Leading Orthopaedics Together with Frederick M. Azar, MD, FAOA

If orthopaedic surgeons stop showing up, who decides what our profession becomes? We sit down with Dr. Fred Azar, past president of the American Academy of Orthopaedic Surgeons, a longtime leader and current Department Chair at Campbell Clinic Orthopaedics, to talk about the future of organizational involvement in orthopaedic surgery and why it matters more than ever as healthcare grows more complex.

We get practical about the pressures surgeons feel right now: hospital employment, limited reimbursement for memberships, shrinking time, and the reality that many clinicians no longer want to “fly to learn.” Dr. Azar argues that the winning model is not meeting-based societies but connected knowledge networks where education, mentorship, data science, AI, and shared outcomes move fast and reach surgeons where they live. The standard for engagement changes too: it has to be meaningful, efficient, and clearly tied to impact for patients.

If you care about the future of musculoskeletal care, this is a conversation about unity, credibility, and showing up before someone else writes the rules. Subscribe for more, share this with a colleague, and leave a review with your take: what would make organizational involvement worth your time today?

Transcript

Series Welcome And Dr. Azar Intro

0:23

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. Fred Azar. Dr. Azar is a professor of orthopedic surgery at the University of Tennessee Campbell Clinic in Memphis, Tennessee. He's the chief of staff of the Campbell Clinic Orthopedics and the Sports Medicine Fellowship Director. Dr. Azar is past president of the American Academy of Orthopedic Surgeons and is currently a senior director of the American Board of Orthopedic Surgery. He's a member of the Herodike Sports Medicine Orthopedic Society, the 20th Century Orthopedic Association, the Magellan Orthopedic Society, and the Interurban Orthopedic Society. He served on the board of AOSSM and previously served as a team physician for the Memphis Grizzlies for 22 seasons and was selected as the 2012 Team Physician of the Year. He's a former president of the MBA Physicians Association and is a current consultant to the NBA. He also serves as the team physician for Christian Brothers University, Lemoyen Owen College, and Christian Brothers High School. He went to college at Notre Dame Medical School at the Tulane University School of Medicine, his orthopedic residency at the University of Tennessee Camp Clinic, and then did his sports medicine fellowship at the American Sports Medicine Institute in Birmingham, Alabama. He's board certified by the ABUS and holds a subspecialty certificate in orthopedic sports medicine. Dr. Azar, thank you, sir, for being on the podcast. Doug, thanks for having me. It's great to be with you. Good to hear you, Fred. Good to talk to you again, my friend.

What Organizational Orthopedics Becomes Next

2:31

And tonight we're going to talk about the future in orthopedic surgery in terms of organizational involvement. So it was easy as you and I run in the same circles. We are good friends and we know a lot of other really influential people that have been involved a lot in orthopedics. But, buddy, you have achieved so much in organizational orthopedics. You are the natural person to talk to about this because we just got done talking to James Saucedo, who is a younger orthopedic surgeon. We were talking about the future orthopedics from the younger perspective. But you and I are of similar vintage here. And I think a great question is what's the future in organizational orthopedics? Where are our organizations going to be? What are they going to look like? How are our members going to be involved? Just different things like that. So just off the top, what are your thoughts, sir? Well, in a transformative time, the history of a lot of things, obviously, AI is moving things. This is a response period in technology. Certainly, orthopedics has changed, medicine's changed. It's a lot more complicated now. But orthopedic surgery has always been innovative and always worked to advance surgeons to come together and sharing ideas and building standards and really mentoring the next generation. I think that we're entering a new era that's defined by technology and data and really rapidly changing healthcare systems. And I don't think the future of organizational involvement's going to be just about meetings or committees. It's going to really be about creating networks that harness the collective expertise of orthopeak surgeons, including the subspecialties, guiding innovation responsibly and really ensuring the orthopeak surgeons continue to lead the advancement of musculoskeletal care. There's several things I think about with organizational involvement. One of them really starts with our patients, the commitment to our patients and to our profession. It's foundational. That's really important. I think that mentorship and leadership developments are really important part of that. I think that the shared knowledge and data, data science and AI is going to be a huge part of it, like it is globally and every other facet of our lives. Adaptability to change, innovation is really important. Complacency is the eighth deadly sin, and we need to try to avoid that. And then, of course, unity. I really think that as we seem to become more divided with subspecialties and our silos, that unity is even more important now than it ever has been. And I think that we look less than 3% of physicians, if we're not together, we can certainly be focused on our subspecial societies and the organizations we care about. We have to be unified collectively to really face what's in front of us. So it's pretty exciting times. I wish I could start all over again because it was a fun ride. It's not over yet, but it's the future is so bright. And I think it's even brighter than it has been in the past.

The Big Three Missions Explained

5:27

So let's go back a minute to when you were president of the Academy, without question, the largest orthopedic group or orthopedic organization we have in the country. What are some of the wisdom or the gleanings that you took from Academy when you were Academy president about the importance? And you've already mentioned some of them about the importance of unity, but anything else strike you in terms of the importance of organizational orthopedics from the conglomeration, the consolidated viewpoint of the Academy versus AOSSM or Posna or AUKUS or something like that? Well, I think that an organization like the Academy speaks collectively for everyone. And I think that there's value to me, the three that certainly subsessionally societies are very important. I've been fortunate to be involved with some of them. I will say that when I think about the Academy and I think about the AOA and I think about the ABOS, those are the ones that seem to be out there in front doing things that have a broader picture of what's going on in the world. They all have different missions. And I think that we think about what the AOA does, the AOA's really into leadership development and develop some resources to that. The Academy is about education and advocacy, and that's a big part of what they do. And of course, the ABOS is really all about serving the public. The missions are providing safe and ethical and effective practice for the big surgery. And these all fit together. There's no competition in those three because they really they complement one another. You've got the AOA developing leaders and vision, the academy providing education and advocacy and practice management support. You've got the ABOS ensuring the standards and certification and protecting the public and ensuring the trust in the public of our brand and who we are. So the AOA helps shape the future, the Academy supports the present, the ABOS safeguards the standards of our profession. So those are the things. Unity has always been a big deal with the Academy. The specialty societies are really important, but collectively, we need a single voice to speak for us. And we can't do that if we're siloed in our subspecialties.

When Employers Will Not Pay

7:29

So now that I'm in hospital employment, as opposed to before, and other times just trying to talk to folks through the academy, through the Trauma Association, through the AOA, I run up against this narrative more often. It's not too often, but it's more often than I'd like to hear it. And what I hear is, hey man, I'd love to be involved, but my hospital, my employer, whatever, compensates me or reimburses me only for so many memberships. And this just isn't in my wheelhouse anymore. I don't what they're basically saying is they don't see value paying their own money to be in the organization if their employer is not gonna compensate them for that. What would you say to those folks that are you and I are Southerners? They're basically poor mouthing, right? There it is. What do we say to those folks when they say stuff like that? Well, I think that when I think about this discussion today, to me it's about the younger or the pig surgeons. So that's what I think that's what we were focusing on. I think that the rest of us had our time to do what we want to do. And it's up to us to try and mentor and pass things on. I think that the healthcare environment is so complex, just like you said, I always like to say healthcare deliveries like politics, it's local. You do what's best for you in your community to practice. There are really half a dozen or so practice models that are out there, and whatever works in your community is what you have to do to be in that community. And I respect that. But if you're thinking about the orthopedic surgery with healthcare becoming so much more complex, and the days of meeting-based societies, I think are over. It's more and more now like knowledge networks of the information is flowing and you don't have to fly somewhere to get it. So it's really what's changing is how it's delivered, how that value is delivered. So you don't, yeah, you have if you're limited in the time you have a way to do that, that's really not a big deal. I think that the societies have to recognize that and realize that people aren't just gonna jump on a flame and fly to get this information. How we provide and deliver value and content knowledge needs to meet our diplomates and our academy members where we are. And I think for the young people, uh, I think a lot of young surgeons feel overwhelmed because it's so much more complicated than when we started. And we talk about work-life balance. I don't love that phrase. Um, to me, work is a part of your life. That's what we do. I like to maybe more focus on your priorities. Priorities are really foundational to the priorities we prescribe that we prescribe here, at least, is we talk about faith and family and patient care. And that medicine is a vocation. It's not a job, it's a calling. And you may say, okay, you got my family number two there, patients number three. How do I balance that? Well, the way you balance is you bring your family along with this. It is a vocation, it's a calling. Bring them along with serving our patients. Uh they're side by side with us. Patients aren't prioritized over them, they're part of the whole experience of what we're trying to do. So you have to have some foundational fundamentals about how you're going to approach your life. And we chose orthopedic surgery. It's not a nine-to-five job. And we take care of people that don't expect to be where they are on certain days. And so having those sort of priorities and having an institution where you're at where there's a mission and a vision and their core values that you can lean into to address things is really important. So I think that we have to, for the younger surgeons, they want purpose, they want efficiency, they want impact. These hierarchical committee structures and meetings are really a thing of the past. And but I think that if we can appeal to our younger members, uh, the younger generation, first of all, I think they're really deeply committed to patient care and to the profession, but they're also very thoughtful about how they're going to invest their time. So organizations need to respect that. So engagement has to be meaningful, has to be efficient, and has to be clearly tied to impact. And that I think that we can appeal to these young members that way.

Beyond Meetings Toward Knowledge Networks

11:29

Really, you're calling for an entire overhaul of the organizational structure of our national organizations. Now, we have noted that these specialty societies seem to be doing increasingly better after the pandemic, whereas some of the more global organizations uh are getting a hit on, like I know that we're not picking on the academy, but the academy has taken a significant hit after the pandemic in terms of attendance. Without question, the academy drives significant value to its members. But to your point, people are trying to get that value through different pathways than they were previously. Is there other advice that you would give to any national society in terms of how to you've given a lot right there, but is there anything else that you would address to say that what people should do in terms of addressing the new paradigm? Well, I would say certainly respect what the subspecial societies are doing. Look, it's we're all so much more specialized, even when we started this. Every decade we seem to get more specialized. And these subspecies societies do bring a deeper level of expertise, more focused education, and more technical innovation. And there's also professional identity that our people want. The advocacy part is trickier because we have to be unified with that. Now, again, some of this stuff happens at a state level, but a lot of it happens at a federal level, national level. And I think to appeal to these individuals, yes, there's value in what you do in the subspecial societies, but instead of competition, this is not a competitive thing. The mothership is the academy. It just speaks for everybody. And it's pretty nimble. It's a lot more nimble now than it used to be. 10 or 12 years ago, they recognized that content was the future for education, and they really shifted to that. But the Academy and any other umbrella organizations really does provide really excellent professional leadership. Subspecial societies can really focus more on clinical science innovation, but there's tremendous value in having us unified. And the advocacy part is something the academy can provide. The education part you can get from your subspecial societies, but the academies can certainly work with those subspecies societies to help get it out. Research initiatives are still an opportunity. Advocacy, again, and patient-reported outcomes, things like that, the public trust, our brand, the marketing, getting information out to who we are to add value to our society is really important. That's easier to do collectively than it is through a subspecialty society.

Leadership Skills From Service And Networking

13:53

Now, you and I have also been in multiple leadership opportunities throughout our careers. And what I've found is that in my day job where I get paid to lead there, there seems to be what's the word? There's like an increased amount of competence, bandwidth, and understanding that I received through leadership within the societies. So yeah, I get a lot from when I was leading at Resurgence, what I'm leading here at St. Luke's, places like that, absolutely, 100%. However, I will find myself at times pulling stuff in that I learned at the AOA, at the Academy, at the Trauma Association, at the ACS. If there's a decreased interest, or if the national societies are not providing those opportunities that sometimes come up through the committees and other things, are we cheating people out of leadership development? There's definitely some tremendous cross-pollination that happens for things that we learned from one another when we're in a meeting, when we're networking, whether it's through social networking or at a dinner, a faculty dinner or something, we're at, we learn a lot of stuff. And that part is really important. It certainly helped me in my leadership here in my practice and learning from people outside of here. It's helped me for sure. And you miss that. That's something that's not really necessarily, it's not a didactic way of learning things. But it's there's tremendous value there. It's very gratifying to first of all have these friendships and colleagues, as you know, uh in orthopedics, because we all eventually, if you go two or three people down, we all sort of know each other, we're connected, which is kind of cool. But there is a lot to be learned. If we put ourselves out there and we're doing it for the right reasons, trying to do something to give back to our profession and trying to do it not for personal development, for a professional development of yourself, but really trying to do something to get back to our profession, you do get the blessing of being uh personal development as you go. But you have to do it for the right reasons. The volunteerism thing, when I started out, I'm probably like you, I was told never say no. I never said no. And that doesn't exist anymore. And that's okay. That's just not where we are now. But if you do it for the right reasons, while you want to be involved, get back to your profession, and you want to learn some leadership skills, and you put yourselves out there, whether it's a special society or a bigger national organization, but you're gonna benefit from it. And you're gonna learn things that will help you in your own practice in your own life in many different ways.

Campbell Clinic Growth And Lessons Learned

16:20

So, how big is and y'all, Campbell Clinic's huge? How many folks do y'all have down there? Well, we're now in three states. We've got about 1,200 employees. That's a whole nother discussion that avoid private equity. It's more of an affiliate model, more like it, more like an MSO that we've expanded to. We've been in Mississippi and Tennessee, we're now in Virginia, and we crossed the entire state with some practices. That's another discussion. But it's a lot of the things that I know I've learned from these organizations that I've volunteered in and not been compensated for. I've just learned, I gave my time, have really helped me and helped our practice. I think I have other partners that have done leadership to that have helped our practice being involved at different levels. It doesn't have to be a national level, it didn't have to be a subspecial society, it can be state level or local. You want to get involved in things that you're interested in doing for the right reasons, not for this is who I am. That's the wrong reason to do it. You got to have the desire to do it, you got to have the wisdom that it takes, whatever it is, the skills to make it work. And you have to have the purpose to do it the right reason, and you'll do well at it. And uh you got to put the time in to do it. It's about attitude and effort. It's not just something somebody hands you and you're checking a box to get to the next place. That is not the reason to do it. Yes, sir. Well, let's talk about Campbell Clinic in Memphis, then. How many folks do y'all have around there? We have 90 providers. We've uh about two dozen of them are PAs, and we also have uh I think the latest count is nine family practice sports docs, and we've got several physiotrists and a bunch of orthopedic surgeons and cover all this up specially. So we've been pretty fortunate to navigate through these tough times because we are a private practice we're founded in 1909 by Dr. Campbell. We're the University of Tennessee Department of Orthopic Surgery. And so we've able to balance that and we hope to continue to go on for another 100 plus years. And so that's what we're always planning with along the horizon. And it's been a blessing for me to be here. It's been a great experience for me for sure. What I'm belaboring to get to here is Campbell Clinic is well known for the number of leaders that y'all have generated out of there. Of course, there's you, there's Dr. Beatty who was involved in there. Dr. Canale, how many other? I mean, there's a bunch of folks that y'all have had at the national level come out there. Anybody on missing? No, it goes back a long way. Dr. Campbell was one of the founding members of the academy. He was the first elected academy president. And but we've been involved in AOA, ABOS, many of the subspecialty societies, probably most prolific in the Posno because we've got all of our pediatric docs are pretty academic. But you have to be in a place that nurtures that. We've got a guy right now on traveling fellowship, and you have to support that. That's got to be a part of what's important to your priorities. And it's harder and harder today to do that. And especially 80% of physicians in the United States work for somebody. And it was 20% not that long ago. So the paradigms change, and that's okay. It's like I say, you do what's best for you and your community, but you still need to be involved because if you're not involved, you somebody's gonna make that decision for you. And you know how that is, it's the seat at the table. You're on the menu if you don't have a seat at the table. So that's a political talk, but that's true. And if you want to have a role in the future of your profession, you have to be involved somehow. Again, it can be at the local level, but you don't have to go national. You can be whatever you desire to do to give back and to advocate for our patients and for our profession, there's an opportunity there. And the fact that we're physicians, whether you like it or not, people look at us as leaders. The fact that we are professionals, they assume that we have some leadership skills. And by the way, you can't go out there and proclaim you're a leader. Other people define what you do in your actions and words define you as a leader, and other people would designate you as a leader. You don't just say I'm gonna be a leader. But it doesn't hurt, though, to say I want to develop some leadership skills. That's okay. That's what you want to do. I remember taking a Kellogg course through the AOA at some point when the AOAs had great courses over the years. Um it was pretty formative for me to be able to have access to that. But I did it because I wanted to get better at to learn some leadership skills. So I think that it's so much easier now these days, you can just give like a TED talk or get something online. You don't have to show up anywhere to get this stuff. So take advantage of that and try and give back to our profession. And at the end of the day, it's all about our patients that we serve. And we're not gonna be able to serve it very well if we just got our head in the sand and we're letting somebody else make decisions for us. That's just not sustainable for our profession. So you but as you said, y'all are a private practice model. Yeah, y'all are able to consistently put people not only just in organizations, but folks in organizations that are so bought in they rise to the top of these organizations after years of commitment to that. What's the secret sauce at Camel Clinic that you guys have figured out on how y'all get folks to join, not only just join the organizations, but become involved, get involved in organizational leadership.

Building Culture Through Mentorship And Values

21:23

What's the culture that y'all have formed that's enabling that? How can we spread that across the country? Well, I hit on it earlier. It really does start with our priorities of faith and family and the care of our patients. We have a mission statement, we have a vision statement, our core values are excellence and integrity and compassion, innovation, commitment, legacy, and unity. We don't just have them on the wall somewhere. We really do try and live those. Uh, and we're not perfect and we make mistakes, but the net result is something like leadership is really promoted. We try and mentor, and mentoring is really important, giving back. I had tremendous mentors myself. I've been really blessed over the years. Because of that, and I have not forgotten that. And so I really feel like a big part of what I'm supposed to be doing is mentoring others. So we have really good internal mentoring in our practice. The way it works is we have there basically subspecialty mentoring mentoring that goes on, but we also mentor across the subspecialty. So it's very collaborative and we support that. And again, like I said, we support you want to go to your traveling, you need to go do a traveling fellowship at some point if you want to get involved in the society and you want to have do some leadership. We obviously do a lot of writing and editing and publishing too. And Campbell's operative is something we just launched edition 15. And that world continues to change every five years we launch it. It's different. So we're already looking for 16. That's going to be so much more different than what it is, 15 is. So things like that that we're fiduciaries of that it's passed down. That culture, which is a challenge, the culture is always a challenge. But that's something that we work really hard on. We focus on it. You have to invest in that, though. You can't just say, well, we're going to have a good culture. You have to invest in it. There are a number of things we do, not just among ourselves, but with our employees, our trainees, we make business decisions that benefit our patients, our employees, and our trainees. If it costs us more, that's just what we do. And that culture of taking care of our patients and our trainees and our employees is really important. I think it if you do that, the rest of the stuff will come. All right.

A 2040 Vision And Final Charge

23:20

So where do you see the organizations? You've touched on this already, but if we could just sum stuff up here, where do you see the organizations 15, 20 years from now, in terms of involvement of our obviously our younger doctors at that point in time? What will it look like? What will the thing be there? And what can we do as more senior leaders to encourage our younger partners and younger leaders to get more involved to develop such an organization as that? I remember doing a 2030 talk about four or five years ago, and I went back and looked at it. I think if you look at 2040, think about data-driven orthopedics and think about global collaboration and think about leadership development. That's going to be a big part of the future. Obviously, the unity of our profession is going to be first and foremost for the profession to survive. And we can do that with our sub-specialty societies. Absolutely do that. We collaborate together. But many times we need a common voice, and that's where the Academy, the AOA, ABOS come in, those big three, I think, will really to serve our profession in different ways. And they all complement one another. I think that uh shared data is going to be such a big part of the future and adaptability and innovation. We're very innovative already, and that's just become even more important. Every generation of orthopedic surgeons inherits uh the profession from those who came before us. And we also have a responsibility to improve it. Professional organizations uh are where the stewardship happens. The future of orthopedics will be shaped by surgeons who not only care for our patients in the operating room, but who also invest their time and leadership in the institutions that guide our profession. Thank you so much, Fred. And it's been an absolute pleasure talking with Dr. Fred Azar at the Campbell Clinic about the future of organizational involvement in orthopedic surgery. Dr. Azar, sir, thank you for being on the podcast. Thanks for having me. Appreciate it. Yeah, buddy, so good to see you. I'll see you soon at the meeting coming up. And y'all join us again for other episodes in this future orthopedic surgery podcast series.