Tom Grogan, MD
First and foremost, I am a country doctor living in the gentrified urban sprawl of Santa Monica, California. I am also an orthopedic surgeon, trained at UCLA with three subsequent fellowships in Pediatric Orthopedics, Adult Reconstruction, and Trauma. I have been in practice for over 23 years and have seen just over 34,000 new patients in my current office. It has been an interesting, if not amazing life journey.
After finishing at UCLA, I pictured myself as always being an academician. After my fellowships I came back to Los Angeles to be on the faculty at UCLA with my position as the assistant chief of staff at Shriner’s Hospital Los Angeles. After enjoying several years of working at Shriner’s doing thousands of operative cases, I realized that what I truly loved about medicine was not the surgery, but the interaction with patients and the thrill of having a positive impact on my patient’s lives. I truly loved to be able to help guide a patient through the pain and disruption an injury or illness could cause to watch them overcome the obstacles and feel better. In short, I craved the thrill of improving patient’s lives.
I also began to appreciate what patients needed and wanted in their doctor. First they want access. They want to be able to pick up the phone and talk to someone who cares about their problem. They do not want to talk to a phone answering tree. My receptionist is my first contact with a huge majority of patients. She is a single mom, who happens to also be an ex-model and airline flight attendant. She understands customer service and is very easy for the parents to relate to and trust. I have found patients want someone who is knowledgeable, thoughtful, and respectful of them as individuals. Above all, they want to learn about themselves, why did this injury happen – how can we prevent it in the future. Patients are sponges when it comes to medical information that they consider relevant. Instead of dictating or lecturing to them about what they should or should not do, I find myself acting as a life “coach” teaching and explaining issues on a level they understand.
This was not how I was trained. Our program at UCLA was about the Attending balancing research, patient care, and teaching residents. Our attendings typically saw patients in clinic one day a week and operated one day a week. They never fielded phone calls from patients or spent time explaining options. Their goal was to run the service as the captain and delegate to junior attendings and residents the patient care responsibilities.
I evolved into my current solo practice over many years spent finally understanding that my greatest asset to my practice was my patients, as opposed to me being theirs. I shaped my practice to be available, able, and affordable to my patients. I realize that they come into my practice to see me, not a PA or cast tech. I listen to them, learn from them, and hopefully improve their lives. I understand that the highest form of praise is for them to refer family and friends to me. I came to see third party payers (including Medicare and Medicaid) as an impediment to my caring for my patients so I dropped off all plans over 5 years ago. At first, there was a drop in the rate of new patients in the practice, but now I am seeing more than ever. Patients find a way to see me – lots are on payment plans over time. If a patient can not afford to pay, I give them services for free. In fact I give away on average 15% of my time for free. Yet these patients are some of my greatest referrers – if a child goes down on a soccer field my mane flies out. My collection rate is close to 96%. I take care of my patients and they take care of me.
Over the years I have finally learned that patients are not just what I need to generate cases for my practice, my patients are my practice. I wouldn’t have it any other way.
After finishing at UCLA, I pictured myself as always being an academician. After my fellowships I came back to Los Angeles to be on the faculty at UCLA with my position as the assistant chief of staff at Shriner’s Hospital Los Angeles. After enjoying several years of working at Shriner’s doing thousands of operative cases, I realized that what I truly loved about medicine was not the surgery, but the interaction with patients and the thrill of having a positive impact on my patient’s lives. I truly loved to be able to help guide a patient through the pain and disruption an injury or illness could cause to watch them overcome the obstacles and feel better. In short, I craved the thrill of improving patient’s lives.
I also began to appreciate what patients needed and wanted in their doctor. First they want access. They want to be able to pick up the phone and talk to someone who cares about their problem. They do not want to talk to a phone answering tree. My receptionist is my first contact with a huge majority of patients. She is a single mom, who happens to also be an ex-model and airline flight attendant. She understands customer service and is very easy for the parents to relate to and trust. I have found patients want someone who is knowledgeable, thoughtful, and respectful of them as individuals. Above all, they want to learn about themselves, why did this injury happen – how can we prevent it in the future. Patients are sponges when it comes to medical information that they consider relevant. Instead of dictating or lecturing to them about what they should or should not do, I find myself acting as a life “coach” teaching and explaining issues on a level they understand.
This was not how I was trained. Our program at UCLA was about the Attending balancing research, patient care, and teaching residents. Our attendings typically saw patients in clinic one day a week and operated one day a week. They never fielded phone calls from patients or spent time explaining options. Their goal was to run the service as the captain and delegate to junior attendings and residents the patient care responsibilities.
I evolved into my current solo practice over many years spent finally understanding that my greatest asset to my practice was my patients, as opposed to me being theirs. I shaped my practice to be available, able, and affordable to my patients. I realize that they come into my practice to see me, not a PA or cast tech. I listen to them, learn from them, and hopefully improve their lives. I understand that the highest form of praise is for them to refer family and friends to me. I came to see third party payers (including Medicare and Medicaid) as an impediment to my caring for my patients so I dropped off all plans over 5 years ago. At first, there was a drop in the rate of new patients in the practice, but now I am seeing more than ever. Patients find a way to see me – lots are on payment plans over time. If a patient can not afford to pay, I give them services for free. In fact I give away on average 15% of my time for free. Yet these patients are some of my greatest referrers – if a child goes down on a soccer field my mane flies out. My collection rate is close to 96%. I take care of my patients and they take care of me.
Over the years I have finally learned that patients are not just what I need to generate cases for my practice, my patients are my practice. I wouldn’t have it any other way.
Tom Grogan, MD
Dr. Grogan is a board certified practicing pediatric orthopedist in Santa Monica. He graduated cum laude from Princeton and received his medical degree from the University of Cincinnati. He did his orthopedic residency at UCLA and also completed fellowships in pediatric orthopedics, trauma, and an NIH sponsored joint replacement fellowship. Following training, he returned to LA where he spent 6 years at Shriner's Hospital for Crippled Children, including 2 years as Assistant Chief. In addition to clinical practice, he has been a managed care consultant and has developed special expertise in this area. He collaborated with the AAOS in the development of a handbook and audiotape entitled, "Health Care Reform and Managed Care: A guidebook for Orthopedic Surgeons". In addition, he has served as the lead faculty member for the AAOS for their 1995 educational seminar, "Taking Charge: Managed Care Contracting for Orthopaedic Surgeons", and he served as a faculty member for the AAOS 1996 seminar series, "Winning at Risk; The Interplay of Cost, Quality, and Access in Orthopaedic Practice". Currently, he is on the AAOS Practice Management Committee and will serve as chairman for the next 2 years.
Karl Koenig, MD, MS
Dr. Koenig is an Assistant Professor of Orthopedic Surgery at Dell Medical School, and he leads the Integrated Practice Unit for Osteoarthritis and works in developing Integrated Practice Units for other musculoskeletal conditions. He also serves as Residency Program Director and leads the initiative to improve access to musculoskeletal care for Austin’s underserved population. Clinically, he specializes in treatment of hip and knee arthritis.
After receiving his undergraduate degree at the MIT, he attended medical school at the Baylor College of Medicine. Dr. Koenig went on to complete his residency at Dartmouth-Hitchcock Medical Center in Orthopedic Surgery and fellowship training for Adult Reconstruction at Stanford University Medical Center. He is also a graduate of the Dartmouth Institute for Health Policy and Clinical Practice, where he began his work on patient outcomes and cost-effectiveness research. Prior to joining the faculty at Dell Medical School, Dr. Koenig led the Division of Adult Reconstruction at DHMC for 5 years and was one of the architects of the GreenCare Pathway, a sweeping quality improvement initiative to create a self-improving microsystem around total joint replacement.
Throughout his career, he has worked to improve musculoskeletal care for patients through a health care climate that can often be described, at best, as difficult and dysfunctional. Like all of us, he believes that the existing paradigm must change in order to create value-based, person-centered ways to care for patients.
He has devoted much of his career to patient care and health care system reform. He is a native Texan who grew up uninsured, and that perspective has helped shape every facet of his medical training and patient care. He focused the early years of practice on building an evidence-based treatment pathway for hip and knee osteoarthritis called GreenCare. It’s based on prospective data collection, shared decision-making, and assessment of patient-reported outcomes, all aligned to build upon each other and create a self-improving microsystem.
Alexandra Page, MD Dr. Page works on healthcare delivery and policy with a specific interest in high-value healthcare. She serves as Chair of the Health Care Systems Committee of the AAOS and vice-chair of the AAOS Board of Specialties Communications Committee. Dr. Page’s work beyond orthopaedics includes serving on the Harvard Medical School Health Policy Advisory Committee and as a clinical consultant to the West Health Institute, a think-tank working to improve healthcare value.
Dr. Page has an interest in health care disparities, working locally as a member of the leadership team and providing direct patient care through Project Access San Diego, a safety net health system, and nationally with the Ruth Jackson Orthopaedic Society.
She serves as the AAOS representative to the AMA, the US Bone and Joint Initiative Chronic Osteoarthritis Management Initiative, and the Intersocietal Accreditation Committee MRI section. In California, Dr. Page serves on the board of the San Diego County Medical Society and as a voting delegate to and Council on Legislation member of the California Medical Association (CMA).
After an undergraduate degree in mechanical engineering from the Massachusetts Institute of Technology, Dr Page graduated cum laude from Harvard Medical School. She completed her orthopaedic residency at the Hospital for Special Surgery in New York City, followed by a Foot & Ankle fellowship jointly at the Hospital for Special Surgery and Roosevelt Hospital. Dr. Page maintains a full-time clinical practice in San Diego with a large integrated care system (Kaiser Permanente).