How wonderful. What attracted you to the Brigham initially?

Transcription

1 THOMAS THORNHILL, MD Interviewed by Peter Tishler, MD, July 26, 2012 It s wonderful to be able to interview you Dr. Tom Thornhill on July 26, As a start, would you please give us your name and academic and hospital affiliations? Yes my full name is Dr. Thomas Stone Thornhill. I am the Chairman of Orthopedics at the BWH and I am the John B. Buckminster Professor of Orthopedic Surgery at Harvard Medical School. Thank you. We are going to start by my asking you some questions of a personal nature. After graduating from Cornell University Medical School, you completed residency training at the Brigham in both internal medicine and orthopedic surgery. What motivated you to train in both specialties? I ll give you the short version and that is that I, at Cornell, I did a lot of work with the infectious disease group there which was a spectacular group of superstars and I became very interested and elected to do a medical internship and I was fortunate enough to come here to the Brigham in And during my first, between my internship and my junior residency year, the next year, one of the early rotations was at the Robert Breck Brigham Hospital. And this was with rheumatology and orthopedics. And Dr. K. Frank Austen was head of rheumatology/medicine there and Dr. Clement Sledge, who was chairman here at the Brigham and at the Robert Breck, was my role model. So one day I drew a Venn diagram and I figured that the things that I liked best were rheumatology, neurology because of the rich tradition at Cornell, and surgery. And that during my internship at the Brigham, we had medicine and surgery. We were on every other night so Dr. Thorn and Moore, we had a lot of cross- reactivity and so I got for a medical intern we had a lot of surgical exposure. So orthopedics was calm to that and so I spent some time at the NIH in England and then came back into the Harvard Combined program which included the Brigham. How wonderful. What attracted you to the Brigham initially? 1

2 I m it was funny. I went to a small school in western Massachusetts called Williams College and the only time I came to Boston during that period of time was to play basketball or tennis competitively. So I actually didn t like Boston that much. I was not a Celtics fan. I didn t know much about hockey being from West Virginia. And I didn t even apply to the Harvard Medical School. And so I but the Brigham, it was just the name of the Brigham and when I came up here it was the people that I met. It was a perfect marriage for me. How wonderful. You ve mentioned one person but are there others who were your mentors? Probably too numerous to count. I think all the way along. I think that Clement Sledge played a pivotal role. I think that if I had to start singling out too many other people, I would probably do some disservice. I mentioned Dr. Austen and all the way along and most of them, obviously over the past 30 years, have been orthopedic surgeons who have done nothing but codify that in fact I think I made the right decision. Let me ask you some questions now about your role at the Brigham. You have spent most of your professional life at the Brigham and you became Chair of the Department of Orthopedic Surgery in What have you accomplished to keep your department at the cutting edge of orthopedic surgery? Well I think traditionally people would look at the Brigham, that would be the Robert Breck and the Peter Bent, and think in orthopedics I would think of joint arthroplasty. And I think we still continue to be at very much the forefront of joint arthroplasty. But one of the things that we ve really done both at the Brigham and through Partners with our association and our combined residency, is we are now a very good place in trauma. We have a very good spine group. We have a very good foot and ankle and hand/upper extremity. With the Dana- Farber we have a very strong oncology group. So I think that if I m not sure I ve done but I think we together have done a lot. Each person we ve hired I want somebody who is a good surgeon and somebody who is a good person and I want someone with both academic and educational interests. We ve been able to achieve that with each of our hirees. And then the final thing that we ve done is we didn t have a whole lot of now if you look at us as orthopedics and rheumatology - which we like to think of ourselves our relationship in orthopedics and rheumatology here at the Brigham is unique around the country. And I think it has been strength on both sides. And it s been very good for patient care. But so we now get about $18 million in research, combined research dollars, and if you add that to the $24+ that the rheumatologists have because they are very heavily funded. The musculoskeletal program is very competitive on research and we have a lot of interaction in each of our areas of research so I think it s clearly a team effort and we continue to grow. 2

3 Can you give me an overview of the research that you and the others in the department have taken care of? And if we go down, and in no particular order, I would start with our cartilage biology group and I would divide it in a couple of wings. Dr. Julie Glowacki is a very renowned cartilage researcher who has this really unique way of working with and fostering translational research. The two areas that I would talk about would just be in some of cartilage work that she has done but also the work that she has done with Meryl LeBoff and our trauma people in looking at treating metabolic bone disease; a program called Be Fit which has been adopted around. So Julie, Shuichi Mizuno, a group of people that are doing it. Another wing would be Anuj Bellare who is an MIT trained polymer chemist and a scientist has done some very important things in things to improve and design other areas. Mark Brezinski is the world s authority on optical coherent tomography and has done some terrific work and is very well funded. Jeff Katz and Elena Losina run our outcomes group and Jeff is both in our department and rheumatology. He is a rheumatologist and Elena is a PhD biostatistician. And we have this dynamic group of people who are doing all these wonderful studies in outcomes and so that is a very integral part. So we are a whole bunch of different pieces and many of the clinicians in each of our subspecialties interact across and with our rheumatologists. It s very diverse and very wonderful. Has the Brigham and its administration been supportive of your department, the treatment of orthopedic patients and your leadership? I mean when I first assumed this role, we had about four different either foundations or for- profit entities. And we ve been able to bring them all, first under the not- for- profit foundation and then merged into the PO. But since much of our stuff was a previous for- profit, we didn t have some of the things that were necessary to get into this. And so the hospital has been just outstanding. The second thing is we are a diverse campus now, because we are at Faulkner, we re at 850 Boylston, we re at Foxboro and that requires a lot of infrastructure. I think that the hospital leadership has been and continues to be outstanding because this is a pretty competitive orthopedic environment. Can you tell me what is unique about your residency training program in orthopedic surgery? We re unique because of the fact that we are a combined program. It s one of our strengths and one of our weaknesses. We are the Brigham, the MGH, Children s Hospital, Beth Israel and the VA Hospital System. And so there is nothing that really isn t available to the residents. But it s also spread out over several hospitals and we work as an executive committee and we have a new program director, George Dyer, who has just been outstanding. Our last two program directors Jim Herndon and Dempsey Springfield kept moving the ball forward in lots of areas - each of them added some unique things and George just will do the same thing. So I think the 3

4 quality or the best thing about our residency program is the starting sample - the residents we get. So if you start with the quality we get, there is going to be quality out the other end. Do you think you get the best applicants and individuals intending to go into orthopedics nationwide? Well of course we like to think so. I m sure that some of our colleagues at some of the other great orthopedic training programs would feel the same. But there is enough quality applicants to go around. And of course each year you see them and you say I could never get into the program with the quality of these people. But it s really fun the residents. I have only one final question to ask you and this is on the future of medicine. What do you predict for the future of orthopedic surgery both for the Brigham and nationally especially since we are facing issues of cost containment? Well I think, I mean I think every facet of medicine is going to be affected by this. The first thing for us to begin to understand is with resident work hour restrictions. It puts a little bit of challenge on us getting the curriculum and the experience we need in a surgical sub- specialty. You need a certain time in the OR. These are rules that we take very seriously and we abide by. In terms of much of the stuff that we do, is very device oriented and so what happens is, is that there is going to be cost accountability. Comparative effectiveness is going to force us and we are in a position with our outcomes group to look at outcomes. And I think the challenge within our group is going to be to understand to convey to our surgeons the importance of functioning no longer in a pay for performance mode but in an episode of care. In terms of accountable care organizations, in terms of medical homes, medical neighborhoods and so I think that that will be a challenge but every challenge is also an opportunity. Is this something that the executive committee, of which I presume you are a part, are working with in concert? Well we have an education committee which is run by the program director and an education person from each of the institutions. So that they really look at the educational benefits for the residents and choose the best curriculum for them. So that is independent and in conjunction with the executive committee. We look at the overall strategy and we look at blending that in because we are taking care of patients. 4

5 And dealing with that in the institution. Much of the overall health care and cost accounting or value care really comes within the institutions. And of course Partners, we share much of the same leadership as the MGH does. So and it s not really a challenge for us that Children s and the BIDMC are great organizations in their own rite and I think it s the executive committee that helps bridge that for orthopedics. 5