Dr. Callaghan looks back on presidency

John J. Callaghan, MD, scanned through three typed pages listing all the places he had visited over the past year on behalf of the American Academy of Orthopaedic Surgeons and the American Association of Orthopaedic Surgeons (AAOS). “You do get around,” he said, with his characteristic smile and chuckle. “But it is a fantastic experience to represent the profession and our members, working with colleagues toward a common goal of improving care and outcomes for orthopaedic patients.”

In a conversation with AAOS Now, Dr. Callaghan shared his impressions of his year of service—the highs, the lows, and the lessons.

AAOS Now: What was the best part about being Academy president?
Dr. Callaghan:
The best part is the interaction with the colleagues with whom you’ve had so many different relationships—professionally and socially. Having worked hard together over all these years, now you have the opportunity to lead them, and in the process, you learn about leadership in a very different way.

Leadership used to be more dictatorial; now, it’s a lot more listening, consensus building, and making sure everybody is informed and comfortable with decisions. In this era, if you are going to be effective, decisions have to be transparent, and I hope that I have been able to do that.

AAOS Now: What was the hardest part?
Dr. Callaghan:
The hardest part is having to make tough decisions or have tough discussions with people as you try to make sure that the organization is moving forward appropriately. We are not all going to agree on everything, and sometimes you have difficult discussions about decisions.

In my time on the presidential line, the Academy has faced huge financial challenges related to a national economic crisis. Although we had the reserves to get through without cutting many programs, there were some tough choices, and we had to make some cuts in some areas. But we did it without getting rid of staff or key programs.

AAOS Now: Your thematic focus as president was quality. What were you able to accomplish in that area?
Dr. Callaghan:
This was a continuum of an idea that had been developing ever since we added “Quality Assessment and Technology” to the Council on Research, to CORQAT. All I’ve tried to do is jump-start it in a new era.

The issue of quality came to the forefront when the healthcare reform bill was passed. The office of government relations identified all the areas of quality in this bill—more than 50 initiatives. Some of them required quality assessment but didn’t outline what that assessment or the metrics should be. But it gave us the incentive to get involved and have a seat at the table when these measures are developed. So we dissected the bill and brought in experts who had been involved in the quality assessment movement. We’ve been able to construct with our partners, especially the cardiologists, what we think will be a framework for the future with an eight-point Quality Initiative.

One of these points is a multi-stakeholder Quality Institute, which will include insurance companies and hospitals, among others. We also have our guidelines development and our technology assessment programs; in the future, members will hear about appropriate use criteria, which is part of the new wave in quality initiatives.

Continuing education and working with the specialties are part of the quality initiative. When I came into this position, I knew that unity in orthopaedics was important. We’re not going to all agree on everything, but if we understand each other’s positions, we can deal with differences and find areas that we can advance together.

I had been involved with regional societies, specialty societies, and other leadership societies. Now, from the Academy’s perspective, making sure that those relationships are always front and center is important. We can do a lot better together than apart. The more collaborations we have, whether with specialty society partners or other organizations, the better. There’s no way the AAOS could contemplate doing appropriate use criteria without the help of the specialty societies. They’re the ones who know what the best indications are for surgery and what the outcomes are.

In recent years, the language about quality has changed, focusing on patient care. The Academy’s priority is helping patients and ensuring the best utilization of resources. Those who follow me will continue this work; it will not stop the day I leave office.

AAOS Now: Passage of the healthcare bill was certainly a memorable event of your presidency.
Dr. Callaghan:
We had to make sure that we were leaders in shaping the implementation of the bill and that our voice was heard. We now believe that the AAOS is well positioned to be a leader in the quality movement and to make sure that our members and their patients will benefit from it.

It’s clear that the office of government relations and the advocacy movement, which Dr. (E. Anthony) Rankin highlighted a couple of years ago, are vitally important. Under the leadership of William R. Martin III, MD, we have a very capable staff who are well acquainted with the issues and advocacy. And I have to mention the volunteer effort, especially through the Council on Advocacy, Board of Councilors, Board of Specialty Societies, and, most importantly, through our orthopaedic political action committee (PAC) under Stuart L. Weinstein, MD. The success of our PAC has demonstrated the huge commitment our members have made to the political process. It’s really something when a group of 22,000 has a PAC that is larger than the American Medical Association’s PAC.

AAOS Now: What would you tell a younger member about getting involved in the Academy?
Dr. Callaghan:
The great thing about the Academy is the volunteerism, the amount of interest members have in the organization. Volunteers are necessary to make the Academy what it is. We really see this in the committee appointment process, when we see how many people have applied. We have programs set up to help newer members find ways to get involved, if not in their first choice, maybe in another way. I would encourage every young orthopaedist to find a mentor, including ex-presidents like myself.

AAOS Now: Members are concerned about the image of the orthopaedic surgeon.
Dr. Callaghan:
When we started the Communications Cabinet, we realized the need to show our true worth in helping patients with musculoskeletal conditions. That cabinet has really taken us forward, through public service announcements and other initiatives that explain what an orthopaedic surgeon is.

The great challenge today is that doctors are going to be constantly scrutinized over conflicts of interest, or inappropriate use of resources, or doing things that don’t really help patients. And the AAOS is positioned to show the true worth of orthopaedics in serving patients. Going back to the quality initiative, we have to show how we give value to the patient and to the healthcare system, where it is not just the result but the cost of care. We have to try to do things efficiently and cost effectively.

AAOS Now: What is your advice to your successor, Daniel J. Berry, MD?
Dr. Callaghan:
Things will come up that you don’t expect. Just recognize that you are in the position of president because we know that you will do a great job of handling them.

Try to take from the best of your colleagues. The people on the presidential line and board were people that I’d known for 20 years. If we had disagreements, I always felt comfortable that we could get them worked out. When you have friendship going with professionalism, it is very special.

Remember that you have help. Having served in a number of roles in the Academy, I’ve seen all the terrific staff we have. Hats off to Karen Hackett and all the staff; there is no way anyone could do this job without them. Working with the members and the staff is what keeps you enthusiastic, even when the work is hard.

You always feel like your board is the best, but I think I had a tremendous board. They had many diverse opinions that created challenges for me at times, but I wouldn’t have wanted it any other way. They were always engaged, trying to do the right thing. Your board and council chairs are so important. They help keep you straight; I think they did that in the case of this Irishman.

Interview conducted by Terry Stanton, senior science writer for AAOS Now, who can be reached at