The world’s shoulder and elbow surgeons have more in common than they might think. And William Levine, MD, believes that realization could change how the specialty operates.
At an international gathering in Vancouver in September, leaders from more than 25 shoulder and elbow societies compared the challenges facing their surgeons. They came from countries with different healthcare systems, resources and approaches to medicine. Yet the conversation kept circling back to the same concerns: declining reimbursement, government intervention, limited resources and access to specialized care.
For Dr. Levine, the similarities were as striking as the differences.
“Everybody’s facing the same challenges,” he told Becker’s. “Sometimes you get so myopic in your thinking.”
The experience helped crystallize an ambition he is now positioned to pursue as the seventh president of the International Board of Shoulder and Elbow Surgery: transforming an organization best known for overseeing a congress every three years into a more active force connecting surgeons, exchanging expertise and potentially advocating for the specialty worldwide.
Dr. Levine, chair of orthopedic surgery at New York City-based Columbia University and orthopedic surgeon-in-chief at NewYork-Presbyterian/Columbia University Medical Center, will serve through 2032.
A legacy worth rethinking
The international shoulder surgery community was considerably smaller when its first congress convened in London in 1980, drawing just 70 surgeons. Attendance grew to 200 in Toronto in 1983 and doubled to 400 in Fukuoka, Japan, in 1986.
Charles Neer, MD, a pioneer of modern shoulder surgery and founder of Columbia’s Shoulder Service, brought the meeting to New York in 1989. As the congress grew, so did the need for a permanent governing structure. In 1992, Dr. Neer became the founding president of the International Board of Shoulder and Elbow Surgery, establishing a framework to oversee the recurring meeting and select future host cities.
The structure reflected the specialty’s geography at the time. Nine board seats and 25 voting delegates were distributed among regions, with North America and Europe receiving substantial representation.
Over the following decades, shoulder and elbow surgery evolved into a far more globally connected field. Its governing framework, however, remained largely rooted in those early arrangements.
Louis Bigliani, MD, another prominent Columbia shoulder surgeon and one of Dr. Levine’s predecessors, helped formalize the organization’s bylaws and financial structure during his presidency.
Dr. Levine now wants to take that evolution further. Within weeks of assuming office, he began overhauling the bylaws, including plans to expand the board from nine to 11 members and voting delegates from 25 to 35. The changes are intended to give growing shoulder and elbow communities a more meaningful voice in decisions that shape the field.
But expanding representation is more complicated than adding seats. Who represents Asia when its shoulder societies span countries with vastly different populations, resources and clinical traditions? How should Latin America’s many professional organizations select their representatives? Those questions, Dr. Levine said, are already prompting conversations that the organization has not previously approached with the same degree of formal deliberation.
“We’ve really tried to democratize, standardize and globalize the organization,” he said.
The changes also reflect a broader philosophy: An international organization should do more than bring established leaders together. It should ensure the next generation, including surgeons practicing far from traditional centers of influence, has a place in shaping the specialty.
What the U.S. can learn from the rest of the world
Dr. Levine sees international collaboration as more than an exercise in professional diplomacy. It can challenge assumptions about which surgical techniques, technologies and approaches deserve attention.
Surgeons working in resource-constrained environments often develop solutions that differ from those used at major American academic centers. Limited access to equipment or infrastructure can demand creativity without diminishing the importance of outcomes.
Clinical experience also varies considerably by region. In parts of Asia, for example, surgeons encounter less shoulder arthritis than their counterparts in North America and Europe, Dr. Levine said. But they treat substantial volumes of rotator cuff disease and shoulder instability, developing expertise shaped by a different mix of clinical conditions and procedures.
Those differences create opportunities for surgeons to learn from expertise developed under circumstances unlike their own. Surgeons around the world often approach the same clinical problems from different perspectives, Dr. Levine said.
The implications extend beyond surgical technique. At the Vancouver congress, younger surgeons described the value of meeting colleagues from Bangladesh, Poland and other countries, discovering different clinical perspectives alongside familiar professional concerns.
For Dr. Levine, those relationships are part of what makes a global organization valuable. A difficult case in one country may be routine elsewhere. A problem that appears unique to one healthcare system may already have prompted an effective response in another. The challenge is creating a way for those exchanges to continue long after the congress ends.
A bigger role between meetings
One of Dr. Levine’s priorities is to make the organization useful to surgeons throughout the year, rather than primarily during its triennial congress.
A newly developed IBSES website is intended to support international case discussions, allowing surgeons to share difficult clinical scenarios and seek perspectives from experienced colleagues around the world. A surgeon in Cairo, for instance, could eventually present a complex shoulder or elbow case and receive input from specialists practicing under different healthcare systems.
The organization is also exploring grants to help younger surgeons attend international meetings, particularly those who might otherwise lack the resources to participate.
Meanwhile, Dr. Levine wants to bring greater continuity to the congress itself. Future organizing committees should be able to build on established processes instead of repeatedly starting from scratch, he said, leaving more time to develop meaningful scientific programming and recruit a genuinely international faculty.
That last priority is particularly important to him. As a co-chair of the 2026 congress, Dr. Levine helped assemble what he described as its most internationally diverse faculty to date. The effort was intentional: Rather than relying primarily on familiar colleagues in North America and Europe, organizers sought expertise across a wider range of countries.
He wants that approach to become part of the institution’s expectations. Yet the most consequential possibility may lie beyond education and professional networking. During the Vancouver meeting, society presidents discussed challenges extending from reimbursement and government policy to access to specialists and the question of whether shoulder and elbow surgery needs more clearly defined subspecialty certification.
But he believes it could provide something the specialty has historically lacked: a place where those problems can be examined collectively.
Dr. Levine is careful not to overstate what the organization should undertake. He does not want its mission to expand indiscriminately, nor does he suggest that a global board could resolve the policy disputes facing individual countries.
But he believes it could provide something the specialty has historically lacked: a place where those problems can be examined collectively. His goal is to position IBSES as “a sounding board and as a board of advocacy” for shoulder and elbow communities around the world.
It is an ambition still taking shape, but one informed by an increasingly apparent reality: The challenges facing surgeons are often international, even when the policies creating them are local.
What comes after the pioneers
Dr. Levine’s presidency will span the next two international congresses, in Cairo in 2029 and Australia’s Gold Coast in 2032. By then, he hopes IBSES will have become more than a meeting organizer, with stronger international collaboration, broader representation and greater opportunities for younger surgeons.
He also wants more women represented among the organization’s delegates and board members, reflecting the growing number of women leading shoulder and elbow societies worldwide.
Following in the footsteps of Columbia predecessors Drs. Neer and Bigliani, Dr. Levine sees preserving their legacy as a responsibility to advance it, not simply maintain it.
“I don’t think we should look at this as a honorific thing to put on your CV,” he told fellow board members. “I want you to come to work. I want you to be prepared. I want you to challenge me and challenge this organization.”
Three decades after Dr. Neer helped establish the international shoulder community’s governing body, Dr. Levine wants to give it a broader purpose. The question is no longer simply where the world’s shoulder surgeons will meet next, but what they can accomplish together between meetings.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
