Joseph Zuckerman, MD is a practicing orthopedic surgeon and Chair of Orthopedic Surgery at the Hospital for Joint Diseases at New York University in Manhattan.
Earlier this fall President Obama made a comment that surgeons were responsible in part for increasing costs of healthcare by performing procedures that were not indicated, for instance leg amputations. What was your take on that?
There were two specific comments he made. The first was about tonsillectomies, which was obviously not orthopedic surgery-related. He implied that doctors would do tonsillectomies because it would pay better.
And then the comment about amputations had a lot to do with the issue that surgeons are less likely to try and prevent the problems that diabetics face with peripheral vascular disease because it was so lucrative to perform an amputation compared to all the time and effort that goes into the prevention and non-operative management of the disease.
The biggest problem we had with his comments is that it just showed a lack of understanding of, of the role that orthopedic surgeons or vascular surgeons play in the treatment of patients with diabetic peripheral disease.
Also, his comments about the fees paid were completely off â€“ they were absolutely wrong.
Now, truth be told, he probably meant that the hospitalization for an amputation could cost $30,000, $40,000 or $50,000 and there is some truth to that.
But, when you are President of the United States and you misspeak it has an impact. So, if you are going to say things like that you need to have the right information or recognize that you donâ€™t have the correct information and act accordingly.
And that was our biggest concern. I think what was missing was not recognizing the role that orthopedic surgeons have in the comprehensive care of diabetic patients with peripheral vascular disease problems that may require amputation or have open wounds.
And secondly, misstating what the reimbursement may be and how that fits into the healthcare system.
After you made your public statement disputing the Presidentâ€™s statements, did you ever get contacted by anybody from the administration?
No. We didnâ€™t get a letter back, we didnâ€™t get a phone call and we certainly didnâ€™t get invited for a beer.
Does your organization support a public option?
We have tried to be very active in the healthcare debate because it is critically important. So our basic principles is that we believe that patients should have access to affordable healthcare, but particularly have access to specialty care.
Any system that decreases or limits the patientâ€™s access to specialty care and, in our case, orthopedic surgeons as specialists in musculoskeletal care is a problem for us.
We support medical liability reform. We think that should be a part of any healthcare reform because not only will it save money but it will change the whole tenor of how people practice.
But, what about a public option or an expanded Medicare program?
Our position on a public option is that it can have a role in healthcare reform but it all depends on what a public option means. We donâ€™t think a public option should require physician participation and if physicians want to participate they should be able to negotiate their agreement with the insurance entity offering the option in order to determine if they want to participate.
So our position is one that it can certainly have a role but it all depends on what it means.
Well, would you support something like an expanded Medicare where physicians can choose to participate or not choose to participate?
That would probably be fine.
Has the AAOS actually hired lobbyists to get involved in the day to day negotiations taking place on Capitol Hill?
We have an office of government relations in Washington DC. We made the decision a number of years ago to form a parallel organization, a C6 organization, that is actively involved in lobbying efforts.