Abstract
First of all, a salute to our trumpeter who played “Summon the Heroes,” and to all of you who have served our great nation: you are my hero. What an honor to be escorted to the podium by many of the giants of our profession. I know that you all know the quote by Sir Isaac Newton, “If I have seen further . . . it is by standing on the shoulders of giants . . .”, but never has it been more apropos. Those who have proceeded me in this position are a literal who’s who of sports medicine. It has been a career goal to get this gig, and I almost ran out of time. I vividly remember the first AOSSM meeting that I attended as a resident. I was literally awestruck by the sports medicine rock stars present. I am proud of this organization and proud of you all as members. I think I finally was selected to be president because of my wife, Ann. She modeled some people skills that I somehow ignored from kindergarten on in my quest to succeed professionally. Fittingly, that ultimately made her the First Lady of AOSSM—and her friends call her “FLAOSSM,” which I think is cool because AOSSM is awesome! I’m going to take a chance here, and may cause someone to lose a family bet early, but I owe this to Ann. To paraphrase a line from A Man Called Otto, starring the incredible Tom Hanks: “My life was black and white until I met Ann. She was the color.” In addition to my wife, Ann, I would like to recognize other family and friends in the audience today. Thank you to my children—Mike, Matt, Mason, and Missy, and their spouses, Kirby, Lauren, Rachael, and Brannen—all successful in their chosen careers and parenting 8 grandchildren (so far). Love you guys! And a shout-out to Ann’s 2 sons, Jamie and Patrick, also kicking it in their respective careers. Thank you to my UVA sports partners for picking up the slack this year. I would also like to recognize my chair, Dr. Bobby Chhabra, who has encouraged me along this journey. If you’re ever in Charlottesville, we invite you to visit the “house that Bobby built,” the UVA Orthopedic Center at Ivy Road. And, I would like to acknowledge those who are no longer with us: my parents, Lt. Gen. and Mrs. Monte Miller, who taught me to reach for the stars, and my lifetime mentor, Dr. Freddie Fu, who taught me how to get there. There are so many others that I want to recognize, including the AOSSM Board of Directors and my fellow members in the presidential line (Drs. Michael Ciccotti, Kurt Spindler, Dean Taylor, Chris Kaeding, and Eric McCarty, who will join us Sunday morning). Also, I would like to express my sincere gratitude to the professional team, spearheaded by our CEO, Greg Dummer. A special thank you to his No. 2, Christina Tomaso, who helped me finalize this address. I would be remiss if I didn’t give a shout-out to my lifetime friend—and your Kennedy lecturer from this year—Dr. Darren Johnson. We spent a decade together, in Pittsburgh 1 year. I would also like to recognize my colleague and friend, Dr. Steve Thompson, who helped me with the Review Course and coauthored several editions of Review of Orthopaedics and DeLee & Drez over the years, and he rocks a great pink sports coat! I’m forever grateful to Jen and Joe Hart for their 2 decades of service to UVA Orthopedics. And for all the UVA sports medicine Fellows—past, present, and future—remember to keep your wings level and be a rock. Finally, my sincere thanks to our program directors, Drs. Stephen Brockmeier and Robin West—The Dynamic Duo, who put together an awesome program! To all of the rest of my esteemed colleagues, mentors, partners, fellows, residents, medical students, scribes, nurses, staff, friends, etc, please consider this your shout-out and accept my apologies, but I need to get on with this speech.
I started my presidency immediately after our Golden 50th Anniversary Gala at the Broadmoor. We had just completed a new strategic plan and awarded almost $1 million in research funds to our members. So, I asked myself, how can we top that? I remembered that the 51st Super Bowl was promoted as “L-I” (they probably skipped Roman numerals for their 50th game because, well, who wants to buy swag with an “L” on it?). Therefore, I thought it was appropriate to borrow the “L-I” moniker to signify our organization’s entry into its second half century capped by our meeting in the nation’s capital. When I thought about it more, I decided to take it one step further. As the premiere sports medicine organization in the world, I propose that we should lead (“L”) with improvement, innovation, inclusion, and inspiration. This falls nicely in line with our new strategic plan and has been our focus for the past year. Allow me to elaborate. . . .
We improve through education. The strategic plan has designated education—knowledge access—as the top priority for AOSSM. As a former Education and Program chair and the so-called “king of review,” I have been intimately involved in providing knowledge access to our members my entire career. I have a passion for education and love to interact with medical students, residents, fellows, and anyone who will listen.
As Arnold Glasow noted, “Improvement begins with ‘I.’” Indeed, it is up to each of us to keep up with the rapidly evolving knowledge of orthopaedic sports medicine. We have all observed surgeons who still perform out-of-date procedures they were taught decades earlier that no longer reflect the best interests of their patients. AOSSM can help us stay current on the art and science of our specialty as we all make a commitment to lifelong learning.
One of our initiatives this year was to foster improvement by reevaluating what education means in the post-COVID world. A fresh look at how we educate will better serve our members—especially our younger members, the so-called “next-gen learners,” who may assimilate things differently than our senior members, myself included. I struggled early in medical school until I realized that if you knew all of the material, then tests were easy. So, I developed a method of summarizing the material and then summarizing the summary, adding charts, tables, and composite figures. This approach resulted in the template for the Miller Review text, which I started on day 1 of my residency. As successful as that was for me, I realize that others have different ways of learning. Improved education requires an investment of time and resources, and we have worked closely with the Institute for Association and Nonprofit Research conducting a thorough education assessment. One of their recommendations is to meet the demand for on-demand education, and we plan to do so. But the investment will pay off. As Benjamin Franklin noted, “An investment in knowledge pays the best interest.”
I ask each of you to consider the times in your lives when a learning experience was rich and full of professional meaning and applicability. Was it a course? Was it a discussion at a meeting? Was it a hands-on opportunity in the clinic or OR? Were you by yourself or engaged with colleagues? Would the memorable and impactful learning experiences of close colleagues be similar to, or different from, your own?
Considering questions like these illustrates the challenge of the task ahead as we strive to retain the effective aspects of legacy learning systems, while also developing new approaches that incorporate revolutionary technologies. Any changes must recognize the interwoven realities of how we, as students, teachers, and doctors, communicate and learn.
Of course, we will continue our rich tradition of in-person meetings (barring another pandemic), but we will also explore other educational formats, including virtual or hybrid events, sharing knowledge from experts, webinars, journals, self-assessment examinations, machine learning, virtual reality, instructional course lectures, educational forums, and mentoring opportunities.
I want to recognize our Education Committee chaired by Dr. Brian Wolf and Associate Executive Director Joyce Paschall, who, with the help our consultant, took a “deep dive” into our educational offerings. I am excited to see what ideas surface as we embark upon our goal of improving on improvement.
That brings us to innovation. Innovation is achieved through research. Unlike my immediate predecessor in the presidential line who is a research expert, I have been referred to as a “closet researcher,” completing projects on nights and weekends in dark labs with little fanfare. I often tell my residents and fellows that every project needs a locomotive, engineering projects on to completion and publication. We have all seen too many projects go off track—so I encourage you all to be good engineers and arrive at the station on time.
The late Steve Jobs, former CEO of Apple and chairman of Pixar, noted that “innovation distinguishes between a leader and a follower.” Since our message is all about leadership, we should take note. But how does innovation relate to research? Bill Gates, co-founder of Microsoft, answers that question for us: “. . . the way you get innovation is you fund research. . . .” AOSSM has funded research—to the tune of over a half million dollars last year—culminating in the “big reveal” at the 50th anniversary meeting. (Congratulations to the Jupiter group, led by Drs. Shubin Stein and Parikh.) And more research funds are on the way. The Aircast Foundation has funded an additional $450,000 to the runner-up from last year’s multicenter research competition. Congratulations to Dr. Jeffrey Nepple and his team from Washington University, who will lead a multicenter study on optimizing outcomes of hip surgery in borderline acetabular dysplasia. No celestial name there, but OOH BAD is kind of catchy! Additionally, the Arthritis Foundation is collaborating with our Society on new projects to evaluate posttraumatic osteoarthritis. And several other research projects are underway, to include the Young Investigators Grant, the JRF Research Grant, the Return to Play Grant, and the Playmaker Grant.
We recently invested in Proposal Central, an online grant management system that has enhanced our ability to apply for, fund, track, and collaborate on projects with others to include the Orthopaedic Research and Education Foundation. This tool has given our research committee the ability to review and score research applications online—and allows faster responses and improved collaboration. Your Society has made innovation and research foundations of our strategic plan top priorities for our organization. However, funding must be partnered with leadership. This year we welcomed Dr. Lynette Craft to the professional team. Lynette has a strong background in academia and worked at the American College of Sports Medicine for several years. Together with our chairman of research, Dr. Ben Ma, we stand poised to launch AOSSM research into our second half century.
We are also grateful to our industry partners. Early in my career, I shied away from industry, mistakenly believing that I could be tainted by what I considered overt influence. Perhaps this was because the military discouraged relations with industry, down to forbidding free donuts and ink pens. I now recognize and value industry representatives as partners sharing similar goals as the surgeons they serve. Many of the grants mentioned earlier are supported with investments from our corporate partners. And, with the help of many of our members, their innovations result in the tools and implants that we use daily in our craft. A special thank you to Melanie Stanton, who has excelled at managing corporate and individual giving. She, along with the Corporate Advisory Group, composed of our elite corporate organizations and your Society leadership, is actively pursuing many collaborative efforts.
The very nature of research is that we don’t have all the answers. Albert Einstein noted, “If we knew what it was that we were doing, it would not be called research, would it?” That’s what makes research so exciting. I encourage all members to “put on your thinking caps,” investigate something that you have always wondered about, challenge dogma, finish that lingering project, and share it with others—be a locomotive!
Inclusion is an American ideal and should be at the heart of any organization with education as its fundamental mission. Growing up as a military brat, I never gave this as much thought as it deserves. It is simply a matter of recognition and acceptance—putting yourself in someone else’s shoes. AOSSM welcomes all members and prospective members regardless of race, gender, sexuality, or background and, as an extension of that, seeks to mentor, encourage, and support those who aspire to leadership positions in our organization. Jesse Jackson noted, “Inclusion is not a matter of political correctness. It is the key to growth.” And growth is an important goal in our recently adopted strategic plan. Okay, how do we do that? The answer lies within our professional team and key committees, including the Membership Committee, Council of Delegates, Emerging Leaders, and the new Diversity, Equity and Inclusion, or DEI, Committee. Allow me to expand on some ongoing initiatives in your Society.
One of our core principles—and a key strategic initiative—is to recruit and retain new members. There are several thousand general orthopaedic surgeons who also are practicing sports medicine surgeons. We will be reaching out to those individuals to make sure they are availing themselves of our plethora of sports medicine–specific educational content. We are welcoming new members by simplifying the application process, offering reduced rates for qualifying candidate and resident members, and giving all members—existing and new—more bang for their buck through exciting programs at our meetings, online, and meaningful opportunities such as hands-on skills training and testing. Of course, AOSSM also prides itself on providing new members with insightful mentorship—a defining part of AOSSM’s identity.
Our Emerging Leaders Committee has hosted several successful virtual “nightcap” meetings and is launching an exciting new initiative. Your 2024 president, Dr. Dean Taylor, has a passion for coaching and mentoring leaders and has worked with Jenny Ramion and the Emerging Leaders Committee in partnership with “Great on the Job” to launch the new BOLD program: Boosting Orthopaedic Leaders’ Development. This immersive, 2-year opportunity was offered exclusively to AOSSM active and candidate members under the age of 45. Eighteen playmakers will engage in executive leadership education, collaborate with peers on a group project, and receive one-on-one executive coaching and mentoring to hone their leadership skills in the field. The first BOLD cohort kicked off at this meeting. Look for exciting new things from this initiative. We are also piloting a new mentorship program this week. We matched Society leaders with younger members. These mentors and mentees connected this week to make plans for future interactions.
We are actively seeking diversity and inclusion in all our programs. This is a major focus of the Volunteer Appointment Committee, who select members for AOSSM committees. One might ask, “What is the difference between diversity and inclusion?” Verna Myers, an expert on this topic, provides a nice analogy: “Diversity is being invited to the party; inclusion is being asked to dance.” For example, we are partnering with the Gladden Society to invite diverse speakers to the annual meeting. We have also partnered with The Forum—a membership group for sports medicine fellowship–trained women orthopaedic surgeons—for a recent Orthopaedic Learning Center course as well as annual meeting education and networking. And, we are proactively recruiting and encouraging diversity in our selections for all AOSSM leadership positions and committees, which are being modernized to align with our strategic plan. At AOSSM, we have taken intentional steps to ensure a more inclusive future. In addition to integrating DEI into our new strategic plan in 2022, we formalized the DEI Task Force into a committee. Led by co-chairs Drs. Joel Boyd and Constance Chu, with liaisons on other committees such as Education, Membership and Fellowship, this will help ensure we’re asking everyone at the party to dance.
I want to talk about DEI more in depth. First, let’s keep in mind the many types of diversity—race, sex/gender/sexual orientation, age, religion, culture, socioeconomic background, disability, and more. So, think for a minute—and even visualize—the diversity in these many categories, if you will, of places in your life: your family and extended family, your clinics, your operating rooms, your department meetings, your places of worship, your golf clubs or gyms, your neighborhood. Some types of diversity may be obvious, and some may not. But I hope we can agree that diversity enriches us, it makes us better, more balanced, and more open to wider points of view. Those are indeed good things. My very accomplished sister once told me (pejoratively, though with humor) that I was “male, pale, and stale.” Two of those things I can’t do anything about, but one I can—let’s truly embrace strategic ways to advance needed DEI initiatives to enrich who we are and what we do.
Racism is not always overt. In fact, there is a whole lexicon of terms for prejudice or bias. Inherent bias involves underlying assumptions, systemic bias is institutional, and implicit bias may be unintentional. The term “woke” simply means to be alert to racial prejudice and discrimination. You don’t have to lean left to be woke.
A quick story before we leave this important topic. I am a fan of the NBC series “New Amsterdam.” In season 3, Dr. Max Goodwin, the hospital medical director, decides today is the day he is going to address systemic racism at his hospital. He spends the first part of the day trying to tackle the symptoms, but later takes the time to speak one-on-one with a few dozen doctors, hospital employees, and patients. His interviews touch on just a few of the real-life biases affecting the work of the New Amsterdam team—and, of course, each of us here. For example, an African American woman resident relates how much longer it took the department head to learn her name than the names of her White colleagues. A Hispanic surgeon notes that she is not a female surgeon, or a Puerto Rican surgeon, but a surgeon. These conversations demonstrate the importance of integrating DEI programs into all aspects of health care. The same is true of the orthopaedic surgery field and of our own Society. We have made progress, but there is much more work to be done.
Inclusion also requires collaboration. AOSSM is collaborating with many other Societies including ISAKOS, the International Society of Arthroscopy, Knee Surgery, and Orthopaedic Sports Medicine; and ESSKA, the European Society for Sports Traumatology, Knee Surgery and Arthroscopy. And, we had a successful pre-meeting on Wednesday with AAOS and the Biologic Association. AOSSM was also the guest society for the Orthopaedic Research Society’s 2023 Annual Meeting. We have robust relationships, including speaker exchanges, with many other organizations, including the American Academy of Physical Therapy, the American College of Sports Medicine, the American Medical Society for Sports Medicine (AMSSM), and the National Athletic Trainers’ Association (NATA). Speaking of NATA, we just completed our collaboration with them on establishing a Collegiate Standard of Care Resource Toolkit, for all levels of college athletics. Special thanks to our 40th president, Dr. Peter Indelicato, who spearheaded this effort for our Society. Our organization shares many goals with these groups. We all strive to give the best care to athletes at all levels of competition, from the playground to the Olympics.
It is our mission to educate surgeons focusing on sports medicine, and we are doing just that. Our new website includes a novel search engine called “One Place.” As a member, it is now possible to instantaneously search 50 years of sports medicine education, research, publishing, and other content. Through AI, our highly sophisticated technology platform will intuitively learn your areas of interest and be ready to welcome you each visit with an understanding of your personal preferences. Our “Game Changer” sessions at this meeting included symposia on leadership, practice management, and performance optimization. We also held an international session with ISAKOS titled, “Global All Stars of Arthroscopy.” And the session on the team physician was important because we are uniquely positioned as the only orthopaedic society to offer a complete and comprehensive sports medicine perspective. Plans are underway for a new stand-alone course with an across-the-board, holistic focus on the team physician role at the high school, collegiate, and professional levels.
While I am on the topic of team physicians, allow me to address recent challenges to our role. As I am sure many of you are aware, some of our members have been subjected to excessive malpractice claims and unqualified expert testimony that threaten their role and our Society as a whole. We created an open letter with 28 supporting organizations, including AAOS, AMSSM, NATA, and many of the professional league physician associations, as signatories. If you have yet to read the letter, take a moment during this meeting to pick up the most recent issue of the AJSM, Sports Health, or AAOS Now. As a result, ESPN has also taken interest in this critical dilemma: they published an article last month—stay tuned for more on this important issue.
Inclusion includes all of us. As your president, I promise that AOSSM will continue to focus on that principle and consider the views and values of every member and prospective member.
And so that leaves us with the last “I”: inspiration. This one needs no parenthetical explanation—it has been an inspiration to lead AOSSM into its second half-century.
Let’s start with the definition of “inspiration”: “the process of being mentally stimulated to do or feel something, especially to do something creative.” One may ask how an organization like AOSSM can “mentally stimulate” its members. Well, let’s hear from the members themselves. In our awesome 50th anniversary video, Bob Arciero, the 43rd president of our Society, noted the following: “The tremendous commitment that I’ve seen from this group inspires me to take better care of my patients.” More recently, emerging leader Jacqueline Brady had this to say: “For one thing, everybody is a sports patient in their own way, young and old, no matter what activity they are doing. And that keeps it broad, which is nice. But they’re also really motivated. I think they will drive you nuts if you are not careful, asking, ‘When can I get back?’‘When can I take my brace off?’‘Do I really have to keep weight off of this thing?’ They want to get back, and there is nothing more inspiring than standing on the sidelines watching one of my athletes who struggled through injury and surgery get out there and succeed and get back to what they love doing.” Even our motto is inspirational: We keep you in the game! And what role can creativity play among a group of surgeons? In what ways are we creative? A few things come to my mind. It is exciting to witness the evolution of augmented and virtual reality in our world. It is inspiring to see so many of you help develop new tools for our trade. It is rewarding to observe spring sports fellows get out of a jam in the OR—going from plan A to plan B or even C. Look around the room—how many of you are also musicians, artists, woodworkers, handymen? To stay inspired, harness your creative energy, both in and out of work.
When we were both cadets at the Air Force Academy 45 years ago, I was strongly influenced by the leadership of then Wing Commander Ed Rice. He inspired me to become a leader. I encourage you to attend the Leadership Game Changer tomorrow morning so that you can be inspired by General Rice and an all-star panel of sports and sports medicine leaders.
Allow me to reflect on what I found inspirational this past presidential year. Utilizing our strategic plan, developed under the leadership of our 50th president, Kurt Spindler, let’s briefly highlight 3 key initiatives in each component.
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As I traveled the past year, I gained a better perspective on how our organization is honored and valued literally all over the world. It has been inspiring to serve as your ambassador.
I recall when my neighbor, an orthopaedic surgeon from a local community hospital, once told me, “Mark, I have a job, but you have a career.” Well into the fourth quarter of that career, I’m inspired by my younger colleagues. It reminds me of the concept of “paying it forward” and modeling, coaching, and mentoring these bright young surgeons. For example, we recently had a late cancelation, causing our operating room to shut down several hours early. Rather than heading back to the office or going home early (and with a kitchen pass in hand), I invited my resident and fellow out for a spontaneous golf outing. Those kinds of acts, including hosting journal clubs, buying lunch for clinic or the OR, having a beverage with the team, hosting dinners for special occasions, and other initiatives, pay off well into the future. Hopefully, those young doctors will adopt that philosophy and do the same as their hair grays (or goes away).
In conclusion, this organization, your organization, is truly inspiring . . . and it’s only going to get better! The Board of Directors and the incoming presidential line include the best and brightest. The professional team is superbly qualified and are wholly committed to AOSSM. The committees are all making valuable contributions. The journals remain at the top of the heap. And our members—you—are the best. We offer something that no other society in orthopaedic surgery can—the knowledge and experience to help you be a better team physician and the only pathway to subspecialty certification. As more teams and organizations mandate this certification, we will continue to encourage our members to seek it, and help them to achieve it.
It has been a great 51st year for AOSSM. We lead by improvement, innovation, inclusion, and inspiration. As I ride off into the sunset, I am proud of our past and inspired by our future. Thank you for the honor to serve this awesome Society.
Footnotes
This article has been copublished in The American Journal of Sports Medicine and in Orthopaedic Journal of Sports Medicine.
Presented at the annual meeting of the AOSSM, Washington, DC, July 2023.