Lessons in Orthopaedic Leadership: An AOA Podcast
Lessons in Orthopaedic Leadership: An AOA Podcast
Revolutionizing Orthopaedic Surgery: AI, Big Data, and Leadership with Wayne J. Sebastianelli, MD, FAOA
How is artificial intelligence revolutionizing orthopaedic surgery, and what can big data teach us about improving patient outcomes across different healthcare systems? In our latest episode, we feature insights from Dr. Wayne Sebastianelli, a leading expert in orthopaedics, as he discusses the transformative role of AI and big data in advancing orthopaedic care. Dr. Sebastianelli provides a comparative analysis of international big data registries, highlighting the differences between systems in the United Kingdom, New Zealand, and the United States, and the impact these systems have on patient care. We also explore the challenges of managing extensive data and the implications of different healthcare models on orthopaedic practices.
Leadership development and emotional intelligence are pivotal in ensuring the future success of orthopaedists. Listen as Dr. Sebastianelli shares his vision on balancing manpower and honing leadership skills within the field of orthopaedics. We dive into the collaborative efforts of the AOA, AAOS, and ABOS in addressing key issues like compensation and advocacy while emphasizing the critical role of AI in reducing administrative burdens. Dr. Sebastianelli's rich experiences and leadership roles offer valuable perspectives on preparing the next generation of practitioners. Join us for an enlightening conversation that celebrates Dr. Sebastianelli's contributions and looks ahead to the evolving landscape of orthopedic surgery.
Welcome to the AOA Future in Orthopedic Surgery podcast series. This AOA podcast series will focus on the future in orthopedic surgery and the impact on leaders in our profession. These podcasts will focus on the vast spectrum of change that will occur as the future reveals itself. We will consider changes as they occur in the domains of culture, employment, technology, scope of practice, compensation and other areas. My name is Doug Lundy, host for this podcast series. Joining us today is Dr Wayne Sebastianelli.
Dr. Lundy:Dr Sebastionelli is the Kalanick Professor in Orthopedics, medical Director of Penn State Sports Medicine, associate Chief Medical Officer of Center of Penn State Sports Medicine, associate chief medical officer of Center County, penn State Health and the associate dean for clinical affairs at the University Park Regional Campus. He went to medical school at the University of Rochester, did his residency at Rochester and then did his fellowship at the Milton Hershey Medical Center and then went on to become, and eventually become, the team doctor for Penn State University. He's currently a director of the American Board of Orthopedic Surgery and the immediate past president, which is the 135th president of the American Orthopedic Association, dr Sebastian Nelly. Thank you and welcome to the podcast, sir.
Dr. Sebastianelli:Happy to be here, Douglas. Very, very good to be with you and spend some time trying to hash out some of these issues.
Dr. Lundy:And so Wayne and I have known each other for quite a while through the ABOS and through the AOA and absolutely love Wayne and his company and his lovely wife and just being friends and talking through different and complex things with them. And Wayne's got a very unique perspective because as the past president of the American Orthopedic Association he sat in a very specific and unique position to view the future of orthopedic surgery that few of us will ever have and certainly didn't have last year as he was president, certainly through the American Orthopedic Association, then also through Carousel and dealing with the other presidents of the English-speaking orthopedic organization. So, Wayne, based on your perspective from that, can you tell us, sir, what your thoughts are on the future in orthopedics, either short-term or long-term, how you see it?
Dr. Sebastianelli:Sure, doug, you know it's obviously not something that is going to be. Sure Doug, you know it's obviously not something that is going to be settled by one man's thoughts or one man's opinion, but there are multiple things that need to be considered, as we we need to somehow blend everything together with the power of artificial intelligence and the power of computer systems to try to generate the best possible solutions from big data. As I was working through some of this over the presidential line and ultimately through the travel of the carousel, you can see that the problems are pretty, you know, consistent throughout every country that we visited, and training certainly is an issue in the sense of how we best train our residents and our successors to sort of become the stewards of orthopedic care in the next 30 to 40 years to become the stewards of orthopedic care in the next 30 to 40 years.
Dr. Lundy:So thank you for that. Now, as you interacted with the presidents of the other orthopedic organizations across the English-speaking world, did you see anything unique or innovative that one of the other organizations was doing that perhaps we should consider? Or did anything come up where you were like, wow, that's a really good idea, we should do that at Penn State and hopefully across the US.
Dr. Sebastianelli:Yeah, I think you know the big data acquisition that England has is certainly powerful and you know their registries are really really quite sophisticated and New Zealand has really benefited from that connection with the United Kingdom and how they've incorporated their registries as well. But when you put it into the scope of what you know they're dealing with and what we're dealing with and the size differences, you can understand why it's a little bit easier for a country like New Zealand in particular to sort of organize things in a very, very regimented way. There's not as many sort of bodies of influence than you know in a country of New Zealand size as there would be in the United States. So it's a little bit easier to manage some of the opinions and, again, some of the personalities that we're doing, what needs to be in the registry, how to manage it, how to fund it. You know those kind of things are very, very important.
Dr. Lundy:Are Great Britain's registries as comprehensive as ours, or more so, or how does that look?
Dr. Sebastianelli:Well, I think it's been done for a lot longer period of time and I do think that you know their control of the primary care system and the specialty system is a little bit more sophisticated in ways that I think. You know the American model is a little bit different and not a lot of practitioners want to have that necessarily national control over their practice. So it's sort of like looking at annual wellness visits today for our primary care docs and what has to go into you know, the documentation of that visit and how it gets categorized. Well, you know England's been doing that for you know, a lot longer than we have and from the perspective of managing orthopedic maladies, we certainly have done it for, you know, an extended period of time relatively speaking to us.
Dr. Lundy:So the Academy has not only got the AJRR, but it's also shoulder and elbow trauma tumor. I'm probably missing something in there. Does the great Britain system capture all that, or are they just limited to joints?
Dr. Sebastianelli:No, I think they're doing it for just about everything. You know. Pediatric data is really strong. I do think that they're probably not as sub-specialized in ways as we are, like the nine sub-specialties of orthopedics probably aren't as deeply traveled as they are in the United States. They just don't have the same volume of providers that we have. So we tend to have a little bit more manpower in areas where you know you can get stronger data based on the fact that you have, you know, four or five times the number of providers dealing with a particular part of orthopedics.
Dr. Lundy:Right right, you and I were recently at the 90th anniversary of the American Board of Orthopedic Surgery. It seems kind of crazy that that organization's only 90 years old and as I go back to the history, of course I can point out to where the AOA actually formed, the AAOS and the ABOS. But as we were at the ABOS 90th anniversary, you and I both heard about the futures of board certification and how AI and big data will be eventually brought into that. How do you feel that big data, artificial intelligence, machine learning and such is going to impact us in the near and the far future, in your opinion?
Dr. Sebastianelli:You know, I think it's a great question and it's clearly something that has multiple avenues of analysis.
Dr. Lundy:While you're at it, I'll ask you to boil the ocean.
Dr. Sebastianelli:I understand that's like you know tell me about the universe.
Dr. Lundy:Yeah, there you go.
Dr. Sebastianelli:You know, I think what we really need to factor in, that we haven't yet fully understood is, you know, the transition of manpower over the last 20 years and what the full-time equivalent in 2025 will use, say, or 2024 now, is what that full-time equivalent is relatively speaking to what it was in 2015, 2000,. So forth. Going back, you know the balance of work that is being sort of sought after, the holy grail of what makes a good career versus what makes a, you know, a bad career in the sense of time and effort and those kind of things, and it's a very delicate balance. So you know, what a provider you know in 2025 is going to be like remains to be seen and they're beyond right. So residencies are you know, they're beholden to ACGME criteria in the sense of duty hours and so forth.
Dr. Sebastianelli:And things change and you know, you look at not that we're doing it wrong, it's just that it's changing. And the population, my generation, is sort of skewing things to the right in a sense of you know, disease-related problems such as hip fracture, hip osteoarthritis and knee osteoarthritis, and they're going to just multiply the number of cases by factors of two or three over the next 25 to 30 years. Well, we're not certainly training a whole bunch of more people and we're certainly not training a whole bunch of people that are going to work at 1.0 relative to what it was in 2000. So there's a different balance here that we have to figure out. And then we're dealing with sort of the aging population and what's happening there and how we assess, you know, individuals like myself or those older than me in the future. You know there's obviously that concern about discrimination and how to manage that, and so I think we need to come up with some form of board recognition of, in the sense of maintenance of certification, how we come up with the ability to assess a surgeon's skills over time and as they go from you know, their third decade to their fourth decade, to the fifth decade, what is changing. You know, cognitively, what's changing physically and physiologically that allows them to maintain their productivity.
Dr. Sebastianelli:You know some industries mandate retirement. You know healthcare should not mandate retirement but needs to somehow come up with the right kind of way to assess individuals before they get to those ages where now you can sort of you have to confront that discrimination based on the fact that somebody has more gray hair and so forth. So it's a fine balance right. We need to recognize our manpower is going to be stressed because the volume is going to be higher and we need to recognize that our manpower will be stressed because some physicians are going to work into a longer career than some. And we need to be able to assess everybody, whether it's in their first decade of their career or their fourth decade of their career. And we need to be able to assess everybody, whether it's in their first decade of their career or their fourth decade of their career. And we need to make it fair and we need to make it just and equitable and recognize that a mandated retirement because of age 70 is really not appropriate.
Dr. Lundy:Right, yeah, I was about to ask you about workforce issues. Are there other futuristic ideas that you have in terms of workforce? You covered it pretty extensively there, but are there other things in terms of the workforce itself?
Dr. Sebastianelli:Well, I think you know we have. We did have the need to create gender equity in our specialty, despite the fact that we're still, you know, heavily leaning towards one demographic, white male. The last five years in particular, we've escalated the number of women significantly in the residency programs and now are graduating into board certification. So that's a really encouraging statistic and it sort of still needs a ton of work, right. We still need to get into minorities and so forth so that we get a better diversity and try to minimize the social determinants of health or disease that we miss because we're not identifying necessarily with our patients as well as we should. We're not getting, you know, black and brown individuals into orthopedics as frequently as we should. We're not getting, you know black and brown individuals into orthopedics as frequently as we should.
Dr. Sebastianelli:So you know, we've done a good job with women, but we need to get better with minorities in other ways as well, and those kinds of things will help create better balance to healthcare and create better identification, you know, with physicians and patients' relationships than even though the best intentions sometimes create misconceptions because you're not quite identified with the individual you're treating. So very important to recognize that and again, the balance of work-life balance and those kinds of issues. You know, I think I saw a statistic where 40% of the women in medicine don't work full-time and about 20% of the males in medicine don't work full-time as of 2024. Well, that skips back to that workforce issue that I alluded to earlier. We need to figure out what the full-time equivalent is for 2025 and beyond, because we haven't done a good job with that and in order to maintain that balance between what is perceived as the right work-life balance versus overworking needs to be defined, and we haven't defined that yet.
Dr. Lundy:What you say just leads directly into scope of practice issues, right? I mean, if I remember, a few years ago there was the question that orthopedic surgeons number one did not want to take call but number two did not want anybody else fixing fractures and it's like, look y'all, it's one or the other. We either fix the fractures or we let somebody else do it. What's it going to be? So? Do you have any thoughts on as workforce matures, as the future rolls out, is there going to be loosening a scope of practice? There are certain physicians that may have a big crunch. I firmly believe that radiology and pathology are highly at risk with AI to being replaced by computers and they may find radiologists can do some really cool things and they might be able to do what I do. Any thoughts on scope of practice?
Dr. Sebastianelli:Yeah, you know, and I've actually floated this by you know, fellow board members, sort of in a very informal way. You know I've mentioned it even as far back as Shep Hurwitz when he was the executive director. Certainly, david Martin, you know we spend a lot of time training our graduates. You know our residents have five years, probably four and a half, of doing orthopedic surgery and then they become board certified and as soon as they sort of get that big certificate, all of a sudden they migrate towards those things that they like to do and things that they don't like to do. Right, and the one thing that I sort of maybe we can consider is that until they get past that first 10 years, sort of as a pay it forward kind of process or proposition, you know, certain types of cases should continue to be done by orthopedic surgeons in its basic fracture care and community support and a sense of covering an ER and those kind of things.
Dr. Sebastianelli:It's really hard to sort of think that everybody's going to come out and do nothing. But you know, outpatient surgery after being trained for five, you know, for five years and maybe six years or seven years if they've done one or two fellowships. So it's hard, it's hard again to sort of create that manpower balance and I'm not saying that people aren't entitled to sort of develop social specialties I don't want this to be taken the wrong way but in the sense of utilizing your manpower as most productively, efficiently and as skillfully as possible, if you've been trained to do some of these things, you should do it and you should continue to do it until you get past a certain point in your career where now those behind you can now bring up the energy that starts to dwindle as we get a little bit grayer and longer in the tooth.
Dr. Lundy:Right. One thing that I've always admired and enjoyed about the AOA is that it was in dramatic, conscious distinction to most of the activities that I did over on the academy side, because in the advocacy realm I dealt with a lot of scope of practice, compensation, a lot of more protection kind of things, whereas AOA is kind of looking at more. I'm not being critical because those are very important things, but they're very lofty things. But acknowledging that the AOA doesn't focus on a lot of those things, do you have any thoughts on the future in terms of compensation of the workforce? Certainly it's. You know we got to be compensated for what we do and how the changes in the entire future will affect that.
Dr. Sebastianelli:Yeah, and you know I actually mentioned this.
Dr. Sebastianelli:You know my presidential address, you know, two years ago in June, where all three arms of orthopedics are crucial to work together in a way, in a sense of sort of assessing critical issues, trying to incorporate education into leadership development and the critical issues that are in front of us.
Dr. Sebastianelli:You know the ABOS needs to sort of develop that minimum sort of expectation of what it needs to be a certified orthopedic surgeon so we protect the public. And then the advocacy efforts and the scope of size of the AOS is just, they're just so much bigger right that you know we need all three arms to sort of lobby in ways that we stick to our lanes and use our strength. And certainly AOS has a much more influential, you know, presence in Washington and state capitals and so forth than AOA or ABOS will ever have. Nor should necessarily those two organizations be involved the same way as AOS is. But all three need to work together and clearly, you know, with resources being squeezed and revenue being tightened and you know margins being sort of trimmed up to the bare minimum, unfortunately, we need to have more direct influence on what's happening in Washington at a federal level, so that that's where the AOS is going to be really, really important.
Dr. Lundy:Right, yeah, and that was the center of my lane through my stuff over there. I agree, 100% may be in the future, do you? And understanding to what you said earlier, with the changes in workforce and what does the orthopedic surgeon 25, 30 years from now look like? We're kind of making those folks now. So what should we be looking for?
Dr. Sebastianelli:Well, I think, I think you know it all comes down to, I think, emotional intelligence and really picking. Well, I think we need to pick better before we ever get them into the orthopedic residency. So it really starts way back in college and getting into medical school and making sure we're picking the right people to go into medicine, because it really, you know, we can all talk about work-life balance but healthcare is, it's a calling, it's not a job, and you sort of have to have a little bit of that sort of that ingrained in your thought process. You know it's hard to sort of walk away from something in the middle of, you know, a disaster medically. You know you want to have that sort of that ability, that innate care, to sort of stick around and try to see it through. So I think we need to be better at judging emotional intelligence, picking our candidates better, but, more importantly, when we do find that we've had a problem, we need to somehow either remediate it or identify a way to sort of release that individual into another pathway, because if it's not going to work, it's not going to work, whether it's failure at year two or failure at year five and after they've been certified.
Dr. Sebastianelli:In practice. We all saw that, you know, as, as board members, doing our credentials work and so forth, where we, where we just you know what. Where did this fall off the track and probably should have been picked up in medical school? And so we sort of need to realize that we again have to develop fair assessments and be careful and obviously not over-assess or over-penalize situations. But if we can't remediate things early on, it just continues to develop in their career.
Dr. Sebastianelli:But you know, with that said, we can use things like artificial intelligence to take away some of the administrative burden or the regulatory required to do. Now, whether it's ACGME related or even, you know, medical health system related, there are things that all of us have to do every year to sort of meet corporate compliance and this compliance and that compliance. Well, that all takes time, and so we can't dilute the necessary development of the clinical skills by having time taken away by other things. So I think we need to be a little bit more efficient, a little bit more dependent on some of the automated things that we not every health system has developed yet. You know, some of the bigger systems probably have it, you know, like Mayo and so forth, but we're just not in that realm right now unanimously across healthcare.
Dr. Lundy:Right, absolutely Well, my friend, everything we have talked about matters for nothing, not one bit, if we fail in what the AOA does best, which is the development of leadership. Everything we've talked about in the future doesn't matter, and as former chair of the council on advocacy, I can see how the government would love to take over what we do as a profession. And if we're going to maintain ourselves as a profession and continue to develop our unique specialty as we move into the future, it is absolutely requisite that we have high levels of efficient and capable orthopedic surgeon leaders. So, with that, how are we developing the leaders for the future in orthopedics, especially through the AOA?
Dr. Sebastianelli:I think you know we have come to the realization that in order for us to do that, we need to get back into the C-suite, and so we need to identify segments of our specialty.
Dr. Sebastianelli:Certain percentage of us need to sort of not only utilize the skills we have clinically but also utilize some of the skills we have politically and administratively and start to train those individuals and develop coursework. You know, through the AOA and the critical issues, to maybe try to get some of our symposiums that specifically embellish our younger leaders to sort of take an interest in this and to sort of recognize that those that get to the top do have a skill set that not everybody has. They need to use that to sort of help embellish the development of the specialty itself in general. You know they're not only sort of getting there individually and becoming successful, but also utilizing that knowledge and database to sort of take the entire department or the entire health systems division or again department of whatever specialty maybe, but orthopedics in general and specifically. You know, as we're speaking here, it needs to sort of get more people into the C-suite, no doubt about it.
Dr. Lundy:Very good Any specific programs within the AOI you see as being transformational as we move into the future here.
Dr. Sebastianelli:I think we've developed, you know, the APEX program.
Dr. Sebastianelli:We try to get you know individuals even earlier with the resident leaderships forum and try to get you know those PGY-4s and 5s that get into that program, interested in understanding that. You know patient care is the North Star, the patient's the North Star, but that North Star has rays that go off in the different directions and administration is one of those directions and leadership in that area by a clinician means more when they understand what is involved to take care of a patient with a difficult problem. You know the patient has a diagnosis but they're not the disease, they're a patient that still has needs and wants and sort of family issues. Only a clinician really understands that. Administrators don't understand that and so having more clinicians in that space and performing in those areas is really, really important. So whether it's the ELF or, you know, the Emerging Leaders Forum or the Resident Leaders Forum or APEX, those areas really hone in on having young physicians and developing physicians understand how important that is to their career and sort of moving the specialty forward.
Dr. Lundy:Very good. Well, we've covered a whole lot of things. Is there any other insight into the future of orthopedics that you've gleaned in your time in leadership in the AOA?
Dr. Sebastianelli:something. We should also recognize that even though, again, we may, we may not necessarily have succeeded in the way we wanted to, we own the outcome. We should analyze the outcome and we should find value in the outcome. And every situation has value, whether, whether you've succeeded or whether you did not succeed. I won't use the word failure, but you know, you learn from it and and you and you move on and you analyze how it could have been done differently or how it could have been, even though you may have achieved the goal, done it better, with less sort of pain to others or less expense. You know and sort of analyze the true value, what it was and how to get there, and sort of reserve the resources so that it could be again moved into the future and help others. So we don't want to succeed and sort of exhaust our resources. We want to succeed and preserve resources and utilize them for other goals in the future.
Dr. Lundy:Well, thank you very much and I'd just like to, if y'all don't know, wayne Spassionelli, he is an absolutely fantastic gentleman. I've always been impressed by your graciousness, both when you first met my wife and you graciously dealt with her very aggressive University of Georgia football taunting you as the Penn State doctor. You handled her with absolute finesse and grace. And then, after your team pounded my Auburn Tigers, both in Happy Valley and down in Alabama, you were such a gracious winner after that. So I can't emphasize enough what a pro you are and how lucky we were to have you as our president of the AOA. So, dr Spacinelli, thank you very much for being on the podcast, sir, and appreciate your time.
Dr. Sebastianelli:Thank you so much for the invitation and certainly want to identify your significant role in orthopedics, not only as a physician leader in your large group in Georgia, but what you did for the state of Georgia and your leadership there, and ultimately as an American Board of Orthopedic Surgery member and for AOS and now working with us in the AOA. We look forward to great things in the future.
Dr. Lundy:Well, thank you very much. My friend Appreciate you and I hope that y'all will join us again for more additions in the future of orthopedic surgery podcast series. Thank you,