Mr. President, distinguished international presidents and visitors, members of The American Orthopaedic Association, ladies, and gentlemen:
It is a great honor for me to address this assembly and to assume the presidency of the oldest and most distinguished society of orthopaedic surgeons in the world. Today I have chosen to speak about a subject that has long been on my mind, and one that I think has been on your minds as well, a subject of importance to all in this room. That subject is The American Orthopaedic Association and the critical choice before us in 1997.
For 111 years, those elected to The American Orthopaedic Association have been faced immediately with a critical choice: is the invitation to join this illustrious body an end or a beginning? Or, to put it more bluntly and more directly, do you think of your membership as a culmination, an honor in recognition of past achievements and providing you with a citation for your curriculum vitae and a plaque for your wall? Or is it a beginning, a challenge to apply the considerable talents, skills, and leadership abilities that garnered you membership to a more far-reaching and more enduring purpose: the over-all betterment of our specialty? Now, as in the past, the character, quality, and effectiveness of this organization depends upon the wishes of its members. If you believe, as I do, that membership is a beginning and not an end, then we as Association officers also face a critical choice: should we focus our energies on the ceremony and social interchange that we all enjoy or should we take advantage of The Association's unique position in our specialty to launch a new venture for the common good? What should The Association be doing, beyond its current programs, to shape the direction in which orthopaedic surgery should be heading? Should The Association take the lead in addressing the orthopaedic issues of the day and defining specialty-wide strategies for the future?
Membership in The American Orthopaedic Association is indisputably the most coveted symbol of accomplishment in orthopaedic surgery, an honor bestowed upon only our specialty's elite. Despite the current unpopularity of the word elite, we should not draw back from this designation, for on the most fundamental level elitism is a good thing. Those who have arrived at a recognized pinnacle of achievement deserve to be honored by their peers. What is at issue, in my view, is not elitism itself but the responsibilities that elitism entails. As Dr. Urbaniak observed in his 1994 Presidential Address: "We cannot covet the prestige of being a member of The American Orthopaedic Association and not accept the responsibility for leadership that comes with that prestige.... It is not enough to have excellence; we must use it." Elitism in and of itself means nothing; it must be justified by action and deed.
The French concept of noblesse oblige certainly applies here for there is no doubt that The American Orthopaedic Association constitutes an aristocracy, an aristocracy of merit, and therefore has obligations to something larger and more important than ourselves. Throughout our 111-year history, our Association predecessors have defined this larger commitment as the advancement of our specialty. Now we, in 1997, have clear obligations to those who have gone before us.
From the beginnings of orthopaedic surgery in this country, members of this Association have exerted themselves earnestly, actively, and altruistically to give as much as they have received, and more, to improve the status of our specialty and broaden its benefits to others. The history of The American Orthopaedic Association, as recounted in the recorded thoughts, ideas, and words of my predecessors and as chronicled in The American Orthopaedic Association. A Centennial History by Thornton Brown et al., is not only the history of an organization; it is the history of orthopaedics in the United States. Indeed, the fabric of orthopaedic surgery is woven of the fiber of The American Orthopaedic Association.
At its inception, The American Orthopaedic Association had only one purpose, which was unmistakable and unambiguous: the advancement of orthopaedic science and art, a goal aimed at the establishment of our specialty as a recognized branch of medicine. In those early years, in the words of De Forest Willard, an orthopaedist was considered a mere "buckle-and-strap man," "a fitter of apparatus," and as late as 1891, as A. B. Judson noted in his Presidential Address, there was confusion even among the learned as to the difference between orthopaedic surgeons and chiropodists and between orthopaedists and brace-makers. At the outset, the specialty of orthopaedics was essentially limited to the treatment of those conditions "which its name connoted": deformities of childhood such as bowed legs, knock knees, scoliosis, congenital dislocation of the hip, and clubfoot10. Yet, by the time of the 1894 Presidential Address, it was possible for A. M. Phelps to envision the orthopaedic surgeon of the future as one "who has been thoroughly schooled in all the departments of medicine ... he will secure for our specialty the subjects which are rightfully ours ... colleges will want professors of orthopedic surgery."
Two years after The Association's formation, our predecessors, in response to the needs of our emerging specialty, made the first in a long series of epoch-making critical choices: The Association published the inaugural issue of the Transactions of the American Orthopedic Association to record and distribute the papers given at the Annual Meeting. Thus began the development of the body of American orthopaedic scientific literature. That critical choice in 1889 spearheaded the ascent of our specialty and eventually led to its broader acceptance among the disciplines of medicine. As the journal evolved, so too did its name. In 1904, the Transactions became The American Journal of Orthopedic Surgery; in 1919, when it became the official organ of The British Orthopaedic Association, it dropped American from its title; in 1922, it adopted its present name, The Journal of Bone and Joint Surgery; and in 1954, its ownership was transferred to an independent corporation. Thus, the initial decision to found our journal, a publication that developed into "the greatest unifying force in orthopaedic surgery"2-4, was a critical choice for The Association, and it marks a major milestone in the advancement of our specialty.
Another critical choice for The Association, and for our specialty, came with the end of World War I. The wartime advent of orthopaedic training for military surgeons, an initiative led by members of The Association, had sparked the sudden advancement of orthopaedics from a specialty concerned mainly with the correction of deformities of handicapped children to one that "dealt with all lesions of the locomotor system,"15 and by the war's end the national and international importance of The American Orthopaedic Association was firmly established. However, with the new wave of war-trained orthopaedic surgeons, back from the war and eager to expand their knowledge and enhance their expertise, The Association was faced with a critical choice, this time concerning membership requirements. At this critical juncture, our predecessors voted to relax The Association's restriction on the number of active members but not to alter its stringent requirements for membership. In retrospect, this decision was probably the most critical in our history because it both ensured the continuing honorific status of The Association and led to the formation of a second national orthopaedic society, which was to become the representative body for orthopaedic surgery in this country.
In effectively shutting out our specialty's most rapidly growing sector, The American Orthopaedic Association indirectly fostered the rise of numerous regional and local clubs, most of which were formed by members of The Association. The obvious next step was the founding, in 1933, of a second national orthopaedic society, The American Academy of Orthopaedic Surgeons, an idea first proposed by Dr. Willis Campbell at the 1931 meeting of The Clinical Orthopaedic Society, successor organization to the Central States Orthopaedic Club. In his Presidential Address to The Academy in 1934, Dr. Campbell credited The American Orthopaedic Association with performance of "an enormous service in the advancement of the specialty not only by the development of scientific knowledge but also by fostering various orthopaedic clubs throughout the country."7 He stated that The Association, "through a large majority of its members," sponsored the formation of The Academy and "may be regarded as the father of this association." Even more important, Dr. Campbell noted that "there is no conflict between these societies as their functions are materially different, and their friendly cooperation will continue and do much for the development of orthopaedic surgery, and individually, both associations."
We are all proud to be members of The Academy, which has grown far beyond the imagination of our forebears into, without a question, the finest representative specialty organization in the world. Relationships between The American Academy of Orthopaedic Surgeons and The American Orthopaedic Association have never been better, thanks in part to the superb leadership of both organizations. We have continued to work closely with The Academy on many projects, such as the Joint Parade, support of site visitors for residency review, and support of the recent Rand Manpower Study. The Association has also worked very closely with The Academy's International Committee to avoid overlap and to provide better coordination of our efforts in the international area. All of this resulted from the critical decision of The American Orthopaedic Association in the 1930s to endorse The American Academy of Orthopaedic Surgeons as the educational forum for the steadily increasing number of orthopaedic surgeons in the United States. In this situation, as in many others, we can be proud that our Association identified a need in our specialty, made a critical choice, proposed a solution, and brought about the formation of The Academy as an independent organization, establishing a pattern that has come to characterize the endeavors of The Association. With that critical choice, The Association began a course of action directed at addressing the major issues, needs, and problems facing our fast-growing specialty in changing times.
From The Association's long list of other major contributions to our specialty, I will quickly summarize some of the highlights, beginning with the establishment of a national standard for graduate medical education. In 1934, The Association joined with the newly formed Academy and the Orthopaedic Section of the American Medical Association to charter a certifying body, the American Board of Orthopaedic Surgery. The Association's 1931 proposal for a "standard course in orthopaedic surgery which might be adhered to as closely as possible in the various teaching institutions of America" led eventually to the foundation of the Residency Review Committee for Orthopaedic Surgery7. In 1953, Association President A. R. Shands, Jr., addressed the long-felt need for a national research effort in orthopaedics and, in 1954, The Association invited The Academy and the Orthopaedic Research Society to join with it in establishing the Orthopaedic Research and Education Foundation3. This child of The Association became independent in 1984 and continues today to be a major source of musculoskeletal research funding in this country. Thus, again and again, over many decades, we see the same pattern: The Association identifies a need, proposes and implements a solution, and engenders another independent organization, all based not on the tenet of what is best for The Association but instead on what is best for our specialty.
Having received so much from the past, it falls now to us to exert ourselves all the more earnestly for the benefit of our successors. We must decide what kind of elite organization we want to be. Inward-looking or outward-looking? Passive or active? Self-satisfied or altruistic?
The current mission of The American Orthopaedic Association, as articulated in our 1990 strategic plan, is to "enhance the quality of musculoskeletal care nationally and internationally through the recognition and provision of leadership in the acquisition and dissemination of relevant knowledge, skills, and attitudes." How well are we accomplishing that mission? In my opinion, we do a very good job of recognizing leadership, identifying those individuals who are the leaders in all aspects of orthopaedic life and bringing them into The Association. One has only to read the membership rolls to verify that point. As for providing leadership, we can be justifiably proud of our existing programs for they are of great service to our speciality. As befits our mission, we have excelled in the acquisition and dissemination of relevant knowledge and skills. However, in these turbulent times, there is much more that we can and should be doing for the betterment of orthopaedic surgery and its future advancement, particularly in the area of our mission that touches on attitudes. In times of stability, accepted norms can be adhered to; traditions, nurtured; the status quo, maintained. However, during times of cataclysmic or perceived cataclysmic change—the times in which we are now living—the requirements of leadership are much more demanding. The challenges that we face today demand a cohesive effort by all orthopaedic associations and require, as Doug Jackson alluded to in his Academy Presidential Address, a uniting of the "House of Orthopaedics."
What has certainly been predicted but hardly imagined by most physicians is the new playing field of health-care delivery today. Never has there been this much uncertainty at all levels of health care. The enthusiasm of our residents is thwarted and dampened at every opportunity by those who pine about how good it was in the past and how terrible it is now to practice medicine. As physicians, we are constantly barraged by statements concerning quality, when in actuality quality is yet to be defined. Cost-control in the eyes of the investors in health-care companies, the only sector currently profiting from changes in health care, has erroneously been equated with quality. Issues of choice and point of service are the battle lines, which have now been drawn not only between physicians and health-care plans but also between specialists even within our own specialty and within our own communities. There are even forces within the medical community that, under the guise of claiming improved quality of care, are attempting to usurp the role of our certification and accreditation organizations. If instituted as currently described, this movement has the distinct possibility of lowering the standard and quality of medical care in this country.
In addition, we are beset by concerns as varied as who should pay for medical education, who should educate residents, fellowships and their future, competence and the maintenance thereof, decreased funding for graduate medical education, decreased funding for research, relationships with industry for education and research, the impact of medical liability, intrusions into the doctor-patient relationship, and the role of the orthopaedic surgeon as a primary-care physician in the new health-care environment. The entire face of academic medicine is changing, and its very existence is threatened.
We seem to be losing control in our educational institutions, in our communities, and in our most prized relationship, that with our patients. We are not used to being out of control or being controlled. We as perceived leaders do not like to be led, particularly by those not among us. Exacerbating our sense of disarray is our growing difficulty in speaking with one voice. The fascinating, explosive developments in our specialty predicted by Henry Mankin for the year 2013 are already upon us. Our mechanical solutions to biological problems have improved the quality of life for patients over the years, but the horizon is filled with forthcoming biological solutions that we must be prepared to address through our educational programs. These biological and technological advances have come at the price of increasing fragmentation of our specialty, a problem our forefathers could not have foreseen. With specialization and fragmentation has come the strengthening of loyalties to specialty societies at the expense of our national orthopaedic associations. This is extremely dangerous. Standing together, orthopaedic surgeons constitute only 3 to 4 per cent of all physicians; if we cannot speak with one voice on the issues of the day, we will have little impact on their outcome.
Some comfort can be taken from the Addresses of previous presidents, which make it evident that we have always been in times of perceived disastrous change. In 1971, Garber wrote: "The structure of American medicine is being shaken to its foundations by cyclonic gales blowing from every direction." We are certainly in a similar storm now, and it is a storm that no doubt we will weather.
The Academy has responded with innovative leadership. It has adapted to the changes in orthopaedic surgery and its environment by restructuring, by establishing councils, and by forming the Council of Musculoskeletal Specialty Societies (COMSS) and the Board of Councilors to be able to be responsive to its membership and yet be able to respond to the changes in the health-care environment taking place on an almost constant basis. Now more than ever there is a need for the leaders of all aspects of orthopaedic life to meet and discuss the pressing issues of the day, be they political, scientific, educational, ethical, or research-related, and to anticipate the emerging issues that we must address in the future. What better catalyst for such an effort than The American Orthopaedic Association? No other organization within our discipline has the structure, the fluidity, the economic and political independence, and the membership to bring the leaders of American orthopaedic surgery together to prevent overlap and to strengthen our voice.
The Association is ideally suited to exert itself in the more active leadership role that our times demand, first by virtue of its main asset: you, its members, the leaders of every aspect of orthopaedic life. To this key asset we can add the advantages of The Association's relatively small size, relatively loose organizational structure, and absence of specialty barriers. Our organization is not bound by convention, extensive and constraining bylaws, or the need to be democratic and representative or to cater to orthopaedic special-interest groups. This enables The Association to react quickly to issues, be they medicopolitical, educational, academic, or research-related. In The Association, medical politics can be emphasized or de-emphasized; the scope of the issues that we address can be limited and clearly defined or broad-based and speculative, and we long ago made the critical choice to reject profit as a motive for any of The Association's activities. Moreover, The Association, unlike any other orthopaedic organization, fosters the development of cross-specialty interpersonal relationships. Interpersonal relationships can not only enhance The Association's ability to address specialty-wide issues and to define broad-based goals but also carry over into our work with and for other orthopaedic organizations. In the context of The Association, we are able to air our views on a wide variety of topics. We can set aside our titles of office and bring our expertise to the table to arrive at a consensus as to what is best for our discipline and what will do the most to advance musculoskeletal care in the United States and the world. Again, to quote Dr. Urbaniak: "We have the rare advantage of owing no special allegiance to constituents, special interest groups, or industry. As a result, The Association is aptly positioned to provide objective leadership in controversial areas that may benefit all orthopaedic surgeons and the various subspecialty groups."
The obvious arena for exerting our leadership is the Annual Meeting, the main activity in which most members participate and from which you should derive the most benefits. With some redesigning, we can create a new program format better suited to prepare us to provide leadership in addressing the challenges of our times. The Association is not and should not be a mini-Academy or specialty society. You as leaders do not need to be led; instead, you should be stimulated, invigorated, informed, energized, and primed with ideas that you can use in turn in your respective leadership roles. The Annual Meeting must be a showcase event—timely, dynamic, innovative, original, motivating, and most importantly interactive. You need to hear cutting-edge basic-science presentations and well thought-out evidence-based clinical topics evaluated with the use of appropriate outcome measures. You need to be addressed by the experts on each topic and you must be afforded the time to react to what is presented, be it in a symposium or a scientific or position paper. The Association must provide you with information that is not available elsewhere, in a format that allows you maximum participation.
To that end, our Program Committee has already begun working with the leadership of the The American Academy of Orthopaedic Surgeons, the American Board of Orthopaedic Surgery, and all other major orthopaedic organizations to have input into our program preparation. We have in the past developed important interactive symposia on cross-organizational topics, conducted by the leaders of our specialty and dealing with the important issues and research topics of the day, and we will redouble this effort in the future. The Education Committee will interact with the membership throughout the year to develop new and innovative program ideas that will be implemented by the Program Committee. With your help, the Committee will develop a topical symposia matrix of the major problems facing us today and will anticipate the issues that will confront us tomorrow. Also with your help, the Committee will help identify those among us who are most able to address and define these important issues.
It would be ideal if the symposia presented were published so that this information would be available to all to be used as a reference framework for future discussions or deliberations and to act as a stimulus to others interested in the topic. To that end, we have begun discussion with The Journal of Bone and Joint Surgery and The American Academy of Orthopaedic Surgeons to achieve this goal.
We also need to provide, through our program, even greater recognition of some of our leaders, like the Bristol-Myers Squibb/Zimmer Award winner and our Association Visiting Professor and Hatcher Fellowship recipients. These leaders should make formal presentations in our program. We should also provide the membership with the opportunity to interact with the leaders of our Academy, the American Board of Orthopaedic Surgery, and our Journal. These individuals regularly give brief reports to our business meetings but in my opinion they should occasionally be engaged in an open-forum format for the membership. The Annual Meeting could also serve as a focus group for many other orthopaedic, surgical, medical, or even lay organizations. The Association provides the ideal sounding board for new organizational ideas and direction. At the Annual Meeting, we need to hear regularly from our American-British-Canadian (ABC) and North American Traveling Fellows (NATF), to give them deserved recognition and to let us preview the leaders of the future. We must also hear from our new members in some form or another to get to know them and to learn of the attributes, expertise, and leadership skills that they bring to The Association. Finally, we need to hear continually from our senior members, whose institutional memory of all of our orthopaedic associations and organizations provides a critical perspective on the issues of today.
The Association has had an international focus and commitment since its inception. This is a commitment that I would like to see us expand and strengthen in the future. Past landmarks include incorporation of the notable European orthopaedic surgeons in the early years, with The Association having the first Combined Meeting in 1929 with the relatively young British Orthopaedic Association, establishing the American-British-Canadian Traveling Fellowship, renewing the tradition of Combined Meetings with other national associations in 1948, and establishing the International Visiting Professor Program in 1987.
We must continue to enhance our international friendships and, as we have done since The Association's inception, continue to identify the leaders of international orthopaedic surgery. Our tradition of Combined Meetings has afforded us the opportunity to learn firsthand about orthopaedic surgery around the world, to meet our international colleagues and appreciate the problems that they face both educationally and politically, to learn how their educational systems work, to understand the problems that they face in the delivery of health care, and to comprehend the needs of their members. This spirit of cooperation can only enrich our orthopaedic lives. We should continue our periodic Combined Meetings with international orthopaedic associations, on the condition that they enhance the quality of our meeting with good science and with shared concerns about dealing with problems that are common around the world. The international orthopaedic community has always looked to America as the model for health-care delivery as well as medical education and research, but with the changes in health care taking place in this country and as our system begins to resemble those of other nations, we can learn a great deal from these world orthopaedic leaders. Our international colleagues have much to offer us in many realms, not only within the scientific aspects of our discipline but also through their considerable experience with the strengths and weaknesses of different health-care-delivery models. These select individuals, who should meet the same high standards that we set for our membership, should be incorporated into our ranks for their input and perspective on the political, social, economic, and educational problems around the world.
In 1992, an international symposium was held in San Francisco under the direction of Mike Chapman and Harlan Amstutz and was attended by representatives from seventy-four national societies, seven international societies, and forty-nine countries. The Association had perceived a need for the organization of international educational exchanges. It was apparent at that time that the arrangements for short and some long-term international post-training educational experiences—be they observerships, clinical clerkships, or research, service, or teaching experiences—had been haphazard at best. Most of the experiences were arranged on a word-of-mouth basis or through personal contacts, journal advertisements, chance meetings, or prearranged relationships between institutions, countries, or individuals. Individuals seeking an educational, clinical, research, service, or teaching experience lacked complete information on what experiences were available and, similarly, those who offered these experiences had only limited numbers of applicants because interested or qualified individuals were unaware that the experiences were being offered. Thus, there was clearly a need for a system to match educational needs with available resources. As a result of this international symposium, the International Center for Orthopaedic Education (ICOE) was established, with the ultimate goal of improving patient care by bringing to the bedside advances from around the world14.
The International Center, originally envisioned as a three-year pilot project, was designed to facilitate the organization and development of worldwide exchanges and to act as a worldwide clearinghouse for postgraduate orthopaedic education, matching educational, research, teaching, and service needs with available resources. For individual members of The Association, the arrangement of an educational experience either at home or abroad is not difficult because of their extensive network of connections. However, for the average orthopaedic surgeon around the world, this is not possible. The chance to open a new door, expand a horizon, or gain an opportunity is almost unimaginable, but the development of the International Center for Orthopaedic Education has made these dreams a reality for orthopaedic surgeons around the world. The Center began operation in July 1994 and has thus far exceeded our wildest expectations. As of May 1997, more than 2000 offerings were available from 821 institutions in sixty-eight countries and almost 1900 applications were processed from seventy-eight countries. The response from the world orthopaedic community has been overwhelming, with many individuals reporting that their ICOE exchange opportunity was the experience of a lifetime. The Center is available by telephone, by fax, by mail, and on the Internet. It has its own Web site and can also be accessed through The Association's or The Academy's Web site. In addition, many international associations have made it a menu item on their own Web site.
This Center, although conceived by The American Orthopaedic Association, is a project that belongs to all associations and all orthopaedic surgeons around the world. It is a project that has unlimited potential. We have provided this service for free and plan to continue to do so. For the initial period, funds were raised through the generosity of the world orthopaedic community, with contributions from individuals, associations, specialty societies, national societies, regional societies, journals, and industry. Over the last several years, we have been trying to find permanent funding for the Center. I am pleased to announce to you today that the International Center for Orthopaedic Education will be able to continue to develop and reach its almost unlimited potential thanks to the Foundation of the Orthopaedic Hospital of Los Angeles. The Foundation has committed to funding the operating expenses of the Center for the next ten years, during which time it will raise a permanent endowment to allow the Center to continue its work in perpetuity. On behalf of the members of The American Orthopaedic Association and indeed on behalf of every orthopaedic surgeon in the world and of future generations, our heartfelt thanks go to the Orthopaedic Hospital for its generosity and vision in recognizing the potential of this project and its good for humankind. Its generosity will help the Center to flourish, thrive, and grow to reach its full potential. This has all been done without monetary motive, with the sole intent of developing a solution to an international orthopaedic need and providing a service to the world orthopaedic community and ultimately to the patients. No doubt in the future, when the endowment is completed, another organization will have been fostered and nurtured to maturity by The Association for the good of the specialty and of musculoskeletal care around the world.
We have worked closely with The Academy and the specialty societies, as we will continue to do, to bring the Center's message to the community of orthopaedic surgeons. In addition, we will continue to work closely with the leaders of orthopaedic surgery around the world—the English-speaking associations SICOT (Société Internationale de Chirurgie Orthopédique et de Traumatologie), EFORT (European Federation of National Associations of Orthopaedics and Traumatology), ASEAN (The Association of Southeast Asian Nations), WPOA (Western Pacific Orthopaedic Association), WOC (World Orthopaedic Concern), AOS (Academic Orthopaedic Society), and SLOAT (Sociedad Latinoamericana de Ortopedia y Traumatologia)—to get the information about the Center out to their constituents. These world leaders are helping to spread the word about the Center—what it is, what it is accomplishing, and what it can accomplish in the future. Now, with the attainment of a secure financial foundation, The Association in conjunction with the Foundation of the Orthopaedic Hospital of Los Angeles will begin to expand the Center's current mission and chart its course for the future.
My last area of concern, an area in which I believe The Association should also exert its leadership, is with the preparation of residents. In 1968, The American Orthopaedic Association Residents' Conference, now in its thirtieth year, was established. This outstanding conference, run by and for residents, continues to be a superb educational experience. This year's Program Committee received 272 abstract submissions. The conference was attended by 214 residents, who made 168 podium presentations and presented sixty-two poster exhibits. I participated in this conference as a resident and had the great pleasure of attending this year's conference as an observer. The excellent quality of this meeting rivals, and may in fact surpass, the majority of scientific conferences in existence. I referred earlier to the demoralizing pressures placed upon the current generation of residents by the recent upheaval in our health-care system. We should consider using the conference as a vehicle to help educate our residents about the world that they are about to face, not only in its negative aspects but also with an emphasis on the exciting opportunities opened by recent advances in musculoskeletal care. The conference should challenge these young men and women to explore the unlimited horizons of our specialty. The conference should also encourage these future members of the orthopaedic community to learn of the importance of the Orthopaedic and Research Education Foundation and stimulate them to apply for the several fellowships offered by The Association and to learn about functions of the various orthopaedic organizations. We should consider incorporating presentations by the leaders of The Academy, the Orthopaedic Research Society, and the Orthopaedic Research and Education Foundation. This vehicle could be used as a major sounding board for these organizations to interact with the orthopaedic surgeons of the future, not only to educate and inspire them but also to learn of their concerns for the future.
With all of this on our agenda—a revitalization of the Annual Meeting, a rededication to international outreach, and an expansion of our offerings to residents—the year ahead is shaping up as a time of action. We are ready for the challenge. We are a society small enough to keep faith with our past but influential enough at the national level to develop creative and effective responses to the changes in organized medicine and within our own specialty. We must use these advantages to transcend the status quo and summon the resolve to make critical choices for the future.
Recognizing this imperative, I personally have made a critical choice, with the full support of the Executive Committee, to forgo the international symposium, which has traditionally been a presidential prerogative. Instead, I will be organizing a strategic planning retreat. It is time for us to review all aspects of our Association and to develop an updated strategic plan—one that will be fluid and dynamic, capable of being re-evaluated and continually refocused in response to emerging needs. Some of you will participate in the actual planning session, but all of you, through the questionnaire that you received earlier this year, have had the opportunity to contribute to the strategic planning process. Our survey had a return rate of nearly 70 per cent, far in excess of any statistical expectations for this kind of exercise, and that in itself shows that you wish to be makers and shapers of your own destiny and of the destiny of this Association. You have signaled that you intend your Association membership to be a beginning, not an end. And I promise you that all of you will be heard.
Of the four types of orientation—reactivist, inactivist, preactivist, and interactivist—identified by Ackoff in his discussion of organizational planning, the interactivist model is the most positive and goal-directed. Reactivists look backward. Inactivists are content with things as they are. Preactivists—the dominant type in United States management today—seek to accelerate change and to exploit the opportunities that it brings. However, interactivists are more imaginative. They believe that the future depends at least as much on what they and others like them do between now and then as it does on what has happened in the past. Interactivists maintain that the future is largely subject to creation; they don't just prepare for the predicted future but decide on the desirable future and create ways to bring it about. This is the model of leaders—the model exemplified in your responses to The Association questionnaire. As an organization of interactivists, we will commit ourselves to directing our own future. We will use our distinguished history as a foundation upon which to build, a compass to guide our way.
Our professional careers are limited, in most cases, to thirty to thirty-five years, and during that time few of us in orthopaedic surgery have the opportunity to extend our influence beyond our immediate circles of family and patients; even fewer can influence generations of students, residents, professional colleagues, and other associates; and fewer still have the opportunity to influence our profession. Those of you in this room, the leaders' leaders of our specialty, are among the lucky few who have been given the opportunity to contribute. In becoming members of The American Orthopaedic Association, the premier leadership organization in our field, all of us accepted a stake in its mission. A major part of that mission is to provide leadership to our specialty. The American Orthopaedic Association must never relinquish its unique position of specialty-wide leadership. This is too vibrant an organization to dwell upon what has already been done. It is time to focus on the future. Don't be satisfied with ceremony. Don't settle for less than what you deserve from this organization: an opportunity to take your membership to a new level, an opportunity to move our specialty forward.
Paul DeRosa, in speaking of professionalism at this podium last year, noted that "internal rewards" far outweigh the compensations of salary and social recognition. As he stated: "Internal rewards include the well being and gratitude of the individuals who have been served, an involvement in the lives of others, a sense of mastery, the satisfaction of curiosity, the acquisition of wisdom, and the esteem of fellow professionals." These are indeed the lasting rewards of our profession, carried to its highest level through membership in The Association, with a focus on action, not reflection. In due course, there will be time to look back on past accomplishments, but now is not the time. I urge you to use your membership for dynamic interaction, for bringing about change in our specialty. In return, you will be rewarded with a lifetime of meaningful experiences, development of strong cross-specialty friendships, camaraderie, and a sense of accomplishment.
As I stated when I was elected Second President-Elect, I view the opportunity that you have given me not as a reward for past accomplishments or hard work for The Association but as a challenge to greater service in the future. Today I would like to reaffirm that pledge. I consider this office a mandate to put all my energies into working to ensure that The Association fulfills its mission and expands that mission, wherever appropriate, into new areas of service to our specialty. With your help and commitment, our organization cannot fail to meet this challenge. Thank you for the opportunity and the responsibility. I won't let you down.
†Department of Orthopaedic Surgery, 01026 JPP, University Hospital, University of Iowa, Iowa City, Iowa 52242. E-mail address: stuart_weinstein@uiowa.edu.