Roby C. Thompson Jr, MD

Interviewed by Emmett T. McEleney, MD

How did you become active in the Academy's affairs? Did you have a mentor or someone who introduced you to the Academy? Was there a specific objective to becoming active with the Academy?

I first got started before I was a fellow actually. The academy was initiating its in-service training exam and it happened when I was a resident and we were the first in-training exam done by a sub-specialty. The Chief of Orthopaedics where I trained enlisted me to become a question writer and right after I finished training I started in that sphere of writing questions. There was a committee that I worked on, an interactive format of in-training questions, and that's how I became involved with the Academy even before I was a fellow, actually.
I regard as my idol and leader, Dr. Frank Stinchfield. He was the Chief of Orthopaedics, where I did my residency, New York Orthopaedic Hospital, which was affiliated with Columbia, and he had eight department chairs who graduated from his program in 20 years. I was there from 1962 to 1967 and, at that time, there was a magnificent faculty. Many of the residents who I trained with went on to become leaders in the American Academy of Orthopaedic Surgeons and Presidents of their specialty societies.

Is there a particular historical figure whose leadership style you admire?

I don't think there is a single one. I have read a lot of biographies of great leaders from Churchill and Eisenhower to Alexander Hamilton, Jefferson and other people whom I admire.

What acts of leadership in the Academy or in the public light have impressed you?

I became a junior member of the Academy Board in 1974. It was a one-year election at that point and the president was Bill Donaldson and the first vice president was John Wilson, and Ed Henderson was president-elect, as I recall. Watching those three work together for the good of the common rather than the individual was very impressive and all three of them had the interest of the orthopaedic community as a priority rather than an individual interest on their part. To me, that's the act of true leadership, when you can put aside certain interests of an individual and convince the other people in the room that it is in the best interest of the organization. I think it takes a very insightful person who is analytic and articulates the analysis that is in the best interest of the organization I think leaders need to be aware when they may be advancing their own personal interests.

Again, a leader's ability to be analytic and articulate about the process that they are going through determines whether they are going to be able to lead or not.

What are the leadership skills you think are most important for an Academy President? Is there an Academy President whose style you try to emulate?

The leader I appreciated the most, and who had an accumulation of various styles of a lot of great leaders, was Frank Stinchfield. He was probably one of the most impressive people I ever worked for. I gave a memorial talk about him a couple of years ago at the New York Orthopaedic Hospital and I asked a variety of the residents to send me recollections of him, and it was amazing how many people had things that were unique to say about him. Frank Wilson said "he was a likable leader because of his emotional form, his energy, and his ambition. He also had a remarkable gift to find a workable middle ground." Jack Wickstrom wrote a history of the American Board of Orthopaedic Surgeons for that organization's 50th anniversary. Wickstrom in that publication described Stinchfield as "being one of the most exuberant and charismatic individuals ever to serve on the board." It was indeed a pleasure to observe him exercise his special skills of diplomacy. He always made a point of recognizing any individual who reported back to him with successful completion of a task.

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

Obviously one has a lot on one's plate when starting a practice as the young orthopaedic surgeon. Once one has passed the boards and finished that long train of education and examination for credentialing, becoming involved with the Academy offers huge opportunities to interface with other colleagues.

The Academy has been and I think remains the premier educational institution for the orthopaedic community, and obviously a piece of advice we all can take is that of continuing your education as you go forward throughout your career. The primary benefit that comes from being involved in the Academy is the acquisition of new knowledge. A lot of people I know were asked to get involved in the Academy early on in their career, including myself. I was flattered and I was not about to turn my chief down. I think that is an important point of the Academy today - to reach out and recruit the younger people and get them involved. For example, had Dr. Stinchfield not asked me to get involved at such an early stage in my career, I don't think I would have been involved with the Academy at the same level.

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

When I was elected as second vice president that started the presidential chain, the big issue was the fragmentation of orthopaedics. David Murray, who preceded me as Academy president by three years, initiated a program within the Academy to try to do something about it and I sort of inherited that challenge. I was one of the principals forming COMSS at that time. We met with the presidents of various sub-specialty societies and created the Council of Musculoskeletal Specialty Societies, and up until this time it has been a positive thing for orthopaedics, to have these specialists involved in the orthopaedic community. This issue has come back to the front again. Those organizations have matured and specialty societies of orthopaedics have become more and more diverse. Thus, the issue is going to continue to be there, I am sure. You look at where orthopaedic surgery is going at this point in time and without sub-specialists there really wouldn't be much orthopaedic surgery anymore. It is the discipline that is held together by the biology of the musculoskeletal system, really, and if you can't keep that common theme in there it is going to be difficult to hold us all together.

One of the more difficult things that I wrestled with during my tenure, or that fell into my lap, was changing the legal structure of the Academy. We did not have a legal council for the Academy; we had a consulting firm. At the time we weren't that happy with our consulting legal arrangement so I put together a study that looked at putting the legal council in house. We made the decision to bring it in house and I drew the short straw to tell our outside legal consultants that they had just been fired. These guys had been with the Academy for years and years and it was a difficult call to make, but I think it was the right thing to do. I have watched the effect of that decision over the past 20 years and am glad that we did that. We had some lawsuits that were brought against us, AAOS and AMA, by the chiropractors at the time, and we lost a bunch of money. In retrospect, without a doubt, it would have been better to have settled out of court as we would have saved over a million dollars had we done that. The chiropractors sued us and the AMA for restraint of trade.

What achievements in your career are you most proud of?

I don't take credit for any of the Council of Musculoskeletal Specialty Society getting off the ground on my own, but I do feel good about my presence of getting the council formed. I am also pleased with the role I played in bringing the legal council in house. The thing I look back on with most pride is the quality of the residency training programs that I had anything to do with as a leader. The quality of the residents from my training program I consider to be outstanding and that's probably where I would rest on my laurels.

Who in your estimation were the greatest orthopaedic leaders?

I think every generation has had some really truly great orthopaedic leaders. There have just been so many people who have made such huge impacts on orthopaedics. One of the really great ones was Willis Campbell, he founded the Academy. Alfred Shands founded the Orthopaedic Research Society. From then on it just exploded with leaders. In my lifetime, John Charnley was clearly one of the greats. Harrison McLaughlin, a general surgeon who did fracture work and was never a member of the Academy, probably taught more about orthopaedic fracture care than any other orthopaedic surgeon in the 1950's and 1960's. From the 1970's on, there have just been so many great leaders who have advanced this specialty. What so many of those leaders have in common is that they were so objective about the science of orthopaedics. I think that objectivity is the key. What I have seen in the last 30 years has been a drift towards what I call "promotional exuberance," whether upon an individual surgical procedure or treatment protocol, that is less objective or more personally self-promoting.

How is being active in the Academy helped you with your professional practice?

From an educational point of view, I have relied on the Academy tremendously. There is no question about that. Being able to pick up the phone and call a colleague across the country and ask them what are they doing now for this or that and also being able to ask a question about something you don't see every month regarding clinical care decisions has been hugely important to me and my patients. I would also like to make a comment on what being on the Academy Board did for me. I learned how a well organized, large organization can be run, which I have carried through the rest of my professional life. The lessons I have learned while on the Board of Directors that have helped me from simply just being on the medical staff of a hospital or all the way to my current position of being CEO of a 650 position medical group. What I have ended up using in a real positive way in these organizations are things that I picked up while serving in the Academy.

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

Thompson: "The credibility of the orthopaedic surgeon as it relates to the device industry and the drug industry. I think that problem has grown to an almost epidemic proportion at this stage of our history. Almost everyday we pick up the newspaper and see some sort of conflict of interest being discussed in medicine and almost every time it does it has someone in orthopaedics in the article because the profit margins are so high. The big problem is changing the perception the public has of us as orthopaedic surgeons and the perception of the responsibility that a surgeon has to the patient as well as how we get paid for what we do.

Finally, the age old question: "Are leaders born or are they made?"

I think you can make leaders achieve to a certain level. However, I believe that truly great leaders are born. Many of the leaders who are charismatic and are real change agents where they lead have had a history of doing that their whole life and it seems to be just a part of who they are. I think you can teach skill-sets, but I don't think you can teach leadership.