Dr. Butkovich discusses his hopes for building a sports medicine program, his work with professional athletes and the need for orthopedic surgeons to address aging population's needs.
Q: What attracted you to the fields of orthopedics and sports medicine?
Dr. Bradley Butkovich: I was attracted to sports medicine as a direct extension of my involvement in collegiate sports. I enjoyed the lessons and experiences through athletic competition. I wanted to continue to associate myself with that environment and retain that athletic mindset as my playing days were over. Furthermore, I have always enjoyed the challenge of tackling something that was in disarray and essentially "putting humpty dumpty back together again," whether it be a play-set that needed to be built or a complex fracture that needed to be repaired.
Finally, the field of sports medicine encompasses a significant amount of arthroscopy, and I have thoroughly enjoyed using that tool as it requires a certain technical skill to perform and years to master. I take every opportunity to apply arthroscopy to multiple surgical situations. I liken it to at times tackling a complex video game, whereby you complete the ACL reconstruction to perfection or repair a rotator cuff with success and efficiency.
Q: What is the biggest challenge you are currently facing as an orthopedic surgeon?
BB: One of the biggest challenges I am facing within the next year is implementing and building a successful sports medicine practice from the ground up. The coordination and logistics of such an undertaking seems significant, but it is certainly feasible and I am excited about it coming to fruition in the future. I envision having a destination orthopedics sports medicine practice for the Virginia Beach, Norfolk and Hampton Roads Area, that will be regionally recognized.
I see it encompassing surgical and non-surgical care, sports medicine specific therapy, performance enhancement and collaboration with the other sports medicine doctors at Atlantic Orthopaedic Specialists and the affiliated hospital systems to create a sports medicine institute to address every patient from the working man to the professional athlete. Atlantic Orthopaedic Specialists is currently established in the Norfolk City school system, and many other private and public schools in Virginia Beach, Norfolk and Chesapeake. We currently are the team physicians for Old Dominion University, Norfolk State University and the Norfolk Tides.
To add to that I have a close relationship with the Washington Redskins; I have participated in the NFL Combines over the past eight years. I am currently participating in training camp in Richmond. We are in the infancy stage of helping to train sports medicine fellows in affiliation with ODU and Orthopaedic Research of Virginia. At some point, we hope to begin implementing scientific research in the practice. All of these initial steps will be built on in the next year and expanded to provide superior sports medicine care for our community.
Q: How has sports medicine changed since you first began to practice?
BB: Sports medicine has certainly become even more specialized since I started to practice. In the past few years sports medicine has become one of only two subspecialties in orthopedics in which one is able to attain specific board certification, the other specialty being hand surgery. This has benefitted patients and the medical community for a number of reasons. In the past, many doctors could call themselves sports medicine doctors, but not have any formal sports medicine training recognized by the American Board of Orthopaedic Surgery. Now, to attain sports medicine board certification a physician must complete fellowship training in an accredited program, sit for a board exam separate from the general orthopaedic board exam and submit specific sports medicine surgical cases.
This change assures that the sports medicine doctor you are seeing for a sports injury has the appropriate training and skill set to manage those specific sports-related cases and surgeries. In my experience, this has been increasingly apparent in the caliber and quality of surgical cases performed on athletes I see yearly at the NFL Combines through my work with the Washington Redskins. It is remarkable at the change even in the past two years how much better the outcomes of certain surgical procedures including ACL reconstructions, shoulder instability surgeries and various arthroscopic procedures have resulted in full return to function and very little residual issues for the athlete participating in the Combines.
Outside of that, sports medicine continues to push the envelope with arthroscopy, cartilage regeneration and repair and constant vigilance in making good and reliable surgical procedures better. Examples of this include: recent advances and use of single incision arthroscopy. Cutting edge cartilage regenerations techniques in which we can use a patient's own cartilage cells to grow new cartilage and repair a defect. There are even researchers pushing the envelope to develop arthroscopic joint replacement.
Q: How was your experience working with professional athletes contributed to the way you practice?
BB: Working with professional and collegiate athletes has enhanced my practice on a personal level in the satisfaction I receive from getting an athlete with a significant injury back on the field and performing as well as he or she did in the past. Furthermore the knowledge, freedom and 24/7 attention that these athletes receive provide an exceptional environment to utilize cutting edge treatments, improve performance and push the envelope to full recovery. This knowledge can then be applied to my everyday practice and my patients can benefit from these same forward looking ideas that we use with high-performance athletes.
Q: What do you think is the most important issue for orthopedic surgeons to focus on during the next year?
BB: In the next year and beyond, I think the biggest challenges facing orthopedics is the growth of the aging population and finding the manpower to address the needs of that growth. The number of retired persons over the age of 65 is projected to double in the next five years and triple in the next 10 to 12 years. Like other specialties, we do not expect to have enough orthopedic surgeons to care for our active aging population.
To add to that, a significant number of aging orthopedic surgeons are expected to retire and/or leave medicine altogether for a myriad of reasons, including: the medical environment, Affordable Care Act and declining Medicare reimbursement. People are increasingly more active, living longer and as a result, we expect to be treating more people with injuries, fractures and arthritis who will likely require surgical intervention to be able to continue functioning.
There is no immediate answer to address these challenges other than to continue to work and do more for less. I fear patients will end up waiting longer for appointments and surgery, while spending less time per visit with their surgeon as well as dealing with the healthcare changes headed our way.
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