Episodi

  • How Should Orthopaedic Surgeons Be Paid?

    How Should Orthopaedic Surgeons Be Paid?
    Oct 29 2026
    In this episode of the AAOS Now Podcast, host Stuart J. Fischer, MD, FAAOS, is joined by David Jevsevar, MD, MBA, FAAOS, CEO of OrthoVirginia, and Ronald Navarro, MD, FAAOS, Regional Chief of Orthopaedic Surgery, Southern California region, at Kaiser Permanente. Together, they examine the payment models for orthopaedic surgeons in 2026 and what each means for surgeons, practices, and patients. Both guests bring extensive experience in physician payment and administration across independent, employed, and academic settings. The conversation moves through RVU-based pay, straight salary, salary plus incentive, multispecialty groups, and fee for service. Drs. Jevsevar and Navarro discuss the tension between rewarding clinical productivity and valuing leadership, research, and community service. They also explore how ancillary income, bundled payments, and patient-reported outcomes are changing the landscape. The group then looks at how the ideal payment model shifts across a surgeon’s career, from early career stability to mid-career autonomy to planning a graceful exit. They close by describing what a better payment system might look like, while acknowledging that there is no perfect solution. Key topics covered in this episode: How RVU-based models work and why the RUC process is considered a zero sum game Pros and cons of employment and salary models, including concerns about productivity over time The role of salary plus incentive pay and the challenge of rewarding surgeons for providing appropriate, high-quality care How academic productivity, research time, and leadership fit into compensation Why equity and “fence time” comparisons can create friction within groups Whether fee for service is still viable, including OrthoVirginia data showing a 25.2 percent decline in the value of a work RVU between 2019 and 2024 The growing importance of ancillary income and how it can be distributed Which payment models are optimal for early-career, mid-career, and late-career surgeons The value of equity shares, pensions, and phased retirement options Strengths and flaws of bundled payments, including the lack of an appropriateness measure, and how bundled payment income can be divided within a group The promise and limits of patient-reported outcomes, including the effects of mental health and social determinants of health Why one payment model cannot fit every orthopaedic subspecialty As Dr. Jevsevar notes, this is not a one-answer question. A fair and balanced payment system has to reflect the different ways orthopaedic surgeons create value over the course of a career. Host: Stuart J. Fischer, MD, FAAOS, member, AAOS Now Editorial Board Guests: David Jevsevar, MD, MBA, FAAOS, sports medicine surgeon and CEO of OrthoVirginia Ronald Navarro, MD, FAAOS, sports medicine surgeon and Regional Chief of Orthopaedic Surgery, Southern California region, at Kaiser Permanente
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    41 min
  • Challenging the Medicare Physician Fee Schedule (MPFS) Proposed Rule

    Challenging the Medicare Physician Fee Schedule (MPFS) Proposed Rule
    Sep 11 2026
    This episode may include content about the American Association of Orthopaedic Surgeons, its advocacy efforts, and the Political Action Committee of the American Association of Orthopaedic Surgeons (OrthoPAC). In this episode of the AAOS Now Podcast, host Doug Lundy, MD, MBA, FAAOS, sits down with Joel Mayerson, MD, FAAOS, Chair of the AAOS Advocacy Council to discuss the calendar year 2027 Medicare Physician Fee Schedule (MPFS) proposed rule, which AAOS considers one of the most significant threats to orthopaedic practice in decades. Dr. Mayerson explains why this moment is different from past fee schedule fights. He walks through the specific provisions driving AAOS’ concern, starting with the proposed 20 percent reduction in valuation for major arthroplasty codes, including total knee, total hip, and total shoulder arthroplasty, as well as shoulder hemiarthroplasty. He also details a proposed change to the Modifier 25 payment policy that would reduce reimbursement when an evaluation and management service and a procedure happen on the same day. This is followed by a discussion of proposed changes to practice expense RVU calculations. Throughout the episode, Dr. Mayerson emphasizes that these policies will have devastating real-world consequences not only on orthopaedic surgeons, but on the patients they are committed to serving. He explains how independent and rural practices that aren’t able to absorb the additional costs will either close or be consolidated into large systems, leaving fewer options for patients; how Medicare beneficiaries could face longer waits and reduced access to care; and how without timely access to care, simple problems will progress to chronic or debilitating problems, leading to more ER visits and hospitalizations. Rather than negotiating quietly behind the scenes, Dr. Mayerson explains that AAOS is taking a firm public stance: The Academy is calling for a full pause on the proposed cuts and a return to 2026 payment values while a more collaborative, data-driven solution is developed. The episode closes with a call to action. Dr. Mayerson urges every AAOS member to get involved, whether through the AAOS Advocacy Action Center, participation in OrthoPAC, or engagement with their state and specialty societies. As Dr. Mayerson emphasizes, advocacy is an extension of patient care. Every letter, comment, and conversation with a legislator helps protect the house of orthopaedics and ensure access to musculoskeletal care for patients across the country. Host: Doug Lundy, MD, MBA, FAAOS, Deputy Editor, AAOS Now, and Chair, AAOS Now Podcast Workgroup Guest: Joel Mayerson, MD, FAAOS, Chair, AAOS Advocacy Council; Professor of orthopaedic surgery, Associate Chief Medical Officer, and Medical Director of Perioperative Services and Sarcoma Services, The Arthur G. James Cancer Hospital ("The James") at The Ohio State University Wexner Medical Center; Director, Division of Musculoskeletal Oncology, The Ohio State University Department of Orthopaedics
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    30 min
  • The ABOS Knowledge, Skills, and Behavior Program: How Valuable Are the Assessments?

    The ABOS Knowledge, Skills, and Behavior Program: How Valuable Are the Assessments?
    Aug 19 2026
    In this episode of the AAOS Now Podcast, host Doug Lundy, MD, MBA, FAAOS, sits down with two guests who offer differing perspectives about the American Board of Orthopaedic Surgery (ABOS) Knowledge, Skills, and Behavior (KSB) Program. David F. Martin, MD, Executive Director of the ABOS, offers the board's perspective on why the Knowledge, Skills, and Behavior (KSB) Program exists, why it is now required, and where it's headed; Ellen Lutnick, MD, a PGY5 at the University of Buffalo and chair of the AAOS Resident Assembly Executive Committee, shares her experience of living with the program day to day. Together, they trace the KSB Program from its 2018 launch through its 2025 requirement for residents entering the ABOS Part I exam pathway. Dr. Martin explains that the program grew out of decades of interest in competency-based medical education and a recognition that time alone doesn't guarantee a resident has developed adequate orthopaedic knowledge, surgical skill, and professional behavior. He walks through why the ABOS made participation mandatory, how the program integrates with ACGME case logging, and the distinction between formative feedback – meant to help residents improve – and summative feedback, like board exams, that produces a pass or fail outcome. Dr. Lutnick describes how the program was rolled out at Buffalo, what it's actually like to request feedback after or before a case, and how she's learned to be strategic about which cases to submit for evaluation. She also speaks candidly about receiving feedback she disagreed with, how professional behavior assessments surface blind spots, and what other residents have told her they would like to see change about the KSB Program. The conversation closes with a look at where the program might go next, including whether the ABOS will eventually tie participation to specific performance scores rather than just completion numbers. Dr. Martin encourages residents to reach out with feedback so ABOS can continue to make the assessments even more helpful and easier to incorporate into a resident’s busy schedule. Key topics covered in this episode: The origins of the KSB Program and its roots in competency-based medical education Why the ABOS chose to make KSB participation a requirement for the Part I exam Integration between the ABOS case entry system and the ACGME The difference between formative and summative assessment in residency training Strategies to help residents decide which cases to submit for surgical skills evaluation How professional behavior assessments are designed to identify outliers rather than track linear growth The role of verbal vs. written feedback in resident education Resident perspectives on receiving and processing critical feedback Survey fatigue and efforts to streamline the evaluation process What residents want to see improved, including access to individual professional behavior results Where the program may be headed, including the possibility of performance-based scoring requirements Residents starting to navigate the KSB Program will find real value in hearing how a peer has learned to use the tool strategically, not just to meet a requirement, but to actively shape the feedback they receive. Host: Doug Lundy, MD, MBA, FAAOS, Deputy Editor, AAOS Now; Chair, AAOS Now Podcast Workgroup Guests: David F. Martin, MD, Executive Director, American Board of Orthopaedic Surgery; Professor, Orthopaedic Surgery and Rehabilitation (Winston-Salem), Wake Forest University School of Medicine Ellen Lutnick, MD, Chair, AAOS Resident Assembly Executive Committee; PGY5 and Resident Research Coordinator, University of Buffalo Department of Orthopaedics and Sports Medicine
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    37 min
  • The Limits of Orthopaedic Surgery: A Critique of Heroic Salvage Measures

    The Limits of Orthopaedic Surgery: A Critique of Heroic Salvage Measures
    Jul 27 2026
    In this episode of the AAOS Now Podcast, host Ahmed Emara, MD, speaks with Nathan Mesko, MD, FAAOS, to explore the limits of orthopaedic surgery and the difficult decisions surrounding “heroic” measures. Dr. Mesko draws on 13 years of experience in orthopaedic oncology and joint reconstruction to unpack what "heroic" really means in surgery. He argues that heroism has less to do with technical difficulty – ”can I perform this procedure” – and more to do with what a patient is being asked to endure to reach a surgeon's envisioned outcome. Throughout the conversation, Dr. Mesko returns to a central idea: Surgical capability should always be outpaced by wisdom. He walks through how to recognize when the push toward a heroic operation is being driven by the surgeon rather than the patient, and he offers concrete techniques for having honest, humane conversations with patients around amputation, cancer diagnoses, and end of life. He also discusses the emotional toll of these decisions, including guilt, escalation of commitment, and how surgeons can build the humility and self-forgiveness needed for a sustainable career. The episode closes with a personal story that illustrates why staying present with a patient and not turning away from them, even after a frustrating conversation, can matter even more than the surgery itself. Key topics covered: Defining "heroic" measures in orthopaedic surgery and how that threshold shifts over a surgeon's career as the surgeon matures, including the evolution from saying "yes" to every procedure to knowing when to say "no” The challenges of actually getting informed consent for maiming or life-altering procedures, such as sacral resections and proximal femoral replacements, given the challenge of explaining to patients how much the procedure will impact their daily life Recognizing when surgical momentum is being driven by the surgeon rather than the patient, including escalation of commitment and the sunken cost fallacy in surgical decision-making The value of physically equalizing the conversation, such as pulling up a chair and sitting down rather than towering over the patient, to build trust and openness The importance of listening to patients before recommending treatment options to ensure that the treatment aligns with the patient’s goals and personal wishes Strategies for guarding against unnecessary repeat interventions, including peer consultation and pausing after setbacks Rethinking success in orthopaedics beyond X-rays and implant longevity, including patient-reported outcomes Managing surgeon guilt, self-forgiveness, and separating outcomes from the integrity of the decision-making process The importance of never leaving a patient without a clear next step or follow-up plan Listeners are encouraged to reflect not only on how they operate, but on how and why they decide to operate at all. Host: Ahmed Emara, MD, member, AAOS Now Editorial BoardGuest: Nathan Mesko, MD, FAAOS, Vice Chair of Global Clinical Operations, Center Director for Orthopaedic Oncology, and Associate Professor, departments of Orthopaedics (Integrated Surgical Institute) and Hematology/Oncology, Cleveland Clinic
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    43 min
  • Registries: What Happens When Orthopaedic Surgeons Own the Data?

    Registries: What Happens When Orthopaedic Surgeons Own the Data?
    Jun 24 2026
    In this episode of the AAOS Now Podcast, host Stuart J. Fischer, MD, FAAOS, speaks with two leaders in orthopaedic data science about how physician-controlled registries are transforming outcomes measurement, implant evaluation, and clinical decision-making. From the early vision of a national joint replacement registry to a new real-time data partnership with Epic, the conversation traces how far the registries have come and where they are headed. Drs. James Huddleston and Steven Glassman share concrete examples of how registry data is driving practice change. They also address how the data supports Clinical Practice Guidelines and research, why surgeon and patient information is protected from outside access, and what the integration of AI and patient-reported outcomes means for the next generation of orthopaedic registries. Key Topics Covered in This Episode: Origins and goals of the AAOS registry portfolio: How orthopaedic surgeons built a physician-controlled data infrastructure to protect procedures and drive evidence-based care Data sources and infrastructure: AJRR's use of hospital and ASC submissions, Medicare claims for complete follow-up on Medicare patients, and a new Epic Community Registries partnership for real-time data capture Registry scale and participation gaps: Why AJRR has surpassed five million procedures while spine, shoulder and elbow, and musculoskeletal oncology registries are still building volume Real-world clinical impact: How AJRR data has influenced cementless knee adoption, robotics use in unicompartmental arthroplasty, and the growth of triple-tapered femoral stems in hip replacement Research and CPG applications: How the Registry Analytics Institute supports physician-led and industry-sponsored research, with strict controls on data dissemination Patient-reported outcomes: The longstanding role of PROMs in spine and the challenges of scaling PROM collection for hip and knee under new government mandates Data privacy: Why registry data remains de-identified and inaccessible to insurers and government agencies, and what individual surgeon dashboards can offer International comparisons and ISAR: How AJRR benchmarks against registries in England, Wales, and beyond, and why U.S.-specific data remains essential AI and the future of registries: How AJRR is piloting AI-powered EHR extraction to improve data completeness without human intervention About Our Guests: James Huddleston III, MD, FAAOS, is Professor of Orthopaedic Surgery at Stanford Hospital; Co-Chair of the AAOS Registry Oversight Committee; and Chair of the American Joint Replacement Registry Steering Committee Steven D. Glassman, MD, FAAOS, is Professor of Orthopaedic Surgery at the University of Louisville School of Medicine; Medical Director at the Norton Leatherman Spine Center; Chair of the AAOS Registry Oversight Committee; and past Chair of the American Spine Registry Executive Committee
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    40 min
  • The Ortho Surgery Match Game: Signaling, Away Rotations, Research Years, and More

    The Ortho Surgery Match Game: Signaling, Away Rotations, Research Years, and More
    May 29 2026
    In this episode of the AAOS Now Podcast, host Richard Schaefer, MD, FAAOS, sits down with two of orthopaedic surgery's most dedicated advocates for medical student mentorship, William Levine, MD, FAAOS, and Amiethab Aiyer, MD, FAAOS, for a candid conversation about the residency Match process. The discussion tackles the nuts, bolts, and controversies of today's highly competitive application landscape, including how signaling helps students whittle down the number of programs they apply to, why away rotations may have gotten out of hand, and whether every student really needs to do a research year. Drs. Levine and Aiyer share how their decades-long professional relationship helped shape their commitment to guiding the next generation of orthopaedic surgeons. They explain that mentorship is a bidirectional partnership in which the mentee must put forth more than just a desire to learn. They talk about the importance of building a diverse "board" of mentors across institutions. And they encourage students to seek out mentors, including near-peers, who have their “finger on the pulse” of the rapidly-evolving Match process. The episode closes with a candid challenge to prospective applicants: Before attempting to match into orthopaedic surgery, ask yourself why you want to be an orthopaedic surgeon. According to Dr. Levine, mentors should require all of their mentees to answer that question — and if the answer is iffy, encourage them to consider a different specialty. Key Topics Covered in this Episode How the residency Match process works: from application to Match Day Building a mentorship "board": why one mentor isn't enough and how to cultivate relationships across institutions Mentorship as a bidirectional partnership: what mentees must bring to the relationship The origin of OrthoMentor: how Drs. Levine and Aiyer began collaborating to fill a nationwide advising void and how students at institutions with limited advising resources can still access current, accurate guidance Signaling and application caps: understanding the data behind limiting program applications (yes, 100 applications is too many) Away rotations: how many to do and why cohort strategy matters when applying Research years: when they help, when they don't, and what to look for in a productive year Schools without home programs: unique challenges and where to find current guidance Pursuing the right path: why students should reflect on their motivations before pursuing a career in orthopaedic surgery, and why where you train isn’t as important as what you do with the opportunity About Our Guests William N. Levine, MD, FAAOS, the Frank E. Stinchfield Professor and Chair, Department of Orthopaedic Surgery, Columbia University College of Physicians and Surgeons; Chief of the Orthopaedics Service at New York-Presbyterian/Columbia University Medical Center; and Editor-in-Chief Emeritus, Journal of the American Academy of Orthopaedic Surgeons Amiethab Aiyer, MD, FAAOS, Division Chief of foot and ankle surgery and Associate Professor, Department of Orthopaedic Surgery, Johns Hopkins School of Medicine; Deputy Editor, Journal of the American Academy of Orthopaedic Surgeons
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    40 min
  • My Parents Survived the Khmer Rouge: Life Lessons

    My Parents Survived the Khmer Rouge: Life Lessons
    Apr 22 2026
    In this deeply personal episode, Bopha Chrea, MD, shares the extraordinary story of her family's survival of Pol Pot and the Khmer Rouge regime in Cambodia, their harrowing escape from the Killing Fields across the border into Thailand, and their eventual resettlement in Canada. Dr. Chrea, now a foot and ankle surgeon at Iowa Health Care, connects her family's journey to three core lessons she carried into her career: that opportunities are often disguised as misfortune, that growth requires getting comfortable with being uncomfortable, and that gratitude is a genuine superpower. She reflects on how her early experiences navigating the healthcare system as a young child of immigrant parents shaped her path to orthopaedics, and how she now uses those lessons to guide trainees through the challenges of residency and fellowship, as well as the transition into practice. Key Topics Covered in This Episode Opportunities can be disguised as misfortune — How a series of trials and tribulations, including losing his glasses and the destruction of his family’s home, miraculously ended up saving Dr. Chrea's father from execution by Pol Pot’s brutal regime. The lesson: tragedy can lead to positive outcomes and growth. It’s important to get comfortable with being uncomfortable — How her parents’ willingness to take risks in the absence of a guaranteed path enabled the family to escape the Killing Fields and safely reach the refugee camp in Thailand, where Dr. Chrea was born. This lesson: focus on clarity of vision over certainty of path; as long as you believe in the vision, you can navigate through the uncertainty, but if you aren’t willing to try, you definitely won’t succeed. Gratitude is a superpower — How her brother chooses to emphasize the positive aspects of the family’s time in the refugee camp, not just the horrors. The lesson: mindset matters; you can actively choose to frame experiences in a more affirming way. To this day, Dr. Chrea is intentional about expressing gratitude to the people who have supported her journey. Mentoring is not one-size-fits-all — How meeting learners where they are helps them build confidence through small, achievable goals. The path to orthopaedics is paved with personal experiences — How translating for her mother at medical appointments as a child sparked a lifelong commitment to providing compassionate, patient-centered care. Guest: Bopha Chrea, MD, Assistant Professor of Orthopaedics and Rehabilitation in the Carver College of Medicine at the University of Iowa Host: Robert M. Orfaly, MD, MBA, FAAOS, AAOS Now editorial board member
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    21 min
  • The AAOS Patient Engagement Task Force

    The AAOS Patient Engagement Task Force
    Mar 17 2026
    This episode spotlights the AAOS Patient Engagement Task Force and its efforts to increase patient involvement in and education about orthopaedic care. Host Stuart J. Fischer, MD, FAAOS, welcomed task force co-chairs James W. Barber, MD, FAAOS, and Monica Payares-Lizano, MD, FAAOS, to discuss the creation and structure of the task force and its focus on patient engagement as a key part of the 2024-28 strategic plan. They explain that the task force was designed to promote bi-directional communication between the AAOS Board of Directors and the AAOS councils and committees that are already involved in patient-facing work. Highlighted task force accomplishments include a major revamp of OrthoInfo.org – AAOS’ most comprehensive patient-facing musculoskeletal health resource – to make the website more accessible and easier to navigate, as well as provide the content in multiple languages. Drs. Barber and Payares also talked about patient advocacy and the powerful impact of sharing patient stories with policymakers on Capitol Hill, about other AAOS patient education tools such as CPGs, and about the positive effect of patient engagement on PROMs. Both doctors share perspectives about how they are able to effectively inform and communicate with their unique patient populations, emphasizing the importance of placing patients at the center of orthopaedic care. Host: Stuart J. Fischer, MD, FAAOS, member, AAOS Now Editorial Board, and former Editor-in-Chief of OrthoInfo Guests: Monica Payares-Lizano, MD, FAAOS, pediatric orthopaedic surgeon at Phoenix Children’s; Member-at-Large, AAOS Board of Directors; co-chair, Patient Engagement Task Force James W. Barber, MD, FAAOS, orthopaedic surgeon with Southeastern Orthopaedics and Surgery Center; Secretary, AAOS Board of Councilors; co-chair, Patient Engagement Task Force
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    28 min