Once again I want to welcome everyone to San Diego. It is really great to see everybody here. This year has been a rewarding and interesting one for me as the board chair. It's not been without its challenges, but with a wonderful board, every unexpected issue was dealt with fairly and with tremendous integrity. I've always felt lucky to be an orthopedic surgeon, able to help people to time of need, generate long lasting bonds with patients with colleagues, with residents who have since become colleagues it's incredible. Our orthopedic families give us much more back than we give to them. Not surprisingly, the title of my talk this year is gratitude, which is both an emotion and a tool. First, I'm grateful for the privilege of working with a devoted board and staff on behalf of you and all of your patients. As I said last year, what's good for patients is good for us, and that has never been more true than it is now. Every day we help people regain function, overcome injury, relieve pain, and improve health. What a privilege. The work we all do is at the heart of the AOS, and it has been the north star of your board's activities. We all spent the last year working diligently on many fronts and with more input than ever before from our members, including our sister BOS societies with the help of Armando Vidal and many regional meetings with BOC and state societies organized by Joel Meyerson. I'm proud to say that we listen carefully to support the best interests of our fellows in all aspects. Our world is changing with more threats to our patients and practices than ever before. Investments in digital health platforms that pitch their services is keeping people away from orthopedic surgeons, venture capitalists and health systems who act to diminish and undervalue physician and patient autonomy, and the pressures that insane amounts of debt place on our youngest surgeons, just some of the stresses that our profession feels. But as change occurs, we must adapt. Your board and council chairs have spent the year working to improve our situation. Part of this effort is in activating the strategic plan that Kevin Bozick shepherded in last year. Our membership council is starting a new effort focused on young members as we seek to build our organization from the ground up with energetic young surgeons who are the future of our field. Our education council continues to tailor offerings to our members and work closely as possible, especially societies. The Rock residency curriculum is also being refined annually. It now offers time tracking for program directors. In fact, one recent unpublished as yet study demonstrated a clear a clear correlation between time spent in the curriculum and in the outcome of the in training exam in terms of knowledge. The Research and Quality Council continues to develop useful tools and guidelines to help us all navigate a very complex world. Our advocacy efforts with the leadership of Adam Bruggeman and our PAC chair Wayne Johnson are ubiquitous in Washington. The last election cycle saw 94% of our supported candidates winning office. We're aggressively pursuing new legislation to call back the absolutely unacceptable Medicare cuts recently passed, and we are always involved in any proposal for alternative payment plans based on our incredibly strong reputation in Washington as patient advocates. Given the challenges that I've described, the other area of focus that the board has had for over 2 years is evolving our governance structure. Last year I told you that we'd be recommending major changes. You saw those at the business meeting. To that end, we'll all vote on a streamlined set of bylaws after this meeting that have been created with the help of two different boards, amended and supported overwhelmingly by the BOS societies and the BOC representatives. The goals of these changes is to allow the organization to evolve with the times, more specifically to maintain and become a higher functioning board that's responsive to the rapidly changing environment we face while holding ourselves to a high standard. These bylaws will focus on practicing orthopedic surgeons. Additionally, our board evaluation project is in its 3rd year, and as you can see, we continue to improve as a board in providing strategic governance while working with transparency and inclusiveness, and this is just the beginning. These proposed changes have been highlighted on the AOS website since last August. They've been the focus of an AOS Now article, and you've seen them in the dailies at this meeting. I personally view these bylaws changes as critical to our organization's health, and I would be more than happy to talk to all or any of you, as would any other board member offline about their importance. I think you know that my career has been shaped by brutal honesty, hasn't always worked for me. But in this case, just please trust me when I tell you that these changes are not only required but long overdue. The past few years have put me in front of thousands of our members. Almost every conversation I've had at these meetings has been centered on how to be a better doctor. What matters to our patients? I also saw the very appropriate desire to have a satisfying practice while hearing the challenges that our fellows face. Moreover, our lack of control of some of these issues leads to stress, might even influence one's ability to be empathetic. To this point, I have encountered some members who truly seem to have lost their purpose, focusing exclusively on themselves and not on the reasons they went into medicine. As someone who runs a practice in an indigent center, I promise I absolutely feel those pressures as well, but I try not to see the world that way. I try to see it more broadly, not focused on me. So I go back to the concept of gratitude and last year's discussion. It's not about me. There's abundant evidence that practicing gratitude, even journaling it, I had to put some literature and I'm sorry, even journaling it leads to high job satisfaction and increases empathy. It should be easy for all of us to feel lucky and grateful for our station in life. We have a calling and the skills to help people. We hold a relatively revered position in our communities and despite some mild negative changes are extremely well compensated for our efforts. It's easy to forget these things and focus on the threats to our practice and our autonomy, but day to day we still have the best job in the world. We must actively balance our emotions and the challenges we face with the very real and much more important rewards that we should be seeing from grateful patients every day, and it should be easy for us to feel grateful. Imagine for a moment that instead of the opportunities you've had that I was personally given by the hardworking guidance of my mother that you were born in different circumstances but with the same intellect and skills would you be successful? Would you be well educated? Would you be struggling? Would you be financially viable? Could you have been led down a bad path? Would you like patients that I've seen, have multiple fractures from climbing a wall just to have the opportunity to be free. I realize this sounds a little bit like you should eat your food because there are people in other countries starving, but we actually know the terrible things that happen in our world and given all of this, I feel even more grateful to become an orthopedic surgeon and I'm not speaking politically. I'm speaking as a person who cares about others just like you. So for a minute, please imagine that your greatest concern is not where to buy a vacation home or how to maintain a high standard of living. But whether you can feed your family after being injured like many of my patients, I do this thought experiment myself on a very regular basis and it helps. I believe that actively tapping into gratitude gives us the ability to give back more because we realize just how much we have to give. Don't get me wrong, like you, I feel like I've earned everything that I have, but at the same time it's quite clear to me that many who could be exactly like me, like us, will never have that chance because they didn't have the same start in life. Not everyone has the same opportunities. I see people every day who are raised here or emigrated here working multiple jobs for their children to have a better life. Hardworking people whose dream it is for their children to be successful, maybe become an orthopedic surgeon, and I feel grateful for the opportunity we have during my travels, when I talk to other surgeons, I see so often the greatest attribute that a person can have compassion. I want to thank the hundreds of us that I've met that represent the thousands who I haven't, who consistently demonstrate compassion, who go to meetings like this one to learn how to better care for others and spend time taking care of people who are less fortunate in addition to the ones that are educated and lucky. I thank those who feel the drive to make our world better one person at a time. Those who understand and are thankful for all that we have and the gift of being able to contribute the way that we do. I stand here with you, my colleagues, and so many friends, proud to be an orthopedic surgeon. Proud of the work that you all do and the sacrifices that you all make. There is no more rewarding job I can imagine. I expect you all feel the same way because it's good for patients is good for us as a group and great for us individually. Everybody is someone's loved one. This year has been a blur of activity for me and it's been difficult to navigate at times. Thankfully I have had the pleasure of leaning on transparency and a strong board who always have made decisions in the best interests of our members, their patients, and the AOS, along with a quite insightful executive committee, council chairs, and a truly dedicated staff. As with everything else, we succeed only as a team, and I have had a great one. I specifically want to thank some people who have been sorry. Specifically, I want to thank some people who have been on the board with me for multiple years. Kevin Bozick, who I consider a close friend for his advice and support for my entire presidential line. The presidential line who follow me, Ned, Wilfred, and now Michael for their camaraderie and support throughout the year. Lisa Masters, one of our board members, our lay board members who consistently helped us all to learn by providing an outside lens on not just what we do but how we do it. Evelyn Berger, who may be the only person as candid as I am, and Chick Yates, see, I knew that would get a laugh, and Chick Yates who's always prepared, challenged me and broadened my thinking. The board also owes a great debt to Armando and Joel, our BOS and BOC chairs who are invaluable in forming the board how our members see things and, and really facilitating that two-way communication. I also want to thank Donna Mallard and Jocelyn Koki, who worked tirelessly for all of us, and Tom Aaron and Dino Damala who operationalize the board's directions. Lastly, I'm grateful to all AOS members for having faith in your board and for representing your profession's standards and missions every day. The AOS exists to further MSK Care through all of you. Just like I'm grateful to be one of you, I'm also thankful to have been able to work on behalf of you this year. I appreciate all of what you do every day for people's loved ones. Thank you very much. Thank you. Thank you.
