dozens of things to disclose, given my interest in research and business, this is perhaps my real disclosure. It's always kind of fun to go back and be reminded of the stories they tell when we look back at these pictures. This picture in 2004 pretty much says it all, especially compared to the more recent one you see on the right. I was clearly out of balance at that time. I remember thinking that when I'm successful, I can finally take time for myself and family and take advantage of the fruits of my years of labor at the proper time. However, seeing the consequences of that earlier decision, I now try to view balance in the context of days and weeks, rather than something achieved over decades that actually gets reconciled in the end. I am frequently reminded that I am far from perfect as it relates to balance and family and work, and sometimes I think work is sort of like a ball. You drop it and it bounces back. And then there's family, health, friends, and spirit. Those are the things that are far more fragile. And once dropped, they shatter irreversibly like a glass. The opportunity to share these things at moments like this is always a reminder that I can do better. I liken what I wish to convey this morning as analogous to building a house. It has a foundation, it is framed floor by floor, and it delivers a final structure completed with all the finishing touches. But really mostly this is about the opportunity, the privilege to express my gratitude to so many of you who have shared with me along the way. Now a foundation is the start of any good home for which everything else is built upon. Essentially, the foundation provides a stable platform for sustainable growth. This is my wife, Emily, of 26 years. As a career prosecutor and essentially the CEO of our home and our family, she tends to nearly every responsibility. Emily is full of positive energy and balance. I am fortunate to have her love, her patience, her unconditional support that has really enabled me to balance family and my passion for education and research and notably to answer my calling and the satisfaction and fulfillment that comes from caring for patients. Thank you. Our children are a gift of life, love, and future vision. They are my greatest source of pride and happiness. This is Ethan, Adam, and Ava, two of whom are here today. We are proud of each of you for what you will become and how you exist today and how you will emerge tomorrow. You bring us great pleasure, even when we get angry or frustrated when you're simply acting your age. As Mark commented, these are my parents who were married more than 65 years. My two brothers, Russ and Mike, are in business. My dad is 87, a former commercial real estate broker after being a tool and die baker. He also runs our Sports Medicine Weekly podcast for 11 years, and he has self-taught skills that are better than most 20-year-olds at this time. My mom passed peacefully last August at the age of 84, and as mentioned, she loved to golf and was an interior decorator. Fortunately, I don't have any major childhood stresses to report and all the activities I enjoyed with my own family growing up, such as skiing and sailing, are what I actually enjoy today with my own family. My parents provided a loving and supporting environment and a foundation to enable me to pursue my wish to become a doctor starting as early as the eighth grade. Like most of us in this room, I chose medicine to make a difference in people's lives. I was clearly not born to be an orthopedic surgeon, as Mark said, and as Mike Simon, the then chairman of the University of Chicago, said in my letter of recommendation for residency, after first considering pediatrics, psychiatry, and infertility, I was pretty late to the game. These individuals are my lifeblood at work, and they're here today. My PAs, Kyle, Paige, Kaylee, and my administrators, Sam, Val, and Val, and some recent research assistants. These individuals exude loyalty, compassion, patience, a tireless work ethic, and an amazing tolerance for my last-minute change, which happens pretty commonly. On a daily basis, I make sure they know how much I truly value them. These are my partners in a second family, the section of sports medicine, under the leadership of Nick Verma, one of our program chairs, and more importantly, my friend. Most are here today. As a fifth-year resident at HSS, Bernie Bock called me and said, look, if you're not going to train with us at Rush, please consider joining us after you are done. And I did. Bernie Bock has been my mentor and friend for 26 years. He has always reinforced the concept of life being a marathon and not a sprint. One of his greatest strengths is his ability to remember everyone's name in a not-so-irrelevant fact, such as your birthday, your kids' names, your dog's names, and all the colleges they go to. He is a savant in that way. Our fellowship has been around for more than 30 years. We have trained more than 100 sports, 33 primary care sports, and 10 shoulder and elbow fellows. We have a lot to be proud of. From this legacy, 60% have pursued academics, and many are taking care of professional or college teams, are chairmen of their departments, and have assumed leadership positions in several specialty societies. We are very, very proud of what you've done, and I look forward to seeing many of you tonight at our annual fellowship reception. Framing of my allegorical home includes my connection to my other family, Anna, and our many accomplishments over the last year. Those of you who have had the privilege of knowing the late Howard Sweeney will always equate Anna in the Orthopedic Learning Center with selfless commitment to teaching and education, otherwise known as academic philanthropy. I remember my first course in 1997 as a junior instructor, as you see here with Tom Wikowitz. I thought I had arrived. Anna embodies meritocracy and mentorship. There is something for anyone who wishes to contribute at any age, and advancement is based upon merit and not ego. Anna provides a level playing field for those who have common interests and to unconditionally share ideas and foster innovation and education and research. No is a complete sentence. Every time I say yes, I am saying no to something else. Les Besson, my longtime friend, reiterated that to me recently. In reality, we don't pay for things with money, but rather with time. After my run on the board more than 10 years ago, Rick Ryu, as you see here, asked me if I'd be interested in moving up the Anna leadership ladder. Now, as healthcare providers, we are all seeking affirmation. Really, in part, our validity comes from the dependence on our patients and our peers and the feedback we get. We have a lot of trouble just saying no. We need that feedback loop. I now try at least to ask myself, will the obligation enhance my career? Will the commitment take me away from my family and my friends, and can I deliver with excellence? Will this obligation take me out of balance? Now, at that time, I said no to Rick. I was petrified. I believed that I could not deliver with excellence. Rick was incredibly gracious. I feared that I may never have this privilege again. Six years later, fortunately, when I was in a much better position to say yes, I found myself on the Anna board as treasurer. I learned it was initially okay to say no. Now, I've enjoyed my more than 10-year run on the board with Anna, and in this setting, I've observed so many leadership styles from the individuals you see here. I paid attention to what they said, how they said it, and most importantly, to how they built consensus to do the work on behalf of an organization for those of you in this room. As you saw previously, this is a picture of a recent board meeting in Arizona. Currently, we have these individuals to thank for their tireless commitment to Anna. Now, I do confess, while we work very hard, we actually have a lot of fun and play hard. Clearly, we have great affection with each other. As you can see me here kissing Bill Beach on his cheek at one of our past board meetings on a slightly sunburned face after a day of golf. Now, I had to protect the identity of those playing flippy cup after a recent night following a board meeting, but arguably, this is balance in the workplace. As Mark said, I often wonder how I ever became president of anything because my golf game is probably the worst of anyone I know. You can ask Chris Harner. When I was a fellow at Pitt and teed off at the most foo-foo golf course when we were finishing our fellowship, the ball bounced straight down, up in the air, and landed in my shirt pocket. Truly one of the most embarrassing moments of my life. One cannot lead without excellent teams in front of them. This is our current Anna staff. The Anna mentality is a can-do attitude. They dig in and they get it done with excellence. Thank you for making my year easy and productive, especially in the midst of a global pandemic. Now, taking off is exactly when the pandemic started and finishing at a time when we can actually all see the other side, and as we frequently say, unprecedented. I swear, I thought I had COVID on a weekly basis. I tested when I could to protect my family and my patients. I washed groceries like it was a surgical procedure with bathroom cleaner. In the early days, there was seemingly no good information to rely upon. I know many of you in this room lost family members, got sick, and may have residual symptoms from this crazy disease. It still amazes me that this massive public health issue became a contested political narrative at the expense of so many. I sincerely hope that all of you are vaccinated or considering doing so. The vaccine is what opened the door to allow us to be together safely today. Now the silver lining of this pandemic included the opportunity for many of us to spend time with our families in unexpected, unprecedented ways. While most Americans raced to the stores to get their first Peloton, my kids went out and acquired Felix, the most amazing yet inappropriate dog a busy family could ever have, a Border Collie, especially in the city of Chicago. This picture depicts a typical night during the pandemic, home testing kits that offered false reassurance, lots of wine and games with the family. Now I never thought I would drink boxed wine, but at times it was all we could do to actually keep up our supply. And surprisingly, it really doesn't taste half bad. This year was a time of reflection for most of us. After a nearly two-month hiatus in Chicago from clinical activities, many of us felt the palpable absence of the gratification that comes with seeing and treating patients. But the pandemic reinvigorated our core values and reinforced why we do what we do with so much passion and relentless commitment. And then there were these perpetual Zoom calls. I think the most common expression over the year was, your mic is muted. We have all missed our personal interactions, which we are fortunate to experience this week. Now there were some pretty funny times. As you see here in the top left is Jeff Abrams, well past his prime. Clearly very interested in the discussion. And Joe Toro, seen on the top right, who had clearly forgotten to take his ADHD medications once again. Now this patient of mine decided during a telemedicine visit that smoking during our first post-operative visit was a good idea following a rotator cuff repair. At least I can stop blaming myself for having to revise our cuff three times in two years. Now despite the pandemic, AND a membership grew more than 10% with representation in more than 80 countries. The Journal of Arthroscopy, the family of journals, continues to thrive, much like AGSM. It's earned a high impact factor under the oversight of its editor-in-chief and my friend, Jim Lubowitz, with more than 2,000 submissions last year. AND's commitment to skills and performance-based training continued throughout the year, and many of us hope that this will become an integral part of the board's certification process. Eric Stiefel and his team worked tirelessly on several initiatives in collaboration with other specialty societies to protect us from the economic impact of reimbursement and coding changes. Under the oversight of Jim Stone and Joanne Halbrecht, we initiated the PSO to provide additional value to AND a members. Thank you to all of your hard work and to those that you see here. Because of the generosity of many of our AND a members, our industry partners as well as a favorable economic climate related to investment opportunities, AND a's endowment remains strong, allowing us to deliver value to members well into the future. We initiated the legacy campaign in recognition of our 40th anniversary. This campaign is to assure AND a's future. We are grateful for the 100% participation of the AND a board and the generosity of many of our past presidents and many of our members. We have now raised more than $1.5 million toward our $4 million goal over the next year, which will culminate at Mark Gettleman's meeting in San Francisco in May of 2020. We need diversity. 2022, excuse me. We need diversity in orthopedic surgery. Two minority groups, women and nonwhite medical students are essentially equally represented in medical school. Now, after medical school, practicing orthopedic surgeons are 94% men and 70% white. Bright, talented nonwhite male medical students are choosing specialties other than orthopedics. As a profession, we are missing the innovation, the competency and the unique perspectives that a wide range of individuals would otherwise provide. In an effort to do something meaningful in 2020, we activated the diversity and inclusion task force led by Julie Dodds and Don Buford along with these committee members who contributed several initiatives. The annual meeting lecture which will be delivered tomorrow by Rick Ryu on behalf of both organizations, the diversity research award for the best paper authored by an individual who was underrepresented in medicine, and a yearly OLC course introducing minority medical students to orthopedics in a welcoming, supportive environment to connect them with mentors. I am learning that diversity and inclusion is not an endpoint or a demographic percentage, but it's an ongoing practice just like we practice medicine and surgery. I would like to bring your attention to this recent publication in CORE by the lead author, Lisa Canada, and her co-authors on Speak Up Ortho. Now, as many of you may know, Speak Up Ortho is a social media platform that provides the opportunities for individuals to share actual experiences of bias, inequities, and harassment within orthopedic surgery. I wish to thank those who have shared their stories for providing awareness to so many. Now, while not always related to diversity, underrepresented groups are often the targets of harassment and unfair treatment in our white male dominated society. Reading posts on Speak Up Ortho made me cringe and I felt uncomfortable, and likely most of you feel the same way. But as uncomfortable as I feel, I can't imagine how uncomfortable it must feel to be on the receiving end. Over the last 12 months, I have recognized my own blind spots, some of which may be part of the problem for not seeing or redirecting when I had the opportunity to do so. In addressing this topic, I worried that I might say the wrong thing or that I could not possibly say the right thing because of my station as a white male. I certainly don't want to preach or make anyone feel uncomfortable, but I do feel comfortable saying today that I can do better. I will do better. We will do better, together. Collaboration. Today our presence reflects true collaboration. As an active member of ANA and AOSSM, this year was especially meaningful to me. When it became clear that our annual meeting in April was threatened by the pandemic, on a Saturday morning in August of 2020, I called Mike Ciccotti, and now my very good friend, and asked him if he would contemplate working with his board and presidential line to collaborate on this annual meeting. Mike agreed that a combined meeting made sense and that organizational differences could be effectively blended to deliver on our respective missions. Time was short. We quickly and efficiently built consensus amongst our leadership and our constituents. Now, interpersonally, getting to know Mike was the most rewarding aspect of this. We exchanged these weekly text messages even up until the last moment, every Saturday morning. But I really want to thank the program chairs, Nick Verma, Kevin Bonner, Steve Cohen, and Brett Owens, for creating a truly blended program that you're seeing here today. And all of these people that we had on a recent Zoom call from both sides working collectively together. I want to acknowledge the organization's CEOs, Greg Doomer and Laura Downs, for assuring that what you see here today is truly a blended, collaborative effort. I am proud to be standing here with you. We can all acknowledge that we delivered with excellence. Home. I'm generally more comfortable sharing what I've learned about research, treating patients, and decision-making. However, as I sort of put the final touches on my proverbial home, I'd like to share perhaps what is much harder but more meaningful to me. It's rare to actually have the opportunity to share with so many. These are 10 lessons that I've learned that I think kind of transcend my medical knowledge. Managing time. This picture is a pretty typical day, simultaneously catching up on sleep while operating and writing a paper. I get teased about that all the time. And I'm frequently asked, how do I do it all? How do I manage my time? And frankly, I found that I can achieve much more success by ceding control to the right people and accepting that perfection is not always achievable and is not always the end goal or the end game. So first, I surround myself by people that are much better than me. And more importantly, I regularly let them know that they are valued. Second, I have learned to delegate responsibly. Theodore Roosevelt said that the best executive is the one who has the sense enough to pick good enough people to do what needs to be done and the self-restraint to keep from meddling while they do it. This quote by Warren Buffet recently hit home as it emphasizes the point about the value of extra effort for just marginal return. The interesting thing about business is that it's not like the Olympics. You don't get any extra points for the fact that something's very hard to do. So you might as well just step over one foot bars instead of trying to jump over seven foot bars. So related to this is this balance of perfection versus efficiency, and it's a tough one. In an effort to achieve perfection, I was often over-prepared for things like tests and lectures. And because of the sheer volume of opportunities that had come my way, I really came to realize that there's a sweet spot that balances this perfection and efficiency. This graph depicts the challenges with this balance. I have learned when to strive for perfection and when I can reach the same result with good enough. Colin Powell once said that it is okay to make a decision if the probability of success is between 40 and 70. I think it's also okay that I might be wrong sometimes. We are by design human and clearly not flawless. Mentors. I've spent a lot of time contemplating exactly what a good mentor is. I've learned from a lot of you in this room, and I'm thankful to those who I've met along the way who provided a menu, a sort of smorgasbord, if you will, of character traits to emulate. Now I've pointed out a lot of people, and I don't want anyone to feel that you also haven't contributed, but in addition to these people that you see here, who I go back more than 20 years, you have had a tremendous, enormous impact on who I am today. I want to thank you all for teaching me to be thoughtful, resilient, patient, fair, respectful, and probably most importantly in the environment we live in, collegial. We need to preserve our roles to deliver the best care. We have hundreds of team physicians in this audience. Early on, Neil Elitrosh taught me something very important about our role as team physicians. While building friendships with our athlete patients is really gratifying, in the end, it's important to give them something to believe in when the time comes where they really need our help. This advice has served me very well in providing the best care when athletes need us most. To be a good leader, put yourself in other's shoes. Similarly, this room is full of amazing leaders. I think Mark Twain said it well, really great people make you feel that you, too, can become great. I have learned that an essential aspect of leadership is focusing on your own perspectives, excuse me, is focusing on perspectives other than your own. Now again, Colin Powell, the military seems to be replete with excellent lessons on leadership, and these points are adapted from Colin Powell's thoughts on leadership. Being a leader sometimes means pissing people off. Build consensus with preemptive communication. The day your team stops bringing you their problems is the day that you stopped learning. Look below the surface even if you are afraid of what you might find. Never let your ego get so close to your position that when your position goes, so does your ego. And I think that speaks to a lot of us who take care of teams and often loyalty could be lacking. Great leaders are also great simplifiers. Surround yourself with people who take their work seriously but not themselves and have fun as a leader. And if you are successful, you will be criticized. When I'm criticized, I try at least to look for a grain of truth in that criticism. I try to make necessary changes to show a sincere commitment to teamwork, collaboration. I don't always get it right. Validating other's concerns rather than dismissing them has helped me immensely to understand differing viewpoints and to solve problems. Finally, showing remorse, not just regret for mistakes, has been an important avenue for my own personal growth and effectively, I hope, has made me a stronger leader. Be a good listener. Early on, I was not a good listener. In fact, I think like some of us here, it took me an average of seven seconds before I routinely interrupted my patients while speaking. Over time, I've learned that patients are very complex and they have lots of concerns. Disarming patients who catastrophize their problems by helping them reframe them has also been particularly effective once I took the time to really understand their concerns. Ultimately, like many of us, I learned to sit down, ask targeted questions. Why are you here? What are you hoping for from our visit today? This editorial by Lisa Rosenbaum, The Art of Doing Nothing, speaks to our preoccupation that our society has with technology, even to the extent that it supersedes the importance of listening, examining our patients, and borrowing from our knowledge base. Directly related to this is my favorite quote by Voltaire. The art of medicine consists of amusing the patient while nature cures the disease. It took me some time to figure out that mostly patients have concerns and want reassurance. What if I do nothing now? Will I end up in a different place later on that could otherwise be avoided? Can I remain active without making my condition worse? I've come to realize that our jobs are actually pretty simple. Have a firm understanding of the natural history of disease, maximize skillful neglect where it makes sense, and add a strong dose of reassurance by being kind, a good listener, and validating our patients' concerns. And if necessary, we will perform well-indicated orthopedic surgery that will hopefully avoid the most common complication, a failure to deliver to meet our patient expectations. Take off the blinders. I once practiced that whenever I was overwhelmed with challenges, I would just put my head down and get it done. I have since learned that the fallout from this is a total lack of self-awareness and alienation of those closest to me. I learned over time to take the blinders off. Mercedes Lackey said it well, once the blinders are off, it is hard to go back to seeing the way you used to. Showing gratitude. I recall an amazing NPR episode where an 85-year-old former kindergarten teacher came upon a student from 60 years earlier. He told her that she was the most influential person in his life and that he simply wanted to thank her. The teacher responded that no one had ever taken the time to pay her a compliment or reference her teaching skills or that she was ever a good teacher at all. I have learned that showing gratitude is time-sensitive. If you think it, just say it right then and there. I recently counted that there's 32 people involved with initiating and delivering the care to a single patient undergoing an ACL reconstruction from the time they make their appointment to the time they are cleared to play. My role was actually quite small in the total delivery of care. Now data supports that people value appreciation even more than salary. While I am absolutely terrible at remembering names, as my wife frequently reminds me, I will routinely recognize people for their efforts and simply say, thank you for doing what you do. Humility and self-awareness. C.S. Lewis once said, humility is not thinking less of yourself, but thinking of yourself less. I recognize that humility is not something we are born with, but rather something that we learn and acquire after experiencing life. I experienced my first impactful lesson in humility in my early 40s. My career and family, I felt, were on track. I was happy with where I was. And then my family and I were hit with two personal crises. And suddenly I felt helpless, vulnerable, a loss of control, and embarrassed. I felt ill-prepared to manage that time in my life as I had very little to borrow from in my early life experiences. Good news is eventually I felt we got through it, we found the other side, and most importantly I learned humility. More than anything, this lesson in humility taught me to look outside of myself as best I can. I now embrace the fact that my own humility and self-awareness are interconnected and critical character skills to improve upon over time. Of course, now that I've learned that no one really knows humility until they have a teenage daughter, so I want to thank Ava for teaching me that. And finally, family and friends are what matter most. There's an abundance of research that suggests that experiences that are shared, not things, are what make us happy. If you look at the marginal utility of a dollar versus our happiness, philosophers have long argued that it will asymptote at a surprisingly low value. It is often said that youth is wasted on the young, and in the end, money has no value at all. The importance of friendship. I wish I could put each and every one of you on this slide. Dr. Barbara Fredrickson recently determined that we have a forward-looking immune system. Having meaningful social interactions as we age has a positive impact on happiness, our overall health, and meaning in life. Some of my happiest moments have been with my family. And beyond that, I can also say that at the times that many of us in this room have shared face-to-face have been particularly meaningful. I think that this last year was a true reminder of what is and what is not important. The pandemic provided the opportunity for many of us to actually reboot in a meaningful way. Because we are always learning, we can always do better. I sincerely want to thank you for taking the time to listen, and I have enjoyed sharing some things that really matter to me most. Thank you. Thank you. So, at this time, I would like to introduce Dr. Mark Gettleman. Good. Dr. Mark Gettleman, back to the stage as Anna's 41st president. That was incredible. Congratulations. Great job. Okay, the piece, the resistance. The gold medal. It's time to work. It is time to work. Although you've been working pretty hard over the last couple of months, my friend. And then for you, Dr. Cole, we have your past president's pin. Thank you for your service, your incredible leadership, and delivering a poignant message that's going to make my speech now way more difficult next year. Thank you for all you did for Anna. We really appreciate it.

Dr. Brian Cole

balance

fragility

gratitude

time management

family

presidency handover