Lessons in Orthopaedic Leadership: An AOA Podcast
Lessons in Orthopaedic Leadership: An AOA Podcast
Navigating the Future of Rural Orthopaedic Surgery: Insights from Dr. Jim Barber
Douglas W. Lundy, MD, MBA, FAOA, interviewed Jim Barber, MD who is an accomplished orthopaedic surgeon who practices in Douglas, Georgia. Dr. Barber shares his compelling journey, the various leadership roles he has embraced, and his experiences enriching a close-knit community despite the geographical limitations of a small town. His story illuminates the challenges and rewards of rural healthcare, showing how one dedicated individual can make a significant impact both locally and nationally.
Drs. Lundy and Barber tackle the evolving landscape of rural solo private practice, touching on the mounting pressures from insurance companies, the complexities of electronic medical records, and the growing need for larger teams. Dr. Barber offers his thoughts on state support programs, value-based care, and the pressures of consolidation, while reflecting on the changing dynamics of physician collegiality and scope of practice. Through innovative collaboration with local hospitals and Medicare shared savings programs, various pathways are explored for sustainability and the importance of staying positive and proactive in this challenging environment.
Welcome to the AOA Future in Orthopaedic Surgery podcast series. This AOA podcast series will focus on the future in orthopaedic surgery and the impact on leaders in our profession. These podcasts will focus on the vast spectrum of change that will occur as the future reveals itself. We will consider changes as they occur in the domains of culture, employment, technology, scope of practice, compensation and other areas. My name is Doug Lundy, host for the podcast series. Joining us today is Dr. Jim Barber.
Dr. Lundy:Dr. Barber is an orthopedic surgeon practicing in a rural setting in Douglas, Georgia. He graduated with his bachelor's degree from the Georgia Institute of Technology, his medical degree from the Medical College of Georgia and he completed his residency at the Georgia Baptist Orthopaedic Program. He completed the AOS Leadership Fellows Program and ascended to become president of the Georgia Orthopedic Society. He has faithfully served as a member of the AOS Board of Counselors and now sits on the AOS Board of Directors as the Secretary of the BOC. He also serves as Speaker of the House of the Medical Association of Georgia, president of the Georgia Society of Ambulatory Surgery Centers, chair of the Georgia Board of Healthcare Workforce appointed by Governor Kemp and Vice Chair of the Board of Trustees of the Okefenokee Swamp Park. Dr Barber, welcome to the podcast.
Dr. Barber:Thank you Doug.
Dr. Lundy:Great to talk to you. So, jim, before we get started, how far is Douglas Georgia from Hartsfield International Airport in Atlanta?
Dr. Barber:Infinity. It's about three hours south of Atlanta, Georgia.
Dr. Lundy:It just staggers me, brother, that you've been able to do all these things living so far from a major hub airport.
Dr. Barber:It's just it staggers me that my wife has let me do all these things.
Dr. Lundy:There you go. Well, jim, in this series you know we're discussing the changes that we will believe that occurs in the future of orthopedic surgery, and today I would love to discuss the future of a small rural private practice which, my friend, you have been in for quite a long time. Can you tell the listeners about your practice?
Dr. Barber:Love to Doug Douglas. Georgia is a town of 13,000. It's about three hours south of Atlanta, about two hours north of Jacksonville and about two and a half hours west of Savannah and those would be the nearest what we'd call cities. There's about 45,000 people in the county. The nearest trauma center is probably Savannah and when you count loading time by helicopter it's about two hours to get to the trauma center there, about four hours by ambulance or so.
Dr. Barber:My first ER patient 25 years ago was a farmer whose hog had bitten off his finger and I went to the ER to see him and he was adamant that he could go get that finger if I was able to put it back on, and I assured him that no, we just need to shorten his finger. They're very hardworking in this area and it's rare to meet a patient that I don't know or is a stranger. I get a lot of feedback. Some of that is positive and some of that's negative, but in a small town you just can't escape it. It's a great place to raise a family. I've got a wife and three daughters and it's just. I really enjoy living here.
Dr. Lundy:But you're not a small town guy. I mean, you grew up in ATL. You, like I said, you went to tech, you went to high school in Atlanta.
Dr. Barber:I mean, that's quite a shift, isn't it? You know, they say that God has a funny sense of humor, and when I was in Atlanta, I lived in Atlanta for 20 years and I swore I would never live in a small town ever. And I used to visit my grandparents in a small town in South Georgia and I just thought it was terrible. I could never live there, never be happy. But my best friend in residency came to Douglas the year before. He was a year ahead of me in residency and he just insisted that I needed to come down and join him and I thought it'd be great to work with him. So I ended up coming straight to Douglas from residency and I'm so glad I did. It's just been a great experience and I'm really thankful that I'm here. I wouldn't want to be anywhere else.
Dr. Lundy:So, jim, this is not a small thing. You have elevated, all on your own and in the setting that you practice in, up to becoming the secretary of the board of counselors, which is a pretty big deal.
Dr. Barber:Well, thank you, Doug. I do want to make it clear that I'm speaking on my own behalf and not on behalf of the AOS board of directors, of course, and that's fair.
Dr. Lundy:Thank you Now, before I go too far. I mean you are also the poster child for all the people who just can't seem to get involved because of fill in the blank. I mean you are all by yourself, way down there, far from the airport. When you go out of town, you have a PA right.
Dr. Barber:I do.
Dr. Lundy:So your PA then is covering your patients, but somehow you've been able to become very involved, obviously extensively there in Georgia, but also on a national level.
Dr. Barber:Well, the reality is around here. Most people spend a lot of their time hunting or fishing, and I just don't enjoy either one of those. So I have a lot of free time and I have a very understanding family and I just really enjoy serving in organized medicine. It's just a passion and a fun thing for me to do and I feel really rewarded in giving back that way and I feel really rewarded in giving back that way, but I also am able to keep my head above water by being engaged and involved, and I can see what changes are coming down the pike, so to speak.
Dr. Lundy:And so it's just something I really enjoy doing. Based on your experience, both in the state of Georgia, regionally in the southeast, and then your experience in the in the country, being involved in the BOC and the AOS, how many folks do you know out there have similar rural, small town solo private practices like you?
Dr. Barber:You know, I think there's a lot more than we think. I think we're just not very well organized. But I think that it's we, we all. We know about the big groups and everything, but we just don't know about the solo guys in rural. But I don't know a number. Honestly, I, I, I would just suspect that it's more than we think.
Dr. Lundy:Well, my point is when you go to the meeting and you're, when you meet somebody, it's not, it's not a total rarity. You meet folks that you go. Hey, I do the same thing and it's. It doesn't seem that uncommon to you.
Dr. Barber:That's right. Is that fair? That's fair.
Dr. Lundy:Yeah, so over the past 25, 26 years you and I finished residency at the same time. So we're dating ourselves True and in full disclosure. You and I finished residency together since we were co-residents. Hey, jim, over the past 25 years I'm sure you've seen a market change in the development of your practice. Certainly that goes along with the development of your skillset and your comfort and taking care of complex patients and routine patients and to your point, by now a lot of these folks are your neighbors and your friends, which puts a certain twist on it that a lot of the rest of us like. When I was practicing in Atlanta, most of the folks I saw I never would run into again outside the clinical setting and you see them all the time at the grocery store and at church and at Friday night football games and all that Over the period of time. How has your practice changed? How have you seen, specifically, this fellow private practice in rural America change?
Dr. Barber:Well, one thing that hasn't changed is my income. I've made about the same every year for the last 25 years, but I certainly have worked harder. I'm sure that all of the listeners would feel the same way about that, but I know for a fact that I'm seeing twice as many patients now as when I started. I think that in many ways the burdens have gotten more difficult with dealing with insurance companies and the bureaucracy of practicing medicine. I think maybe in some ways it's gotten a little bit better. I think I really am not a very big fan of the EMR, but I have to admit in some ways that's made it easier to practice. I think the biggest problem is just it seems like it takes a larger and larger team to get through the practice of medicine now and we just don't have those type of teams in my area.
Dr. Lundy:Specifically, how do you think that impacts you more than if you had had like, if you have like a half a dozen partners with you?
Dr. Barber:half a dozen partners with you. I'm really jealous of those guys. I think you know I would love to have a CEO and a CFO and a CAO and an HR department and marketing department. I'd love to have all of those things working with me. And those are the things I don't have and I just have to do more jobs, wear more hats. I put more responsibility on my office manager and others, and so that's just gotten harder over the years with the increasing complexity of practicing. How many staff do you have? I have 13 staff. Okay.
Dr. Lundy:So I'm sure with the past 25 years you have a trajectory. I mean you can see where this is heading. What's your, what is your predictions of where solo rural private practice is headed in the next pick it brother, five, 10, whatever, whatever you're comfortable with.
Dr. Barber:Honestly, I am not. I'm not sure I, I really don't know for certain. I'm optimistic that at least in Georgia I don't know about the other states, but in Georgia the legislature has put a real tremendous emphasis on rural health care and there are really good state programs in Georgia that have support for undergraduate medical education tied to rural health care and residency slots tied to rural health care and a lot of loan forgiveness programs for rural physicians and others. I'm optimistic about our community here. We have a tight community with the hospital and we have really embraced value-based care. So we've had a great involvement with a risk-based ACO for several years now. Last three years we've actually earned shared savings and we've started a direct-to-employer collaboration between the hospital and the private practice physicians, which is right along the lines of value-based care. All that I'm really excited about. I think that it's surprising that a small town could do so much with value-based care, but that's been really encouraging.
Dr. Barber:I've been a little bit pessimistic about the whole concept of consolidation. I'm a little bit worried about what am I going to do. Am I going to join the hospital and get employed or am I going to look into private equity or venture capital? But the reality is the power of the insurance companies just continues to grow. If you think about prior authorization, that's just a great example. But I feel like I need a larger team with me to navigate all of that. So I'm a little bit pessimistic about that and I think the collegiality has been tougher over the last 25 years. It seems to be getting tougher. I think the physicians tend to be more siloed as they're more employed and less likely to hang out and talk, and there's just more apathy in general. I think At least I see more apathy in general and I remember a talk you gave that I stole about 15 years ago about famous excuses for not getting involved. They were politics are dirty, contributions are bribery. Only big industry corporations have influence. Politicians should do the right thing without influence and I can't give much. It won't make a difference. And that was 10 or 15 years ago and it's gotten worse since then. Doug, I was so a little worried about scope of practice. I think that has eaten into our fiduciary responsibility with patients. That seems to be getting worse.
Dr. Barber:Ultimately, one of my biggest concerns is complacency. I think we are at the top of the medical specialties as far as advocacy, as far as solving problems for our patients. As far as demonstrating that fiduciary responsibility to our patients, we are at the top. But I think we might be getting a little bit complacent on that and I don't want to polarize any of the listeners, but I do want to quote coach Nick Saban, who was reflecting on his disappointment and successes over the years and said for us to have the kind of team we need to have, there's got to be an element of being hungry.
Dr. Barber:We've had to deal with complacency at times because of the success that we've had and I think that creates a blatant disregard for doing what's right. So, a little concerned about complacency in our profession so mixed picture and our profession so mixed picture. I'm optimistic, I want to stay positive and I think that if we, if I, if we, if I, look for solutions, they're out there, we'll find them. I just don't know if that's going to be staying in private practice solo, or if that's going to be getting employed or private equity or whatnot.
Dr. Lundy:Well, before we go on, if you're going to quote Saban, I got to drop a War Eagle Go Auburn in there, so I knew you would back to a more holy presence here.
Dr. Barber:That's why I quoted him. I needed a reaction.
Dr. Lundy:There you go. So it's fascinating to me that you were able to work a lot. So you're in pure private practice. You don't have any formal relationship with the hospital, right, I don't? Ok, so you're able to work with the hospital in a Medicare share savings program through the accountable care organization that y'all have set up. Clearly, that is a sustainability factor that other folks in your situation could engage with, because one advantage I would say if I could go out on this limb that y'all have is that the hospital has got to play with you because there's it's not like they can go cross street and get the other group with a dozen orthopedic surgeons and get them to play. So they're going to work with y'all because you're engaged in the system, engaged in the community. Am I on par with this?
Dr. Barber:You're on track. It's just think of us as an oasis. You know there's a. We don't have an interstate within 50 miles, so we're a bit isolated, so to speak, and so we are responsible for the outcomes of our care in this community. And so it is imperative that the hospital work with the physicians and vice versa, that the hospital work with the physicians and vice versa, and that gives us a little bit of an advantage as far as being able to I don't want to say control outcomes, but to monitor outcomes. Let's say monitor outcomes, and if someone has an idea on improving quality of care.
Dr. Barber:we can implement that pretty quickly and it is local, so there is some advantage to that.
Dr. Lundy:Okay, have you noticed other collaboration? I guess there's a bunch of other solo private practice doctors outside of orthopedics in your community, right?
Dr. Barber:Yes, and we all work well together. That is one of the things I'm encouraged by.
Dr. Lundy:Do you feel like they have a bullish or a bearish approach to the future in terms of how they think this is going to go?
Dr. Barber:I think people are kind of sitting their ways at this point. Most that are employed and the ones that are in private practice are comfortable riding it out. The things are going okay, you know, I think people are kind of sitting their ways.
Dr. Lundy:So what would you recommend? So a kid comes up through the, a guy or a girl comes up through the Coffey County school system, goes off to Georgia Tech, goes off to the Medical College of Georgia, goes off and becomes an orthopedic surgeon and wants to come back. What would your recommendation be if they wanted to move down to Coffey County and work there? Would you recommend to go into private practice? Would you recommend joining the group in one of the big mega groups around the area or work for the hospital? What would you say?
Dr. Barber:You know, that's a great question and I think that you basically have to know yourself and what conditions you work best in. I think there are people that are well-equipped and ready to be an employee, you know, and they need an employed scenario and I don't think they would work well in a private practice type practice. Are there others that really want to be able to control the way that they treat patients in terms of how they interact with patients, the types of patients they see and the services that they offer, and I think to have that level of control you really need to be in private practice. That is one, and the services that they offer, and I think to have that level of control you really need to be in private practice. That is one of the things that keeps me going is, if I see a deficit in how we're treating patients, I can fix that that day or that week pretty easily and basically, you know, solve problems very quickly when we see them and that is something that's been really nice as far as being in private practice. But I also know plenty of colleagues that are very comfortable in a more of an employed role and that suits them well and I don't think they would really like the management type role that is required in a small private practice.
Dr. Barber:Let's say that I don't really think there's a tremendous difference, honestly, doug, between rural and metro. As far as the employment style, whether that's employed or academic or private practice, I think that those scenarios are the same, at least in my limited viewpoint. I think those scenarios are all the same throughout. I think people need to know what style they want to work in and where they want to live. I think that's the two big issues there.
Dr. Lundy:I think it's important to point out that your viewpoint is not limited. You know a lot of folks and you've done a lot of things. Well okay, maybe now an interesting aside here is you and your own surgery center, right, I sure do so to some degree. That does put you at odds with. Is it coffee regional? Is that what?
Dr. Barber:that's right yeah.
Dr. Lundy:So that does put you at odds with the hospital, since you're supposedly cherry picking and lemon dropping and we both know I'm being sarcastic here- but, if you're, if you're pulling revenue off the hospital, how does that? Does that help or drive a wedge into the sustainability of your, of your ability to practice in the, in the methodology that you've been doing as you go forward?
Dr. Barber:That's a great question and complex, and I would say that I didn't want to build a surgery center, but I felt like I had to because patients needed a more economical option for getting things done. And so my surgery center is very good at efficiency and you may believe it or not, but it's truth at efficiency, and you may believe it or not, but it's truth, we operate one day every two weeks and we are incredibly efficient and I don't make much money off it, but it just feels good to offer that surgical option to the patient. That's a lot easier to swallow. But it does cause some strife with the hospital. It's nothing major and we've worked through it and I don't think it really affects their bottom line too much. Honestly, there are so many restrictions on who we can operate on in my surgery center that we're not really pulling a lot from the hospital, honestly, and I don't think it's been too harmful to the hospital. Let's put it that way.
Dr. Lundy:Another big thing that's often touted as damaging the folks the men and women in your type of practice setting is the ability to comply with the complexities that Centers for Medicare and Medicaid Services continue to spew out at us. Yet it seems that you found a sweet spot with working alongside Coffee Regional in order to get this done, through the Accountable Care Organization and other things. Do you feel that your ability to comply and be compliant with federal and state mandates has been made easier because of, even though you're remaining solo and private practice? The collaboration with the hospital is enabling you to get by and sustain that further.
Dr. Barber:Honestly, I wouldn't say it had much to do with the hospital. I would tell you, though, doug, that the key there has been getting involved with organizations like my state ASC organization, like my state orthopedic society, even my state medical association, obviously AAOS and through BOC and whatnot. I think being involved with those things has really given me so much more than I put into it in terms of knowing what's coming, what we need to comply with, how do we do it. It's just so nice to go to meetings like that and find someone who's already solved the problem that I have, so that I don't have to recreate the wheel. So I think it's more being involved. That's really been the key to to keeping my head above water with the regulations.
Dr. Lundy:And how difficult is contracting with the insurance carriers been for you?
Dr. Barber:Is impossible a word I could use here. It's just very difficult. As you can imagine, I pay top dollar for implants. There's probably nobody that pays more than me and that really impacts the cases I can do. I'm just low volume, I'm a low volume guy.
Dr. Barber:So that's an example of a negative of being solo, and the same goes with contracting. Thankfully there is a very vibrant and active independent physicians association, IPA, that I'm a member of. That helps so much with the contracting and so we come together. We've got about 600 physicians in the IPA and that does help a lot with dealing with insurance companies. But we have the same nightmares that I'm sure everybody has with denials and recoupments and things that just make me just really upset. So I know the insurance commissioner on a first name basis and I do not hesitate to give the insurance commission phone number to patients. We have a problem. We have it printed out on a piece of paper. Here's the insurance commissioner's office. Give them a call, Tell them what's going on. So it's been a challenge, but I suspect that's been a challenge everywhere.
Dr. Lundy:Honestly, Administration of your group. I mean, you've got said you have 13 FTE staff right, correct, right and these folks live in South Georgia, probably were born and raised in south georgia and have family connections and social connections throughout the area there. Yep, I would think, if I had to guess, that you could really leverage that to make yourself pretty valuable in the community, especially if you gain the, the loyalty and the vision of the staff you cast the vision that they could buy into of what your practice could be. That's got to go a long way in terms of maintaining the sustainability of your practice and you know, in many ways I think many of us want you and your people, your colleagues, to survive this. We kind of love the idea of the solo person out there. What are your thoughts?
Dr. Barber:Well, first of all, I appreciate that. So you know, I think I don't do a good enough job with exactly what you're describing and I think that, frankly, I don't think any of us do a good enough job. I think the reality is, if you look at teachers, they teach students. They have a very powerful advocacy source with students and parents when they have a problem. You know, and we have an equal, maybe even greater, advocacy source our patients. If we were able to communicate with them better about our problems and why it's a problem for the patient and the doctor, those patients could be such powerful advocates for things like prior authorization and whatnot. But I just don't do that. I don't know why I don't do it. I just feel a little bit awkward about spending time during an E&M talking about political things, but I do think that we could do better with motivating our patients to be our advocates with insurance issues, with bureaucracy issues, all of those things.
Dr. Lundy:I'm a little surprised at your EMR discussions. I mean, you did go to Georgia Tech. Let me remind you of that. That is one of the best engineering schools around. Yet you say you struggle with the EMR and you just recently got it. I'm surprised you haven't made your own EMR. But obviously this is a point of the sustainability of your practice into the future. So how has the EMR affected your practice? How do you think it will change things going on? Will it help you sustain this or will this be one of the nails that destroys solo rural private?
Dr. Barber:practice search. That's a good question too, doug. So my my, you know, my undergraduate degree was computer science and that kind of tainted me for 20 years or so. I just couldn't find an EMR that I could live with, you know, just because they all sucked, you know. So it took me a long, long time and eventually I got my arm twisted so hard. Hey, you got to have an EMR, we've got to integrate your EMR with our ACO, et cetera. So I did a little shopping and I found one, and I'm not going to tell you which one it is. I like it, I don't like it. It's a love hate thing. I'll tell you one thing that recently I remember it used to be Doug, did you ever have paper charts ever?
Dr. Lundy:Oh yeah, when I first started in Colorado, we had them, yeah, all right.
Dr. Barber:So you remember, if you forgot to dictate a paper chart, that could be a nightmare. You know you've got to find a chart and someone else had it and it was just. You know nothing worse than a stack of charts to have to dictate at the end of the day or on a weekend or whatever. And the one thing for sure that the EMR has done for me is I get all my, all my stuff done while the patient's there and many times I can I immediately print the note out for him. Here's your note for today and that that truly is a benefit. And I realized that I'm the last orthopedic surgeon on the planet to acknowledge this, but I'm just telling you it took a lot of therapy. After, after all those years and seeing how awful the EMRs are, the simple fact is they need to allow a lot more customization of the user interface and the EMR that's the number one problem is I know how, what I want to see on that screen and they should let me choose what I want to see on that screen and nobody can do that for me. But that's, that's the biggest problem as far as you know.
Dr. Barber:Bigger question overall is EMR specifically a negative or positive. It's a positive. I mean it's positive for our billing. It's positive for our billing, it's positive for my notes, it's positive for the patient. It's a pain in the butt to deal with and you know, it just makes me frustrated when I can't fix the clickies. Why do I have to click so many times? This should be on the page that I'm looking at, et cetera. But overall it's a positive and I don't think the EMR is necessarily going to cause me to change my practice style or give up private practice. It is expensive though, doug. I mean the EMR is pricey when you're solo and you're paying full freight for the EMR and you're not distributing that over a bunch of partners. There is a lot of expense to that and at the end of the day, thank goodness, money is not that important and I don't mind, you know, necessarily making a little less if life is easier, but there is a large cost to it.
Dr. Lundy:I understand the hospital couldn't work with you in terms of.
Dr. Barber:Sure, if I would just get employed, all I had to do is sign the contract and all that would be no problem. And honestly, I don't know what I'm going to do. I'm being honest with you, I've thought about it, I've actually talked to him a little bit and I've also started reaching out to some PE people, and I'm nowhere close to making a decision or anything. But that is one of the advantages of getting employed, or PE is a lot of that stuff is taken care of for you. But I have employed colleagues that just love to gripe about their particular EMR and they have no control over it. And you know, if tomorrow I decided that I hated my EMR, I could change it tomorrow. That would not be a big deal, other than the cost, of course. Right, right, yeah.
Dr. Lundy:All right then. So, with all we've talked about, what else is impacting the future of the solo private practice role? Orthopedic surgeon.
Dr. Barber:I would say the number one thing that I would like to see, which I'm just dreaming here. I realize this is unrealistic, but I think we should work on it anyway. But we need better coordination between rural and urban, rural metro, whatnot, and I don't think any urban metro orthopedist wants a delayed presentation of something that should have been there long ago. We just don't have great coordination when it comes to arranging that. I want to brag on you just a little bit, if I could. Uh-oh.
Dr. Barber:Uh-oh, I think it was about 20 years ago, doug Lundy came down to Coffey County. You were paid. We did pay you to come to Coffey County, but my partner and I went out of town and you took over the practice for a week. And you took the call and you went to the OR and you handled a week's worth of Coffey County orthopedics. Ironically, when we got back we were considered terrible surgeons because you had just shown them how to do it. We didn't know what we were doing. So the downside was we looked pretty bad when we got back into town.
Dr. Barber:But the fact that you spent a week in Coffey County, I think that and now I'm speaking for you and correct me if I'm wrong, but I think that that really gave you an understanding of some of the limitations, the limitations to subspecialty care, you know, etc. So, as you recall, for the last I don't know, 15 years before you left atlanta, you you recall that I would frequently call you or text you or email you with a tough case. Right, yeah, and you gave me great advice. You know you would say, hey, put a plate on that, hey, put a rod on it, whatever. You know, you would give me good advice on the case. And then other times you would say, oh Jim, you just need to send that to me and it was great. I mean, it's exactly what I need more of even now is the ability to collaborate like that. But there's just no payment mechanism for that. Really, you were just being nice, you were just being a friend, you know.
Dr. Barber:So that kind of ties in with the second thing I'd like to see, and that is the dreaded telemedicine which is so overhyped. Again, computer science, I'm just a Luddite with all that. But telemedicine has a lot of potential. But the huge mistake is it should never have been or should be. Doctor to patient. Telemedicine should be doctor to doctor, doctor to mid-level specialist to generalist, whatever. But in terms of a force multiplier, in terms of, in your case, you educating me or you giving me advice, it's very quick for you to say, hey, you need to send that to Atlanta or oh, you can do that, just put a plate on it, you know. And that we need, we need telemedicine, doc to doc, and we need a funding mechanism so that it's it's sustainable. You know, it's not that we're not asking favors for that. That would really really help rural orthopedics. I think we could really work on a better coordination in telemedicine.
Dr. Barber:There's an interesting company that exhibited at the last AAOS meeting that I've talked to very briefly. I don't know much about them, I can't vouch for them, but the company is called InHealth and they do locums in rural areas and that's another interesting concept of guys bringing in orthopedic surgeons to a rural area for a period of time and kind of fulfilling the needs there for that time. So interesting. I'm going to look more into that and I don't know a lot about them but that's another interesting solution. But you know, I do think the fact that you spent a week in Coffey County was amazing and I would love to force every AOS member to have to do one week a year something like that, almost like a missions project, you know, in a rural area. I think that would be amazing.
Dr. Lundy:In true fairness, I was a trauma fellow at the time I went down there. I was in the middle of my fellowship.
Dr. Barber:So I appreciate your kind words my fellowship. So I appreciate your kind words.
Dr. Lundy:Well, thank you, and to your point, though it was a very interesting and enlightening experience that you were, you are out on your own Island. There You're. There was nobody else to call if you, if you needed help or if you got in trouble, and anything else that you would say. That is impacting the future of the folks in your setting.
Dr. Barber:I don't think so. I think we share a lot. I think we just have. I know everyone loves to say they have the sickest patients, but we do have really sick patients. You know, we have the number one group of smokers is rural males, you know.
Dr. Barber:And we have a lot of diabetes, a lot of obesity, a lot of hypertension, a lot of things that lead to worse outcomes. We have a real, a real problem is the social determinants of health, sdoh, the things like transportation, for instance. You know, don't have a car, don't have gas for the car, can't go to Atlanta or Savannah, and then we're stuck with it, you know. So there's a lot of things like that that I think are general problems, but I think everyone feels like they have tough cases.
Dr. Lundy:So, overall, if you had to assess the future in terms of your setting, is it positive, is it negative? How much? How much? I'm not going to let you stay on the midline. You got to go one way or the other.
Dr. Barber:I was going to ask you do I have to?
Dr. Lundy:commit. You could stay on midline if you want. Where do you think it is? Well, you're the one living it.
Dr. Barber:I think that I saw a recent study that showed that rural orthopedic surgeons are much older in general, on average, than metro ortho, and that's a worry. The trend is toward less orthopedic surgeons in rural areas. It was 77% metro in 2000 and 93% metro in 2019. Wow, and there are 93% of US counties have no orthopedic surgeon 93% 93%.
Dr. Barber:That's from JAOS 2022. So I think that's fairly alarming. That's worrisome to me. I think that's not a good sign. I think it seems like it seems like it's getting worse, but I again, I'm I'm optimistic. It seems like there are a lot of people. I mean, look at, you're doing this podcast about rural ortho and that's I'm thrilled. You know, it seems like there's a lot of groups in our state legislature and AOS. I think a lot of people are concerned about rural ortho and that's encouraging. So I think things are going to get better because of that. I always like to remind my city colleagues that you will be driving through a rural area at some point, probably with your family, and the death rate is much, much higher if you have a car wreck in a rural area. So we all need to work on this problem together, all right.
Dr. Lundy:Anything else you'd like to add? My friend.
Dr. Barber:I've really enjoyed talking to you and I've enjoyed your friendship and your leadership, and thank you for paying attention to rural ortho.
Dr. Lundy:Yeah, man, all right. It's been my pleasure to spend this time discussing the future of orthopedic surgery in terms of the solo practice rural orthopedic surgeon with Dr Jim Barber. Dr Barber has obviously been quite successful in his career, both organizationally and in his local practice and setting there, and, jim, thank you so much for spending this time with us.
Dr. Barber:Doug, I loved it. Miss seeing you. Thank you very much.
Dr. Lundy:I miss you too, buddy. All right, and so y'all stay in touch as we continue through this podcast series with the different settings and the different aspects in terms of how is the future going to be defined in orthopedic surgery. Stay tuned.