When Daniel K. Guy, MD, FAAOS, who assumed the position of AAOS 2021–2022 president at the March Business Meeting, speaks of his plans and vision for his coming term, he first cites the groundwork laid by his immediate predecessor, Joseph A. Bosco III, MD, FAAOS, and all the other AAOS leaders and volunteers working to fulfill the organization’s mission.
Because of the COVID-19 pandemic and the rescheduling of this year’s Annual Meeting from March to Aug. 31 to Sept. 3, in San Diego, Dr. Guy did not have the opportunity to introduce himself in a speech before a convention center great room full of members, friends, and family.
“If I were making a speech, the first thing I would do is thank everyone for the honor and opportunity to serve,” he said. “Next, I would recognize Dr. Bosco, along with our Board of Directors (BoD), as together they have done a superb job leading the AAOS this past year. Joe provided great leadership for our Board, and he kept our members informed with frequent and timely updates, as we maintained our focus on achieving AAOS’ strategic goals.”
The need to conduct most business virtually with the near elimination of in-person meetings posed challenges for the typical collaboration among Academy leaders. “Despite the obstacles of distance, Dr. Bosco has kept all our AAOS initiatives on task,” Dr. Guy said. “To name a few: our work in advocacy, registries, biologics, the new AAOS Leadership Institute (ALI), and, on the near horizon, the Resident Curriculum, which is on time to roll out later this year. Again, he’s done a great job.”
Dr. Guy added, “Being president is not a one-person job. It’s a collaboration with the Board, putting their intellects together. The AAOS Board has been engaged and worked hard all year, and no Board has ever spent as much time working on behalf of the Fellowship. I want to recognize our retiring Board members: previous Past President Kristy L. Weber, MD, FAAOS; our 2020 chairs of the Board of Councilors (BOC) and Board of Specialty Societies (BOS), Thomas S. Muzzonigro, MD, FAAOS, and C. Craig Satterlee, MD, FAAOS, respectively; our outgoing lay Board member James J. Balaschak; and, lastly, our two retiring members-at-large, Rachel Y. Goldstein, MD, MPH, FAAOS, and James R. Ficke, MD, FAAOS. They will all be missed.”
Speaking in big-picture terms, Dr. Guy declared, “We are sticking with our Strategic Plan. We are in year three of five [2019–2023], so we’re halfway through. We are going to build on our already-excellent member experience, which is the first goal of the Strategic Plan.”
“Second,” he continued, “we will continue our efforts to support our members’ success in evolving their practices in a value-based healthcare system. That requires a lot of forward thinking and constant advocacy. A lot of people are trying to influence how we provide orthopaedic care, but we want to be the ones to shape our own destiny.”
“The third equal rail of our Strategic Plan is to continue to improve our culture and governance,” Dr. Guy continued. “We have to stay ready and nimble to handle unforeseeable challenges and seize opportunities when we can. No one could have predicted COVID-19, but we adapted, and in spite of these challenges, we found opportunities under difficult circumstances. In terms of the important issue of culture and diversity, we are making progress but still have a way to go, but it’s not for lack of trying. Everybody struggles with how to improve the pipeline into orthopaedics. We want to make sure our members are role models to get younger people interested in our profession. To that end, we encourage everybody we can to apply and participate in our volunteer committee structure, to be that positive example, and to provide a welcoming opportunity to people from all backgrounds. A good example of leadership in this area is our AAOS Nominating Committee. I want to recognize and commend this year’s committee for supporting our strategic initiative. Their thoughtful deliberations have resulted in diversity throughout our incoming Board slate. In addition, through the efforts of the Diversity Advisory Board, which reports to the AAOS Membership Council, as well as other initiatives, such as ALI and various webinars, we encourage and instruct members on how to apply for positions in AAOS. We have a lot of opportunity—more than 800 volunteer positions.”
Dr. Guy, known almost universally to his colleagues and friends as Danny, comes to the presidency from the perspective of a member of a dwindling breed of surgeons: He operates out of what he describes as a “typical small-town, essentially private practice” in LaGrange, Ga., about an hour south of the Atlanta airport. The practice is affiliated with the Emory University system. The town has one hospital and ambulatory surgery center, and Dr. Guy said LaGrange is small enough that “you see all of your patients everywhere, in stores, at church, and in restaurants.” He mostly does shoulder and hip cases and has three associates who focus on spine, sports, and general orthopaedics, with an opening for an arthroplasty surgeon.
As a private practitioner, he has an unbuffered view of how policies of legislators, regulators, and private and public payers affect every surgeon’s ability to provide the highest-quality musculoskeletal care to patients. Thus, he views AAOS’ ongoing efforts in advocacy on behalf of surgeons and their patients as vital, while noting that AAOS’ advocacy activities, led by the Office of Government Relations (OGR), should be nonpartisan and confined to issues involving patient care and fair treatment of physicians.
“We have an obligation to advocate on behalf of our patients and profession. This doesn’t come from a political point of view, but from what is best for the practice of orthopaedics, enabling our Fellows to take care of patients in the best way,” he said. “Regulatory and legislative issues are problems that never offer a break. You have to keep working at it. When you think you’ve solved one problem, another one pops up. We have a great staff in OGR and great support through our BOC, BOS, and state societies when we promote legislation.”
A pressing issue that has come more to the forefront during COVID-19 is prior authorization. “It seems that since the pandemic, the requirement for prior authorization to provide care, perform surgery when needed, or obtain a test for diagnosis has intensified,” Dr. Guy said. “There is little transparency in the current system. With some codes, they’ve recently said, ‘You can never do this,’ and these denials put us on the defensive. This system of delay prevents us from providing timely care, not only by obstructing us when we think a procedure or test should be done but also by increasing the time we have to spend litigating on behalf of our patients with an insurer. It is taking us away from providing care to somebody else. Upgrading and improving the current method of prior authorization is one of our top-tier priorities identified by our Advocacy Council.”
To address this and other pressing issues, in May, AAOS will hold an “in-district” event—Orthopaedic Advocacy Week—during which volunteers will visit with members of Congress, an effort that first took place in August 2020 as a substitute for the National Orthopaedic Leadership Conference (NOLC), which, like so many things in the pandemic, was canceled. “We improvised and, with social distancing, went to members’ offices in their districts or talked to them by Zoom to advocate on relevant legislative topics,” Dr. Guy explained. “Since the pandemic began, this has been the only available means to carry our message. Members are currently not seeing visitors in their Washington offices, and we hope that this prohibition will be lifted by the time our combined NOLC and Fall Meeting take place in Washington in September.”
Accomplishments: delivered or planned
Similar to what he may have discussed during an in-person speech at the Annual Meeting, Dr. Guy touched on a number of issues and initiatives that he views as priorities during his coming term.
Annual Meeting: “We are excited to plan on being in San Diego for the Annual Meeting. You’re going to get a chance to see your colleagues—whom you’ve been distanced from for a year or more—during the meeting and in the evening events. I am hopeful for a large U.S. attendance. There’s a lot of interest. Under the leadership of Andrew Schmidt, MD, FAAOS, Annual Meeting Committee chair, and Susan McSorley, who leads our Academy staff for the Annual Meeting, we can expect another marvelous event. Moving the meeting from March to August has offered an opportunity to rethink how we offer our Specialty Day experience for attendees. When we saw we were running into Labor Day weekend, which was a potential challenge, we pivoted; instead of the usual, dedicated Specialty Day on Saturday, we will be offering a Specialty Focus every day of the Annual Meeting, with specialty sessions that will be moderated and sponsored by almost all of our specialty societies.”
“Our Exhibit Hall will be full, and we already have great commitment from our industry partners. They appreciated our move to August and September, as we made safety a priority for all meeting attendees. There is also a record number of submissions for instructional courses and symposia. It will be a premium educational opportunity, as always,” he said.
Registries: “Sometimes you can’t quite see the personal benefit of registries. However, if your institution participates in a registry, you can use your personal dashboard to compare how you stack up to peers in your hospital and other hospitals across the country. This year’s American Joint Replacement Registry (AJRR) Annual Report included implant performance for the first time. All of the components studied are doing well out of the gate, so this new registry information gives you confidence in the implant you are using. We’ve made amazing progress with registries, under the leadership of William J. Maloney, MD, FAAOS, chair of the Registry Oversight Committee, and our hardworking volunteers and staff,” he said.
“Registries, beginning with the AJRR, have given us opportunities to collaborate with other orthopaedic societies and beyond. Where we crossed paths with the neurosurgeons, who do more spine surgery than orthopaedic surgeons, we collaborated with the American Association of Neurological Surgeons to launch the American Spine Registry. The newest Fracture & Trauma Registry also promises to be a great success,” he said.
Biologics: “Biologics is something that everybody has an interest in, with the hope that we can find new treatments that are safer and perhaps more economical. The problem is that sometimes treatments are offered before there is science behind them and certainly before they are approved. The Biologics Dashboard is well built and will give you information by tissue type, etc. If you are considering biologics, I’d advise you to look through that dashboard. Our tool with the red, yellow, and green lights informs members whether a treatment is approved by the FDA,” he said.
Governance: “The way we were initially structured worked fine for many years and works satisfactorily now. When you look through our history, we have always been open to improving the process. We’ve managed well through this COVID-19 pandemic, but we can be better in how we do things and offer improved governance. For instance, our member-at-large position is a two-year term, but most of those who have held this position will tell you that just about the time they get to a point of comfort and understanding, their term of service ends. The Presidential Line terms are four years, and the treasurer term is three years. The BOS and BOC chairs each have three years. The Lay Board Members serve a two-year term with an option of two additional years,” he explained. “There is great interest in extending our member-at-large terms, perhaps to mirror the two-plus-two, similar to our lay members.”
Resident Curriculum: “We have seen a generational change in resident learning. My generation and those who preceded us followed a similar path, with a senior person teaching them how to perform surgery and a lot of reading out of books. Our young colleagues now rely much more on content they obtain digitally. Many more opportunities exist now than when I trained to get information, and much of it is online, but how can we know what is reliable information? The Resident Curriculum [to be unveiled over the summer and led by curriculum Codirectors Paul Tornetta III, MD, FAAOS, and Carol D. Morris, MD, MS, FAAOS] organizes the educational information needed to learn and practice orthopaedics in a consistent way and provides milestones, so the folks who are training residents can see whether the trainees are on target. The trainees know the information they are getting has already been curated by AAOS, which is a trusted resource. This will certainly benefit both residents and the educators who supervise their training,” he described.
ALI: “ALI is now functional, and I urge everyone to get involved. Level 1 is for every new Fellow. Level 2 offers enhanced information about our governance fundamentals, and, upon completion, applicants will be ready for committee service through our Committee Appointment Program (CAP). These first two levels are currently available. Level 3 prepares one for leadership on a committee, and acceptance to Level 3 is by appointment through the CAP,” he said.
“Dr. Bosco, who has led the development of ALI, calls the program a meritocracy. You get selected based on the things you’ve done. If you are active and have committee experience, ALI offers a real opportunity. For Level 3, beginning this year, we will have a first class of 20, and for level 4, 10. Admittance is based on qualifications, and not just AAOS activity. Our Leadership Fellows Program was 10 to 15 a year, and we are doubling that number in the first year. We are trying to offer more opportunity. We want our younger members to take an interest, go through Levels 1 and 2, volunteer for committees and education, build a resume, and enjoy the opportunities,” Dr. Guy noted. He said his path to the BoD and then a leadership position primarily ran through service in his state society and the BOC, whereas others might follow the lane of ascending activity and leadership in committee service.
The personal side
AAOS leaders who join the Presidential Line know they are signing up for a consuming role that intensifies when they assume the presidency, but Dr. Guy does carve out cherished time for family. “These organizational pursuits are rewarding, but they obviously grab time from other activities you could be doing. My family has been supportive throughout,” he said. His wife, Jill, is a retired nurse practitioner who recently has been volunteering to administer COVID-19 vaccinations. They have two daughters, who live in Atlanta, and three grandchildren. “As our grandchildren get older, there’s a million activities to attend, and we enjoy spending time with them,” he said. At the time he spoke to AAOS Now for this article, he was looking forward to driving to eastern Tennessee to visit his 93-year-old mother, Sallie, as soon as she was fully vaccinated. He has not seen her since the pandemic began.
Dr. Guy, the son of a Presbyterian minister, is active in his church. For recreation, he has had a regular Sunday golf game with friends for many years, and in “normal” times, he enjoys paddling an outrigger canoe, the kind often seen in the South Pacific. He pursues the activity with a friend from Hawaii, and together they have participated in events including a race event on the Missouri River across the breadth of the Show Me State and, in Hawaii, the famed Molokaʻi Hoe, a 43-mile ocean race from the island of Molokai to Oahu.
He looks forward to resuming the sport when his presidential duties have passed. For now, he exudes enthusiasm as he embarks on his year at the top position. He said he hopes that his rise to the presidency signals that “if you want to get involved in AAOS, you have the same opportunity as everyone else. There are many paths to leadership; you have to want to be involved and make yourself available.”
Terry Stanton is the senior medical writer for AAOS Now. He can be reached at email@example.com.