Introduction
Traditionally, each edition of the Iowa Orthopaedic Journal is dedicated to a single individual for their accomplishments in pursuit to uphold the mission of the department. As many may know, October 2014 marked the 100th year anniversary celebration of the University of Iowa Department of Orthopaedics. Given the magnitude and tremendous success of this event, the 2014 Iowa Orthopaedic Journal will be dedicated to the 100th anniversary event. A brief reflection on this remarkable weekend follows.
History of the IOWA Orthopaedic Department
Our department has a history worthy of celebration. Since 1913 when John Bowman, the ninth President of the University of Iowa appointed Arthur Steindler as Instructor in Orthopaedic Surgery, the University of Iowa Department of Orthopaedics and Rehabilitation has become an internationally recognized preeminent clinical, educational and research program. This success is due to the education and talent of generations of faculty, residents, staff and alumni of the residency program and the medical school.
Over the last 100 years, Iowa Orthopaedics has helped advance the entire specialty of orthopaedics. The Department's studies of the cell, molecular and matrix biology of bone, cartilage, growth plate, tendon and ligament and intervertebral disc and the injuries and diseases that affect these tissues have led to many of the most important developments in musculoskeletal research. This work continues in the Ponseti Biology Laboratory and the Spine and Bone Healing Laboratory. The University of Iowa Orthopaedic Biomechanics Laboratory has been a world leader in advancing understanding of the mechanics of the musculoskeletal system, the invention of new joint replacements and methods of fracture fixation and innovative approaches to measuring the wear of joint replacements and the mechanical forces that cause osteoarthritis. Clinical research based in the Department has helped guide improvements in the treatment of patients with fractures and joint injuries, severe arthritis that requires joint replacements and skeletal deformities including congenital hand deformities, clubfoot, scoliosis and hip dysplasia. The Department's teaching programs have educated generations of medical students and Orthopaedic residents, and many former Iowa Orthopaedic residents have become leaders in Orthopaedic surgery. The Department's nationally recognized residency program attracts the best medical students from schools throughout the United States. Faculty have earned national and international recognition for their clinical expertise, research, and regional, national and international leadership positions, and participation in groups dedicated to improving national health policy. Four faculty have served as president of the world's largest Orthopaedic society, the American Academy of Orthopaedic Surgeons, four faculty have served as president of the world's oldest Orthopaedic society, the American Orthopaedic Association, five faculty have served as president of the Orthopaedic Research Society and six faculty have served as directors of the American Board of Orthopaedic Surgery - an exceptional record of leadership and accomplishment. A 100 year timeline of the Department history has been included (Table 1).
Table 1.
Iowa Orthopaedics and Rehabilitation 100 Year Timeline
| 1912 | Arthur Steindler begins holding Orthopaedic Clinics in Iowa City at the first University of Iowa Hospital on the East side of the Iowa River. The building is now known as Seashore Hall. |
| 1913 | Arthur Steindler is appointed as Instructor in Orthopaedic Surgery by University of Iowa President John Bowman. Steindler receives a stipend of '800 per year and moves his orthopaedic practice to the University of Iowa Hospital from the Drake Medical School. |
| 1915 | The Iowa State Legislature passes the Perkins Act which supports transport of children with musculoskeletal deformities and diseases to the University of Iowa for treatment. |
| 1915 | Arthur Stiendler is appointed Professor of Orthopaedic Surgery. |
| 1917 | Construction is completed on the University of Iowa Children's Hospital on the West side of the Iowa River. The new hospital houses the Orthopaedic Clinics, operating rooms, offices, operating rooms, laboratories, library and rehabilitation facilities. |
| 1927 | The Iowa Orthopaedic clinical and academic programs are recognized as an independent department by the Iowa Board of Regents. |
| 1929 | Ruth Jackson joins the Iowa Orthopaedic Residency. After working with Dr. Steindler, she decides to pursue a career in Orthopaedic Surgery. She is now recognized as the first woman Orthopaedic Surgeon in the United States. |
| 1948 | Arthur Steindler leaves the University of Iowa to found the Steindler Clinic at Mercy Hospital. |
| 1950 | Carroll Larson becomes the Chair of Orthopaedic Surgery. |
| 1972 | Reginald Cooper becomes Chair of Orthopaedic Surgery. |
| 1999 | Joseph Buckwalter becomes Chair of Orthopaedic Surgery. |
| 2000 | Joseph Chen joins the faculty and starts the Physical Medicine and Rehabilitation clinical and academic programs. |
| 2013 | Recognition of 100 Years of Iowa Orthopaedics. |
Summary of 100 Year Anniversary Events
This past October, alumni, friends and families from around the world gathered in Iowa City to commemorate the Department's 100th anniversary. In total, 96 alumni with hundreds of other friends and family, participated in the event. Over the course of four days, from October 10th -13th, 2014, we celebrated the rich history of Iowa Orthopaedics (Table 2). We took a look back at our major achievements including Ponseti's revolutionary treatment for clubfoot, advancements in joint replacement surgery, multidisciplinary research to prevent post-traumatic osteoarthritis, and bracing for adolescents with scoliosis. Through the eyes of leaders in the field and world renowned faculty and alumni we reflected on current and future issues in US Healthcare, residency education, certification, philanthropy, research and diversity in orthopaedic surgery. A separate session, entitled “Department Day” celebrated the last 100 years through the eras of each of Iowa's four chairmen: Steindler, Larson, Cooper, and Buckwalter (Figures 1 and 2). The fact that there have been only four chairmen is unique among academic orthopaedic departments with a history that extends back for a century. The academic session concluded with a discussion of the future of Iowa Orthopaedics, specifically reflecting on current and future initiatives to ensure that the future will be better than the past.
Table 2.
100 Year Celebration Schedule of Events
| Thursday, October 10th, 2014 | ||
| Evening | ||
| • Open House Welcome Reception | Location: Hotel Vetro Lehman Ballroom | |
| Friday, October 11th, 2014 | ||
| Morning | Academic Program: The Orthopaedic World: Changes Since You Left Iowa | |
| Location: University of Iowa, College of Public Health Building | ||
| • The Healthcare Environment Overview | Stuart L. Weinstein Ignacio V. Ponseti Chair and Professor |
|
| • Healthcare Delivery System Reform | James N. Weinstein President and CEO Dartmouth Hitchcock Healthcare |
|
| • Department of Orthopaedic Surgery in the New Academic Medical Center | Charlie Saltzman Professor and Chairman Department of Orthopaedic Surgery: |
|
| • The Quality of Movement in Orthopaedic Surgery | Kristy Weber Professor of Orthopaedic Surgery; University of Pennsylvania |
|
| • Residency Training in the 21st Century | J. Lawrence Marsh Carroll B. Larson Professor |
|
| • ABOS in the 21st Century | Ned Amendola John and Kim Callaghan Chair and Professor |
|
| • Research Funding in Orthopaedic Surgery | John Callaghan Lawrence and Marilyn Dorr Chair and Professor |
|
| • Pediatric Orthopaedics; The Iowa Legacy | Dennis Wenger Professor of Orthopaedics UCSD |
|
| • The Adult Hip | Tom Brown, PhD Richard and Jan Johnston Professor and Chair |
|
| • Osteoarthritis Cort Grant (OR) Translational Research | Don Anderson PhD Associate Professor |
|
| • Rehabilitation Service | Joseph Chen Associate Professor |
|
| • The Women of Iowa: A Dynasty of Diversity | Andrea Saterbak St. Croix Orthopaedics |
|
| • Operation Walk | Larry Dorr Clinical Professor of Orthopaedics University of Southern California Keck Medical School |
|
| Evening | ||
| • Black Tie Reception and Dinner | Location: Marriott Hotel and Conference Center | |
| Saturday, October 12th, 2014 | ||
| Morning | Iowa Orthopaedic Department Day | |
| Location: University of Iowa, College of Public Health Building | ||
| • The Steindler Era | Joseph A. Buckwalter Arthur Steindler Chair and Professor; Department Head |
|
| • The Larson Years | Reginald Cooper Professor Emeritus |
|
| • The Cooper Years | Stuart L. Weinstein Ignacio V. Ponseti Chair and Professor |
|
| • The Buckwalter Years | Brian Wolf Ralph and Marilyn Congdon Professor |
|
| • Iowa Orthopaedic Society and Their History with the Department | President of the IOS | |
| • Department Video | Joseph Smucker Associate Professor |
|
| • The Future of the Department | Joseph A. Buckwalter | |
| Afternoon | ||
| • Golf and Tennis Tournament | Location: Brown Deer Golf Course and UI Hawkeye Tennis and Recreation Complex | |
| Evening | ||
| • Cocktail Party and Hor D'Oeuvres Reception, with “special” auction | 126 Restaurant | |
| Sunday, October 13th, 2014 | ||
| • Ponseti Races | UI Sports Medicine Center | |
Figure 1. Department Day Lecture Hall, College of Public Health.
Figure 2. Alumnus, Kevin Jones delivering riveting reflection on the “Buckwalter Years”.
In addition to the rich academic sessions, multiple social events allowed alumni from near and far to reunite and celebrate the past, present, and future. For the last century, Iowa Orthopaedics has been a big family and our anniversary celebration was also our family reunion. Although the weather in Iowa City was perfect, many of our alumni traveled through hazardous wintery conditions, even from as far away as New Zealand (Figure 3). The anniversary opened with a well-attended Welcome Reception held at a downtown Iowa City hotel. The formal black tie dinner event, the following night, marked the highlight of the social program (Figures 4-6). Here alumni, faculty, and residents gathered as family and friends to reminisce. During cocktails and dinner, we shared funny and inspirational stories with friends and learned of new life and career achievements. We were also joined by administrative leaders from the University of Iowa system. Most importantly, we collectively celebrated the financial generosity of donors with a formal presentation from the Orthopaedic Foundation (Table 3). The night concluded with a speech from Dr. Marilynne Robinson, a well-established Iowa Writers' Workshop Professor. The social program concluded Saturday night with hor d' oeuvres and cocktails (Figures 7, 8). Here, Iowa faculty held a special “auction” where department relics were sold-off for high dollars (Figures 9, 10). Some lucky alumni were able to snatch up items ranging from scrub caps to scoliosis braces (Figure 11). Other social events including the tennis and golf tournaments and Ponseti's race were also alumni favorites (Figures 12-14). Not surprisingly, most brought their best, as Orthopaedic surgeons seem to rarely miss an opportunity for a little friendly competition.
Figure 3. Haemish Crawford and family (Pediatric Fellow 1999, New Zealand) with Charles and Barbara Clark.
Figure 4. Reginald Cooper and John Colloton at black tie dinner.
Figure 6. The Callaghans and Bierbaums at black tie dinner.
Table 3.
Iowa Orthopaedics 100 Year Donation List
|
Visionary $1,000,000+ John J. and Kim L. Callaghan Roy D. and Linda Crowninshield Lawrence D. and Mariyln A. Dorr Richard C. and Janice C. Johnston Marvin A. and Rose Lee Pomerantz Vera Patricia Siman-Creebo Estate Benefactor $500,00-999,999 Leeta M. Berry Estate Ron D. and Judith K. Carter DePuy Spine, Inc. Mark A. and Mary Ann Kaufman Arthur D. Steffee Leader $250,000-499,999 Joesph A. Buckwalter IV and Kathleen C. Buckwalter Roy J. Carver Charitable Trust Ralph H. and Marcia A. Congdon Bessie M. Millhone Helena Percas-Ponseti and Ignacio v. Ponseti Theodore A. Willis Founder $100,000-249,999 Benjamin E. and Annabelle Bierbaum Michael and Ruth M. Bonfiglio Byran D. and Nancy K. Den Hartog DePuy Orthopaedics, Inc. Sutherland C. Dows and Frances M. Dows Charitable Trusts Richard J. and Margaret C. Ling Evelyn A. Magoon Estate James V. and Catherine M. Nepola Phinit and Kantima Phisitkul Smith & Nephew, Inc. Martin J. an d Joan L. Steindler Herbert L. and Nancy M. Townsend Peter D. and Susan K. Wirtz Partner $50,000-99,999 Annunziato and Alison L. Amendola Donald W. Blair Estate The Robert Campeau Family Foundation (U.S.) Charles Richard and Barbara S. Clark Grand Chaper of Iowa-Order of the Eastern Star Daniel C. and Denise F. Fitzpatrick Iowa Orthopaedic Society, Inc. Maude-Alice Junk Ralph P. Katz and Dollie S. Gill-Katz Thomas L. Lambert and Mary Ann Bramhall-Lambert E.F. Lindquist Brian D. and Debbie Mulliken Joesph E. and Suzanne M. Mumford Oversol, C.A. Andrea M. Saterbak Shriners Hospital for Children-Chicago Mr. and Mrs. S.G. Stein IV Stryker Endoscopy Stuart L. and Lynn Weinstein Steward $25,000-49,999 Tim and Erika C. Ballard William Catalona Reginald R. and Jacqueline Cooper Richard D. and Barbara J. Corley Ralph E. Cressey Estate Randy F. and Michelle M. Dryer William C. and M. Ruth Hanson James W. and Ann Hayes Edgar O. Hicks III and Elizabeth A. Hicks Mildred E. Little Estate Thomas A. and Chrstine M. Malvitz Joseph G. and Carolyn K. Martin The Edward E. & Marie L. Matthews Foundation Alan C. and A. Joan Merchant Ingrid E. Nygaard and Charles L. Saltzman Thomas P. Steindler James H. and Doris C. Van Olst Patron $10,000-24,999 Aesculap Corpration Fernando Aleu American Prosthetics and Orthotics, Inc. Arthrosurface, Inc. Baltimore Therapeutic Equipment Co. Bissell Helathcare Corporation William F. Blair David and Mary Boyer Ronald K. Bunten Albert H. Burstein Douglas M. Cooper and Margaret J. Fehrle Beulah K. Dickinson Estate Marvin H. Dubansky E.B.I. Medical Systems, Inc. Iowa State Aerie, Fraternal Order of Eagles Martin W. and Allyson J. Egbert J.L. and Jean L. Ehrenhaft Abron A. and Bernice Grandia Peter R. and Margo E. Heinzelmann Carl L. and Sheila E. Highgenboten Howard P. and Janet Bartel Hogshead Margaret Browning Huey Norman H. and Phylis C. Johnson Yong Sik Kim James C. Erika A. Krieg Madelyn M. Levitt Foundation John R. and Ann H. Lindstrom Link Orthopaedics Mrs. Herbert A. Littleton Don A. Lowry Robert E. and Bonnie E. McCoy Paul M. Melvin M.R. Mickelson Sinesio Misol J. Michael Moses Muscatine Foods Corp. Charitable Foundation The Orthopaedic Research and Education Foundation Pfizer Inc. The J.B. Reynolds Foundation Robert L. Roach Estate William J. Robb III and Christine Olson Robb William John and Georgene I. Robb Dr. and Mrs. Richard A. Ruffin Scoliosis Research Society Sears Mfg. Co. David K. Selby William E. Shaddock John E. Sinning, Jr., and Beverly A. Sinning Elizabeth M. Stanley Barbara A. Waters Kristy Weber Jon S. and Jennifer G. Whitmore William R. and Kay M. Whitmore Todd M. and Jennifer D. Williams |
Figure 7. Joseph Buckwalter, Adrian Flatt, and Reginald Cooper at 126 Restaurant.
Figure 8. Two generations of Coopers (Reginald and Doug) and Buckwalters (Jody IV and Jody V).
Figure 9. Stuart Weinstein and Rick Ruf fin celebrating guest speaker Marilynne Robinson.
Figure 10. Guyton, Pyvich, and Cooper celebrate successful auction of the sign Dr. Cooper kept outside his office as Department Chairman.
Figure 11. Stuart Weinstein signing a scoliosis brace at the “auction” Saturday night.
Figure 12. The Ponseti Races, UI Sports Medicine Center, Adult Race.
Figure 14. Ernie Found and daughter at The Ponseti Races.
Figure 5. Larry Marsh with John and Jay Albright at black tie dinner.
Figure 13. The Ponseti Races, UI Sports Medicine Center, Kids Race.
Future Directions
Since 1913, the Department of Orthopaedics and Rehabilitation at the University of Iowa has worked tirelessly to improve the lives of people suffering from diseases, deformities and injuries of the spine and limbs. Our department has proven to be one of the best in the world in patient care, research and education. As we move into our second century, we will continue to pursue excellence and improve upon our traditions. The 2nd Century Campaign has been started to ensure continuation of philanthropy and support of the Department. By October, we were able to raise millions of dollars. This number continues to increase through private support. In line with our vision of continuing to be a leader in Orthopaedic Surgery, we expect the addition a new free standing Orthopaedic Department Building at the Iowa River Landing Site in the next 5 years to further our ability to care for patients. This building will include clinic, office, and operating room space.
Department leadership has also transitioned. Shortly after the 100 year celebration Dr. Joseph Buckwalter announced his resignation of the Chairmanship. As the University finalizes the nation-wide chairman search, Dr. John Lawrence Marsh has taken the intern chair position.
J. Lawrence Marsh MD is a tenured professor in the Department of Orthopedic Surgery at the University of Iowa Hospitals and Clinics. He is the Carroll B. Larson Chair and serves as the Program Director of the Orthopedic Residency Training Program. He received his BA from Colgate University, his medical degree from Upstate Medical Center in Syracuse, New York and trained in orthopedic surgery at Boston University. After the completion of his training he served for two years as University Lecturer in orthopedic surgery at Oxford University in Oxford, England.
Dr. Marsh's clinical practice is devoted to orthopedic trauma and adult reconstruction and he has developed techniques of minimally invasive articular fracture surgery. His research has focused on articular fractures and techniques of image analysis to assess the mechanical factors leading to post traumatic osteoarthritis. He has also been instrumental in initiatives that have led to new requirements for laboratory-based surgical skills training for orthopedic residents and his research in this area has led to new skills assessments and validated skills training techniques. His research has been funded by the NIH, OTA, Arthritis Foundation, AO and by NBME. He and his co-authors were recipients of the 2011 OREF clinical research award for their work on Post Traumatic Osteoarthritis. He is the author of more than 140 peer-reviewed publications on various topics in orthopaedics and trauma.
Dr. Marsh currently serves as the Chair of the Residency Review Committee for Orthopedic Surgery and is a member of the ACGME's Council of Review Committee Chairs. He is a Director for the American Board of Orthopedic Surgery and Chair of the Oral Examination Committee. He is a member of the National Board of Medical Examiners and is the incoming President of the Mid-American Orthopedic Association and American Orthopaedic Association. He has served the AOA as an ASG travelling fellow and has been Chairman of the Fellowship Coordinating Committee, the ASG committee and the CORD Assessment Tools committee and as a member of the Academic Leadership Committee and is currently the incoming President.
Conclusion
Alumnus Dr. William Robb III summed the department vision well, “The next 100 years will be even better than the first.” Our department has many great strengths and rich heritage. We have seen the University of Iowa Hospitals and Clinics thrive as a premier medical center with a tradition of excellence in academic orthopaedics; outstanding, world-renowned faculty; and one of the strongest orthopaedic residency programs in the United States, with an enviable basic translational and clinical research program. Now, more than ever, with the evolving landscape of the healthcare in this country, we are embracing the new challenges for the opportunity to lead advances in the care of patients with musculoskeletal disorders.
The Future of Iowa Orthopaedics and Rehabilitation: A Vision from Departing Chairman, Joseph A Buckwalter
The University of Iowa Department of Orthopaedics and Rehabilitation is a unique institutional resource as well as an international leader in providing superlative care, unsurpassed education and scholarship and leadership of regional, national and international professional and scientific organizations. The department has many great strengths including a heritage of over 100 years of excellence in academic orthopaedics, an outstanding faculty, one of the premier orthopaedic residencies in the United States and enviable basic translational and clinical research programs. Changes taking place in the healthcare environment are creating opportunities for the department to build on its strengths and have an even larger role in advancing the care of patients with musculoskeletal disorders and the position of the UIHC as a premier medical center. To accomplish this goal the Department needs to pursue a series of new initiatives while maintaining its fundamental values.
Changes in the Health Care Environment that Affect Orthopaedics and Rehabilitation
The health care environment is changing at an increasing rate. Important drivers of change in the current environment are the growth of large integrated health systems and changes in the compensation for health care including ACOs and integrated health systems. There are demands to demonstrate the quality of care while decreasing costs. It is essential that institutions such as ours improve the access for patients and the convenience of patient care. We must excel on publicly available comparisons of hospitals and individual physicians. At the same time there is clearly going to be a continually increasing demand in North America for musculoskeletal care driven by raising patient expectations of life long pain free mobility, the aging of the population and new technology. For at least the next two decades demand for the spectrum of orthopaedic services, in particular; joint replacements, treatment of musculoskeletal injuries including fragility fractures and treatment of spinal disorders will increase as much as 50%. At the same time that the department adapts to these changes and identifies and takes advantages of opportunities created by transitions in the health care environment, the department must take new approaches to funding its essential missions in patient care, teaching and research.
Departmental Initiatives to Insure the Future Success of Iowa Orthopaedics and Rehabilitation
The most critical initiative for the immediate future is improving patient access and convenience while meeting the needs for increased musculoskeletal services and doing so in a cost efficient fashion. Specific strategies including efficient and appropriate use of mid-level providers and integration of comprehensive musculoskeletal care with primary care providers that excel in treating common musculoskeletal conditions that do not need surgical care including back pain, shoulder and knee pain. It is clear from the experience of other institutions and the experience in musculoskeletal oncology at Iowa that multidisciplinary teams can improve quality and efficiency of care. Such teams would include orthopaedists, internists and anesthesiologists who provide care for patients with fragility fractures and multiple serious musculoskeletal injuries as well as patients with musculoskeletal complications of diabetes and patients with pediatric disorders. Better integration of musculoskeletal care with critical ancillary services including imaging, physical therapy, electrodiagnostics and sophisticated treatments of chronic pain will further enhance the quality of care and its efficiency.
There are great opportunities for Iowa Orthopaedics and Rehabilitation to help define and demonstrate the quality and cost efficiency of musculoskeletal care. Members of the department working with members of the hospital administration and investigators in other departments are making progress in using the electronic medical record to help define the true costs of care as well as the outcomes of care relative to cost. These strategies will yield many benefits for the department and the hospital. Efficient use of these records and other strategies will help the department excel on publicly distributed measures of quality including patient satisfaction and patient based outcomes. A critical component of the department's initiatives to improve care is the support of new clinical initiatives and technologies. Orthopaedics has a wide range of such potential initiatives and technologies including new approaches to minimally invasive and image guided surgery, new biologic and surgical treatments of osteoarthritis, musculoskeletal injuries and deformities.
The department has a long and impressive heritage of basic and translational research, but in the future these research efforts will need to be more clearly focused on specific diseases that have significant impact on the population. Such disorders include osteoarthritis, musculoskeletal injuries and spinal disorders. The department basic and translational research program must emphasize translation of discoveries in biology and bioengineering and to advances of care and potentially new devices and products that will be of value to patients and the institution. Accomplishing these changes in basic and translational research will require a new approach, a virtual musculoskeletal research center. Such a center will facilitate collaboration with investigators in other departments and colleges at the University of Iowa, facilitate focused grant proposals that build on the University of Iowa strengths and lead to new and innovative departmental research directions. This new structure will require recruitment of scientific leaders to replace the senior faculty who have served well in this capacity in the past.
The department also has a long heritage of ground breaking clinical research, however, the field of clinical research is also changing rapidly. The department, to maintain its role in clinical research, will need to invest in department and institutionally support cost value and outcomes research expertise and capacity. The department has initiated with a series of faculty in participation in prospective national and international studies. These studies will shape clinical practice in the future. The department needs to ensure that our faculty continue to be leaders in these efforts such as the multi-center orthopaedic outcomes network, the high value of health care collaborative, the American College of Surgeons National Quality Improvement Program and others.
One of the critical functions and missions in the department is providing outstanding education for future generations of orthopaedic surgeons. Resident education needs to change to prepare residents to adapt to the changes in the healthcare delivery system and to understand and participate in efforts to demonstrate quality and improved efficiency while decreasing costs. The department is a leader in improving surgical skills education which helps accomplish all of the goals.
Central to the success of these aims is taking new approaches to funding departmental missions. The department has recently established a Finance Committee that is taking a very aggressive yet thoughtful approach to strengthening the department's financial base. Among the initiatives the committee needs to pursue and is beginning to do so effectively are decreasing expenses within the department and decreasing hospital expenses to improve hospital revenue as well as departmental revenue. Among the specific strategies are adoption of voice recognition software and reassigning support staff to areas of the department where there is a need for improved efficiency. Perhaps the most important change needed for the department is a new facility for ambulatory orthopaedic and rehabilitation clinical services. As has been documented in an extensive study and site visits to other academic orthopaedic centers, the department's clinic facilities are decades out of date in terms of patient convenience and provider efficiency. They also have problems with poor access and inefficient patient flow through the clinics, imaging and physical therapy. In every other academic orthopaedic department where a modern facility has been constructed the patient and provider satisfaction has dramatically improved, cost efficiency has improved and revenue generation has increased dramatically. In addition, the department needs to continue to refine the faculty practice plan to recognize and reward academic excellence, high quality efficient patient care and the development of new and productive clinical services.
During this time of change and department approach, the faculty, staff and residents must concentrate their energies and efforts on the enduring missions of the department while adapting to change and recognizing and taking advantages of important opportunities to strengthen the department and institution. Among the most critical elements in accomplishing the goals and initiatives outlined above, we will continue to attract talented students, residents, faculty and staff and give people an opportunity to develop their careers and make contributions to the advancement of the department and the institution. The department's vision and commitment shared by faculty, residents, staff, nurses and alumni will ensure that the future of Iowa Orthopaedics and Rehabilitation will be better than the past.