Residents and Early-Career Orthopaedic Surgeons Greatly Benefit from Participating in the OrthoPAC

In 2005, as an early-career orthopaedic surgeon in Oklahoma, I was concerned about impending Medicare payment cuts. Determined to protect my patients’ access to care, I reached out to Stuart Weinstein, MD, FAAOS, then-president of AAOS, seeking solutions and opportunities to get involved and help avert the cut. His response changed the trajectory of my career—he invited me to engage in state-level advocacy.

By investing in the Political Action Committee of the American Association of Orthopaedic Surgeons (OrthoPAC), joining my state orthopaedic society, and eventually becoming the state OrthoPAC chair, I found my voice as an advocate. That early involvement led to 6 years as Oklahoma State Orthopaedic Society president and ultimately the role of chair of the AAOS Board of Councilors in 2021. Looking back, I can see that getting involved in advocacy early sparked a journey that has allowed me to help shape orthopaedic policy for nearly two decades.

As a resident or early-career orthopaedic surgeon, you are entering the profession at a critical time. While you focus on mastering surgical techniques and patient care, decisions being made in Washington, D.C., are quietly shaping the practice environment you’ll inherit. Whether it’s reimbursement rates that will affect your future earnings, prior authorization requirements that will impact your clinical decisions, or regulations that will determine where and how you can practice, today’s policies will define tomorrow’s opportunities and patients’ access to high-quality healthcare.

OrthoPAC is the only national political action committee (PAC) in Washington, D.C., dedicated solely to representing orthopaedic surgeons. OrthoPAC’s main priorities are to give surgeons a voice in healthcare policy discussions and ensure that PAC contributions are effectively disbursed to advocate for the orthopaedic profession. OrthoPAC maintains a nonpartisan stance, focusing solely on issues relevant to orthopaedic care rather than political affiliations. This approach ensures that OrthoPAC can build relationships across the political spectrum, enhancing its ability to advocate effectively for orthopaedic surgeons and their patients.

Although the demands of residency and early practice may make advocacy seem like a future concern, your early involvement can significantly impact both your career and the profession’s future. The path to meaningful advocacy involvement isn’t steep—it’s a gradual staircase with three easy steps that you can begin climbing today.

Step 1: Stay informed
Staying informed about what the AAOS Office of Government Relations is doing is a great first step to getting involved and familiarizing yourself with the policy issues impacting orthopaedics the most.

Each year, the AAOS Advocacy Council sets an agenda that determines our policy priorities and where we invest our resources. The current agenda seeks to obtain legislative reforms on a host of issues, including some of our top priorities: appropriate Medicare reimbursement, prior authorization reform, restrictions on physician-led hospitals, and medical liability reform. Awareness of the policy issues affecting orthopaedics the most and AAOS’s positions is vital to becoming an effective advocate for your profession. The following is an overview of key advocacy issues for AAOS.

Medicare reimbursement rates will significantly impact your ability to maintain a sustainable practice. As you prepare to enter or establish your practice, these rates will directly affect your financial operations and patient care capabilities. Reduced rates can strain financial operations, limit patient access, and potentially affect quality of care. Advocacy efforts by AAOS are crucial in addressing these challenges, striving for reimbursement policies that accurately reflect the value of orthopaedic care.

Prior authorization is a cost-control measure used by Medicare, Medicare Advantage (MA), and commercial insurance plans, often leading to delays in necessary medical care. An American Medical Association survey found that 34 percent of physicians reported serious adverse events, including death, due to prior authorization delays. On average, medical practices spend 2 business days per week on prior authorization requests, detracting from time spent on patient care. AAOS supports initiatives such as the Improving Seniors’ Timely Access to Care Act (H.R. 8702/S. 4532), which aims to make the prior authorization process electronic and transparent, ensuring timely approvals and public reporting of prior authorization metrics. An Office of the Inspector General report revealed that in 2019, MA plans wrongly denied up to 85,000 prior authorization requests and 20 percent of reimbursements, despite compliance with Medicare rules. Passing the Improving Seniors’ Timely Access to Care Act is crucial to codify these necessary reforms.

The AAOS-supported Physician Led and Rural Access to Quality Care Act (H.R. 9001) aims to lift the moratorium on new physician-led hospitals in rural communities and allow existing physician-led hospitals to expand. The current ban on physician-led hospitals limits access to high-quality care for Medicare patients, especially in rural areas, where physician-led hospitals are often the best option. Physician-led hospitals are known for providing excellent care and meeting increasing healthcare demands. The existing prohibition is viewed as anticompetitive and detrimental to patients, Medicare, and the healthcare system. Notably, in 2017, seven of the top 10 and 40 of the top 100 hospitals were physician-led.

AAOS is dedicated to ensuring safe, accessible, cost-effective, and high-quality patient care. However, the current medical liability system hampers physicians’ ability to deliver optimal care. Broad reforms are needed to compensate negligently injured patients fairly and quickly, enhance patient-physician communication, improve patient safety and care quality, reduce defensive medicine and wasteful spending, lower liability costs, and increase patient access to care. AAOS emphasizes that federal liability reforms should not undermine effective state tort provisions or states’ abilities to enact tailored reforms. Interim relief through proven state or federal measures is critical while broader reforms are piloted and implemented.

Step 2: Support
Your engagement with OrthoPAC plays a vital role in shaping the future of orthopaedic care. Through strategic financial contributions, we can support candidates who champion policies that protect and advance our profession. For residents, this involvement brings immediate benefits— programs achieving 100 percent participation receive complimentary access to OrthoPAC’s resident reception at the Annual Meeting, offering valuable networking opportunities with AAOS advocacy leaders and ambassadors.

A modest monthly contribution can make a significant impact. Residents can join the AAOS Capitol Club with a $10 monthly donation, and fellows can become members with an $84 monthly contribution. Capitol Club membership opens doors to special events and receptions with lawmakers and leaders in the field. Remember, every contribution matters; increased participation strengthens our collective voice in Washington, D.C.

Getting involved is straightforward: Visit the PAC website (aaos.org/pac), donate by credit card or check, text “AAOS” to 41444, or Venmo@OrthoPAC (please include your name, city, and state with Venmo contributions).

Step 3: Engage
Engaging with OrthoPAC early in your career opens doors to invaluable mentorship and networking opportunities. When you engage, you will be connected with seasoned professionals and leaders in the field. These relationships can provide mentorship opportunities, career advancement, and a deeper understanding of the political processes that affect healthcare. Each year, AAOS hosts the National Orthopaedic Leadership Conference (NOLC) in Washington, D.C. NOLC includes in-depth policy briefings from AAOS advocacy experts, training on effective lobbying techniques, and a full day of meetings with lawmakers and their staffs on Capitol Hill. For residents and early-career surgeons, NOLC provides a unique opportunity to learn from experienced advocates while actively participating in the legislative process. (For more perspectives on the benefits of attending NOLC, read the article titled “Residents Share Their Experiences at NOLC” in the March/April issue of AAOS Now.) By joining your colleagues in these congressional meetings, you’ll gain firsthand experience in communicating our profession’s priorities to decision-makers and have an opportunity to advocate for positive policy changes that will directly benefit your practice and patients.

Your voice matters in federal advocacy beyond in-person meetings. When critical legislation affecting orthopaedics is being considered, AAOS provides opportunities to write letters to your representatives through our Advocacy Action Center. These grassroots efforts amplify our message and demonstrate the united voice of the orthopaedic community. Whether you’re interested in addressing reimbursement rates, supporting medical student debt relief, or improving patient access to care, your early involvement can help shape policies that align with your values and priorities.

By following these three steps—staying informed, supporting OrthoPAC, and engaging actively in advocacy opportunities—you join a community of advocates working to strengthen our profession. Your involvement, especially early in your career, helps ensure that orthopaedic interests are effectively represented in the policy discussions that will shape your future practice environment. As you become more experienced in advocacy, opportunities will expand to include organizing in-district events with members of Congress, hosting practice site visits, and mentoring peers in effective advocacy techniques. These leadership roles not only amplify our profession’s voice but also help build the next generation of orthopaedic advocates who will continue to shape healthcare policy for years to come.

OrthoPAC is affiliated with and connected to the 501(c)(6) Association. OrthoPAC is not connected to or affiliated with the American Academy of Orthopaedic Surgeons, which is a 501(c)(3) organization.

Wayne A. Johnson, MD, FAAOS, FACS, is a shoulder and knee arthroscopy specialist and the chief of orthopaedic surgery at the Oklahoma City VA Medical Center in Oklahoma City, Oklahoma. He currently serves as chair of OrthoPAC.

References

1. The Political Action Committee of the American Association of Orthopaedic Surgeons: Advocacy Action Center. Available at: https://www.aaos.org/advocacy/advocacy-action-center/. Accessed Aug. 13, 2024.
2. Essis F, Monroe S: Your dollars invested: how OrthoPAC makes a difference. AAOS Now September 2019.
3. Krueger C, Harwood J, Brackemyre K: Easy steps for advocacy involvement as a resident. AAOS Now June 2015.
4. Weinstein S: OrthoPAC celebrates its 25th anniversary of advocating for patients and the orthopaedic profession. AAOS Now April 2024.
5. Fleeter T: Wayne Johnson, MD, enthusiastically steps into new role as the chair of the OrthoPAC Executive Committee. AAOS Now August 2023.
6. AAOS Now: Help celebrate the OrthoPAC’s 25th anniversary. AAOS Now February 2024.
7. Orfaly R: Persistence and partnerships are key to successful political advocacy. AAOS Now December 2023.