by Augusto Sarmiento, MD
The metamorphosis of our profession over the last several decades prompted me to publish an article in the January/February 2015 issue of Current Orthopaedic Practice. Following is a summary of that article:
The spectacular growth of Orthopaedics in recent decades has primarily been due to mostly-beneficial technical innovations. Much of this growth, however, is threatening our historically high professional standards.
As modern orthopaedics is based mostly on surgical treatments, the teachings of biological foundations have taken a back seat. Thus, the orthopaedist of today is evolving into a “cosmetic surgeon of the skeleton” rather than a surgeon/scientist.
Our orthopaedic discipline has fragmented into sub-specialties. This fragmentation creates problems, particularly in smaller communities where orthopaedists should be prepared to treat most orthopaedic conditions.
Chiropractors, osteopaths, nurse practitioners, and operating room technicians are responding to the impending orthopaedic crisis by seeking to expand their territories, allowing them to perform procedures long considered to be the exclusive domain of medical doctors. The State of Florida’s Health Care Force Innovation is considering a request from Nurse Practitioners to allow them to prescribe medications, including narcotics. In New Jersey, physician assistants with doctoral degrees are lobbying to carry out procedures long under the dominion of medical doctors.
The ongoing Justice Department investigation of what it has called ‘‘egregious unethical transactions’’ and a ‘‘corrupt relationship between industry and orthopaedics” has produced nothing.
We have failed to respond to the increasingly greater control of our destiny by industry, allowing it too much influence over the content of our continuing education and research.
Our discipline has established orthopaedic guidelines, which will encourage complacency by pushing practitioners to accept without question their recommendations. Fear of litigation arising from failing to follow the guidelines will inhibit new ideas and treatments and reinforce the herd mentality.
A number of nations and empires, no matter how powerful and solid they seemed to be, failed not from invasions but from suicide. This could be the ultimate fate of our profession, which is experiencing major changes. It is our responsibility to resolutely address the challenges that these changes present.
Dr. Sarmiento is the former Professor and Chairman of Orthopaedics at the Universities of Miami and Southern California, and Past-President of the American Academy of Orthopaedic Surgeons. He is a contributor to Implant Identification on OrthopaedicList.com and has guest authored a number of other articles for this blog.