Naseem S. Miller

Multiple studies paint a picture of the continuing and projected shortage of general surgeons in the United States, especially in rural areas.

The number of general surgeons per 100,000 population dropped by 3.6% between 2004 and 2008, according to a 2010 study by the American College of Surgeons (ACS) Health Policy Research Institute. Projections by the federal Health Resources and Services Administration show that the number of general surgeons will drop by 3% between 2000 and 2020 from 33,980 to 31,880.

Additionally, the surgeon population overall is aging and retiring at a faster pace than new surgeons are entering practice, according to an analysis done by the ACS Health Policy Research Institute. Approximately one-third of all surgeons are older than age 55 years; the median age for rural surgeons is higher than for those who practice in urban areas.

Dr. Phil Caropreso, age 64, has been practicing in two small area hospitals in Keokuk, Iowa, for the past 13 years. Keokuk, a town of about 11,000 in the southeastern corner of the state, appeals to outdoors enthusiasts who enjoy hunting, fishing, golfing, and boating.

The only other general surgeon there retired, and Dr. Caropreso is now on call 24 hours a day, 7 days a week, for the two hospitals.

"Recruiting has almost been impossible," said Dr. Caropreso. "We’ve been advertising for the last 7 years in both [hospitals]." They have had recruitment services, placed ads in journals, talked with the residency director at University of Iowa, Iowa City, he said. Only a few people came to be interviewed. A couple of surgeons accepted the job, but left shortly thereafter.

"Surgeons today seem to prefer more urban areas; they want a different kind of work ethic. They’re trained differently. They now go into subspecialty surgery, and they don’t want to come here," he said.

Along with primary care physicians, general surgeons are a crucial component of the rural health care team, and they are essential to maintaining the financial health of the rural hospital, according to the Mithoefer Center for Rural Surgery in Cooperstown, N.Y. The center was established in 2004 to develop solutions aimed at benefiting rural citizens, rural surgeons, and rural hospitals.

"There’s a lot of information that shows that [rural surgeons are the] economic engine that maintains small rural hospitals," said Dr. David C. Borgstrom, the center’s codirector. "They’re the primary endoscopist for the community. They do a wide range of surgeries; they do obstetrics services, a bit of orthopedics," and other procedures, he added.

But many of today’s general surgeons are not as broadly trained as their colleagues were a decade or so ago, some surgeons say. Experienced rural general surgeons who can perform a wide range of procedures such as obstetrical, urological, and orthopedic procedures are becoming rare.

"I was trained in the ’70s and ’80s at [the then-Cook County Hospital, Chicago] where we were trained to do just about everything," said Dr. Arnold Serota, who until recently practiced general surgery in Kauai, Hawaii.

"The general surgery training back then was much different than it is now. In addition to routine general surgery – laparoscopic and open cases – I was doing trauma, critical care, placing pacemakers, esophagogastroduodenoscopies and colonoscopies, vascular surgery, and more," he said in an interview. "Now that I have left Kauai, there is no one person who can provide the services that I did." The scope of what more recently trained surgeons do is much more limited, he explained.

The economic and lifestyle preferences of the newer generation of medical school graduates also play into the rural surgeon shortage. According to a study by the Robert Graham Center, the policy arm of the American Academy of Family Physicians, "Growing physician income disparities are a major driver of student behavior. This income disparity explains much of the difficulty in achieving the balance in specialty and geographic physician distribution and will continue to inhibit achieving the workforce needed for better quality, efficiency, and equity."

The study adds that rural birth, interest in serving underserved or minority populations, and rural or inner-city training experience increase the likelihood of students choosing primary care or practice in rural and underserved areas.

This has been the case with Dr. Steve Olson, age 55, who grew up in rural Cooperstown, N.Y., where his father was a surgeon at the local hospital. "I’ve always liked practicing in rural environments and bringing new things to the rural areas," he said.

A resident of Bridgton, Maine, Dr. Olson does not maintain a private practice; instead, he is an employee of nearby Bridgton Hospital. Although he earns less than he would practicing in an urban area, that’s fine with him, he said in an interview. But with only one other surgeon in the area, Dr. Olson is on call every other night during week, and every other weekend. 

"If we had four surgeons, we’d have a really nice lifestyle," he said. "Nobody would be overburdened with calls."

There are programs that encourage and train young surgeons for rural practice, and the ACS continues to raise awareness about the shortage.

"Estimates show that there’s an increasing need to care for rural America, because of retiring rural surgeons. We are trying to fill those needs and to show why being a rural surgeon is a good thing," Dr. Borgstrom said in an interview.

But addressing the shortage of rural surgeons, given the lack of interest among young surgeons and the aging population of the existing ones, is multifaceted.

"It’s clear that our system doesn’t provide an easy way for surgical patients to access the appropriate level of care," said Dr. Olson, chair of the Rural Surgery Subcommittee and vice chair of the advisory council for general surgery for the ACS. "Solutions won’t come until major groups work together. Congress has to pass some laws on how health care is delivered, and physicians and health care organizations in rural areas need to really stand up and be part of that discussion. If we can establish a model on rural health care, we can make a difference."

Meanwhile, rural surgeons such as Dr. Caropreso continue their advocacy – and their search for colleagues.

Multiple studies paint a picture of the continuing and projected shortage of general surgeons in the United States, especially in rural areas.

The number of general surgeons per 100,000 population dropped by 3.6% between 2004 and 2008, according to a 2010 study by the American College of Surgeons (ACS) Health Policy Research Institute. Projections by the federal Health Resources and Services Administration show that the number of general surgeons will drop by 3% between 2000 and 2020 from 33,980 to 31,880.

Additionally, the surgeon population overall is aging and retiring at a faster pace than new surgeons are entering practice, according to an analysis done by the ACS Health Policy Research Institute. Approximately one-third of all surgeons are older than age 55 years; the median age for rural surgeons is higher than for those who practice in urban areas.

Dr. Phil Caropreso, age 64, has been practicing in two small area hospitals in Keokuk, Iowa, for the past 13 years. Keokuk, a town of about 11,000 in the southeastern corner of the state, appeals to outdoors enthusiasts who enjoy hunting, fishing, golfing, and boating.

The only other general surgeon there retired, and Dr. Caropreso is now on call 24 hours a day, 7 days a week, for the two hospitals.

"Recruiting has almost been impossible," said Dr. Caropreso. "We’ve been advertising for the last 7 years in both [hospitals]." They have had recruitment services, placed ads in journals, talked with the residency director at University of Iowa, Iowa City, he said. Only a few people came to be interviewed. A couple of surgeons accepted the job, but left shortly thereafter.

"Surgeons today seem to prefer more urban areas; they want a different kind of work ethic. They’re trained differently. They now go into subspecialty surgery, and they don’t want to come here," he said.

Along with primary care physicians, general surgeons are a crucial component of the rural health care team, and they are essential to maintaining the financial health of the rural hospital, according to the Mithoefer Center for Rural Surgery in Cooperstown, N.Y. The center was established in 2004 to develop solutions aimed at benefiting rural citizens, rural surgeons, and rural hospitals.

"There’s a lot of information that shows that [rural surgeons are the] economic engine that maintains small rural hospitals," said Dr. David C. Borgstrom, the center’s codirector. "They’re the primary endoscopist for the community. They do a wide range of surgeries; they do obstetrics services, a bit of orthopedics," and other procedures, he added.

But many of today’s general surgeons are not as broadly trained as their colleagues were a decade or so ago, some surgeons say. Experienced rural general surgeons who can perform a wide range of procedures such as obstetrical, urological, and orthopedic procedures are becoming rare.

"I was trained in the ’70s and ’80s at [the then-Cook County Hospital, Chicago] where we were trained to do just about everything," said Dr. Arnold Serota, who until recently practiced general surgery in Kauai, Hawaii.

"The general surgery training back then was much different than it is now. In addition to routine general surgery – laparoscopic and open cases – I was doing trauma, critical care, placing pacemakers, esophagogastroduodenoscopies and colonoscopies, vascular surgery, and more," he said in an interview. "Now that I have left Kauai, there is no one person who can provide the services that I did." The scope of what more recently trained surgeons do is much more limited, he explained.

The economic and lifestyle preferences of the newer generation of medical school graduates also play into the rural surgeon shortage. According to a study by the Robert Graham Center, the policy arm of the American Academy of Family Physicians, "Growing physician income disparities are a major driver of student behavior. This income disparity explains much of the difficulty in achieving the balance in specialty and geographic physician distribution and will continue to inhibit achieving the workforce needed for better quality, efficiency, and equity."

The study adds that rural birth, interest in serving underserved or minority populations, and rural or inner-city training experience increase the likelihood of students choosing primary care or practice in rural and underserved areas.

This has been the case with Dr. Steve Olson, age 55, who grew up in rural Cooperstown, N.Y., where his father was a surgeon at the local hospital. "I’ve always liked practicing in rural environments and bringing new things to the rural areas," he said.

A resident of Bridgton, Maine, Dr. Olson does not maintain a private practice; instead, he is an employee of nearby Bridgton Hospital. Although he earns less than he would practicing in an urban area, that’s fine with him, he said in an interview. But with only one other surgeon in the area, Dr. Olson is on call every other night during week, and every other weekend. 

"If we had four surgeons, we’d have a really nice lifestyle," he said. "Nobody would be overburdened with calls."

There are programs that encourage and train young surgeons for rural practice, and the ACS continues to raise awareness about the shortage.

"Estimates show that there’s an increasing need to care for rural America, because of retiring rural surgeons. We are trying to fill those needs and to show why being a rural surgeon is a good thing," Dr. Borgstrom said in an interview.

But addressing the shortage of rural surgeons, given the lack of interest among young surgeons and the aging population of the existing ones, is multifaceted.

"It’s clear that our system doesn’t provide an easy way for surgical patients to access the appropriate level of care," said Dr. Olson, chair of the Rural Surgery Subcommittee and vice chair of the advisory council for general surgery for the ACS. "Solutions won’t come until major groups work together. Congress has to pass some laws on how health care is delivered, and physicians and health care organizations in rural areas need to really stand up and be part of that discussion. If we can establish a model on rural health care, we can make a difference."

Meanwhile, rural surgeons such as Dr. Caropreso continue their advocacy – and their search for colleagues.

Multiple studies paint a picture of the continuing and projected shortage of general surgeons in the United States, especially in rural areas.

The number of general surgeons per 100,000 population dropped by 3.6% between 2004 and 2008, according to a 2010 study by the American College of Surgeons (ACS) Health Policy Research Institute. Projections by the federal Health Resources and Services Administration show that the number of general surgeons will drop by 3% between 2000 and 2020 from 33,980 to 31,880.

Additionally, the surgeon population overall is aging and retiring at a faster pace than new surgeons are entering practice, according to an analysis done by the ACS Health Policy Research Institute. Approximately one-third of all surgeons are older than age 55 years; the median age for rural surgeons is higher than for those who practice in urban areas.

Dr. Phil Caropreso, age 64, has been practicing in two small area hospitals in Keokuk, Iowa, for the past 13 years. Keokuk, a town of about 11,000 in the southeastern corner of the state, appeals to outdoors enthusiasts who enjoy hunting, fishing, golfing, and boating.

The only other general surgeon there retired, and Dr. Caropreso is now on call 24 hours a day, 7 days a week, for the two hospitals.

"Recruiting has almost been impossible," said Dr. Caropreso. "We’ve been advertising for the last 7 years in both [hospitals]." They have had recruitment services, placed ads in journals, talked with the residency director at University of Iowa, Iowa City, he said. Only a few people came to be interviewed. A couple of surgeons accepted the job, but left shortly thereafter.

"Surgeons today seem to prefer more urban areas; they want a different kind of work ethic. They’re trained differently. They now go into subspecialty surgery, and they don’t want to come here," he said.

Along with primary care physicians, general surgeons are a crucial component of the rural health care team, and they are essential to maintaining the financial health of the rural hospital, according to the Mithoefer Center for Rural Surgery in Cooperstown, N.Y. The center was established in 2004 to develop solutions aimed at benefiting rural citizens, rural surgeons, and rural hospitals.

"There’s a lot of information that shows that [rural surgeons are the] economic engine that maintains small rural hospitals," said Dr. David C. Borgstrom, the center’s codirector. "They’re the primary endoscopist for the community. They do a wide range of surgeries; they do obstetrics services, a bit of orthopedics," and other procedures, he added.

But many of today’s general surgeons are not as broadly trained as their colleagues were a decade or so ago, some surgeons say. Experienced rural general surgeons who can perform a wide range of procedures such as obstetrical, urological, and orthopedic procedures are becoming rare.

"I was trained in the ’70s and ’80s at [the then-Cook County Hospital, Chicago] where we were trained to do just about everything," said Dr. Arnold Serota, who until recently practiced general surgery in Kauai, Hawaii.

"The general surgery training back then was much different than it is now. In addition to routine general surgery – laparoscopic and open cases – I was doing trauma, critical care, placing pacemakers, esophagogastroduodenoscopies and colonoscopies, vascular surgery, and more," he said in an interview. "Now that I have left Kauai, there is no one person who can provide the services that I did." The scope of what more recently trained surgeons do is much more limited, he explained.

The economic and lifestyle preferences of the newer generation of medical school graduates also play into the rural surgeon shortage. According to a study by the Robert Graham Center, the policy arm of the American Academy of Family Physicians, "Growing physician income disparities are a major driver of student behavior. This income disparity explains much of the difficulty in achieving the balance in specialty and geographic physician distribution and will continue to inhibit achieving the workforce needed for better quality, efficiency, and equity."

The study adds that rural birth, interest in serving underserved or minority populations, and rural or inner-city training experience increase the likelihood of students choosing primary care or practice in rural and underserved areas.

This has been the case with Dr. Steve Olson, age 55, who grew up in rural Cooperstown, N.Y., where his father was a surgeon at the local hospital. "I’ve always liked practicing in rural environments and bringing new things to the rural areas," he said.

A resident of Bridgton, Maine, Dr. Olson does not maintain a private practice; instead, he is an employee of nearby Bridgton Hospital. Although he earns less than he would practicing in an urban area, that’s fine with him, he said in an interview. But with only one other surgeon in the area, Dr. Olson is on call every other night during week, and every other weekend. 

"If we had four surgeons, we’d have a really nice lifestyle," he said. "Nobody would be overburdened with calls."

There are programs that encourage and train young surgeons for rural practice, and the ACS continues to raise awareness about the shortage.

"Estimates show that there’s an increasing need to care for rural America, because of retiring rural surgeons. We are trying to fill those needs and to show why being a rural surgeon is a good thing," Dr. Borgstrom said in an interview.

But addressing the shortage of rural surgeons, given the lack of interest among young surgeons and the aging population of the existing ones, is multifaceted.

"It’s clear that our system doesn’t provide an easy way for surgical patients to access the appropriate level of care," said Dr. Olson, chair of the Rural Surgery Subcommittee and vice chair of the advisory council for general surgery for the ACS. "Solutions won’t come until major groups work together. Congress has to pass some laws on how health care is delivered, and physicians and health care organizations in rural areas need to really stand up and be part of that discussion. If we can establish a model on rural health care, we can make a difference."

Meanwhile, rural surgeons such as Dr. Caropreso continue their advocacy – and their search for colleagues.

Multiple studies paint a picture of the continuing and projected shortage of general surgeons in the United States, especially in rural areas.

The number of general surgeons per 100,000 population dropped by 3.6% between 2004 and 2008, according to a 2010 study by the American College of Surgeons (ACS) Health Policy Research Institute. Projections by the federal Health Resources and Services Administration show that the number of general surgeons will drop by 3% between 2000 and 2020 from 33,980 to 31,880.

Additionally, the surgeon population overall is aging and retiring at a faster pace than new surgeons are entering practice, according to an analysis done by the ACS Health Policy Research Institute. Approximately one-third of all surgeons are older than age 55 years; the median age for rural surgeons is higher than for those who practice in urban areas.

Dr. Phil Caropreso, age 64, has been practicing in two small area hospitals in Keokuk, Iowa, for the past 13 years. Keokuk, a town of about 11,000 in the southeastern corner of the state, appeals to outdoors enthusiasts who enjoy hunting, fishing, golfing, and boating.

The only other general surgeon there retired, and Dr. Caropreso is now on call 24 hours a day, 7 days a week, for the two hospitals.

"Recruiting has almost been impossible," said Dr. Caropreso. "We’ve been advertising for the last 7 years in both [hospitals]." They have had recruitment services, placed ads in journals, talked with the residency director at University of Iowa, Iowa City, he said. Only a few people came to be interviewed. A couple of surgeons accepted the job, but left shortly thereafter.

"Surgeons today seem to prefer more urban areas; they want a different kind of work ethic. They’re trained differently. They now go into subspecialty surgery, and they don’t want to come here," he said.

Along with primary care physicians, general surgeons are a crucial component of the rural health care team, and they are essential to maintaining the financial health of the rural hospital, according to the Mithoefer Center for Rural Surgery in Cooperstown, N.Y. The center was established in 2004 to develop solutions aimed at benefiting rural citizens, rural surgeons, and rural hospitals.

"There’s a lot of information that shows that [rural surgeons are the] economic engine that maintains small rural hospitals," said Dr. David C. Borgstrom, the center’s codirector. "They’re the primary endoscopist for the community. They do a wide range of surgeries; they do obstetrics services, a bit of orthopedics," and other procedures, he added.

But many of today’s general surgeons are not as broadly trained as their colleagues were a decade or so ago, some surgeons say. Experienced rural general surgeons who can perform a wide range of procedures such as obstetrical, urological, and orthopedic procedures are becoming rare.

"I was trained in the ’70s and ’80s at [the then-Cook County Hospital, Chicago] where we were trained to do just about everything," said Dr. Arnold Serota, who until recently practiced general surgery in Kauai, Hawaii.

"The general surgery training back then was much different than it is now. In addition to routine general surgery – laparoscopic and open cases – I was doing trauma, critical care, placing pacemakers, esophagogastroduodenoscopies and colonoscopies, vascular surgery, and more," he said in an interview. "Now that I have left Kauai, there is no one person who can provide the services that I did." The scope of what more recently trained surgeons do is much more limited, he explained.

The economic and lifestyle preferences of the newer generation of medical school graduates also play into the rural surgeon shortage. According to a study by the Robert Graham Center, the policy arm of the American Academy of Family Physicians, "Growing physician income disparities are a major driver of student behavior. This income disparity explains much of the difficulty in achieving the balance in specialty and geographic physician distribution and will continue to inhibit achieving the workforce needed for better quality, efficiency, and equity."

The study adds that rural birth, interest in serving underserved or minority populations, and rural or inner-city training experience increase the likelihood of students choosing primary care or practice in rural and underserved areas.

This has been the case with Dr. Steve Olson, age 55, who grew up in rural Cooperstown, N.Y., where his father was a surgeon at the local hospital. "I’ve always liked practicing in rural environments and bringing new things to the rural areas," he said.

A resident of Bridgton, Maine, Dr. Olson does not maintain a private practice; instead, he is an employee of nearby Bridgton Hospital. Although he earns less than he would practicing in an urban area, that’s fine with him, he said in an interview. But with only one other surgeon in the area, Dr. Olson is on call every other night during week, and every other weekend. 

"If we had four surgeons, we’d have a really nice lifestyle," he said. "Nobody would be overburdened with calls."

There are programs that encourage and train young surgeons for rural practice, and the ACS continues to raise awareness about the shortage.

"Estimates show that there’s an increasing need to care for rural America, because of retiring rural surgeons. We are trying to fill those needs and to show why being a rural surgeon is a good thing," Dr. Borgstrom said in an interview.

But addressing the shortage of rural surgeons, given the lack of interest among young surgeons and the aging population of the existing ones, is multifaceted.

"It’s clear that our system doesn’t provide an easy way for surgical patients to access the appropriate level of care," said Dr. Olson, chair of the Rural Surgery Subcommittee and vice chair of the advisory council for general surgery for the ACS. "Solutions won’t come until major groups work together. Congress has to pass some laws on how health care is delivered, and physicians and health care organizations in rural areas need to really stand up and be part of that discussion. If we can establish a model on rural health care, we can make a difference."

Meanwhile, rural surgeons such as Dr. Caropreso continue their advocacy – and their search for colleagues.

Multiple studies paint a picture of the continuing and projected shortage of general surgeons in the United States, especially in rural areas.

The number of general surgeons per 100,000 population dropped by 3.6% between 2004 and 2008, according to a 2010 study by the American College of Surgeons (ACS) Health Policy Research Institute. Projections by the federal Health Resources and Services Administration show that the number of general surgeons will drop by 3% between 2000 and 2020 from 33,980 to 31,880.

Additionally, the surgeon population overall is aging and retiring at a faster pace than new surgeons are entering practice, according to an analysis done by the ACS Health Policy Research Institute. Approximately one-third of all surgeons are older than age 55 years; the median age for rural surgeons is higher than for those who practice in urban areas.

Dr. Phil Caropreso, age 64, has been practicing in two small area hospitals in Keokuk, Iowa, for the past 13 years. Keokuk, a town of about 11,000 in the southeastern corner of the state, appeals to outdoors enthusiasts who enjoy hunting, fishing, golfing, and boating.

The only other general surgeon there retired, and Dr. Caropreso is now on call 24 hours a day, 7 days a week, for the two hospitals.

"Recruiting has almost been impossible," said Dr. Caropreso. "We’ve been advertising for the last 7 years in both [hospitals]." They have had recruitment services, placed ads in journals, talked with the residency director at University of Iowa, Iowa City, he said. Only a few people came to be interviewed. A couple of surgeons accepted the job, but left shortly thereafter.

"Surgeons today seem to prefer more urban areas; they want a different kind of work ethic. They’re trained differently. They now go into subspecialty surgery, and they don’t want to come here," he said.

Along with primary care physicians, general surgeons are a crucial component of the rural health care team, and they are essential to maintaining the financial health of the rural hospital, according to the Mithoefer Center for Rural Surgery in Cooperstown, N.Y. The center was established in 2004 to develop solutions aimed at benefiting rural citizens, rural surgeons, and rural hospitals.

"There’s a lot of information that shows that [rural surgeons are the] economic engine that maintains small rural hospitals," said Dr. David C. Borgstrom, the center’s codirector. "They’re the primary endoscopist for the community. They do a wide range of surgeries; they do obstetrics services, a bit of orthopedics," and other procedures, he added.

But many of today’s general surgeons are not as broadly trained as their colleagues were a decade or so ago, some surgeons say. Experienced rural general surgeons who can perform a wide range of procedures such as obstetrical, urological, and orthopedic procedures are becoming rare.

"I was trained in the ’70s and ’80s at [the then-Cook County Hospital, Chicago] where we were trained to do just about everything," said Dr. Arnold Serota, who until recently practiced general surgery in Kauai, Hawaii.

"The general surgery training back then was much different than it is now. In addition to routine general surgery – laparoscopic and open cases – I was doing trauma, critical care, placing pacemakers, esophagogastroduodenoscopies and colonoscopies, vascular surgery, and more," he said in an interview. "Now that I have left Kauai, there is no one person who can provide the services that I did." The scope of what more recently trained surgeons do is much more limited, he explained.

The economic and lifestyle preferences of the newer generation of medical school graduates also play into the rural surgeon shortage. According to a study by the Robert Graham Center, the policy arm of the American Academy of Family Physicians, "Growing physician income disparities are a major driver of student behavior. This income disparity explains much of the difficulty in achieving the balance in specialty and geographic physician distribution and will continue to inhibit achieving the workforce needed for better quality, efficiency, and equity."

The study adds that rural birth, interest in serving underserved or minority populations, and rural or inner-city training experience increase the likelihood of students choosing primary care or practice in rural and underserved areas.

This has been the case with Dr. Steve Olson, age 55, who grew up in rural Cooperstown, N.Y., where his father was a surgeon at the local hospital. "I’ve always liked practicing in rural environments and bringing new things to the rural areas," he said.

A resident of Bridgton, Maine, Dr. Olson does not maintain a private practice; instead, he is an employee of nearby Bridgton Hospital. Although he earns less than he would practicing in an urban area, that’s fine with him, he said in an interview. But with only one other surgeon in the area, Dr. Olson is on call every other night during week, and every other weekend. 

"If we had four surgeons, we’d have a really nice lifestyle," he said. "Nobody would be overburdened with calls."

There are programs that encourage and train young surgeons for rural practice, and the ACS continues to raise awareness about the shortage.

"Estimates show that there’s an increasing need to care for rural America, because of retiring rural surgeons. We are trying to fill those needs and to show why being a rural surgeon is a good thing," Dr. Borgstrom said in an interview.

But addressing the shortage of rural surgeons, given the lack of interest among young surgeons and the aging population of the existing ones, is multifaceted.

"It’s clear that our system doesn’t provide an easy way for surgical patients to access the appropriate level of care," said Dr. Olson, chair of the Rural Surgery Subcommittee and vice chair of the advisory council for general surgery for the ACS. "Solutions won’t come until major groups work together. Congress has to pass some laws on how health care is delivered, and physicians and health care organizations in rural areas need to really stand up and be part of that discussion. If we can establish a model on rural health care, we can make a difference."

Meanwhile, rural surgeons such as Dr. Caropreso continue their advocacy – and their search for colleagues.

Multiple studies paint a picture of the continuing and projected shortage of general surgeons in the United States, especially in rural areas.

The number of general surgeons per 100,000 population dropped by 3.6% between 2004 and 2008, according to a 2010 study by the American College of Surgeons (ACS) Health Policy Research Institute. Projections by the federal Health Resources and Services Administration show that the number of general surgeons will drop by 3% between 2000 and 2020 from 33,980 to 31,880.

Additionally, the surgeon population overall is aging and retiring at a faster pace than new surgeons are entering practice, according to an analysis done by the ACS Health Policy Research Institute. Approximately one-third of all surgeons are older than age 55 years; the median age for rural surgeons is higher than for those who practice in urban areas.

Dr. Phil Caropreso, age 64, has been practicing in two small area hospitals in Keokuk, Iowa, for the past 13 years. Keokuk, a town of about 11,000 in the southeastern corner of the state, appeals to outdoors enthusiasts who enjoy hunting, fishing, golfing, and boating.

The only other general surgeon there retired, and Dr. Caropreso is now on call 24 hours a day, 7 days a week, for the two hospitals.

"Recruiting has almost been impossible," said Dr. Caropreso. "We’ve been advertising for the last 7 years in both [hospitals]." They have had recruitment services, placed ads in journals, talked with the residency director at University of Iowa, Iowa City, he said. Only a few people came to be interviewed. A couple of surgeons accepted the job, but left shortly thereafter.

"Surgeons today seem to prefer more urban areas; they want a different kind of work ethic. They’re trained differently. They now go into subspecialty surgery, and they don’t want to come here," he said.

Along with primary care physicians, general surgeons are a crucial component of the rural health care team, and they are essential to maintaining the financial health of the rural hospital, according to the Mithoefer Center for Rural Surgery in Cooperstown, N.Y. The center was established in 2004 to develop solutions aimed at benefiting rural citizens, rural surgeons, and rural hospitals.

"There’s a lot of information that shows that [rural surgeons are the] economic engine that maintains small rural hospitals," said Dr. David C. Borgstrom, the center’s codirector. "They’re the primary endoscopist for the community. They do a wide range of surgeries; they do obstetrics services, a bit of orthopedics," and other procedures, he added.

But many of today’s general surgeons are not as broadly trained as their colleagues were a decade or so ago, some surgeons say. Experienced rural general surgeons who can perform a wide range of procedures such as obstetrical, urological, and orthopedic procedures are becoming rare.

"I was trained in the ’70s and ’80s at [the then-Cook County Hospital, Chicago] where we were trained to do just about everything," said Dr. Arnold Serota, who until recently practiced general surgery in Kauai, Hawaii.

"The general surgery training back then was much different than it is now. In addition to routine general surgery – laparoscopic and open cases – I was doing trauma, critical care, placing pacemakers, esophagogastroduodenoscopies and colonoscopies, vascular surgery, and more," he said in an interview. "Now that I have left Kauai, there is no one person who can provide the services that I did." The scope of what more recently trained surgeons do is much more limited, he explained.

The economic and lifestyle preferences of the newer generation of medical school graduates also play into the rural surgeon shortage. According to a study by the Robert Graham Center, the policy arm of the American Academy of Family Physicians, "Growing physician income disparities are a major driver of student behavior. This income disparity explains much of the difficulty in achieving the balance in specialty and geographic physician distribution and will continue to inhibit achieving the workforce needed for better quality, efficiency, and equity."

The study adds that rural birth, interest in serving underserved or minority populations, and rural or inner-city training experience increase the likelihood of students choosing primary care or practice in rural and underserved areas.

This has been the case with Dr. Steve Olson, age 55, who grew up in rural Cooperstown, N.Y., where his father was a surgeon at the local hospital. "I’ve always liked practicing in rural environments and bringing new things to the rural areas," he said.

A resident of Bridgton, Maine, Dr. Olson does not maintain a private practice; instead, he is an employee of nearby Bridgton Hospital. Although he earns less than he would practicing in an urban area, that’s fine with him, he said in an interview. But with only one other surgeon in the area, Dr. Olson is on call every other night during week, and every other weekend. 

"If we had four surgeons, we’d have a really nice lifestyle," he said. "Nobody would be overburdened with calls."

There are programs that encourage and train young surgeons for rural practice, and the ACS continues to raise awareness about the shortage.

"Estimates show that there’s an increasing need to care for rural America, because of retiring rural surgeons. We are trying to fill those needs and to show why being a rural surgeon is a good thing," Dr. Borgstrom said in an interview.

But addressing the shortage of rural surgeons, given the lack of interest among young surgeons and the aging population of the existing ones, is multifaceted.

"It’s clear that our system doesn’t provide an easy way for surgical patients to access the appropriate level of care," said Dr. Olson, chair of the Rural Surgery Subcommittee and vice chair of the advisory council for general surgery for the ACS. "Solutions won’t come until major groups work together. Congress has to pass some laws on how health care is delivered, and physicians and health care organizations in rural areas need to really stand up and be part of that discussion. If we can establish a model on rural health care, we can make a difference."

Meanwhile, rural surgeons such as Dr. Caropreso continue their advocacy – and their search for colleagues.

Prolonged use of oral bisphosphonates is associated with an increased risk of subtrochanteric or femoral shaft fractures in older women. However, the absolute risk for these fractures is low, according to a large population-based study.

"This study adds another piece to the puzzle," lead author Laura Y. Park-Wyllie, Pharm.D., said in an interview. "There wasn’t good research about what the absolute risk of the fractures was. This study adds that piece."

During the 7-year study period, researchers found that women aged 68 years or older who used bisphosphonates for 5 years or longer were 2.74 times more likely to have subtrochanteric or femoral shaft fractures after minimal trauma, compared with women who took the medications transiently. (JAMA 2011;305:783-9).

The study also showed that the absolute risk of such atypical fractures was at 1 in 1,000 women.

"If you combine all the information that we have about osteoporosis and the information we have about the risk versus benefits [of bisphosphonates] they would favor the continuation of treatment," Dr. Park-Wyllie said.

Bisphosphonate therapy reduces the risk of osteoporotic fractures, judging from findings from a number of studies. But bisphosphonate-related suppression of bone remodeling could have an adverse effect on bone strength, resulting in atypical fractures, the study authors noted.

The growing number of reports on the issue and conflicting studies prompted the group to launch the study, said Dr. Park-Wyllie, a research fellow at Li Ka Shing Knowledge Institute of St. Michael’s Hospital in Toronto.

The American Society for Bone and Mineral Research recently released a task force report about the issue. The Food and Drug Administration is monitoring instances of such cases. There have also been several studies on the topic, but the authors of this report say that the studies were too small to establish or negate an association.

The population-based, nested case-control study examined 205,466 women 68 years or older who were treated with bisphosphonates between April 1, 2002, and March 31, 2008. The women were followed until the first fracture, death, or end of the study. Women with a history of conditions that could affect bone integrity were excluded.

In the group, 716 women (0.35%) had subtrochanteric (411) or femoral shaft fractures (305). Each case was matched with up to five controls – 3,580 total – from the cohort not hospitalized for either type of fracture, according to the study.

When compared with women who had used bisphosphonates transiently during the study period (less than 100 days in total), women who used the medication for 5 years or longer had an increased risk of subtrochanteric or femoral shaft fracture, the authors concluded.

To validate their findings, the investigators also conducted a secondary analysis, examining the risk of typical osteoporotic fractures among women who used bisphosphonates for 5 years or more, compared with women who used the medication transiently. Of the cohort, 9,723 women sustained femoral neck or intertrochanteric region fractures. "As expected, we found that extended bisphosphonate use was associated with a reduced risk of fracture compared with transient use," the authors wrote.

The absolute risk was estimated from 52,595 women in the cohort with at least 5 years of bisphosphonate therapy. Seventy-one, or 0.13%, sustained subtrochanteric or femoral shaft fractures during the following year and 117 (0.22%) within 2 years.

The study had some limitations, according to the authors. They did not have access to lifestyle behaviors. They relied on prescription data and some degree of exposure misclassification may have occurred, they said. Also, they did not study women aged younger than 68 years, "so the generalizability of our findings to younger women is unknown," they reported.

The authors also noted that during their study period (2002-2008) only a small proportion of the cohort received 5 or more years of bisphosphonate therapy. "It is likely that the prevalence of long-term bisphosphonate exposure will increase over time as more women achieve 5 cumulative years of therapy because these drugs are still relatively new and because sustained adherence to bisphosphonates is actively promoted in the community setting," they wrote.

The study should not deter physicians and patients from the use of bisphosphonates, they said, noting that typical hip fractures were far more common than were subtrochanteric or femoral shaft fractures during the study period (9,723 vs. 716).

Dr. Park-Wyllie and coauthors said their findings showed the need for assessment of individual risk of fractures when extended bisphosphonate therapy is considered, especially in patients at relatively low risk of fractures. They added that additional research is needed to find out whether interruptions in therapy could reduce the risk of such atypical fractures over the long term.

One of the coauthors – Muhammad M. Mamdani, Pharm.D., – reported financial relationships with Boehringer Ingelheim, Janssen-Ortho, Novartis, and Pfizer. The study was funded by the Ontario Ministry of Health and Long-Term Care.

Prolonged use of oral bisphosphonates is associated with an increased risk of subtrochanteric or femoral shaft fractures in older women. However, the absolute risk for these fractures is low, according to a large population-based study.

"This study adds another piece to the puzzle," lead author Laura Y. Park-Wyllie, Pharm.D., said in an interview. "There wasn’t good research about what the absolute risk of the fractures was. This study adds that piece."

During the 7-year study period, researchers found that women aged 68 years or older who used bisphosphonates for 5 years or longer were 2.74 times more likely to have subtrochanteric or femoral shaft fractures after minimal trauma, compared with women who took the medications transiently. (JAMA 2011;305:783-9).

The study also showed that the absolute risk of such atypical fractures was at 1 in 1,000 women.

"If you combine all the information that we have about osteoporosis and the information we have about the risk versus benefits [of bisphosphonates] they would favor the continuation of treatment," Dr. Park-Wyllie said.

Bisphosphonate therapy reduces the risk of osteoporotic fractures, judging from findings from a number of studies. But bisphosphonate-related suppression of bone remodeling could have an adverse effect on bone strength, resulting in atypical fractures, the study authors noted.

The growing number of reports on the issue and conflicting studies prompted the group to launch the study, said Dr. Park-Wyllie, a research fellow at Li Ka Shing Knowledge Institute of St. Michael’s Hospital in Toronto.

The American Society for Bone and Mineral Research recently released a task force report about the issue. The Food and Drug Administration is monitoring instances of such cases. There have also been several studies on the topic, but the authors of this report say that the studies were too small to establish or negate an association.

The population-based, nested case-control study examined 205,466 women 68 years or older who were treated with bisphosphonates between April 1, 2002, and March 31, 2008. The women were followed until the first fracture, death, or end of the study. Women with a history of conditions that could affect bone integrity were excluded.

In the group, 716 women (0.35%) had subtrochanteric (411) or femoral shaft fractures (305). Each case was matched with up to five controls – 3,580 total – from the cohort not hospitalized for either type of fracture, according to the study.

When compared with women who had used bisphosphonates transiently during the study period (less than 100 days in total), women who used the medication for 5 years or longer had an increased risk of subtrochanteric or femoral shaft fracture, the authors concluded.

To validate their findings, the investigators also conducted a secondary analysis, examining the risk of typical osteoporotic fractures among women who used bisphosphonates for 5 years or more, compared with women who used the medication transiently. Of the cohort, 9,723 women sustained femoral neck or intertrochanteric region fractures. "As expected, we found that extended bisphosphonate use was associated with a reduced risk of fracture compared with transient use," the authors wrote.

The absolute risk was estimated from 52,595 women in the cohort with at least 5 years of bisphosphonate therapy. Seventy-one, or 0.13%, sustained subtrochanteric or femoral shaft fractures during the following year and 117 (0.22%) within 2 years.

The study had some limitations, according to the authors. They did not have access to lifestyle behaviors. They relied on prescription data and some degree of exposure misclassification may have occurred, they said. Also, they did not study women aged younger than 68 years, "so the generalizability of our findings to younger women is unknown," they reported.

The authors also noted that during their study period (2002-2008) only a small proportion of the cohort received 5 or more years of bisphosphonate therapy. "It is likely that the prevalence of long-term bisphosphonate exposure will increase over time as more women achieve 5 cumulative years of therapy because these drugs are still relatively new and because sustained adherence to bisphosphonates is actively promoted in the community setting," they wrote.

The study should not deter physicians and patients from the use of bisphosphonates, they said, noting that typical hip fractures were far more common than were subtrochanteric or femoral shaft fractures during the study period (9,723 vs. 716).

Dr. Park-Wyllie and coauthors said their findings showed the need for assessment of individual risk of fractures when extended bisphosphonate therapy is considered, especially in patients at relatively low risk of fractures. They added that additional research is needed to find out whether interruptions in therapy could reduce the risk of such atypical fractures over the long term.

One of the coauthors – Muhammad M. Mamdani, Pharm.D., – reported financial relationships with Boehringer Ingelheim, Janssen-Ortho, Novartis, and Pfizer. The study was funded by the Ontario Ministry of Health and Long-Term Care.

Prolonged use of oral bisphosphonates is associated with an increased risk of subtrochanteric or femoral shaft fractures in older women. However, the absolute risk for these fractures is low, according to a large population-based study.

"This study adds another piece to the puzzle," lead author Laura Y. Park-Wyllie, Pharm.D., said in an interview. "There wasn’t good research about what the absolute risk of the fractures was. This study adds that piece."

During the 7-year study period, researchers found that women aged 68 years or older who used bisphosphonates for 5 years or longer were 2.74 times more likely to have subtrochanteric or femoral shaft fractures after minimal trauma, compared with women who took the medications transiently. (JAMA 2011;305:783-9).

The study also showed that the absolute risk of such atypical fractures was at 1 in 1,000 women.

"If you combine all the information that we have about osteoporosis and the information we have about the risk versus benefits [of bisphosphonates] they would favor the continuation of treatment," Dr. Park-Wyllie said.

Bisphosphonate therapy reduces the risk of osteoporotic fractures, judging from findings from a number of studies. But bisphosphonate-related suppression of bone remodeling could have an adverse effect on bone strength, resulting in atypical fractures, the study authors noted.

The growing number of reports on the issue and conflicting studies prompted the group to launch the study, said Dr. Park-Wyllie, a research fellow at Li Ka Shing Knowledge Institute of St. Michael’s Hospital in Toronto.

The American Society for Bone and Mineral Research recently released a task force report about the issue. The Food and Drug Administration is monitoring instances of such cases. There have also been several studies on the topic, but the authors of this report say that the studies were too small to establish or negate an association.

The population-based, nested case-control study examined 205,466 women 68 years or older who were treated with bisphosphonates between April 1, 2002, and March 31, 2008. The women were followed until the first fracture, death, or end of the study. Women with a history of conditions that could affect bone integrity were excluded.

In the group, 716 women (0.35%) had subtrochanteric (411) or femoral shaft fractures (305). Each case was matched with up to five controls – 3,580 total – from the cohort not hospitalized for either type of fracture, according to the study.

When compared with women who had used bisphosphonates transiently during the study period (less than 100 days in total), women who used the medication for 5 years or longer had an increased risk of subtrochanteric or femoral shaft fracture, the authors concluded.

To validate their findings, the investigators also conducted a secondary analysis, examining the risk of typical osteoporotic fractures among women who used bisphosphonates for 5 years or more, compared with women who used the medication transiently. Of the cohort, 9,723 women sustained femoral neck or intertrochanteric region fractures. "As expected, we found that extended bisphosphonate use was associated with a reduced risk of fracture compared with transient use," the authors wrote.

The absolute risk was estimated from 52,595 women in the cohort with at least 5 years of bisphosphonate therapy. Seventy-one, or 0.13%, sustained subtrochanteric or femoral shaft fractures during the following year and 117 (0.22%) within 2 years.

The study had some limitations, according to the authors. They did not have access to lifestyle behaviors. They relied on prescription data and some degree of exposure misclassification may have occurred, they said. Also, they did not study women aged younger than 68 years, "so the generalizability of our findings to younger women is unknown," they reported.

The authors also noted that during their study period (2002-2008) only a small proportion of the cohort received 5 or more years of bisphosphonate therapy. "It is likely that the prevalence of long-term bisphosphonate exposure will increase over time as more women achieve 5 cumulative years of therapy because these drugs are still relatively new and because sustained adherence to bisphosphonates is actively promoted in the community setting," they wrote.

The study should not deter physicians and patients from the use of bisphosphonates, they said, noting that typical hip fractures were far more common than were subtrochanteric or femoral shaft fractures during the study period (9,723 vs. 716).

Dr. Park-Wyllie and coauthors said their findings showed the need for assessment of individual risk of fractures when extended bisphosphonate therapy is considered, especially in patients at relatively low risk of fractures. They added that additional research is needed to find out whether interruptions in therapy could reduce the risk of such atypical fractures over the long term.

One of the coauthors – Muhammad M. Mamdani, Pharm.D., – reported financial relationships with Boehringer Ingelheim, Janssen-Ortho, Novartis, and Pfizer. The study was funded by the Ontario Ministry of Health and Long-Term Care.

Prolonged use of oral bisphosphonates is associated with an increased risk of subtrochanteric or femoral shaft fractures in older women. However, the absolute risk for these fractures is low, according to a large population-based study.

"This study adds another piece to the puzzle," lead author Laura Y. Park-Wyllie, Pharm.D., said in an interview. "There wasn’t good research about what the absolute risk of the fractures was. This study adds that piece."

During the 7-year study period, researchers found that women aged 68 years or older who used bisphosphonates for 5 years or longer were 2.74 times more likely to have subtrochanteric or femoral shaft fractures after minimal trauma, compared with women who took the medications transiently. (JAMA 2011;305:783-9).

The study also showed that the absolute risk of such atypical fractures was at 1 in 1,000 women.

"If you combine all the information that we have about osteoporosis and the information we have about the risk versus benefits [of bisphosphonates] they would favor the continuation of treatment," Dr. Park-Wyllie said.

Bisphosphonate therapy reduces the risk of osteoporotic fractures, judging from findings from a number of studies. But bisphosphonate-related suppression of bone remodeling could have an adverse effect on bone strength, resulting in atypical fractures, the study authors noted.

The growing number of reports on the issue and conflicting studies prompted the group to launch the study, said Dr. Park-Wyllie, a research fellow at Li Ka Shing Knowledge Institute of St. Michael’s Hospital in Toronto.

The American Society for Bone and Mineral Research recently released a task force report about the issue. The Food and Drug Administration is monitoring instances of such cases. There have also been several studies on the topic, but the authors of this report say that the studies were too small to establish or negate an association.

The population-based, nested case-control study examined 205,466 women 68 years or older who were treated with bisphosphonates between April 1, 2002, and March 31, 2008. The women were followed until the first fracture, death, or end of the study. Women with a history of conditions that could affect bone integrity were excluded.

In the group, 716 women (0.35%) had subtrochanteric (411) or femoral shaft fractures (305). Each case was matched with up to five controls – 3,580 total – from the cohort not hospitalized for either type of fracture, according to the study.

When compared with women who had used bisphosphonates transiently during the study period (less than 100 days in total), women who used the medication for 5 years or longer had an increased risk of subtrochanteric or femoral shaft fracture, the authors concluded.

To validate their findings, the investigators also conducted a secondary analysis, examining the risk of typical osteoporotic fractures among women who used bisphosphonates for 5 years or more, compared with women who used the medication transiently. Of the cohort, 9,723 women sustained femoral neck or intertrochanteric region fractures. "As expected, we found that extended bisphosphonate use was associated with a reduced risk of fracture compared with transient use," the authors wrote.

The absolute risk was estimated from 52,595 women in the cohort with at least 5 years of bisphosphonate therapy. Seventy-one, or 0.13%, sustained subtrochanteric or femoral shaft fractures during the following year and 117 (0.22%) within 2 years.

The study had some limitations, according to the authors. They did not have access to lifestyle behaviors. They relied on prescription data and some degree of exposure misclassification may have occurred, they said. Also, they did not study women aged younger than 68 years, "so the generalizability of our findings to younger women is unknown," they reported.

The authors also noted that during their study period (2002-2008) only a small proportion of the cohort received 5 or more years of bisphosphonate therapy. "It is likely that the prevalence of long-term bisphosphonate exposure will increase over time as more women achieve 5 cumulative years of therapy because these drugs are still relatively new and because sustained adherence to bisphosphonates is actively promoted in the community setting," they wrote.

The study should not deter physicians and patients from the use of bisphosphonates, they said, noting that typical hip fractures were far more common than were subtrochanteric or femoral shaft fractures during the study period (9,723 vs. 716).

Dr. Park-Wyllie and coauthors said their findings showed the need for assessment of individual risk of fractures when extended bisphosphonate therapy is considered, especially in patients at relatively low risk of fractures. They added that additional research is needed to find out whether interruptions in therapy could reduce the risk of such atypical fractures over the long term.

One of the coauthors – Muhammad M. Mamdani, Pharm.D., – reported financial relationships with Boehringer Ingelheim, Janssen-Ortho, Novartis, and Pfizer. The study was funded by the Ontario Ministry of Health and Long-Term Care.

Prolonged use of oral bisphosphonates is associated with an increased risk of subtrochanteric or femoral shaft fractures in older women. However, the absolute risk for these fractures is low, according to a large population-based study.

"This study adds another piece to the puzzle," lead author Laura Y. Park-Wyllie, Pharm.D., said in an interview. "There wasn’t good research about what the absolute risk of the fractures was. This study adds that piece."

During the 7-year study period, researchers found that women aged 68 years or older who used bisphosphonates for 5 years or longer were 2.74 times more likely to have subtrochanteric or femoral shaft fractures after minimal trauma, compared with women who took the medications transiently. (JAMA 2011;305:783-9).

The study also showed that the absolute risk of such atypical fractures was at 1 in 1,000 women.

"If you combine all the information that we have about osteoporosis and the information we have about the risk versus benefits [of bisphosphonates] they would favor the continuation of treatment," Dr. Park-Wyllie said.

Bisphosphonate therapy reduces the risk of osteoporotic fractures, judging from findings from a number of studies. But bisphosphonate-related suppression of bone remodeling could have an adverse effect on bone strength, resulting in atypical fractures, the study authors noted.

The growing number of reports on the issue and conflicting studies prompted the group to launch the study, said Dr. Park-Wyllie, a research fellow at Li Ka Shing Knowledge Institute of St. Michael’s Hospital in Toronto.

The American Society for Bone and Mineral Research recently released a task force report about the issue. The Food and Drug Administration is monitoring instances of such cases. There have also been several studies on the topic, but the authors of this report say that the studies were too small to establish or negate an association.

The population-based, nested case-control study examined 205,466 women 68 years or older who were treated with bisphosphonates between April 1, 2002, and March 31, 2008. The women were followed until the first fracture, death, or end of the study. Women with a history of conditions that could affect bone integrity were excluded.

In the group, 716 women (0.35%) had subtrochanteric (411) or femoral shaft fractures (305). Each case was matched with up to five controls – 3,580 total – from the cohort not hospitalized for either type of fracture, according to the study.

When compared with women who had used bisphosphonates transiently during the study period (less than 100 days in total), women who used the medication for 5 years or longer had an increased risk of subtrochanteric or femoral shaft fracture, the authors concluded.

To validate their findings, the investigators also conducted a secondary analysis, examining the risk of typical osteoporotic fractures among women who used bisphosphonates for 5 years or more, compared with women who used the medication transiently. Of the cohort, 9,723 women sustained femoral neck or intertrochanteric region fractures. "As expected, we found that extended bisphosphonate use was associated with a reduced risk of fracture compared with transient use," the authors wrote.

The absolute risk was estimated from 52,595 women in the cohort with at least 5 years of bisphosphonate therapy. Seventy-one, or 0.13%, sustained subtrochanteric or femoral shaft fractures during the following year and 117 (0.22%) within 2 years.

The study had some limitations, according to the authors. They did not have access to lifestyle behaviors. They relied on prescription data and some degree of exposure misclassification may have occurred, they said. Also, they did not study women aged younger than 68 years, "so the generalizability of our findings to younger women is unknown," they reported.

The authors also noted that during their study period (2002-2008) only a small proportion of the cohort received 5 or more years of bisphosphonate therapy. "It is likely that the prevalence of long-term bisphosphonate exposure will increase over time as more women achieve 5 cumulative years of therapy because these drugs are still relatively new and because sustained adherence to bisphosphonates is actively promoted in the community setting," they wrote.

The study should not deter physicians and patients from the use of bisphosphonates, they said, noting that typical hip fractures were far more common than were subtrochanteric or femoral shaft fractures during the study period (9,723 vs. 716).

Dr. Park-Wyllie and coauthors said their findings showed the need for assessment of individual risk of fractures when extended bisphosphonate therapy is considered, especially in patients at relatively low risk of fractures. They added that additional research is needed to find out whether interruptions in therapy could reduce the risk of such atypical fractures over the long term.

One of the coauthors – Muhammad M. Mamdani, Pharm.D., – reported financial relationships with Boehringer Ingelheim, Janssen-Ortho, Novartis, and Pfizer. The study was funded by the Ontario Ministry of Health and Long-Term Care.

Prolonged use of oral bisphosphonates is associated with an increased risk of subtrochanteric or femoral shaft fractures in older women. However, the absolute risk for these fractures is low, according to a large population-based study.

"This study adds another piece to the puzzle," lead author Laura Y. Park-Wyllie, Pharm.D., said in an interview. "There wasn’t good research about what the absolute risk of the fractures was. This study adds that piece."

During the 7-year study period, researchers found that women aged 68 years or older who used bisphosphonates for 5 years or longer were 2.74 times more likely to have subtrochanteric or femoral shaft fractures after minimal trauma, compared with women who took the medications transiently. (JAMA 2011;305:783-9).

The study also showed that the absolute risk of such atypical fractures was at 1 in 1,000 women.

"If you combine all the information that we have about osteoporosis and the information we have about the risk versus benefits [of bisphosphonates] they would favor the continuation of treatment," Dr. Park-Wyllie said.

Bisphosphonate therapy reduces the risk of osteoporotic fractures, judging from findings from a number of studies. But bisphosphonate-related suppression of bone remodeling could have an adverse effect on bone strength, resulting in atypical fractures, the study authors noted.

The growing number of reports on the issue and conflicting studies prompted the group to launch the study, said Dr. Park-Wyllie, a research fellow at Li Ka Shing Knowledge Institute of St. Michael’s Hospital in Toronto.

The American Society for Bone and Mineral Research recently released a task force report about the issue. The Food and Drug Administration is monitoring instances of such cases. There have also been several studies on the topic, but the authors of this report say that the studies were too small to establish or negate an association.

The population-based, nested case-control study examined 205,466 women 68 years or older who were treated with bisphosphonates between April 1, 2002, and March 31, 2008. The women were followed until the first fracture, death, or end of the study. Women with a history of conditions that could affect bone integrity were excluded.

In the group, 716 women (0.35%) had subtrochanteric (411) or femoral shaft fractures (305). Each case was matched with up to five controls – 3,580 total – from the cohort not hospitalized for either type of fracture, according to the study.

When compared with women who had used bisphosphonates transiently during the study period (less than 100 days in total), women who used the medication for 5 years or longer had an increased risk of subtrochanteric or femoral shaft fracture, the authors concluded.

To validate their findings, the investigators also conducted a secondary analysis, examining the risk of typical osteoporotic fractures among women who used bisphosphonates for 5 years or more, compared with women who used the medication transiently. Of the cohort, 9,723 women sustained femoral neck or intertrochanteric region fractures. "As expected, we found that extended bisphosphonate use was associated with a reduced risk of fracture compared with transient use," the authors wrote.

The absolute risk was estimated from 52,595 women in the cohort with at least 5 years of bisphosphonate therapy. Seventy-one, or 0.13%, sustained subtrochanteric or femoral shaft fractures during the following year and 117 (0.22%) within 2 years.

The study had some limitations, according to the authors. They did not have access to lifestyle behaviors. They relied on prescription data and some degree of exposure misclassification may have occurred, they said. Also, they did not study women aged younger than 68 years, "so the generalizability of our findings to younger women is unknown," they reported.

The authors also noted that during their study period (2002-2008) only a small proportion of the cohort received 5 or more years of bisphosphonate therapy. "It is likely that the prevalence of long-term bisphosphonate exposure will increase over time as more women achieve 5 cumulative years of therapy because these drugs are still relatively new and because sustained adherence to bisphosphonates is actively promoted in the community setting," they wrote.

The study should not deter physicians and patients from the use of bisphosphonates, they said, noting that typical hip fractures were far more common than were subtrochanteric or femoral shaft fractures during the study period (9,723 vs. 716).

Dr. Park-Wyllie and coauthors said their findings showed the need for assessment of individual risk of fractures when extended bisphosphonate therapy is considered, especially in patients at relatively low risk of fractures. They added that additional research is needed to find out whether interruptions in therapy could reduce the risk of such atypical fractures over the long term.

One of the coauthors – Muhammad M. Mamdani, Pharm.D., – reported financial relationships with Boehringer Ingelheim, Janssen-Ortho, Novartis, and Pfizer. The study was funded by the Ontario Ministry of Health and Long-Term Care.

Bipartisan support of health information technology is urgently needed so that incentives aimed at encouraging physicians and hospitals to adopt electronic health records systems remain in place, according to a report by the Healthcare Information & Management Systems Society.

"Our member-created Call-for-Action report offers policy makers concrete solutions that will help promote the adoption and use of health IT to contribute to higher-quality, more cost-effective patient care," David Roberts, HIMSS vice president for government relations, said in a statement.

It is yet to be seen whether the federal stimulus funds for health IT will be affected during the current budget battles at the Congress.

Nevertheless, the report, 2011-2012 Public Policy Principles, encourages continued progress toward implementation of the "meaningful use" criteria, which enable physicians to receive incentives tied to Medicare reimbursements if their adoption of EHR systems meets the criteria. The provision is part of the Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Recovery and Reinvestment Act of 2009.

"We agree with Dr. David Blumenthal," national coordinator for Health IT, that "these are historic times. The HITECH Act is bringing the power of electronic health records to our health care system. However, these new initiatives should not create a new form of 'digital divide' and our goal is to make sure that all constituencies benefit from these efforts," the organization wrote in its annual report.

The report urges policy makers to make the following their top priority:

• Supporting the National Quality Forum’s National Priorities Partnership, which aims to create a consensus on standard for measuring performance in health care.

• Ensuring a consolidated communications tool and comprehensive road map for meaningful use.

• Defining each new meaningful use stage at least 18 months before the beginning of the next stage.

• Establishing grievance processes for providers seeking to fulfill meaningful use criteria.

• Developing an open and transparent EHR certification criteria process.

• Supporting the establishment of an informed patient identity solution.

• Expanding and making permanent the current Stark exemptions and anti-kickback safe harbors for EHR users.

• Eliminating the HIPAA Business Associate Agreement requirement.

• Providing grants and other incentives to establish so-called Health IT Action Zones that demonstrate effective health IT adoption practices by providers who care for patients in medically underserved populations.

• Aligning federal policy to facilitate electronic business processes.

The report also calls for a "structural payment reform," suggesting the repeal of the Sustainable Growth Rate (SGR) physician payment program and bringing up Medicaid reimbursement up to that of Medicare’s. Without such changes, the report warns, "all health IT initiatives are at risk as providers may choose instead to withdraw from these federal programs."

In his proposed budget, President Obama has laid out a plan to pay for the first 2 years of the SGR so that the physician reimbursement rates won’t be cut. His plan is to fix SGR in 10 years.

Bipartisan support of health information technology is urgently needed so that incentives aimed at encouraging physicians and hospitals to adopt electronic health records systems remain in place, according to a report by the Healthcare Information & Management Systems Society.

"Our member-created Call-for-Action report offers policy makers concrete solutions that will help promote the adoption and use of health IT to contribute to higher-quality, more cost-effective patient care," David Roberts, HIMSS vice president for government relations, said in a statement.

It is yet to be seen whether the federal stimulus funds for health IT will be affected during the current budget battles at the Congress.

Nevertheless, the report, 2011-2012 Public Policy Principles, encourages continued progress toward implementation of the "meaningful use" criteria, which enable physicians to receive incentives tied to Medicare reimbursements if their adoption of EHR systems meets the criteria. The provision is part of the Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Recovery and Reinvestment Act of 2009.

"We agree with Dr. David Blumenthal," national coordinator for Health IT, that "these are historic times. The HITECH Act is bringing the power of electronic health records to our health care system. However, these new initiatives should not create a new form of 'digital divide' and our goal is to make sure that all constituencies benefit from these efforts," the organization wrote in its annual report.

The report urges policy makers to make the following their top priority:

• Supporting the National Quality Forum’s National Priorities Partnership, which aims to create a consensus on standard for measuring performance in health care.

• Ensuring a consolidated communications tool and comprehensive road map for meaningful use.

• Defining each new meaningful use stage at least 18 months before the beginning of the next stage.

• Establishing grievance processes for providers seeking to fulfill meaningful use criteria.

• Developing an open and transparent EHR certification criteria process.

• Supporting the establishment of an informed patient identity solution.

• Expanding and making permanent the current Stark exemptions and anti-kickback safe harbors for EHR users.

• Eliminating the HIPAA Business Associate Agreement requirement.

• Providing grants and other incentives to establish so-called Health IT Action Zones that demonstrate effective health IT adoption practices by providers who care for patients in medically underserved populations.

• Aligning federal policy to facilitate electronic business processes.

The report also calls for a "structural payment reform," suggesting the repeal of the Sustainable Growth Rate (SGR) physician payment program and bringing up Medicaid reimbursement up to that of Medicare’s. Without such changes, the report warns, "all health IT initiatives are at risk as providers may choose instead to withdraw from these federal programs."

In his proposed budget, President Obama has laid out a plan to pay for the first 2 years of the SGR so that the physician reimbursement rates won’t be cut. His plan is to fix SGR in 10 years.

Bipartisan support of health information technology is urgently needed so that incentives aimed at encouraging physicians and hospitals to adopt electronic health records systems remain in place, according to a report by the Healthcare Information & Management Systems Society.

"Our member-created Call-for-Action report offers policy makers concrete solutions that will help promote the adoption and use of health IT to contribute to higher-quality, more cost-effective patient care," David Roberts, HIMSS vice president for government relations, said in a statement.

It is yet to be seen whether the federal stimulus funds for health IT will be affected during the current budget battles at the Congress.

Nevertheless, the report, 2011-2012 Public Policy Principles, encourages continued progress toward implementation of the "meaningful use" criteria, which enable physicians to receive incentives tied to Medicare reimbursements if their adoption of EHR systems meets the criteria. The provision is part of the Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Recovery and Reinvestment Act of 2009.

"We agree with Dr. David Blumenthal," national coordinator for Health IT, that "these are historic times. The HITECH Act is bringing the power of electronic health records to our health care system. However, these new initiatives should not create a new form of 'digital divide' and our goal is to make sure that all constituencies benefit from these efforts," the organization wrote in its annual report.

The report urges policy makers to make the following their top priority:

• Supporting the National Quality Forum’s National Priorities Partnership, which aims to create a consensus on standard for measuring performance in health care.

• Ensuring a consolidated communications tool and comprehensive road map for meaningful use.

• Defining each new meaningful use stage at least 18 months before the beginning of the next stage.

• Establishing grievance processes for providers seeking to fulfill meaningful use criteria.

• Developing an open and transparent EHR certification criteria process.

• Supporting the establishment of an informed patient identity solution.

• Expanding and making permanent the current Stark exemptions and anti-kickback safe harbors for EHR users.

• Eliminating the HIPAA Business Associate Agreement requirement.

• Providing grants and other incentives to establish so-called Health IT Action Zones that demonstrate effective health IT adoption practices by providers who care for patients in medically underserved populations.

• Aligning federal policy to facilitate electronic business processes.

The report also calls for a "structural payment reform," suggesting the repeal of the Sustainable Growth Rate (SGR) physician payment program and bringing up Medicaid reimbursement up to that of Medicare’s. Without such changes, the report warns, "all health IT initiatives are at risk as providers may choose instead to withdraw from these federal programs."

In his proposed budget, President Obama has laid out a plan to pay for the first 2 years of the SGR so that the physician reimbursement rates won’t be cut. His plan is to fix SGR in 10 years.

Bipartisan support of health information technology is urgently needed so that incentives aimed at encouraging physicians and hospitals to adopt electronic health records systems remain in place, according to a report by the Healthcare Information & Management Systems Society.

"Our member-created Call-for-Action report offers policy makers concrete solutions that will help promote the adoption and use of health IT to contribute to higher-quality, more cost-effective patient care," David Roberts, HIMSS vice president for government relations, said in a statement.

It is yet to be seen whether the federal stimulus funds for health IT will be affected during the current budget battles at the Congress.

Nevertheless, the report, 2011-2012 Public Policy Principles, encourages continued progress toward implementation of the "meaningful use" criteria, which enable physicians to receive incentives tied to Medicare reimbursements if their adoption of EHR systems meets the criteria. The provision is part of the Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Recovery and Reinvestment Act of 2009.

"We agree with Dr. David Blumenthal," national coordinator for Health IT, that "these are historic times. The HITECH Act is bringing the power of electronic health records to our health care system. However, these new initiatives should not create a new form of ‘digital divide’ and our goal is to make sure that all constituencies benefit from these efforts," the organization wrote in its annual report.

The report urges policy makers to make the following their top priority:

• Supporting the National Quality Forum’s National Priorities Partnership, which aims to create a consensus on standard for measuring performance in health care.

• Ensuring a consolidated communications tool and comprehensive road map for meaningful use.

• Defining each new meaningful use stage at least 18 months before the beginning of the next stage.

• Establishing grievance processes for providers seeking to fulfill meaningful use criteria.

• Developing an open and transparent EHR certification criteria process.

• Supporting the establishment of an informed patient identity solution.

• Expanding and making permanent the current Stark exemptions and anti-kickback safe harbors for EHR users.

• Eliminating the HIPAA Business Associate Agreement requirement.

• Providing grants and other incentives to establish so-called Health IT Action Zones that demonstrate effective health IT adoption practices by providers who care for patients in medically underserved populations.

• Aligning federal policy to facilitate electronic business processes.

The report also calls for a "structural payment reform," suggesting the repeal of the Sustainable Growth Rate (SGR) physician payment program and bringing up Medicaid reimbursement up to that of Medicare’s. Without such changes, the report warns, "all health IT initiatives are at risk as providers may choose instead to withdraw from these federal programs."

In his proposed budget, President Obama has laid out a plan to pay for the first 2 years of the SGR so that the physician reimbursement rates won’t be cut. His plan is to fix SGR in 10 years.

Bipartisan support of health information technology is urgently needed so that incentives aimed at encouraging physicians and hospitals to adopt electronic health records systems remain in place, according to a report by the Healthcare Information & Management Systems Society.

"Our member-created Call-for-Action report offers policy makers concrete solutions that will help promote the adoption and use of health IT to contribute to higher-quality, more cost-effective patient care," David Roberts, HIMSS vice president for government relations, said in a statement.

It is yet to be seen whether the federal stimulus funds for health IT will be affected during the current budget battles at the Congress.

Nevertheless, the report, 2011-2012 Public Policy Principles, encourages continued progress toward implementation of the "meaningful use" criteria, which enable physicians to receive incentives tied to Medicare reimbursements if their adoption of EHR systems meets the criteria. The provision is part of the Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Recovery and Reinvestment Act of 2009.

"We agree with Dr. David Blumenthal," national coordinator for Health IT, that "these are historic times. The HITECH Act is bringing the power of electronic health records to our health care system. However, these new initiatives should not create a new form of ‘digital divide’ and our goal is to make sure that all constituencies benefit from these efforts," the organization wrote in its annual report.

The report urges policy makers to make the following their top priority:

• Supporting the National Quality Forum’s National Priorities Partnership, which aims to create a consensus on standard for measuring performance in health care.

• Ensuring a consolidated communications tool and comprehensive road map for meaningful use.

• Defining each new meaningful use stage at least 18 months before the beginning of the next stage.

• Establishing grievance processes for providers seeking to fulfill meaningful use criteria.

• Developing an open and transparent EHR certification criteria process.

• Supporting the establishment of an informed patient identity solution.

• Expanding and making permanent the current Stark exemptions and anti-kickback safe harbors for EHR users.

• Eliminating the HIPAA Business Associate Agreement requirement.

• Providing grants and other incentives to establish so-called Health IT Action Zones that demonstrate effective health IT adoption practices by providers who care for patients in medically underserved populations.

• Aligning federal policy to facilitate electronic business processes.

The report also calls for a "structural payment reform," suggesting the repeal of the Sustainable Growth Rate (SGR) physician payment program and bringing up Medicaid reimbursement up to that of Medicare’s. Without such changes, the report warns, "all health IT initiatives are at risk as providers may choose instead to withdraw from these federal programs."

In his proposed budget, President Obama has laid out a plan to pay for the first 2 years of the SGR so that the physician reimbursement rates won’t be cut. His plan is to fix SGR in 10 years.

Bipartisan support of health information technology is urgently needed so that incentives aimed at encouraging physicians and hospitals to adopt electronic health records systems remain in place, according to a report by the Healthcare Information & Management Systems Society.

"Our member-created Call-for-Action report offers policy makers concrete solutions that will help promote the adoption and use of health IT to contribute to higher-quality, more cost-effective patient care," David Roberts, HIMSS vice president for government relations, said in a statement.

It is yet to be seen whether the federal stimulus funds for health IT will be affected during the current budget battles at the Congress.

Nevertheless, the report, 2011-2012 Public Policy Principles, encourages continued progress toward implementation of the "meaningful use" criteria, which enable physicians to receive incentives tied to Medicare reimbursements if their adoption of EHR systems meets the criteria. The provision is part of the Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Recovery and Reinvestment Act of 2009.

"We agree with Dr. David Blumenthal," national coordinator for Health IT, that "these are historic times. The HITECH Act is bringing the power of electronic health records to our health care system. However, these new initiatives should not create a new form of ‘digital divide’ and our goal is to make sure that all constituencies benefit from these efforts," the organization wrote in its annual report.

The report urges policy makers to make the following their top priority:

• Supporting the National Quality Forum’s National Priorities Partnership, which aims to create a consensus on standard for measuring performance in health care.

• Ensuring a consolidated communications tool and comprehensive road map for meaningful use.

• Defining each new meaningful use stage at least 18 months before the beginning of the next stage.

• Establishing grievance processes for providers seeking to fulfill meaningful use criteria.

• Developing an open and transparent EHR certification criteria process.

• Supporting the establishment of an informed patient identity solution.

• Expanding and making permanent the current Stark exemptions and anti-kickback safe harbors for EHR users.

• Eliminating the HIPAA Business Associate Agreement requirement.

• Providing grants and other incentives to establish so-called Health IT Action Zones that demonstrate effective health IT adoption practices by providers who care for patients in medically underserved populations.

• Aligning federal policy to facilitate electronic business processes.

The report also calls for a "structural payment reform," suggesting the repeal of the Sustainable Growth Rate (SGR) physician payment program and bringing up Medicaid reimbursement up to that of Medicare’s. Without such changes, the report warns, "all health IT initiatives are at risk as providers may choose instead to withdraw from these federal programs."

In his proposed budget, President Obama has laid out a plan to pay for the first 2 years of the SGR so that the physician reimbursement rates won’t be cut. His plan is to fix SGR in 10 years.

Bipartisan support of health information technology is urgently needed so that incentives aimed at encouraging physicians and hospitals to adopt electronic health records systems remain in place, according to a report by the Healthcare Information & Management Systems Society.

"Our member-created Call-for-Action report offers policy makers concrete solutions that will help promote the adoption and use of health IT to contribute to higher-quality, more cost-effective patient care," David Roberts, HIMSS vice president for government relations, said in a statement.

It is yet to be seen whether the federal stimulus funds for health IT will be affected during the current budget battles at the Congress.

Nevertheless, the report, 2011-2012 Public Policy Principles, encourages continued progress toward implementation of the "meaningful use" criteria, which enable physicians to receive incentives tied to Medicare reimbursements if their adoption of EHR systems meets the criteria. The provision is part of the Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Recovery and Reinvestment Act of 2009.

"We agree with Dr. David Blumenthal," national coordinator for Health IT, that "these are historic times. The HITECH Act is bringing the power of electronic health records to our health care system. However, these new initiatives should not create a new form of ‘digital divide’ and our goal is to make sure that all constituencies benefit from these efforts," the organization wrote in its annual report.

The report urges policy makers to make the following their top priority:

• Supporting the National Quality Forum’s National Priorities Partnership, which aims to create a consensus on standard for measuring performance in health care.

• Ensuring a consolidated communications tool and comprehensive road map for meaningful use.

• Defining each new meaningful use stage at least 18 months before the beginning of the next stage.

• Establishing grievance processes for providers seeking to fulfill meaningful use criteria.

• Developing an open and transparent EHR certification criteria process.

• Supporting the establishment of an informed patient identity solution.

• Expanding and making permanent the current Stark exemptions and anti-kickback safe harbors for EHR users.

• Eliminating the HIPAA Business Associate Agreement requirement.

• Providing grants and other incentives to establish so-called Health IT Action Zones that demonstrate effective health IT adoption practices by providers who care for patients in medically underserved populations.

• Aligning federal policy to facilitate electronic business processes.

The report also calls for a "structural payment reform," suggesting the repeal of the Sustainable Growth Rate (SGR) physician payment program and bringing up Medicaid reimbursement up to that of Medicare’s. Without such changes, the report warns, "all health IT initiatives are at risk as providers may choose instead to withdraw from these federal programs."

In his proposed budget, President Obama has laid out a plan to pay for the first 2 years of the SGR so that the physician reimbursement rates won’t be cut. His plan is to fix SGR in 10 years.

Bipartisan support of health information technology is urgently needed so that incentives aimed at encouraging physicians and hospitals to adopt electronic health records systems remain in place, according to a report by the Healthcare Information & Management Systems Society.

"Our member-created Call-for-Action report offers policy makers concrete solutions that will help promote the adoption and use of health IT to contribute to higher-quality, more cost-effective patient care," David Roberts, HIMSS vice president for government relations, said in a statement.

It is yet to be seen whether the federal stimulus funds for health IT will be affected during the current budget battles at the Congress.

Nevertheless, the report, 2011-2012 Public Policy Principles, encourages continued progress toward implementation of the "meaningful use" criteria, which enable physicians to receive incentives tied to Medicare reimbursements if their adoption of EHR systems meets the criteria. The provision is part of the Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Recovery and Reinvestment Act of 2009.

"We agree with Dr. David Blumenthal," national coordinator for Health IT, that "these are historic times. The HITECH Act is bringing the power of electronic health records to our health care system. However, these new initiatives should not create a new form of ‘digital divide’ and our goal is to make sure that all constituencies benefit from these efforts," the organization wrote in its annual report.

The report urges policy makers to make the following their top priority:

• Supporting the National Quality Forum’s National Priorities Partnership, which aims to create a consensus on standard for measuring performance in health care.

• Ensuring a consolidated communications tool and comprehensive road map for meaningful use.

• Defining each new meaningful use stage at least 18 months before the beginning of the next stage.

• Establishing grievance processes for providers seeking to fulfill meaningful use criteria.

• Developing an open and transparent EHR certification criteria process.

• Supporting the establishment of an informed patient identity solution.

• Expanding and making permanent the current Stark exemptions and anti-kickback safe harbors for EHR users.

• Eliminating the HIPAA Business Associate Agreement requirement.

• Providing grants and other incentives to establish so-called Health IT Action Zones that demonstrate effective health IT adoption practices by providers who care for patients in medically underserved populations.

• Aligning federal policy to facilitate electronic business processes.

The report also calls for a "structural payment reform," suggesting the repeal of the Sustainable Growth Rate (SGR) physician payment program and bringing up Medicaid reimbursement up to that of Medicare’s. Without such changes, the report warns, "all health IT initiatives are at risk as providers may choose instead to withdraw from these federal programs."

In his proposed budget, President Obama has laid out a plan to pay for the first 2 years of the SGR so that the physician reimbursement rates won’t be cut. His plan is to fix SGR in 10 years.

Bipartisan support of health information technology is urgently needed so that incentives aimed at encouraging physicians and hospitals to adopt electronic health records systems remain in place, according to a report by the Healthcare Information & Management Systems Society.

"Our member-created Call-for-Action report offers policy makers concrete solutions that will help promote the adoption and use of health IT to contribute to higher-quality, more cost-effective patient care," David Roberts, HIMSS vice president for government relations, said in a statement.

It is yet to be seen whether the federal stimulus funds for health IT will be affected during the current budget battles at the Congress.

Nevertheless, the report, 2011-2012 Public Policy Principles, encourages continued progress toward implementation of the "meaningful use" criteria, which enable physicians to receive incentives tied to Medicare reimbursements if their adoption of EHR systems meets the criteria. The provision is part of the Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Recovery and Reinvestment Act of 2009.

"We agree with Dr. David Blumenthal," national coordinator for Health IT, that "these are historic times. The HITECH Act is bringing the power of electronic health records to our health care system. However, these new initiatives should not create a new form of ‘digital divide’ and our goal is to make sure that all constituencies benefit from these efforts," the organization wrote in its annual report.

The report urges policy makers to make the following their top priority:

• Supporting the National Quality Forum’s National Priorities Partnership, which aims to create a consensus on standard for measuring performance in health care.

• Ensuring a consolidated communications tool and comprehensive road map for meaningful use.

• Defining each new meaningful use stage at least 18 months before the beginning of the next stage.

• Establishing grievance processes for providers seeking to fulfill meaningful use criteria.

• Developing an open and transparent EHR certification criteria process.

• Supporting the establishment of an informed patient identity solution.

• Expanding and making permanent the current Stark exemptions and anti-kickback safe harbors for EHR users.

• Eliminating the HIPAA Business Associate Agreement requirement.

• Providing grants and other incentives to establish so-called Health IT Action Zones that demonstrate effective health IT adoption practices by providers who care for patients in medically underserved populations.

• Aligning federal policy to facilitate electronic business processes.

The report also calls for a "structural payment reform," suggesting the repeal of the Sustainable Growth Rate (SGR) physician payment program and bringing up Medicaid reimbursement up to that of Medicare’s. Without such changes, the report warns, "all health IT initiatives are at risk as providers may choose instead to withdraw from these federal programs."

In his proposed budget, President Obama has laid out a plan to pay for the first 2 years of the SGR so that the physician reimbursement rates won’t be cut. His plan is to fix SGR in 10 years.

Bipartisan support of health information technology is urgently needed so that incentives aimed at encouraging physicians and hospitals to adopt electronic health records systems remain in place, according to a report by the Healthcare Information & Management Systems Society.

"Our member-created Call-for-Action report offers policy makers concrete solutions that will help promote the adoption and use of health IT to contribute to higher-quality, more cost-effective patient care," David Roberts, HIMSS vice president for government relations, said in a statement.

It is yet to be seen whether the federal stimulus funds for health IT will be affected during the current budget battles at the Congress.

Nevertheless, the report, 2011-2012 Public Policy Principles, encourages continued progress toward implementation of the "meaningful use" criteria, which enable physicians to receive incentives tied to Medicare reimbursements if their adoption of EHR systems meets the criteria. The provision is part of the Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Recovery and Reinvestment Act of 2009.

"We agree with Dr. David Blumenthal," national coordinator for Health IT, that "these are historic times. The HITECH Act is bringing the power of electronic health records to our health care system. However, these new initiatives should not create a new form of ‘digital divide’ and our goal is to make sure that all constituencies benefit from these efforts," the organization wrote in its annual report.

The report urges policy makers to make the following their top priority:

• Supporting the National Quality Forum’s National Priorities Partnership, which aims to create a consensus on standard for measuring performance in health care.

• Ensuring a consolidated communications tool and comprehensive road map for meaningful use.

• Defining each new meaningful use stage at least 18 months before the beginning of the next stage.

• Establishing grievance processes for providers seeking to fulfill meaningful use criteria.

• Developing an open and transparent EHR certification criteria process.

• Supporting the establishment of an informed patient identity solution.

• Expanding and making permanent the current Stark exemptions and anti-kickback safe harbors for EHR users.

• Eliminating the HIPAA Business Associate Agreement requirement.

• Providing grants and other incentives to establish so-called Health IT Action Zones that demonstrate effective health IT adoption practices by providers who care for patients in medically underserved populations.

• Aligning federal policy to facilitate electronic business processes.

The report also calls for a "structural payment reform," suggesting the repeal of the Sustainable Growth Rate (SGR) physician payment program and bringing up Medicaid reimbursement up to that of Medicare’s. Without such changes, the report warns, "all health IT initiatives are at risk as providers may choose instead to withdraw from these federal programs."

In his proposed budget, President Obama has laid out a plan to pay for the first 2 years of the SGR so that the physician reimbursement rates won’t be cut. His plan is to fix SGR in 10 years.

Bipartisan support of health information technology is urgently needed so that incentives aimed at encouraging physicians and hospitals to adopt electronic health records systems remain in place, according to a report by the Healthcare Information & Management Systems Society.

"Our member-created Call-for-Action report offers policy makers concrete solutions that will help promote the adoption and use of health IT to contribute to higher-quality, more cost-effective patient care," David Roberts, HIMSS vice president for government relations, said in a statement.

It is yet to be seen whether the federal stimulus funds for health IT will be affected during the current budget battles at the Congress.

Nevertheless, the report, 2011-2012 Public Policy Principles, encourages continued progress toward implementation of the "meaningful use" criteria, which enable physicians to receive incentives tied to Medicare reimbursements if their adoption of EHR systems meets the criteria. The provision is part of the Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Recovery and Reinvestment Act of 2009.

"We agree with Dr. David Blumenthal," national coordinator for Health IT, that "these are historic times. The HITECH Act is bringing the power of electronic health records to our health care system. However, these new initiatives should not create a new form of ‘digital divide’ and our goal is to make sure that all constituencies benefit from these efforts," the organization wrote in its annual report.

The report urges policy makers to make the following their top priority:

• Supporting the National Quality Forum’s National Priorities Partnership, which aims to create a consensus on standard for measuring performance in health care.

• Ensuring a consolidated communications tool and comprehensive road map for meaningful use.

• Defining each new meaningful use stage at least 18 months before the beginning of the next stage.

• Establishing grievance processes for providers seeking to fulfill meaningful use criteria.

• Developing an open and transparent EHR certification criteria process.

• Supporting the establishment of an informed patient identity solution.

• Expanding and making permanent the current Stark exemptions and anti-kickback safe harbors for EHR users.

• Eliminating the HIPAA Business Associate Agreement requirement.

• Providing grants and other incentives to establish so-called Health IT Action Zones that demonstrate effective health IT adoption practices by providers who care for patients in medically underserved populations.

• Aligning federal policy to facilitate electronic business processes.

The report also calls for a "structural payment reform," suggesting the repeal of the Sustainable Growth Rate (SGR) physician payment program and bringing up Medicaid reimbursement up to that of Medicare’s. Without such changes, the report warns, "all health IT initiatives are at risk as providers may choose instead to withdraw from these federal programs."

In his proposed budget, President Obama has laid out a plan to pay for the first 2 years of the SGR so that the physician reimbursement rates won’t be cut. His plan is to fix SGR in 10 years.

Bipartisan support of health information technology is urgently needed so that incentives aimed at encouraging physicians and hospitals to adopt electronic health records systems remain in place, according to a report by the Healthcare Information & Management Systems Society.

"Our member-created Call-for-Action report offers policy makers concrete solutions that will help promote the adoption and use of health IT to contribute to higher-quality, more cost-effective patient care," David Roberts, HIMSS vice president for government relations, said in a statement.

It is yet to be seen whether the federal stimulus funds for health IT will be affected during the current budget battles at the Congress.

Nevertheless, the report, 2011-2012 Public Policy Principles, encourages continued progress toward implementation of the "meaningful use" criteria, which enable physicians to receive incentives tied to Medicare reimbursements if their adoption of EHR systems meets the criteria. The provision is part of the Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Recovery and Reinvestment Act of 2009.

"We agree with Dr. David Blumenthal," national coordinator for Health IT, that "these are historic times. The HITECH Act is bringing the power of electronic health records to our health care system. However, these new initiatives should not create a new form of ‘digital divide’ and our goal is to make sure that all constituencies benefit from these efforts," the organization wrote in its annual report.

The report urges policy makers to make the following their top priority:

• Supporting the National Quality Forum’s National Priorities Partnership, which aims to create a consensus on standard for measuring performance in health care.

• Ensuring a consolidated communications tool and comprehensive road map for meaningful use.

• Defining each new meaningful use stage at least 18 months before the beginning of the next stage.

• Establishing grievance processes for providers seeking to fulfill meaningful use criteria.

• Developing an open and transparent EHR certification criteria process.

• Supporting the establishment of an informed patient identity solution.

• Expanding and making permanent the current Stark exemptions and anti-kickback safe harbors for EHR users.

• Eliminating the HIPAA Business Associate Agreement requirement.

• Providing grants and other incentives to establish so-called Health IT Action Zones that demonstrate effective health IT adoption practices by providers who care for patients in medically underserved populations.

• Aligning federal policy to facilitate electronic business processes.

The report also calls for a "structural payment reform," suggesting the repeal of the Sustainable Growth Rate (SGR) physician payment program and bringing up Medicaid reimbursement up to that of Medicare’s. Without such changes, the report warns, "all health IT initiatives are at risk as providers may choose instead to withdraw from these federal programs."

In his proposed budget, President Obama has laid out a plan to pay for the first 2 years of the SGR so that the physician reimbursement rates won’t be cut. His plan is to fix SGR in 10 years.

Bipartisan support of health information technology is urgently needed so that incentives aimed at encouraging physicians and hospitals to adopt electronic health records systems remain in place, according to a report by the Healthcare Information & Management Systems Society.

"Our member-created Call-for-Action report offers policy makers concrete solutions that will help promote the adoption and use of health IT to contribute to higher-quality, more cost-effective patient care," David Roberts, HIMSS vice president for government relations, said in a statement.

It is yet to be seen whether the federal stimulus funds for health IT will be affected during the current budget battles at the Congress.

Nevertheless, the report, 2011-2012 Public Policy Principles, encourages continued progress toward implementation of the "meaningful use" criteria, which enable physicians to receive incentives tied to Medicare reimbursements if their adoption of EHR systems meets the criteria. The provision is part of the Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Recovery and Reinvestment Act of 2009.

"We agree with Dr. David Blumenthal," national coordinator for Health IT, that "these are historic times. The HITECH Act is bringing the power of electronic health records to our health care system. However, these new initiatives should not create a new form of ‘digital divide’ and our goal is to make sure that all constituencies benefit from these efforts," the organization wrote in its annual report.

The report urges policy makers to make the following their top priority:

• Supporting the National Quality Forum’s National Priorities Partnership, which aims to create a consensus on standard for measuring performance in health care.

• Ensuring a consolidated communications tool and comprehensive road map for meaningful use.

• Defining each new meaningful use stage at least 18 months before the beginning of the next stage.

• Establishing grievance processes for providers seeking to fulfill meaningful use criteria.

• Developing an open and transparent EHR certification criteria process.

• Supporting the establishment of an informed patient identity solution.

• Expanding and making permanent the current Stark exemptions and anti-kickback safe harbors for EHR users.

• Eliminating the HIPAA Business Associate Agreement requirement.

• Providing grants and other incentives to establish so-called Health IT Action Zones that demonstrate effective health IT adoption practices by providers who care for patients in medically underserved populations.

• Aligning federal policy to facilitate electronic business processes.

The report also calls for a "structural payment reform," suggesting the repeal of the Sustainable Growth Rate (SGR) physician payment program and bringing up Medicaid reimbursement up to that of Medicare’s. Without such changes, the report warns, "all health IT initiatives are at risk as providers may choose instead to withdraw from these federal programs."

In his proposed budget, President Obama has laid out a plan to pay for the first 2 years of the SGR so that the physician reimbursement rates won’t be cut. His plan is to fix SGR in 10 years.

Bipartisan support of health information technology is urgently needed so that incentives aimed at encouraging physicians and hospitals to adopt electronic health records systems remain in place, according to a report by the Healthcare Information & Management Systems Society.

"Our member-created Call-for-Action report offers policy makers concrete solutions that will help promote the adoption and use of health IT to contribute to higher-quality, more cost-effective patient care," David Roberts, HIMSS vice president for government relations, said in a statement.

It is yet to be seen whether the federal stimulus funds for health IT will be affected during the current budget battles at the Congress.

Nevertheless, the report, 2011-2012 Public Policy Principles, encourages continued progress toward implementation of the "meaningful use" criteria, which enable physicians to receive incentives tied to Medicare reimbursements if their adoption of EHR systems meets the criteria. The provision is part of the Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Recovery and Reinvestment Act of 2009.

"We agree with Dr. David Blumenthal," national coordinator for Health IT, that "these are historic times. The HITECH Act is bringing the power of electronic health records to our health care system. However, these new initiatives should not create a new form of ‘digital divide’ and our goal is to make sure that all constituencies benefit from these efforts," the organization wrote in its annual report.

The report urges policy makers to make the following their top priority:

• Supporting the National Quality Forum’s National Priorities Partnership, which aims to create a consensus on standard for measuring performance in health care.

• Ensuring a consolidated communications tool and comprehensive road map for meaningful use.

• Defining each new meaningful use stage at least 18 months before the beginning of the next stage.

• Establishing grievance processes for providers seeking to fulfill meaningful use criteria.

• Developing an open and transparent EHR certification criteria process.

• Supporting the establishment of an informed patient identity solution.

• Expanding and making permanent the current Stark exemptions and anti-kickback safe harbors for EHR users.

• Eliminating the HIPAA Business Associate Agreement requirement.

• Providing grants and other incentives to establish so-called Health IT Action Zones that demonstrate effective health IT adoption practices by providers who care for patients in medically underserved populations.

• Aligning federal policy to facilitate electronic business processes.

The report also calls for a "structural payment reform," suggesting the repeal of the Sustainable Growth Rate (SGR) physician payment program and bringing up Medicaid reimbursement up to that of Medicare’s. Without such changes, the report warns, "all health IT initiatives are at risk as providers may choose instead to withdraw from these federal programs."

In his proposed budget, President Obama has laid out a plan to pay for the first 2 years of the SGR so that the physician reimbursement rates won’t be cut. His plan is to fix SGR in 10 years.

Bipartisan support of health information technology is urgently needed so that incentives aimed at encouraging physicians and hospitals to adopt electronic health records systems remain in place, according to a report by the Healthcare Information & Management Systems Society.

"Our member-created Call-for-Action report offers policy makers concrete solutions that will help promote the adoption and use of health IT to contribute to higher-quality, more cost-effective patient care," David Roberts, HIMSS vice president for government relations, said in a statement.

It is yet to be seen whether the federal stimulus funds for health IT will be affected during the current budget battles at the Congress.

Nevertheless, the report, 2011-2012 Public Policy Principles, encourages continued progress toward implementation of the "meaningful use" criteria, which enable physicians to receive incentives tied to Medicare reimbursements if their adoption of EHR systems meets the criteria. The provision is part of the Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Recovery and Reinvestment Act of 2009.

"We agree with Dr. David Blumenthal," national coordinator for Health IT, that "these are historic times. The HITECH Act is bringing the power of electronic health records to our health care system. However, these new initiatives should not create a new form of ‘digital divide’ and our goal is to make sure that all constituencies benefit from these efforts," the organization wrote in its annual report.

The report urges policy makers to make the following their top priority:

• Supporting the National Quality Forum’s National Priorities Partnership, which aims to create a consensus on standard for measuring performance in health care.

• Ensuring a consolidated communications tool and comprehensive road map for meaningful use.

• Defining each new meaningful use stage at least 18 months before the beginning of the next stage.

• Establishing grievance processes for providers seeking to fulfill meaningful use criteria.

• Developing an open and transparent EHR certification criteria process.

• Supporting the establishment of an informed patient identity solution.

• Expanding and making permanent the current Stark exemptions and anti-kickback safe harbors for EHR users.

• Eliminating the HIPAA Business Associate Agreement requirement.

• Providing grants and other incentives to establish so-called Health IT Action Zones that demonstrate effective health IT adoption practices by providers who care for patients in medically underserved populations.

• Aligning federal policy to facilitate electronic business processes.

The report also calls for a "structural payment reform," suggesting the repeal of the Sustainable Growth Rate (SGR) physician payment program and bringing up Medicaid reimbursement up to that of Medicare’s. Without such changes, the report warns, "all health IT initiatives are at risk as providers may choose instead to withdraw from these federal programs."

In his proposed budget, President Obama has laid out a plan to pay for the first 2 years of the SGR so that the physician reimbursement rates won’t be cut. His plan is to fix SGR in 10 years.

It's a simple idea, but it could help save millions of lives: a Web site helping hospitals and surgeons worldwide improve surgical outcomes by making a commitment to implement proven protocols in their operating rooms, to share ideas, and to receive feedback on what works best.

Called ORReady, the grass roots project is the brainchild of Dr. Paul Alan Wetter, founder and chairman of the Society of Laparoendoscopic Surgeons. Inspired by the humble beginnings of Facebook, and the power of collaboration in the Human Genome Project, Dr. Wetter decided that his idea - a global effort to improve surgical outcomes - would be just as feasible because "smart doctors around the world can get together and do it." No bureaucracy. No big dollar budget.

Launched in early 2010, the project is still in its infancy, and the Web site (www.orready.com) is still maturing. But the power of it all, he said in an interview, lies in the number of people who know about it and use it.

"There are many examples of people who have really improved outcomes in surgery with increased use of safety measures," said Dr. Wetter, who is an ob.gyn. in South Miami, Fla., and an internationally recognized leader in the field of minimally invasive surgery.

He hopes that by sharing OR safety information, there will be at least a 2%-3% improvement in outcomes. That's six million lives saved worldwide each year. He hopes that hospitals, medical societies, and surgical centers worldwide sign onto this effort within the coming years.

He admits that it's a lofty goal. But he also believes that the increasing emphasis on improving patient safety will help the initiative take off. Add to that the power of technology and collaboration: "[The] world is becoming a small place and information is disseminated quickly," said Dr. Wetter, who is also clinical professor emeritus at the University of Miami.

ORReady is a nonprofit project run by members and institutions that have volunteered their time and resources. The Web site follows the Creative Commons guidelines. "We encourage you to copy and use any materials that will help improve surgical outcome and create Centers of Merit in Surgery and MIS [minimally invasive surgery]." It encourages hospitals and departments to download and sign an "Outcome Commitment Letter"; to choose from a set of protocols on the Web site that suit their operating rooms; and register as an ORReady Center of Merit.

The guidelines suggest three main steps for surgeons and their teams: "Slow Down for Warm Up and Check Lists; Stop for Time Out before you Go." A stoplight on the site sums up the message.

Soon, participants can register with an open-access database that can be used for research to improve outcomes and to provide feedback. The school of biological and health systems engineering at Arizona State University, Tempe, has offered to help create the database. Dr. Wetter said that with the rapidly changing technology and arrival of new procedures, ORReady can be the tool through which surgeons and institutions can quickly share their data and receive feedback on what works best.

Dr. Wetter said that so far he has approached a handful of institutions in the United States and abroad and has received a unanimously positive response.

The project also recently won its first award. The Society of Laparoendoscopic Surgeons won the 2011 Alliance for Continuing Medical Education Great Idea Award in the Medical Specialty Societies Member section for introducing ORReady as a way to encourage surgical facilities to improve CME for improved surgical outcomes.

"We're looking for things that are best practices, are innovative, and that other people may want to replicate, adapt, [and] consider using," Jann Balmer, Ph.D., president of the Alliance, said in an interview.

"It's very exciting to do this and see this great enthusiasm," said Dr. Wetter. "For almost any doctor, the main concern is the safety of their patients."

Dr. Wetter is now focusing on spreading the word and making more surgeons and hospitals aware of and involved in ORReady. "The more people that know about this, the more successful it's going to be."

He hopes to see his project make an impact within the next few years.

It's a simple idea, but it could help save millions of lives: a Web site helping hospitals and surgeons worldwide improve surgical outcomes by making a commitment to implement proven protocols in their operating rooms, to share ideas, and to receive feedback on what works best.

Called ORReady, the grass roots project is the brainchild of Dr. Paul Alan Wetter, founder and chairman of the Society of Laparoendoscopic Surgeons. Inspired by the humble beginnings of Facebook, and the power of collaboration in the Human Genome Project, Dr. Wetter decided that his idea - a global effort to improve surgical outcomes - would be just as feasible because "smart doctors around the world can get together and do it." No bureaucracy. No big dollar budget.

Launched in early 2010, the project is still in its infancy, and the Web site (www.orready.com) is still maturing. But the power of it all, he said in an interview, lies in the number of people who know about it and use it.

"There are many examples of people who have really improved outcomes in surgery with increased use of safety measures," said Dr. Wetter, who is an ob.gyn. in South Miami, Fla., and an internationally recognized leader in the field of minimally invasive surgery.

He hopes that by sharing OR safety information, there will be at least a 2%-3% improvement in outcomes. That's six million lives saved worldwide each year. He hopes that hospitals, medical societies, and surgical centers worldwide sign onto this effort within the coming years.

He admits that it's a lofty goal. But he also believes that the increasing emphasis on improving patient safety will help the initiative take off. Add to that the power of technology and collaboration: "[The] world is becoming a small place and information is disseminated quickly," said Dr. Wetter, who is also clinical professor emeritus at the University of Miami.

ORReady is a nonprofit project run by members and institutions that have volunteered their time and resources. The Web site follows the Creative Commons guidelines. "We encourage you to copy and use any materials that will help improve surgical outcome and create Centers of Merit in Surgery and MIS [minimally invasive surgery]." It encourages hospitals and departments to download and sign an "Outcome Commitment Letter"; to choose from a set of protocols on the Web site that suit their operating rooms; and register as an ORReady Center of Merit.

The guidelines suggest three main steps for surgeons and their teams: "Slow Down for Warm Up and Check Lists; Stop for Time Out before you Go." A stoplight on the site sums up the message.

Soon, participants can register with an open-access database that can be used for research to improve outcomes and to provide feedback. The school of biological and health systems engineering at Arizona State University, Tempe, has offered to help create the database. Dr. Wetter said that with the rapidly changing technology and arrival of new procedures, ORReady can be the tool through which surgeons and institutions can quickly share their data and receive feedback on what works best.

Dr. Wetter said that so far he has approached a handful of institutions in the United States and abroad and has received a unanimously positive response.

The project also recently won its first award. The Society of Laparoendoscopic Surgeons won the 2011 Alliance for Continuing Medical Education Great Idea Award in the Medical Specialty Societies Member section for introducing ORReady as a way to encourage surgical facilities to improve CME for improved surgical outcomes.

"We're looking for things that are best practices, are innovative, and that other people may want to replicate, adapt, [and] consider using," Jann Balmer, Ph.D., president of the Alliance, said in an interview.

"It's very exciting to do this and see this great enthusiasm," said Dr. Wetter. "For almost any doctor, the main concern is the safety of their patients."

Dr. Wetter is now focusing on spreading the word and making more surgeons and hospitals aware of and involved in ORReady. "The more people that know about this, the more successful it's going to be."

He hopes to see his project make an impact within the next few years.

It's a simple idea, but it could help save millions of lives: a Web site helping hospitals and surgeons worldwide improve surgical outcomes by making a commitment to implement proven protocols in their operating rooms, to share ideas, and to receive feedback on what works best.

Called ORReady, the grass roots project is the brainchild of Dr. Paul Alan Wetter, founder and chairman of the Society of Laparoendoscopic Surgeons. Inspired by the humble beginnings of Facebook, and the power of collaboration in the Human Genome Project, Dr. Wetter decided that his idea - a global effort to improve surgical outcomes - would be just as feasible because "smart doctors around the world can get together and do it." No bureaucracy. No big dollar budget.

Launched in early 2010, the project is still in its infancy, and the Web site (www.orready.com) is still maturing. But the power of it all, he said in an interview, lies in the number of people who know about it and use it.

"There are many examples of people who have really improved outcomes in surgery with increased use of safety measures," said Dr. Wetter, who is an ob.gyn. in South Miami, Fla., and an internationally recognized leader in the field of minimally invasive surgery.

He hopes that by sharing OR safety information, there will be at least a 2%-3% improvement in outcomes. That's six million lives saved worldwide each year. He hopes that hospitals, medical societies, and surgical centers worldwide sign onto this effort within the coming years.

He admits that it's a lofty goal. But he also believes that the increasing emphasis on improving patient safety will help the initiative take off. Add to that the power of technology and collaboration: "[The] world is becoming a small place and information is disseminated quickly," said Dr. Wetter, who is also clinical professor emeritus at the University of Miami.

ORReady is a nonprofit project run by members and institutions that have volunteered their time and resources. The Web site follows the Creative Commons guidelines. "We encourage you to copy and use any materials that will help improve surgical outcome and create Centers of Merit in Surgery and MIS [minimally invasive surgery]." It encourages hospitals and departments to download and sign an "Outcome Commitment Letter"; to choose from a set of protocols on the Web site that suit their operating rooms; and register as an ORReady Center of Merit.

The guidelines suggest three main steps for surgeons and their teams: "Slow Down for Warm Up and Check Lists; Stop for Time Out before you Go." A stoplight on the site sums up the message.

Soon, participants can register with an open-access database that can be used for research to improve outcomes and to provide feedback. The school of biological and health systems engineering at Arizona State University, Tempe, has offered to help create the database. Dr. Wetter said that with the rapidly changing technology and arrival of new procedures, ORReady can be the tool through which surgeons and institutions can quickly share their data and receive feedback on what works best.

Dr. Wetter said that so far he has approached a handful of institutions in the United States and abroad and has received a unanimously positive response.

The project also recently won its first award. The Society of Laparoendoscopic Surgeons won the 2011 Alliance for Continuing Medical Education Great Idea Award in the Medical Specialty Societies Member section for introducing ORReady as a way to encourage surgical facilities to improve CME for improved surgical outcomes.

"We're looking for things that are best practices, are innovative, and that other people may want to replicate, adapt, [and] consider using," Jann Balmer, Ph.D., president of the Alliance, said in an interview.

"It's very exciting to do this and see this great enthusiasm," said Dr. Wetter. "For almost any doctor, the main concern is the safety of their patients."

Dr. Wetter is now focusing on spreading the word and making more surgeons and hospitals aware of and involved in ORReady. "The more people that know about this, the more successful it's going to be."

He hopes to see his project make an impact within the next few years.