James W. Strickland, MD

Interviewed by Michael Archdeacon, MD

How did you become active in the Academy affairs? Did you have a mentor or someone that introduced you to the Academy and was there a specific objective to becoming active in the Academy?

Dr. Strickland's primary objective for being involved in the Academy was education related. While he was serving as president of the American Society for Surgery of the Hand, he was nominated to serve as a member-at-large of the AAOS Board of Directors. The following year, he was shocked when he was nearly nominated for Academy vice president. The following year there was a move to nominate him for the Academy presidency, which he initially declined. However, at the urging of some friends, he later reconsidered and was nominated for the presidential line from which he moved on to the presidency in 1995. In terms of a mentor, he does not feel that he really had any particular AAOS mentor who pushed him in a leadership direction. However, he states that Dr. George Garcia and Dr. William Stromberg were huge mentors in his development in orthopaedic surgery and helped him move forward in organized orthopaedic medicine.

Is there a particular public figure or historical figure whose leadership style you admire and in what ways have you tried to emulate him or her?

Dr. Strickland did not have a particular person in mind. However, he did have tremendous respect for Ronald Reagan and Sir Edmund Burke of England. He feels that leaders who have a cause, for which they feel strongly and aggressively champion, are more successful than those leaders who have personal success and grandeur as their motivating factors.

What acts of leadership either within the Academy or in public life impressed you? Please describe.

Dr. Strickland specifically referred to Dr. Jim Urbaniak as a consensus builder and as an excellent role model for leadership. He felt that Dr. Urbaniak as well as many other successful leaders in orthopaedic surgery, are directly successful because of their ability to direct a discussion, and to elicit well-considered decisions by allowing all interested parties to express their opinions. Leaders like Jim Urbaniak try to build a consensus of opinion rather than lobbying for a specific vote or outcome.

What leadership skills do you think are most important in an Academy president during your career? Is there an Academy president whose style you tried to emulate and why?

Dr. Strickland felt there have been a number of excellent Academy presidential models. He listed Dr. Roby Thompson, Dr Newton McCullough, Dr. Bernie Morrey, and Dr. Charlie Rockwood, among others, as great role models within the Academy. He felt like he was fortunate to have a superb presidential line around him which allowed the development of a consensus strategic plan that would be adhered to over a continuum of years rather than the annual changes of course resulting from the varied agendas of a succession of presidents. He feels that the democratic process is critical in the Academy and that responsible, unbiased leadership is critical for true consensus building and sound decision making. His personal opinion was that having some time as an active participant in the AAOS, committees and educational programs, helps develop a member's organizational skills and fosters recognition for those abilities among one's peers. This in turn allows for a natural progression towards leadership within the society. He feels that this is probably similar to the rise in leadership responsibility in the sub-specialty organizations as well.

What advice would you share with young orthopaedic surgeons just beginning their careers and why should they become involved with the Academy? How did your involvement with the Academy teach you leadership skills?

In Dr. Strickland's opinion, involvement in the AAOS is a way to give back to the profession. One can contribute in terms of educational activities, research projects as well as helping to carry out the mission of the Academy and support the research intent of our organization, through the OREF. He further feels that there are several issues facing young orthopaedic surgeons that are important in terms of our ability to effectively practice orthopaedic surgery and provide the best, most compassionate care for the patients we treat. He feels that declining reimbursements for the orthopaedic services rendered have led to an increase in the volume of services that young surgeons believe they must achieve in order to make an acceptable living. Consciously or unconsciously, they establish self-quotas of services including a desired number of surgeries that need to be performed in order to generate adequate income. By practicing with self generated service quotas, they lessen the time spent with patients and inevitably dilute and diminish the quality of care they provide. Dr. Strickland believes that the decrease in reimbursement has led to what he refers to a volume driven approach to the practice of medicine that has directly degraded the doctor/patient relationship and promoted a lower quality of care for a higher volume of services. In summary, Dr. Strickland feels that this particular situation must be recognized and the altered quality of care that it breeds addressed through the Academy partnering with the American Medical Association and the other large medical organizations, so that aggressive strategies can be instituted to minimize the emphasis on volume of services and restore the physician-patient relationship and the quality of orthopaedic services we provide.

During your tenure as the Academy president, what were the key leadership challenges and how did you deal with them? And in retrospect, would you have handled them differently?

Dr. Strickland feels that the biggest issue that he faced during his presidency was the debate over changing the Academy from a 501c3 not- for- profit organization to a 501c6 Association in order to allow the Academy to conduct greater political and lobbying efforts. This was an area of vigorous and impassioned debate among Academy members and the Board of Directors was evenly divided on the subject, with many feeling that the Academy's primary role was education, not political activity. Dr. Strickland's personal opinion was that the AAOS mission was not really designed for the protection of the financial well being of its membership, but rather to concentrate on education, research, and the mission of orthopaedic surgery as a medical specialty devoted to the betterment of orthopaedic care. Ultimately, Dr. Strickland had to exercise the chairman's tie breaking prerogative to maintain the 501c3 status of the Academy. However, the following year the board voted to split the organization into both a 501c3 and 501c6 entities and it has remained divided until the present time. In retrospect, Dr. Strickland feels that if he had to face that situation again, he would not manage it any differently. To this day he feels that he was acting in the best interest of the Academy and he still harbors the belief that the decision to divide the organization constituted a radical departure from the Academy's historic education and research mission and adheres to his opinion that lobbying and political efforts for the economic betterment of orthopaedic surgeons are beyond the true purpose of the Academy. He further doubts that such efforts have been particularly effective over the long haul.
In terms of failures during his presidency, one of the agenda goals for his presidential year was a program to build bridges among other musculoskeletal organizations including rheumatology, physical medicine, physical therapy, internal medicine, and osteopathy. Dr. Strickland feels that this agenda was largely a failure due to the varied acceptance of the initiative by some of the other musculoskeletal societies, the cumbersome nature of the process, and the prioritization of other programs deemed more important by subsequent Academy governance. He recognizes that while there has been modest progress toward meaningful collaboration between musculoskeletal organizations, there is still a long way to go to build the kind of strong interactive bridges among other associations that are necessary to make an effective musculoskeletal coalition that can speak forcefully for issues affecting patient care.

As Academy President what achievements are you most proud of? Can you describe the leadership challenges that these achievements presented and how you overcame them?

The thing Dr. Strickland feels was most significant during his presidential line with Dr. Morrey, himself, and Dr. DeHaven, was the prioritization of initiatives and finances through a careful process of strategic planning by the Board and the annual review and re-prioritization of the Academy's goals and objectives that resulted from their collaborative commitment to such a structured planning process. He believes that this helped provide a much better continuum of policy and project implementation and completion than existed when there was a succession on one year presidents with personal agendas, many of which could never be completed because of the rapid change over of Academy leadership. While Dr. Strickland is very proud of this achievement, he is quick to credit Dr. Bernie Morrey for fostering the strategic planning initiative and Dr. Kenneth DeHaven for his cooperative commitment to the process He believe that the three of them had a unique and dedicated approach to accomplishing the highest priority projects with a strong emphasis on fiscal responsibility.

Who in your estimation were the greatest orthopaedic leaders? Please explain why.

Dr. Strickland first replied that there are too many to mention and it would be unfair to single out just a few. However, he recognized that Dr. Roby Thompson and Dr. Newton McCullough were individuals that everyone admired and that they were able to concisely express the consensus opinion of a large group and bring people together on important issues. He also mentioned that Dr. Augusto Sarmiento was an excellent role model who was extremely fair and honest. And finally, he mentioned his own role model, mentor, and long time best friend in orthopaedic surgery, Dr. Jim Urbaniak, who he feels is the most dedicated, honest, and well respected ambassador of our specialty that he has ever known.
"Jim is universally revered for his research, clinical innovation, teaching, and leadership. I am proud of our close friendship", said Dr. Strickland.

What do you believe are the most critical issues facing orthopaedic surgeons today?

Dr. Strickland revisits the concern he has over our declining reimbursements in the field of medicine, particularly in orthopaedic surgery, which has driven the emphasis on high service volume that is so prevalent in orthopaedic surgery and, for that matter, all of medicine today. He feels that because of this nefarious change, orthopaedics has been transformed into a very competitive business where the collegiality among groups and practitioners has been largely lost and there is now a more disparaging, competitive behavior between groups and surgeons. He feels strongly that this is a volume driven phenomena tied directly to declining reimbursement for services and, in his opinion, it has damaged the doctor/patient relationship and diminished the quality of patient care. He feels that "medicine, particularly orthopaedic surgery, cannot be done as an assembly line process." He believes that this is the greatest issue facing our specialty today and that addressing the problem requires a collective effort among musculoskeletal organizations such as the Academy to affect a return to the old fashioned values of physician collegiality and a dedication to the highest quality, compassionate patient care.

Are leaders born or are they made?

Dr. Strickland states very clearly that leaders develop. Certainly the home environment, schooling, and training influence the leader; however, their underlying principles of humanity and ethics carry through. If the person has the desire and works hard to develop these skills, aligns themselves with strong mentors, considers input from multiple sources and then develops a consensus building management style, strong leadership characteristics will fall naturally. However, he does believe that there are some innate characteristics to becoming a successful and strong leader. In summary, he feels like leaders are probably made more than they are born.
Dr. Strickland thanked the Academy and the Leadership Fellows Program for allowing him to talk about his experience and he's very excited about the presidential history program.