Dr. Miller, who was named chair of orthopedics at the Lebanon, N.H.-based health system in January, spoke with Becker’s about her plans in the role and trends in the specialty she’s following.
Note: This conversation was lightly edited for clarity.
Question: What are some interesting trends in trauma surgery that’s going on right now that excite you?
Dr. Anna Miller: There’s always a lot of exciting changes. In orthopedic trauma and in orthopedics in general, there’s a lot of innovation. One of the biggest things that is changing in our field is how artificial intelligence is going to affect our work in the future. I think there’s been a lot of talk about using AI for diagnosis and looking at radiology, but I think there’s a lot more investigation now on how AI is going to help our patients get information. How are we going to interface with our patients? Is it going to change how we bill and code? Could it improve treatment? There’s a lot about AI that we’re just really starting to scratch the surface there.
Orthopedics has also been one of the front-running specialties in robotics. A lot of places are already doing a lot of joint replacements using robotics. I think that will continue to expand, potentially to all of our fields of orthopedics, and maybe even with robots that have increasing autonomy in the future. There has also been a lot more focus now on customized implants. Other fields of medicine have a lot more customization, like customized medications and treatments, so we may delve into that in the future. But customized implants are a big potential focus for orthopedics, and we in orthopedic trauma have not traditionally had a lot of customized implants, so that may be an area for future growth.
Overall, in healthcare things are changing. We have a lot of headwinds in front of us. So thinking about how we deliver care and how we take care of our patients on a bigger picture level is another big change that’s coming, especially with our recent changes from the federal government potentially changing the landscape significantly.
Q: To what extent do you see 3D-printed models playing a role in orthopedic trauma’s future?
AM: Traditionally, we have used the same implants for every patient no matter how tall or short they are, whether they’re male or female, or how big their bones are. We have a set group of implants that we can use, and not every implant fits every patient. I think having the ability to do some customization in the future will be really important if we can get that speedy turnaround. Three-dimensional printing will come in handy, but how that will apply I don’t know, until we can really scale that up to get it done very quickly.
We currently use 3D printing more for preoperative planning in very complex cases, and usually those are ones that are not urgent. They’re ones that either the patient has, for example, a tumor, or they grew their bone incorrectly from a prior surgery or injury, or they have an unusually shaped bone. Then printing can be used to model how we’re going to fix that patient and how we’re going to change what surgery we do. But currently, as far as I know, there are no places that have the ability to do emergency 3D printing to get that implant availability.
Q: What are your goals for your new role at Dartmouth Health and its orthopedics program?
AM: One of my big goals is to create a musculoskeletal institute, and we have talked with leadership about this. This is the kind of thing that’s happening all across the country – having more focused institutes that can really provide patients the entire spectrum of musculoskeletal care in one place. So that is a huge long-term mission.
In the shorter term, we’re working on improving our patient care flows, having more patient-reported outcomes measured, having the ability to evaluate and treat each of our patients individually and really catering to what they need. But within Dartmouth Health, there has been a long history of doing a lot of work and research with public health and overall patient trends in the community, and I want to keep working on that and build on the amazing work Dartmouth Health has done in the past for patient population outcomes.
Q: What are some most important metrics that you want to measure to make sure this musculoskeletal Institute is monitoring, not only for patient reporting reported outcomes, but also in terms of population public health?
AM: With a musculoskeletal institute, one of the biggest things is that we as orthopedic surgeons have our bias that we want to focus on the surgery. But we really want to look at the big picture of the musculoskeletal health of the patient, and a lot of that is chronic disease management when it comes to things like osteoporosis and prevention. It will be really critical to involve all of the aspects of health care for these patients, including things like endocrinology or bone health, to make sure that we’re treating the osteoporosis and getting our physical therapy and our physical medicine colleagues involved for post operative management and preventative treatment. We also want to make sure to focus on other components of the whole patient, including mental health, trauma-informed care, and other socioeconomic disparities. We have a significant focus on the entire patient experience here at Dartmouth Health, so I want to work on integrating those things into the center.
Q: Orthopedics is a largely male dominated field. Can you share more about your experience as a woman in the field and where you see the specialty improving in terms of diversity and where you think things could be more improved still?
AM: In a field like this with so few women, I have been really lucky to have great mentors. And most of my mentors have been men. They all supported me along the way as an orthopedic surgeon, and not just as a female orthopedic surgeon. I really wanted to try my best to not be thought of just as the female orthopedic surgeon as I have progressed in my career. I realized that there definitely are still barriers for women in orthopedics, and I have also worked hard to really try to support my female colleagues and our female medical students, residents and fellows to make sure that everybody is getting opportunities equally.
One of the things that we need is just to have more people who are a minority in any way, whether that is gender or race or sexuality, etc., on staff because the more diversity we have, the better our workforce will be. At this point, unfortunately, orthopedics is pretty far behind most other fields in almost all of those categories. I think there has been a real recognition in our field that we are behind. One of the biggest things is not only to recruit people, but to embrace the diversity once they arrive, and to really see the benefits of having those diverse groups by supporting them to thrive.
Q: Are there any interesting programs or initiatives going on at Dartmouth Health right now, or anything that you’re planning to bring to the department?
AM: I was very excited to learn that we have some connection with the Ruth Jackson orthopedic society, which is one of our women in orthopedic societies that was started by one of our surgeons here, Frances Faro, MD. Because of that connection, I think we’re going to have the ability to start building more opportunities to get women involved in orthopedic surgery. One of the things that is really different for me since my move is that this is a much smaller geographic and population area than where I came from. The idea that we can actually connect throughout New England is really exciting for me. We can include all the states around us and really bring diverse groups from a lot of areas to help build those programs.
Q: What is the state of outpatient orthopedic surgery at Dartmouth? What direction do you see going with that health system?
AM: They are already doing a lot of procedures as outpatients here in our system, and some of our arthroplasty partners in particular have really pushed that to improve the outpatient surgery numbers. I think that will be a big focus in the future with the musculoskeletal institute. Just as many hospitals do across the country, we have some issues with having a shortage of beds for all of the volume of patients who need to be taken care of. So having the ability to safely do outpatient surgery in more and more areas will be really important in the future for us. I see further innovation throughout all subspecialties of orthopedic surgery in this area as we look ahead.
