Recording - 10-25-2024 13:59:51

00:02 This is Mark Swiontkowski at the 40th anniversary Orthopedic trauma association meeting in Montreal. And I'm taking the opportunity to grab a few of my colleagues as they walk by and discuss their involvement in this organization. And I, of course, know Dr. Kyle Jeray from Greenville for many years and our involvement at this organization as well as the AOA and in other spaces, and he has a pretty long history with this organization. When was your first meeting? Can you recall?

00:36 I recall coming here in 1998 as a fellow.

00:42 98, yeah. Okay. And was that the Louisville meeting? Do you. Nobody's going to fact check.

00:50 I couldn't remember, honestly. I just know it was as a fellow under Dr. Kelam. He was really and Mike Bossy, both very big advocates at the ota. And they were insistent that we go to the OTA and say it was a good organization to get involved with. And as you know, Jim Kellum was one of the sort of founding members back in 1984. So, I mean, it wasn't that far, far gone. I mean, it was only 14 years at the time that the OTA has been there, and now it's 40. So that tells you that I'm feeling old.

01:29 Yeah, maybe old in chronology, but not old in energy level. That's for dog. Unsure. So what were your initial thoughts? You're a fellow, obviously, so you're committed to this career.

01:46 But yeah, I mean, at that time, there was so much talk about if you're a traumatologist, it's going to be hard to do it your whole career. That seemed like that was the big focus and the message that we kept hearing. But that changed pretty rapidly. I think the OTA really helped move forward the idea of traumatologists, because up until the mid-80s, it was sort of a new concept. But we started realizing how being a traumatologist and taking care of things that the elective orthopedic surgeons don't want to deal with frees them up, and it allows us to do what we want to do. And then to me, the real big game changer that came along was having a trauma room and recognizing that we could appropriately manage patients in the evenings, off hours. They didn't necessarily have to have an elective ankle fixed at 2am which what we were doing in the late mid-90s, my residency was full of that. And even when I first got into practice, and you could see how that could burn you out eventually. But once everybody started getting these trauma rooms, I think it really changed what we could do with trauma And I think the OTA had a lot to do with that. And the other thing I would say is research. The OTA really instilled the idea of research in trauma. And I think if you look at all the subspecialties across orthopedics, I think we're the leader in doing high quality evidence based research. And I learned it from you and Mo. I mean, that's where it's been.

03:24 Yeah. So you've been involved with research ever since you started your academic career. And so how did this organization facilitate that?

03:38 It facilitated. Well, by having all the connections that are like minded people in orthopedic trauma. So that's how I met Mo Bhandari. And we started talking about the flow study that we did in the late 90s and eventually it came to fruition. But without the OTA, I would never have met a person like that. Without all the education at the ota, I would have never understood the importance of evidence based medicine and all the things that you've brought of doing, you know, randomized controlled trials, which nobody was doing in medicine. And now I still think that orthopedic trauma, we're the leaders in it. Look at all our groups all over the country working together. I mean, it's pretty amazing.

04:21 Yeah.

04:22 And then that's all really, I think, because of the ota.

04:24 Yeah, I couldn't agree more. I think it's something we can definitely be proud of. You're also a very experienced administrator in your own institution. Maybe you can talk a little bit about how you got brought into that position. Those positions that you've had, you've had more than one.

04:47 Yeah. So sometimes it feels like it's trial by fire a little bit. But it really, as I started my career and being involved in the OTA was helpful, but I was involved in the South Carolina Orthopedic association and there it's a little different. The roles there were a lot about advocacy and a lot about health policy, specifically in the state of South Carolina. And so that's kind of where I got my feet wet a little bit on the other side of medicine, not the clinical, but more the advocacy side. And that sort of translates a little bit more into the administrative side. So the administrators are more concerned with, at least in my opinion and certainly in my place, about the money and the dollars and where they're flowing and who's getting it and is it coming from Medicare, is it coming from Medicaid? How much money do we have in this state to take care of trauma? So from that advocacy side, I really developed a lot of knowledge. And then with that, they start looking at you as a leader in your department because you have a lot of knowledge on things they find important. They're not all that excited about how I take care of a trauma patient in reality. But that really, I think, opened the doors for me on the administrative side, and I did a lot of the other things as well. Education is important, so residency program director for 10 years and research. But on the administrative side, it's been a really trying and learning experience, but I didn't get a formal mba, and I know you hear a lot about, well, should you have a formal MBA if you're a vice chair and then eventually chair of your department? I'm sure it helps. But along the way, I went to a whole lot of different leadership courses and administrative courses through the aoa. I'm sure you're familiar with the Kellogg courses, so I did all seven of those. And so you kind of help, you know, prepare yourself for those roles and give you some background and some knowled so that you can really make a difference in those meetings rather than just sit there as a clinician and all you can add is patient care.

06:56 Yeah, patient care. And complaining about lack of resources.

06:59 Right.

07:00 Which a lot of our peers do. In some of those meetings, though, you also have had a major leadership role in the AOA and. Or in the presidential line. And is there an interaction between your experience in this organization versus that, would you say?

07:16 When you say interaction, I mean just.

07:20 Things you've learned from the OTA that have crossed over into your. What you've done in the aoa. I mean, I know that you really had a major influence in the own. The BROME program. Would you say there's kind of a connection there, being interested in fragility fractures?

07:35 Oh, for sure. I think that it's kind of funny. I mean, I spent a lot of time in the ota, and a big part of it is fragility fractures. And that's really what got me in the door to the aoa. I mean, the aoa, as you know, isn't something that you start out with. So when you finish and you graduate, you can go. Now they have the elf, so the Emerging Leaders Forum, you can do that for five years. But in order to get in the AoA, you typically have to be out in practice for usually a minimum of about five to eight years and be seasoned. But with the OTA and fragility fractures, it really made a nice transition for me to get involved in the aoa, and. And I did a lot with Own the Bone, and that really helped advance me through the ranks, I think, in the AOAs to where I'm going to be now. The incoming president.

08:26 Yeah.

08:27 And there's so much overlap with fragility, fractures and Own the Bone and the ota.

08:31 Yeah.

08:32 And we've been putting on symposia here that are related to Own the Bone. We've put on podcasts, webinars, and that, and that's good. And I think also with the aoa, it's all about leadership. And so that helped me here as I had a career path in the ota. So I think they're very synergistic.

08:52 Yeah. And you worked very closely with Andy Bunta, who was a member of the ota.

08:57 Absolutely.

08:58 I know you had a close relationship with Andy and it's too bad we lost him too soon, but he had a major role in that. And I think just the population demographics are gonna really make that more and more of a factor in this organization as we continue to try optimized care and outcomes. And the tsunami has already started with people my age and older.

09:28 I look at my clinic for the day and I'm looking at the 20 patients that I'm going to see and the average age keeps going up and up and up and I'm like, where's the 25 year olds? People are driving and they're 75 and they're getting in a car wreck and they're breaking multiple bones because they're fragile. And that's what we see.

09:50 Yeah, we have a lot of work to do in that area. So if you had to project where you think this organization would be, say, 10 years from now, what do you think it might look like? I mean, there's now something like 2,000 members, something like that. And there's the iota, the International Orthopedic Trauma Association.

10:17 It certainly has gotten big very quickly. When you think that this organization is only 40 years old and growth is good and at some point there are only so many orthopedic traumatologists in the United States and we produce some, but some retire. So that number isn't going to continue to exponentially grow. I think that was a big reason that they looked overseas and we have iota, and that helped and to a certain extent grow. But I think what we need to do now is mature and develop and really focus on the things that we do well. And we need to be advocates for the orthopedic traumatologists in the United States and make it better. And I think that's the direction that we're going to end up moving towards. At some point, you're only going to be so big, and then we're going to have to figure out what it is that we do well and what we need to concentrate on and how we can make a difference. With Cure of the with Peter Tribulation.

11:18 That's excellent advice. And I'm sure you're going to have something to say about that in the future. I would. I would predict so. Thank you, Dr. Geray, for spending almost 12 minutes with me to do this brief interview. And it's been. It's been a pleasure.

11:34 Thank you.