James R. Kasser, MD


Hello again from Children’s Hospital Boston. We continue to grow, specialize, teach, perform research and provide outstanding patient care with a constant emphasis on improvement and effectiveness. Our success is a product of teamwork which comes from the creation of an environment of respect and support which is at times missing in the academic and practice environment. It is this spirit of cooperation that has allowed us to continue to grow and prosper in a competitive environment.

Peter Waters has taken over as the clinical chief of the Department of Orthopaedic Surgery here at Children’s, performing a role that is integral to our continued success. In this role, he has responsibility for ambulatory and surgical volume, as well as distribution of resources and planning in order to achieve our volume targets. He has developed an OR time bank in which OR time is redistributed in an organized fashion, allowing us to achieve higher levels of block time utilization, facilitating continued acquisition of this precious resource for our department. Achieving higher productivity levels is critical in this time of greater need for efficient use of resources.

While we strive for greater efficiency, we also are pursuing a higher level of quality. Our goal is to measure outcomes of 80% of our surgical procedures on a routine basis over the next 5 years. Our Clinical Effectiveness Research Unit which was put into place about 6 years ago will be central to this effort. Peter Waters is leading this effort, along with Susan Mahan, Travis Matheney, Tim Hresko and many other members of the department. Quality improvement and improved efficiency are the major efforts in our department at this time.

Clinical care in our department has been markedly improved by the addition of an ever-expanding group of midlevel providers, “MLP’s.” This group of individuals, now numbering 15, is comprised of nurse practitioners and physician assistants. They perform all the work-ups in the ambulatory area, assist at surgery at the main hospital and at the satellites, see emergency room consults for routine emergency room visits, and provide inpatient care on a daily basis. They also see post-op visits at times, again improving our efficiency of care. An NP or PA makes rounds with the residents between 6:15AM and 6:30AM, obtaining the sign-out list for the day with identification of inpatient problems and discharge criteria on all patients. During the day, care and consultations are coordinated by the NP or PA, ensuring that discharges are done as soon as possible.

With the recognition that Emergency Room ad-ons will continue to increase and overwhelm the orthopaedic staff, we embarked upon the Orthopaedic Surgeon of the Week Program (OOW). The OOW is an orthopaedic department member who gives up all elective practice a week at a time and takes emergency call from 7AM to 7PM daily. During this time, they do consultations, emergency surgery, and back-up the NP’s and PA’s on emergency or trauma call, as well as seeing all urgent patients and providing surgical care. This has resulted in an effective way to see consultations and emergency patients with the mandate of attending physician care and supervision. This change is an effort to improve care, recognizing that with limited resident work hours, the resident experience is markedly improved by this attending supervision and teaching, as well as the assistance of the MLP’s. Night call is still done by a resident with rotating orthopaedic staff.

It is significant that this year’s U.S. News & World Report again recognized pediatric orthopaedics at Children’s Hospital Boston as being Number 1 in the country. The score of the top three hospitals in orthopaedics is essentially identical but we will take this as an outside validation of our efforts at clinical excellence.

We have made a commitment to growth in satellite locations primarily in the form of megasatellites. In this respect, the Waltham satellite functions as a small hospital with a 12-bed inpatient unit, 6 operating rooms, and a large ambulatory orthopaedic area. Our space there is about 8,000 square feet with 7 pods, each containing 3 exam rooms, a cast room, physical therapy unit, and brace shop. With a comprehensive orthopaedic department such as this, we are able to carry out many of the ambulatory evaluations as well as much of the routine orthopaedic care in Waltham, just as we would in the Longwood Avenue environment. Satellites on the North Shore and South Shore on a somewhat smaller scale will be opening this January.

The satellite strategy has allowed us to satisfy the demands of a market which requires routine orthopaedic care closer to home, as well as providing a lower cost environment in which to provide that care. Anesthesia, nursing and medical care is the same in the satellite environment as it is on the Longwood campus. As we achieve greater efficiency, decreased turnover time and more rapid surgical time, we intend to pass such savings on to the insurers and hopefully to the pubic who is paying the bill for medical care.


We continue to educate residents from the Harvard Combined Orthopaedic Residency Program with a 6-month rotation in the third year. We have 6 Harvard residents, a resident from Dartmouth and one from Lenox Hill. Photos are included of the latest classes of residents in our program. Our most recent fellows were Darin Davidson, Benjamin Shore, and Mike Glotzbecker, a previous HCORP resident who spent an additional year with us. Darin is pursuing a tumor fellowship in Toronto, prior to embarking on a career combining pediatric orthopaedics and orthopaedic oncology. Mike Glotzbecker has completed his fellowship and will join the staff here at Children’s, with a primary interest in spine surgery, in addition to general pediatric orthopaedics. The third fellow, Ben Shore will join our staff as well. He has an interest in neuromuscular disease as well as epidemiology and outcomes research. He is presently attending the Harvard School of Public Health part-time, as well as beginning an orthopaedic staff job with us.

The teaching program at the present time is under the direction of Young-jo Kim and Peter Waters. We continue to re-evaluate the program and make efforts to improve the education of our residents and fellows. The clinical material of over 85,000 ambulatory visits and over 5,000 surgical cases provides an outstanding basis for education but requires constant attention to coordination and detail, as you might guess.

We continue to have ACGME approval for both the residents’ and fellows’ program and at the present time, we and they believe that the educational program is on the right track and improving. The conference remains a daily educational experience but has evolved to include a journal club and an indications conference, as well as the traditional pediatric teaching conference, Chief’s Conference, Fellows’ Conference and a Mortality and Morbidity Conference. The greatest challenges to the educational environment at this time, I think, are the need for greater efficiency and volume in the hospital and satellite settings and the 80-hour work week imposed by ACGME, superimposed on an environment of changing patient, parent, and physician attitudes.


Over the past year, we have seen several promotions within the department, including Dr Michael Millis’ promotion to Professor of Orthopaedic Surgery at Harvard Medical School, as well as Young-Jo Kim’s promotion to Associate Professor at Harvard Medical School. There have been several changes in the HMS endowed chairs with Dr Peter Waters assuming the John E. Hall chair at Harvard Medical School; Phyllis Brewer was the major donor to this chair, with many orthopaedic surgical staff and fellows who had worked with Dr Hall also providing major gifts. It seemed appropriate to me that the John E. Hall chair remains with the clinical chairman of the department.

I assumed the Ormandy chair in Orthopaedic Surgery and Dr Matt Warman moved to the Harriet Peabody Professorship in Orthopaedic Surgery, replacing Melvin Glimcher. Matt is the director of our orthopaedic research laboratory and has been in this position now for 3 years.

In the basic science research lab, Dr Matt Warman continues as the director of the lab, with an emphasis on genetics and orthopaedic surgery. We have added a new person to the lab this year, Matthew Harris, PhD, an assistant professor, recruited by a combined search with Genetics from the Max Planck Institute in Germany. His expertise is skeletal development in zebra fish; we look forward to great things from him.

The publication and promotion record within the department continues on track. My request is that all staff members publish at least 3 papers per year and continue to expand their roles on a local, national, and international level with respect to teaching. With these goals in mind, all staff have received promotions on target and the academic level of the department continues to rise at an appropriate level.

Dr Charles Johnson from Texas Scottish Rite Hospital was the Visiting Professor for our annual Grice Day lecture. He spoke on spinal growth as well as spinal fusion and presented a very interesting discussion about congenital deformities in the lower extremities. Case presentations were done by the residents and fellows that resulted in lively discussion and, as always, we welcome new and different ideas from outside of Children’s Hospital. As always Charlie was an outstanding visiting professor and brought with him a sense of humor, excellent ideas and concepts which will improve orthopaedic care at our hospital, as well as the knowledge base of our staff.

With respect to individual accomplishments, Dr Waters is the first vice-president of the Pediatric Orthopaedic Society of North America and will take over as president next year.

I have continued my work with the American Board of Orthopaedic Surgery, for which I am in charge of the oral examination. I hope any of you taking the oral exam, either for Part II certification or recertification found this to be a valuable experience, as we put a great deal of effort into making it be both fair and comprehensive. I will take over as president of the ABOS next year. To mention each individual member of the staff in the department would take more space than that allotted to us. They have been listed with academic rank and role within the department. As our orthopaedic staff has grown to 26 orthopaedic surgeons, 8 residents and 9 fellows (including subspecialty fellows in Sports, Tumor, Hand and Hip), we continue to grow, develop subspecialties and provide excellent clinical care as well as a continued research effort.

Update on Dr John E. Hall: John and Frankie have moved back to Toronto where they are living in an apartment near their family. John’s interest in reading orthopaedic material and in the development of our department continues.

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