ofOrthopedics from 2005 to 2021.
Dr Salzman, welcome to thepodcast, sir.
Nice to be with you, doug, andit's always good to see you
again.
Charlie and Charlie and I havebeen friends for a long time and
(02:17):
it's really great to talk toCharlie because Charlie is going
to give us insight into thefuture in foot and ankle surgery
and all the things that aregoing to be coming down the pike
in terms of that, and I wouldargue that Charlie knows that as
well or better than anybody.
But, charlie, before we go intothat, you served for quite a
lot I guess 16, 17 years as thechair at the University of Utah
(02:42):
and you have a wealth ofexperience in leadership.
What was your philosophy whileyou were chair at Utah and what
were the key takeaway learningsthat you took from that position
and that experience?
Speaker 3 (02:53):
Thanks, doug.
I had a great opportunity atUtah when they brought me on as
chair to create an environmentand a program in a direction
that I thought that programshould move, and my philosophy
for doing that pretty simple,actually.
The first was to see my jobprimarily as a person who was
(03:18):
tasked with resourcing otherpeople and giving others an
opportunity to grow, to moveinto the shadows and not be in
the limelight so that otherscould shine and I could
basically rejoice in thereflected glow of others.
And so my role I saw it as afiduciary role to one extent,
(03:40):
which is to make sure there wasenough resources to share and to
help everyone become the personthey wanted to become within
the department.
I do think it's very importantfor a chair or a person in
leadership to help pick theright people and to get the
wrong people basically, as iscommonly referred to, off the
(04:02):
bus, and I took that veryseriously and we were able to
recruit wonderful people.
We did remove a few people andthe environment flourished as a
result.
I think it's very important toset a North Star for the group
and to have this done mutually,but to make sure it's consistent
with the leader's vision and,for us, the North Star was like
(04:25):
it should be for most orthopedicprograms excellence in patient
care, excellent in education,concern about our community and
trying to improve orthopedics bybeing engaged in the
progression of the science ofthe field, as well as the
national organizations oforthopedics, and we try to do
(04:47):
that and involve everyone insome aspect of that so that
everyone felt that they achievedtheir personal goals.
And, as a leader, I think it'spretty simple.
Actually, it's not about youever If you take that job, it's
never about you.
It's about serving the otherpeople.
It's almost an upside downtriangle, surprisingly, and
(05:09):
that's what works.
And I do think it's importantto set a vision.
I do think you should have acommon set of ethical principles
that you enforce and holdeveryone to, or at least ask
everyone to pay attention to it,and when they don't pay
attention, that you act on those, on that.
(05:30):
And I think it's that simple andit is not unique to say this,
but I've heard this from othersand I think it rings true and
I'm just going to read you thisGood people plant trees the
shade of which they will neversit under, and that's the whole
point of leadership.
I do take my work veryseriously.
I don't take myself thatseriously, but I love taking the
(05:54):
work seriously and I'm enthusedabout the work.
I've always been enthused aboutorthopedics.
I think we are the mostfortunate people in medicine and
we have maybe the mostfortunate people in anything,
because we have this great joband we're able to help so many
people.
And I think that level ofenthusiasm in a leader is also
(06:16):
helpful to the esprit de corpsof the group.
So I'll leave it at that.
Speaker 2 (06:21):
We can close right here and thank you for being on
the podcast.
That was fantastic.
Thank can close right here andthank you for being on the
podcast.
That was fantastic.
Thank you, my friend, and Ithink people can clearly see why
we were looking so forward tohaving you on the podcast and
talking with you about that, andI know a lot of folks at Utah.
Y'all developed a tremendousprogram there.
It was a very historic programanyway, and so that would have
(06:44):
been easy to be in a low and youpicked it up and took it along
and the facilities that y'allbuilt out there the Orthopedic
Institute is spectacular.
Speaker 3 (06:53):
Yeah, I think it's fair to say I was very fortunate
, and I'll just make two points.
One is that I moved into anarea where the population was
growing and so the economy isgood and the population is
growing.
You got to be pretty bad toscrew that up, okay, because
(07:13):
businesses do well when thingsare growing.
And the other point is when Ilooked at this job I didn't
understand what I understand nowat all, but I do think if it
had been an A-plus program Iprobably would have driven it
down If it had been a D program.
(07:34):
I may never gotten out of thehole, but I was fortunate to
come into a program that wasvery well managed and had a
great trajectory, first reallyunder unbelievable previous
leadership here, including apast president of the AOA who
(07:55):
was Dr Sherm Coleman, who is theperson who first announced to
the AOA that he thought thefuture of orthopedics was
subspecialization, for which hegot roundly criticized, and then
by Harold Dunn, who was ahistoric and amazing chair.
So I was very lucky to come inafter tremendous leadership.
(08:15):
So I think all that theenvironment helped.
There are three things thatmatter in life in my view of
things.
Whether it's right or wrong,this is my view.
One is preparation and theother two are luck and timing,
and I had a lot of luck andgreat timing.
Speaker 2 (08:33):
That's fantastic, fantastic.
Now, through your role you'vehad many roles in orthopedics,
of course, within your specialty, and then also being editor of
the big journal you can see alot of the trends of the future.
And I get it, brother, you andI were talking about it earlier.
That predicting the future is,and you had a great yogi bear
(08:56):
quote you threw in there.
It's impossible, but to thebest of your ability, with the
tremendous knowledge base thatyou have, where's foot and ankle
go and in the future, and youcan define whatever that is in
terms of 5, 10, 20, 100 years.
I'm kidding.
Okay, you're both thanks.
Speaker 3 (09:15):
Yeah, so I did bring up joe grieber's quote, which is
the future ain't what it usedto be, which is on the surface,
just just humorous, but, as you,if you think about it, he's
absolutely right.
None of us really, or very fewof us really, can see very far
into the future because there'sso many changes.
The tectonic plates ofengineering and science and
(09:39):
geopolitical activity is arealways moving and none of us can
really us can really computewhere we're going.
And to give my perspective,which is one person's
perspective, number one, I knowI was incredibly lucky to grow
up in the United States at atime where we were the dominant
(10:00):
country and I was a white male.
So there I start and I look outacross my universe.
At that time, the world andwhen I was starting my residency
, I was no.
I would not believe if you toldme that the USSR would collapse,
the wall between East and WestBerlin would come down, they
(10:23):
would become unified.
I wouldn't believe that.
Nor could I imagine in any waythe internet.
I could not have imagined itbeing real.
I could not have imaginedhaving an iPhone that works like
a computer and not using a.
I used a slide rule when I wasin school to give you a sense of
(10:43):
where it came from, and I don'tthink any of us, even 15 years
ago or 10 years ago, couldimagine what artificial
intelligence is.
So to give you some perspectiveon looking forward, the one
thing you know is things aregoing to change and you don't
(11:04):
know where that change is comingfrom.
So I'll take this a littledifferently.
I'll first start with a patientperspective.
One thing that's not going tochange is patients, like
consumers, want something easy,want it quick, want it reliable
and patient.
And those features of medicine,those don't exactly fit with
(11:29):
what our current medicine is.
I guess.
For foot and ankle patients,first of all, it's not so easy
to get into the office.
Then you have a surgery that'snot necessarily reliable.
It's got a 10% non-union rateacross the foot for any fusion
let's start with that.
So you get one out of 10patients who aren't going to
heal and you're telling them tostay off their foot for three
(11:52):
months, four months and theymight have to have the surgery
done again.
So all those things aredissatisfiers to patients.
So that's a concept thateveryone should keep in mind.
It's the same concept of Icould go out and buy Christmas
(12:14):
presents at five differentstores, not have what's in place
.
Come back finally, get it,bring it home, wrap them up, put
them under a tree or somethinglike that, or a Hanukkah bush in
my case.
Wrap them up, put them under atree or something like that, or
a Hanukkah bush in my case.
Or I can now go on Amazon andorder it all wrapped and it'll
be delivered.
(12:34):
It's probably less costlyactually to the world because of
the system that they have forfulfillment.
It's probably less pollutionbecause I'm not driving all over
the place three times.
It takes no time for me, so Idon't have to invest my time.
So how is medicine going to movetowards Amazon?
(12:54):
And I would say we're not goingto move quickly.
We're a slow moving huge vesselwith a lot of tugboats around
us pulling in oppositedirections.
But those who figure out how tomove in that direction will be
rewarded and the patients willdo better and will have a better
(13:15):
experience.
So for foot and anklespecifically, if I was to look
at it, I say my biggest problemis I put patients out of work.
I put patients who are 70 yearsold on crutches routinely and
have them not in weight-bearingfor a prolonged period of time
(13:35):
and somebody's got to figure outhow to avoid that, how to
change that.
So where is that going tohappen?
It could happen in bone biology, it could happen in bone
mechanics, it could happen inboot mechanics.
It could happen in ways I can'timagine, but it will happen.
It will happen and it willshorten their recovery.
So from the patient'sperspective and I think that's
(14:04):
what all of us should keep inmind as we look to the future
what is going to make it betterfor them?
And it may be that if we canmake the surgeries more reliable
, if we can get them recoveringquicker, any of that stuff is
going to make our world better.
So if you look at what's goingon now, mis surgery is booming
in the foot and ankle world incertain areas of Europe, in
certain parts of South America.
It's coming to the UnitedStates and most of it tends to
(14:28):
work and the patients have lesspain, they recover quicker.
They recover, say, in six weeksinstead of 12 weeks, and to the
surgeon it doesn't seem tomatter that much, because you're
going to see the patient backat 6 and 12.
You're going to have to haveyour clinic full of the patients
anyway, but to the patient itmatters a lot, and so I think
(14:50):
the field will move towards inthat direction.
Now all of us see robotics, someof us see AI coming in, and I
am sure that for foot and ankle,either robotics or navigation
will come in.
Ai will help predict things.
So where will it help us in thenear future?
Well, if AI gets smart enoughto look at two orthogonal planes
(15:13):
of plane x-rays and build a 3Dmodel, then they can direct
surgery.
You can do all your planningoff those x-rays in a reliable
manner, and I think that'slow-lying fruit, probably right
now for AI, but eventually youcan see where it's going.
I think you can see where it'sgoing, which is okay.
(15:35):
Now you got the plan, now thetools.
Now the tools relate to theplan and relate to the AI
intraoperatively, and basicallyyour job is to make sure you put
the tools on correctly.
But maybe it's even better thanthat.
It already knows how to put thetools on correctly, and then
you make your cuts perfectly.
Your screws are allpredetermined.
You've done it in a third ofthe time because you don't have
(15:57):
to think.
Actually, all you have to do isset it up and it's more
reliable.
The basic for all of orthopedicsapproach.
The other thing I'd say is wedon't know what the future
pathologies will be.
Okay, so what we do know iswhat today's pathologies are.
And to give you a broader sortof long review sense, I want to
(16:17):
just take a moment and justexplain this perspective.
In 1900, orthopedic surgeonshad trauma.
They had syphilis to take careof because of the tabes dorsalis
and the joints being destroyed.
And then, if you take from thatpoint forward and think about
what has not, has gone away fromorthopedics.
(16:39):
So syphilis went away, poliowent away, leprosy has mostly
gone, at least in the world thatwe all live in.
Hansen's disease 1900, hansen'sdisease was prevalent in Europe.
It's called Hansen becauseHansen was a scientist in Norway
(17:02):
that determined the organismthat caused the disease, to give
you a sense of the prevalenceof this disease.
So it was across the world.
You don't see leprosy in theUnited States.
We don't take care of it now,but there was a huge need for
that, especially in hand andfoot and ankle to do tendon
(17:23):
transfers.
We don't do any of that anymore.
We don't take care of polio andpolio was a big disease for
foot and ankle surgeons Triplearthrodesis at University of
Iowa, where I was at, drPonsetti did 400 triples for
polio alone.
And then so we don't see that,so that's gone okay.
(17:44):
Rheumatoid arthritis when Istarted in 1992, I was doing one
out of 10 operations was on arheumatoid forefoot.
Now probably one in a hundred,maybe less.
So it's gone okay.
So what's the next disease togo?
I'm guessing that somebody'sgonna figure out how to slow
(18:07):
down the progression ofosteoarthritis pharmacologically
.
It can't be that hard to figureout, and it's such a big market
, right?
Somebody's going to get there.
And just like GLPs, right?
Glps never heard of that threeyears ago, five years ago.
Glps are killing it right nowand they're helping a lot of
(18:29):
patients and beauty stars andGLPs.
Imagine a GLP forosteoarthritis.
Okay, that all of a suddenyou've gone from rapidly
progressing to half the speed ofprogression of your
osteoarthritis.
Well, that'll cut out half ofthe total joints, probably.
And then so imagine that.
(18:50):
But also imagine self-drivingcars.
Self-driving cars that areactually 10 times as safe as
driving cars, so that thegovernment says no more driving,
you can't drive yourself unlessyou're under these
circumstances and where there'sno self-driving, because they're
10 times safer.
Well, that'll get rid of 85% ofour trauma here or 75% of our
(19:15):
trauma here.
So there's a lot of changesthat we can't see, but we know
one thing.
We know one thing which is thatif we focus on what making the
patient experience better, wethink deeply about that We'll
make a difference and we'llembrace the changes that are
coming towards us, because weknow that's our goal, that's our
(19:38):
North Star.
Now I did talk before, just totake it a little further.
I did talk a little bit abouton the tissue level and on the
anatomic level, and there's afew things maybe worth saying.
One is, on a tissue level, bonehealing.
Bones love to heal incompression.
Okay, if they could decompress,they'll heal.
Okay, and that's just how itworks.
(19:58):
I think of it in my mind andI've seen a very high resolution
EM that confirms this view,which actually I can't remember
if I thought of it, or I bet Ijust saw it on the image and
decided I thought of it.
But the view that it's thereare stalactites and stalagmites
(20:19):
coming together and merging okay, icicles, you can think of
coming up and coming down andmerging, and compression doesn't
hurt that.
But shear kills it, tensionkills it, okay.
So anything we can do that cancompress bone better is good in
my mind, until a point wherecertainly at some level bone is
(20:41):
gonna crush okay.
So we don't actually know wherethat point is.
That sounds crazy, but I don'tthink anyone really knows has
defined that.
Maybe I'm wrong.
I've looked.
But so some level ofcompression is better than no
compression and continuouscompression, which we see now
with continuous compressionstaples, appear to be helpful.
(21:02):
Certainly are easy to use,certainly are easier for the
patients because less hard work.
But so I think that's adirection.
You know I'm talking aboutnon-biological direction.
Another just great big fatpaintbrush stroke is biology.
Can we have adjuvant biologythat works?
I don't think we really havemuch now.
(21:23):
We got the beginnings of it.
But if we had adjuvant biologythat worked for cartilage,
tendon, old tendons and bone,we'd be in a much better place.
You can expect that eventuallyto emerge.
You can also expect a lot.
(21:54):
Subtail and joint can bepartially incompatible.
It's almost vertical.
So anytime you step downthey're trying to slide, they're
trying to shear.
And the foot we do a lot offusions because we think it
should be stable and we don'thave a lot of options for
(22:15):
replacement because the FDA onlyhas ankle replacements, so as a
lot of ankle replacements sofar.
So we have to fuse, so we needto figure out a better way of
converting the forces ofdistraction, the forces of shear
, or at least resisting thoseforces to get people up and
walking early after these fusionprocedures.
(22:37):
So that's a direction.
And finally, I think, totalankles.
I've been on this total anklebang wagon for too long so I'm
almost believing myself, but Ido think we've already breached
the top and now we're on thedownhill slide and people are
seeing total ankles as a primaryoption for many patients with
(22:58):
ankle arthritis.
And the field has got to getbetter.
We've got to get smaller anklereplacements, meaning we've got
to take out less bone and getthe same results or better
results.
And once we get there, then Ithink the younger patients will
be able to have anklereplacements and be more active.
So that's how I sort of see thefuture.
(23:18):
But again, I can't see thefuture because something is
going to come along that's goingto just completely change how
we look at everything, just likearthroscopy did, just like John
Charnley did with figuring outlow friction arthroplasty.
That guy was unbelievable.
And what does it take to beJohn Charnley?
(23:40):
What it takes and I just liketo leave with this to be John,
charlie or my hero IgnacioPansetti, who I got to know, who
changed clubfoot treatmentaround the world.
It takes a few things.
One is incredible curiosity.
So orthopedic surgeons can benon-curious people, they can
(24:04):
just learn a recipe and you knowall the recipe.
But for those who have naturalcuriosity and tremendous
perseverance, I think, and noconsideration of money, neither
of those guys cared a bit aboutmoney, not anything about money,
neither of them.
They wanted to make the worldbetter and they found it
(24:27):
interesting and I hope that thislittle conversation will
stimulate others to realize thatcan be part of their life, that
can be a fun part of their life, that doesn't have to be their
whole life and they can make abig impact broader than
themselves.
It can make in the opera, onone by one page, one patient at
time, as charlie and ponsettidid right, that's absolutely
(24:53):
spectacular on that.
Speaker 2 (24:54):
so you think that it was interesting hearing what you
were saying so I could see ademographic shift in the
specialties that the residentsare going into, based on the
changes in diseasecharacteristics as the future
continues to roll out.
I mean my beloved traumasurgery.
We're going to become to yourpoint, if motor vehicle road
(25:18):
traffic accidents go way downwith AI, then we are now
becoming more fragility fracturesurgeons, because that's really
the only yeah we're not seeingtrue iss over 16 trauma patients
, but older folks, utterlypeople with proximal femoral
fractures yeah, no, I thinkthat's it.
Speaker 3 (25:37):
Yeah, I, your skill set is very important for the
world.
Let me just make you and theaging population is where you
can make a big difference andthere's not a.
All right, I'm going to go offscript here.
The way it works seems to workOkay.
The way it seems to work to meis that the big companies in
(25:58):
trauma go to the big traumacenters and get the big names to
do big trials or to supporttheir big products, but guess
what?
There's a lot of old people notgoing to the big trauma centers
.
This is the massive amount andit's probably much bigger than
(26:19):
who's going to the traumacenters, but for some reason the
companies haven't figured thatout.
Once the companies figure outthat and this is my take, like,
say, for LC1 fractures, get themup early, get them moving.
Why not put a couple of screwsin transacral screws in to get
them moving?
What is it about the world?
(26:39):
That's ageist, that says theydon't deserve the screws where
they have the worst bone andsome young guy deserves the
screws.
Okay, so that's how I look atthings, okay, so I think
there'll be work, but it willchange.
It could change when I was aresident and it's a little bit
before you, doug, because I knowyour age and you know mine,
because we were on the boardtogether and it's about a decade
(27:01):
before, when I was a resident,almost every night I was on call
, somebody came in dead onarrival, right right, why?
Well, because there wereseatbelts who just started and
there were no airbags.
There were some airbags, butthey were terrible and I think
in my senior year I saw threePILONs.
Why?
(27:22):
Because the patients werekilled Once the airbags popped
up.
Pilons popped up, wow.
So the point is is, if cars getsafer, if transportation gets
safer, and what?
Who's to think it's not goingto get safer?
Because certainly withseatbelts, which was basically
pushed through by a New Yorkstate orthopedic surgeon and
(27:46):
made a law in that state, by theway, and then became a national
law, if seatbelts changedeverything and then airbags
changed everything, I am surethat there'll be another level
that'll change everything fordriving accidents Not going to
get rid of everything, but it'sgoing to change the demographics
.
And it's going to be true forus too, in the foot and ankle
(28:07):
world, because we take care of alot of post-traumatic Ankle
work is basically post-traumaticand we do a lot of trauma in
the foot and ankle area, sowe'll probably see a diminished
volume there.
But there's always going to bework for good people and it's
just a matter of realizing thatthe population is getting bigger
(28:28):
.
They're going to need to betaken care of.
You just have to adapt with thechange.
Speaker 2 (28:32):
Well, so much of your stuff is done in the inpatient
sector.
I would imagine that you'rewell above 80% is outpatient.
Speaker 3 (28:40):
Oh yeah, we don't want to walk in a hospital.
Speaker 2 (28:44):
So what would you guess?
Speaker 3 (28:47):
In Charlie Seltzman's .
Well, in my world it's 90something percent, and that
includes children and adults,not babies, because I don't take
care of babies, but childrenand adults.
And yeah, so there's a group ofpatients who are comorbid
enough that they reallyshouldn't have any surgery done
(29:10):
in an ASC.
They just, you know, you can'ttell, it's just rolling the dice
when they're going to have aproblem in the operating room,
and so they're done at a mainhospital which has all the
resources nearby, you still havethe hospital outpatient
department.
Speaker 2 (29:24):
You can still treat them that way within the
hospital and still let them gohome.
Speaker 3 (29:29):
Yeah, that's what, yeah, and that's what we do.
Yeah, and that's the.
That's the standard I.
Utah is an interesting place towork that people here are
really fit and they don't smoke.
Well, some do, but very fewsmoke or drink.
Diabetes is a lower prevalencein this population because they
really focus on being fit and ifwe had a large diabetic
(29:50):
population it would change thatcalculus a little bit because of
their needs for inpatient care.
Speaker 2 (29:59):
It's been absolutely fascinating because you've gone
into the effect that a lot offolks have not done to this
point that as the pathologychanges because I think that's
one of the first times I'veheard that come up.
But to your point, especiallywith road traffic accidents,
motor vehicle collisions, withAI and then with biologic
(30:19):
advances to mute the progressionof osteoarthritis and to your
to your point earlier, thatwould be, oh my gosh, any drug
company that got a hold of thatwould cease market share and the
return on investment will bespectacular for them.
But the combinations of allthose will change demographics
of our specialty, what we do,who we are and what disease
(30:41):
processes we're taking care of.
And I haven't heard that reallyelaborated to the degree and to
the eloquence that you just did.
Speaker 3 (30:49):
Well, I think my view is embrace change, okay, right,
you asked me about being chairhere earlier and I came out for
an interview, and so part of theinterview process was to sit in
front of the faculty.
At the time there were probably12 or 15 people in the room Now
we're 60, to give a sense andone of the persons asked me
(31:13):
something, and my response wasand I believed this then and I
believe it now my response wasif you don't like change, don't
hire me.
Don't hire me.
I think too much of the worldwas scared of change.
I think too much of the worldis scared of risk, right, just
(31:35):
in general.
And I believe the work that youknow I think it's Kahneman Danny
Kahneman got the Nobel Prizefor on risk avoidance behavior
is a real thing and Traverskyand Conneman got the Nobel Prize
for it.
And I think that this is justfor the members of the AOA
(31:56):
Embrace change.
It's coming.
You can't avoid it.
You know that the world will beinherited by those who embrace
change and everybody else willbe left behind.
And so I think being agile ispart of being a leader, and I
think being willing to engageand keep up is required for all
(32:21):
of us, and I just think that'sthe way the world is and it's
foolish to think you can go back.
Speaker 2 (32:33):
Yeah, yeah.
If nothing else, those changesin technology are going to force
everything else on us because,to your point, it makes
everything much, much differentthan it was earlier.
As you made the shoppinganalogy, yeah, yeah, and I think
it wouldn't make thingsdifferent than it was earlier.
Speaker 3 (32:45):
As you made the shopping analogy, yeah, yeah,
and I think it.
It wouldn't make thingsdifferent if it, if it didn't
make things better.
So temporarily you'll see theselittle blips in technology that
actually hurt patients, andthen they disappear and you try
to trace down what happened andwho published on it.
You can't find a trace, likethe company folded the docs,
(33:06):
going on to another promotinganother product for another
company.
That's probably a terribleproduct, and so you see that all
the time in this field.
So don't embrace all the changeyou see, but these big trends,
the overall trend is things aregoing to have to change in both,
in every direction, and you'rebringing up changes in
technology.
That's out of our control andthat's a good thing, because
(33:30):
there are a lot of smart peoplearound the world figuring out
how to make things better for us.
You know, just to take somethingsimple, like when I started, we
were using all the tools wereplugged in.
All the tools were most of themwere on air compressor controls
.
That was horrible.
I didn't know it.
Then I thought it was great wedidn't have a mini CRM.
We had at the University ofMichigan.
(33:51):
I was excited when they got aCRM and then we got this.
Now I wouldn't use a CRM for90%.
I want to use a mini and I getupset if I don't get the right
mini.
Like so we all love this stuff,admit it, okay, and just
embrace it as it comes along andtest it be skeptical but
(34:11):
embrace it.
Speaker 2 (34:12):
And what a great conversation and I think you hit
directly on what we're lookingfor and we certainly have
discussed the future.
So, dr Charlie Salzman, thankyou very much for being on the
podcast series.
Sir, my pleasure.
Always good to see him again,my friend and for all our
listeners.
Y'all please stay tuned forfuture AOA and future orthopedic
(34:33):
surgery podcasts on thischannel.
Thank you.
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