Episode Transcript
[00:00:03] Speaker A: Welcome to the Ortho Joe Podcast, a joint production of the Journal of Bone and Joint Surgery and Ortho Evidence.
Join hosts Mohit Bhandari and Mark Swankowski as they discuss current topics and publications in the world of orthopedics and beyond.
Well, good morning, Mo. What do you got from Joe this morning?
[00:00:22] Speaker B: You know me, you know me. But, but, but Tim Hortons does one extra thing. They encourage you after you've made your payment, before you made your payment to say, would you like to support the Smile Foundation? And you get your Smile cookie with Tim Hortons for a good cause. I hope Dunkin Donuts is doing that, too.
[00:00:41] Speaker A: Yeah, well, I think you've got, I think you've got Duncan there, but Duncan, Duncan's. The Boston NHL team had a nice win last night. So I think people are, are happy even though they're not supporting a good cause. I guess the Bruins are a reasonable cause.
Anyway. Well, we've got our coffee. It's a beautiful day here in Minnesota. Still chilly. But we get to chat with a wonderful colleague, Dr. Julie Schweitzer, who I've learned is a native of Illinois.
Right, okay. But grew up skiing a lot.
Stanford undergrad, Stanford Med, University of Washington resident, where I got a chance to work with her, and then a fellow at the Vail Sports Group.
And Julie has been a leader in the whole issue of geriatric trauma care, fracture management, fracture preservation, and I think started the first geriatric trauma fellowship.
It's our Honor to have Dr. Schweitzer on.
Julie, why don't you just start with your story about geriatrics and how you got interested in what you're building.
[00:02:13] Speaker C: Thank you so much, Mark and Mo, for having me this morning.
I'll start. I'll tell you a little about myself when I was growing up. I was close to my grandparents.
And when I was in college and med school, I started a program in.
It was called Adopt a Grandparent program. And so I had a chance to spend time. I matched myself with a woman whom I visited for about some seven or eight years while I was in Palo Alto.
And the reason I did that actually was because I had volunteered for a different program where you just see older folks to help rake their lawn or, you know, help with their bills or something like that. And I thought, wouldn't it matter more if, for them if we had longer term relationships, not just like this kind of one off thing?
And then in med school, I realized I really loved surgery and the flow of that kind of project work and Then I had the opportunity to go to the University of Washington, where you helped train me at Harborview.
And then I.
To be honest, after I graduated from residency, I was a little bit lost. I did a fellowship that was trauma and sports. Sports in Colorado. I could ski a lot then.
[00:03:39] Speaker A: Always important.
[00:03:40] Speaker C: Yeah. Yeah. And.
And then I came to Minnesota and I stumbled a little bit trying to figure out what practice was right for me. But I always knew that orthopedic surgery and care of the elderly were things that really moved me. And while I was trying to figure out my career path, I thought, well, hell, why not try to make that happen? And it was around that time that you invited me onto the faculty at the University of Minnesota, and I began working at regions Hospital Level 1 Trauma center in St. Paul, where I got a lot of support for ideas I had about providing best care for older patients. I think I felt at that time like, well, what I was trying to do before that in my early career wasn't working, so I might as well try what I really was passionate about. And I had people with whom I worked at that time, actually, mostly advanced practice providers like Jay Noel, Mike, Tim Lee Shotzko, folks who were doing work in geriatric orthopedics out in the community, actually.
And so I started to feel like there was a possibility to provide care that wasn't being provided otherwise in the orthopedics community and for older folks.
We started a program where we provide, we still do provide orthopedic care to folks who live in care facilities for whom coming back to orthopedics clinic doesn't make sense. So we go out to them.
We really, through your leadership, Mark, we created a secondary fracture prevention program that started, still really robust today.
And then we tried it to track how we were doing in terms of our inpatient fracture care. And all along the way, I had a chance to meet national and international leaders who were doing some of the same stuff. And, yeah, I've just felt really grateful for the opportunity to continue to think and to write and to create programs in the arena.
[00:06:01] Speaker A: So these other leaders that you came in contact with, people like Steve Cates, etcetera, You began to formulate a. I will call it a sub, sub specialty group focused on these issues and eventually ended up providing educational resources like courses and led to a journal, et cetera. How did that all happen?
Was it just hanging out at meetings or.
[00:06:31] Speaker C: You know, it had to do with staying clear about what I thought was important for me and for older patients.
And I don't know how Steve and I first connected, but he was the primary founder and I was one of the few other co founders of the International Geriatric Fracture Society.
I think it was Steve and Simon Mears and Susan Bucata.
There was a big University of Rochester influence at that time. Michael Suk was also part of it from the beginning.
Having a connection with like minded folks was really important. And then Steve really again through his leadership and energy, was the first editor for a long time of the Geriatric Orthopedic Surgery and Rehabilitation Journal.
Simon now is the editor of that. And I think through that kind of work I also, I'll just say one other thing. I also was aware that there's another organization called the Fragility Fracture Network, which is an international organization.
J Magazine or who's at the University of Maryland, David Marshall, folks whom I knew and who invited me to be a little bit a part of. And I've really grown in that organization and the AOA's own the bone Organization on their steering committee.
[00:08:04] Speaker B: So Julie, once again, thanks for joining us. And you know, I remember pretty vividly coming as a fellow to Minnesota and meeting you. I think you had started or just started when I started as a fellow. And I remember that whole exploration of trying to fundamentally build a subspecialty interest in care of the elderly patient in geriatric. I think you were going through that. Jay Noel and I remember Mike, Tim and that group.
So how would like with all of the experience you have now and knowing what you know, how would you advise someone early in their career? Maybe it's as early as, you know, an early career resident or early career faculty member who's just joined thinking about focusing on geriatric fracture care, for example, how would you advise that individual? What sort of focus should they spend in their practice? What types of things should they be learning more about? I presume perioperative care becomes very important in understanding all the things both inside and outside the or. But curious on your thoughts on this.
[00:09:05] Speaker C: Thank you so much. I think last time we spoke you mentioned or you said something mo like shouldn't geriatric orthopedics be a part of residency training like pediatric orthopedics or spine or arthroplasty and absolutely I believe that's true. The older population is the fastest growing, largest population whom we will care for and continue to care for. So I'll just put in a plug. One thing I say to residents is no matter what field you practice, you'll be practicing some form of Geriatric orthopedics, whether it's spine arthroplasty, hand, even pediatric orthopedics, if you have limited weight bearing for kids, I mean, you name it, if you think you're not going to practice it, you're really missing something because you almost certainly will.
And if I were to advise a young person today, I would say one of the most important things that we can do is to be good colleagues and collaborators.
I think as orthopedic surgeons, we have a tendency to set ourselves apart or feel different than I'm just generalizing here, or to think of ourselves more as mechanics.
And the way I look at it is we have the opportunity to be mechanics.
I mean, there's no arguing that surgery and orthopedic surgery allows you to
[00:10:42] Speaker A: have
[00:10:43] Speaker C: a problem, solve a problem, often be in a state of, I think I mentioned earlier, a state of flow where you're being challenged and you're also performing a task.
But also we're physicians and surgeons outside of the operating room, too. So if you were going to.
The way I looked at it was there were a lot of people who were smarter than I am in terms of best care for older folks, but my outcomes were really dependent on their care as well.
And the more I worked with people like physical therapists, occupational therapists, nutritionists, hospitalists, geriatricians, connected with a community, the better I'd be able to create things that are replicable, but also our best care. So for young folks in their career, I would say look beyond the orthopedics department. You know, work on your career within the orthopedics department. But there are a lot of other folks who have interesting ideas and things to contribute. And so partnership is, I think, more most important.
[00:11:55] Speaker B: And can I just have a quick follow up on that, Julie? Right now in residency training and fellowship training, I guess, is there, or are there specialized years where you can actually go and get that training and have that. I suspect that's. I mean, it's much needed and I suspect it's probably happening. But maybe you can explain, you know, the opportunities available to get additional training post residency.
[00:12:17] Speaker C: That's a great question. We, as Mark mentioned, I started a geriatric orthopedic trauma fellowship a few years ago and have trained some extraordinary fellows.
And we haven't trained in the past two years, but next year we're starting again.
And one of the reasons that, well, there haven't been too many fellowships, Eric Mineberg, when he was at ucsf, had one, and there was, I think, one in Texas.
But to do a fellowship, I think, you know, you have to go through a matching process. And to have a fellowship, you have to have at least 20 different options. This was historically the case, and there just weren't enough other geriatric orthopedic trauma fellowships out there. But coming in 2027, the OTA, which oversees the trauma fellowships, has introduced different kind of fracture fellowship, which can and will include different than level one trauma fellowships. And geriatric fracture care is going to be one of those. I think we'll just have a greater population of residents graduating from orthopedic residencies who have an opportunity to know more about and to apply for fellowships.
[00:13:39] Speaker A: And I'm hopeful that there will be an increased interest across young surgeons who are planning their career. There's no doubt that the patient population is guaranteed.
That's just. That's.
I think I mentioned the last time we spoke about Kellogg Speed, who was the American College of Surgeons president, who was an orthopedic surgeon before the academy, et cetera, in his presidential address said that we enter the world under the brim of the pelvis and exit through the neck of the femur.
And it is a population demographic that is undeniable that the job security will be there.
And I am hopeful that there will be more young people that focus their career like you have, because the need is. Is huge.
We also, in our orthopedic community have made a dent, I would say, in the whole issue of identifying patients who get the first fracture at age of 50, getting them the appropriate evaluation with. You mentioned the own the bone program. We haven't moved the needle very much, and I'm just wondering if you have ideas on how we can engage more of our colleagues across the research and education spectrum in our field to really take this responsibility on and not have the standard response which I get when I do oral board exams. Oh, we refer them to the endocrinologist, which probably isn't happening. So do you have ideas what can we do to. To get more orthopedic surgeons to take responsibility for prevention of the next fracture?
[00:15:32] Speaker C: Yeah, great question, and I wish I knew the exact answer.
What I will say is a little. It may not be what you were thinking, Mark, but when I first started practicing orthopedic surgery, I thought the hardest thing I would do is to complete and, well, execute a very difficult case in the operating room. Like the first five years of my practice, I was so stressed and worried about the technical execution of it. But I realized as I got older in my practice that the hardest thing to do is to understand people around you and understand yourself and what motivates you and what you believe are your responsibilities to your practice and to the world, frankly. And one thing I would say this goes back a little ways, but having expectations for our residents when they begin, about those very things like their responsibility to themselves, their families, their communities, their patients, and to the world, because it's difficult talking to people who don't think that's their problem.
And, and I mean, I actually think that's the problem is, I'm sorry to say, but. So if we train more people whom I think have a greater vision for the difference they can make in people's lives, that would be probably the most important thing.
And then also I want to say quickly something else. I'm a part of an organization called the Osteoporosis Action network and also AOA's Own the Bone.
And it occurs to me, if in 20 years we can't change the fact that only about 20 to 25% of patients who sustained a hip fracture or another fragility fracture get counseling and treatment for osteoporosis, we aren't understanding the problem, we aren't understanding patients motivations, we aren't understanding our primary care physicians perspectives. And I sometimes think when we can't solve a problem very well, it's because we don't understand what's happening. I think that about politics as well.
If we can't understand what's happening, I think we probably have an opportunity to better understand the issue. So I feel hopeful, I feel optimistic, and I also think the more we engage other partners for real, the more we'll be able to move that needle.
[00:18:29] Speaker A: Well stated.
[00:18:31] Speaker B: If I were to summarize everything I've heard, you've really put a call out, Julie, through your own leadership to be collaborative. I think, you know, I think I'm learning from you, particularly as, as it relates to the care of the elderly patient, that the or isn't the end. It's actually the beginning of all the other things that would happen thereafter. And I think it takes a great deal of curiosity and genuine quest to say how do we, how can we make things better?
And, and just, it's, it's, it's going to be. Clearly, it's been a lifelong mission for you. And, and I'm hoping that this discussion sparks somebody listening to say, you know what? I think I would like to do more of this and I do hope they contact you and I hope they kind of advocate for similar training and similar opportunities in their own institutions in their own parts of the world. So, again, thank you so much for championing this important, important issue. And, you know, we look forward to chatting with you again as you have more insights in the future.
[00:19:31] Speaker C: Thank you so much for having me.
Really appreciate it.
[00:19:34] Speaker A: Thanks, Julie.
[00:19:35] Speaker C: Thanks so much, Mark and Mo.
