All right, well, I'm honored to have the opportunity to conduct this interview with you, my friend and colleague, Lou McIntyre. This is part of the Anna Oral History Project, and I guess it's meant to be free-flowing and kind of share our common experiences and our experiences with Anna. So I've thought back when I was asked to conduct the interview, my friend, and we've known each other almost 40 years, dating back to our residency, and while I think I might know the answers to some of these questions, I'm excited to hear your answers and take a little walk down memory lane with you today. So of course the goal is not just to reminisce, but to share our experiences with the next generation of Anna members. So with that introduction, I thought before we talk about our experiences with Anna, I thought we'd go back and maybe you can tell me what influenced your decision to pursue a career in orthopedic surgery and then also a career in arthroscopic surgery. Well, I wanted to become a physician from a sort of a young age. I think it was a goal in that I saw the physicians in my, you know, where I grew up were respected and were accomplished people and were leaders in the communities where I lived. And I thought that that would be a great pursuit. It also had the bonus of having the challenges of, you know, some science, which I enjoyed, biology, chemistry, you know, all those things that I sort of excelled at in school. And, you know, when you combine, you know, a love of athletics with medicine, poof, you get orthopedic surgery. Even though I wasn't much of an athlete, I'm not big, but I was slow. And that's what my kids tell me anyway, so, but I did pursue a lot of athletics and played rugby in college and afterwards for about 13 years into my 30s. And certainly sustained enough injuries, especially in my shoulders, where I became very interested in, you know, how you might take care of those things. And then in addition to that, you influenced me significantly in our residency at Long Island Jewish in New York. You were the first to go visit Dr. Dick Caspari in Richmond, Virginia. You came back and, you know, you're a very enthusiastic guy, but you were off the charts, jumping up and down enthusiastic about Dick Caspari and some of the magic that he was performing in Richmond, Virginia. And I remember you actually had one of his suture punches mailed to our hospital. And I was with you the day it arrived in our, you know, our little closet, which was our resident room. And it was like, you know, the Holy Grail had arrived at Long Island Jewish. You opened up the package and you sort of, you know, held the suture punch with great reverence and it was like, this is it. And I was like, what the hell is that? And you know, we actually used it a couple of times, which I thought, and you know, from then I think that was when I was sort of pointed in a direction of finishing up and then doing the same thing that you did and go to Dick. I believe that I was one of, what, four or five of us from LIJ that went down in sequence, right? So it was you, Barry Kleeman, myself, Sal Corso, Randy Jagger. I believe those are the fellows that went from LIJ to Dick and Rick Myers and to Terry Wepple. So that's sort of how I wound up in orthopedics and then in sports medicine. And then specifically as an arthroscopist, because, you know, that was really an arthroscopy fellowship. It was heavy on the arthroscopy, every joint, including hip arthroscopy, which not a whole lot of people were doing at the time. We're talking, this is 30, this is 31, 32 years ago, 33, I think 34 for you, correct? And so, you know, we actually, we did sports medicine also. We covered the local high school teams and things like that. But you know, it was really, the pursuit was arthroscopy. It was a technical fellowship. And since it was a new technique, it was really exciting because we were really on the forefront of what was being done. It was magic time. And you know, it was really, I mean, it was thought provoking and engaging to be part of that. And to see the thought process that went into, you know, how we would approach procedures that had always been taken care of in an open fashion, in an arthroscopic fashion. And certainly Dick suffered his, enough of the slings and arrows of folks who thought that this was, you know, not the way to go, but it was really, it was exciting. I'd say it was exciting. Sure, for sure. And, you know, it brings back memories. I mean, we're talking back late eighties that we first met in residency and these mentors that you've mentioned were, you know, were certainly groundbreaking and the world was very different back then. So you know, you've mentioned a few of our common influential mentors, Dr. Caspari, Rick Myers, Terry Whipple. Tell me a little bit more about those mentors and what they meant to you and how maybe each one of them have contributed to your passion of arthroscopic surgery and how they influenced your career. Yeah. I mean, I wrote about this in my presidential address because it really, you know, and I've reflected on, you know, on how I, you know, how I became an orthopedic surgeon and how I was striving for excellence in orthopedic surgery. And it all went back to those three gentlemen, the sort of Holy Trinity of orthopedic research in Virginia, Dick Caspari, Rick Myers, and Terry Whipple. And the great thing about that is that they each brought their own focus to bear on patient care. So Dick was, you know, he was a visionary. He was thinking five, 10 years ahead. He was an innovator. There was always some kind of new thought emanating from his, you know, his brain. And it was really interesting to see that. Not what is, but what could be. Right. What could be. I mean, I remember one of the first OR days I spent with him, we were driving back in his car to the office and he said, said, boy, you can't wrap your arms around all orthopedics. You're going to have to pick one thing to do well. And he said, all the stuff you're learning now in 10 years, you're not going to be doing it because you're going to be doing something new and different. And I was like, well, that's really cool. And I took that to heart. And, you know, not only that, but I mean, he was certainly in addition to an innovator and a visionary, he was a gifted, he was also a gifted surgeon. So he, he had the ability to make you better just by his presence and his teaching ability, which is an uncommon characteristic. I mean, it's really a gift. And then you had Rick. Rick was much more of a traditional sports medicine doctor, sidelines guy, taking care of the community, out in the community. You know, Dick's patients came from all over the country. They'd come on, you know, Monday night, they'd stay in a hotel, we'd see him on Monday, he'd operate on all of them on Tuesday, and then they'd go home. I mean, it was, you know, unbelievable. Rick was the community guy, took care of the, you know, two of the local colleges, all the local high schools. That was really the sports medicine thing. And he was a bread and butter orthopedic guy. You know, so it was ACLs and rotator cuffs and, you know, stuff like that. And you know, he was that brainset. And then Terry, Terry Whipple was a visionary also. And he was sort of like, he was the most, I think, erudite of the three, and the most intellectual. You know, he was playing 3D chess, and we were all playing checkers. And he had ideas about how to take care of things. And he also had a lot of ideas on the practice management side, you know, how you should run your practice. And, you know, he was one of the first I ever saw that tried to develop a data collection process for arthroscopic surgery. You know, with that, what was the surgical outcome? What was the name of that? I think it was called Surgimates, maybe? Yeah. And so I adopted that in my practice. It was an early patient, there was no patient reported outcome portion to it, but it was much more of a procedure. Way ahead of their time in that. Yeah, way ahead. Right. So, and the whole idea was to create a database of surgical procedures and the outcomes thereof. So it was really interesting. All three of them, I mean, were great in regards to, once again, how to organize your practice to be efficient, and to be productive, and to be able to take care of people in a fashion where they were taken care of properly, but also in the shortest amount of time possible with the least amount of invasion of their person. So these were also the guys, they had a surgery center in their office. This is 19, in the 1990s. That was an eye-opener. And, you know, Dick, when I first went down, he said, I want you to take a look around at all of these things. He says, I want you to look at the surgery center, and I want you to see, look at how many people we employ, and what they do, so that someday you're going to take that home and you're going to recreate that in your practice, too. And I was like, I mean, that was sort of a bonus, right? I mean, I went down there to learn how to be a good surgeon and learned a lot more about how to practice, which I thought was a special opportunity. And, you know, they thought not only what was, but what could be, I think. Right. And I think that was... It was brave new world stuff. It was really exciting. I mean, it really, I mean, it floated. It certainly, it sort of, it made my career as an orthopedic surgeon really much better than it ever would have been if I hadn't had that experience, you know? I mean, I looked at things a whole new way. What could be, not accepting, you know, what was, you know, it made me kind of a pariah around certain hospitals, because, you know, I'd say, this is crazy what you're doing, you know? And they would... I mean, so I, you know, I was persona non grata in many, you know, institutional settings, but, you know, then we opened up our own surgery center and, you know, that went away. But you know that... But more, you've touched on a few things about the career advice that not only your mentors or our shared mentors have given, but best piece of career advice that anyone's given you. The best piece of advice. Wow. You've touched on a few things that Dr. Caspary and all of our shared mentors have provided and, you know, try and expand a little bit on some of that, some of the things that... You know, I think that they say, look, go someplace. I was undecided on where I wanted to practice. There were many areas I wanted to go that were maybe not as... I mean, they weren't as conducive to developing the kind of practice that Dick, Rick, and Terry had. They said, look, you got to go where you want to go. Just go where you want to go and develop what you can there. And I think they didn't give me so much advice on like a game plan as it was their example more than anything else. So I think they said implicitly, look at what we're doing and then you go home and do that. As visionaries, not what was, but what could be. Yeah. Yeah. Go home and do what we're doing, which is, you know, it's not a static practice environment. It's an energetic one that's muscular, that's trying to look at new horizons. And so, you know, that was the way I approached it. I mean, it was certainly really difficult to try to recreate that in New York where the regulatory environment and the strength of the hospital systems was not conducive to that, but it was still possible in a smaller way. But you know, I think that, you know, everything in medicine is local. Learn that too, right? It's a local phenomenon. And, you know, what passes for practices, practice in one part of the country may not necessarily be the same as in other parts of the country. And that's, I think that's going to be true forever. That's just the way medicine is, because it's a, you're taking, you know, you're taking care of the people in your community for the most part, you know, for the most part, right? I think back now, Lou, to our fellowship, which was obviously, you know, a very influential point for both of us in our careers, you know, when I think back to it, I realized that we are now significantly older than our mentors were when we first met them. Well, thank you for reminding me of that, Ray. I had completely forgotten that. So I guess that leads me to the question of, if you could, what bit of advice would you have given to your younger self with the experience now that you've gained from our, you know, our tenure in orthopedics? I think what I would tell myself is this, I was very focused on the technical and management aspects of orthopedic surgery. And I think that's a good thing. But I think in that process, I could have been a better, I could have paid more attention to my patients, right? I think, I think that, and when you're young and you're, you know, you're really trying to establish yourself, I mean, it's all about, you know, what's your reputation, you got to be, you know, you have to be technically excellent, you have to be seen as somebody who really knows what they're doing, and that you know what you're doing in the OR, blah, blah, blah, blah, blah, all that stuff. But really, I would say, you know, pay more attention to the patient. And those other things will take care of themselves. Since the majority, I mean, the greater majority of all orthopedic surgeons, I think are well trained today, right? Everybody's doing a fellowship, or everybody's coming out there a superstar. I mean, these young people are really exceptional that are doing orthopedics now. And so I'd say, okay, what's that? Not like back in our day, well, I think, you know, I think that we were real good at something that not a whole lot of people were really good at. Right? I mean, we had this skill that when we were teaching these courses, and you know, I mean, the skill set of orthopedic surgeons at that time, did not include arthroscopic skills at all. And thus, the explosion of courses, you know, that trying to get everybody up to speed and all those courses were more than didactic, they were laboratory courses, right? So these were hands on courses, and they were all full, right? All of them. I mean, Anna had them, Dick had them, you know, their East Coast, West Coast, South, they're all over the country, right? And so that was, but that's not the case now. Right? I mean, the guys getting out of residency now, are great arthroscopists, right? And if you do a fellowship in it, you're doing the crazy, the really technical stuff that some of it isn't even arthroscopic anymore. It's a lot of osteotomies and things like that to supplement our arthroscopic procedures for joint preservation. And all that stuff, that was in its infancy back then. And now it's really, I think, really starting to bear some fruit. Yeah, so during your years with Dr. Caspari and Whipple and Myers, what was some of the best career advice they gave you? Well, they told me to stay out of New England. I wanted to go to Massachusetts and they said, dad, don't do that. It's crazy up there and, you know, for whatever reason. But I wound up back here anyway. I mean, you know, go figure. And like I said, I think it was more of a advice by example. And- It was from what could be, right? Right, but also they helped a lot in, you know, contacting potential employers, doctors who needed skills all over the country, right? You know, I mean, it was, so they helped in that way too. I mean, a lot of people had already knew what they were doing, so the three of us in my year, we had Mark Oselmeyer who knew he was going to go back and practice in Chicago where his father had played a large role in establishing the multi-specialty group that he joined after fellowship. So he knew where he was going. Bill Beach didn't know where he was going and he had four kids and I was still not married and didn't know where I was going either. So he knew where I was going. And I was still not married and didn't know where I was going either, but Bill decided to stay in Richmond. And of course they, you know, that was a great choice for him. I certainly would have loved to have done that, but, you know, I don't think at the time they could have supported two new doctors, but, you know, so I didn't stay. I went to a friend of theirs who they helped, helped me find. Well, Lou, you've actually, you obviously have had a great career and also a tremendous impact on the Arthroscopy Association. So let's talk a little bit about your ANA membership and tell me what's been some of your favorite aspects of being an ANA member. I'd have to say that the favorite aspect of being an ANA member is the camaraderie and fellowship that we share as ANA members. I mean, that was really, I think, paramount. I mean, ANA meetings were always fun and they were fun because of the people that were there. You know, I think the second aspect is obviously the learning aspect, especially for someone like myself and yourself also who weren't really necessarily tied to academic institutions. It was a way for us to remain current and not just current, but on the very cutting edge of what our profession was doing. It also afforded research opportunities, which, you know, are not really taken advantage of much in the private sector, but, you know, arthroscopy sort of changed that because since it grew up in the private sector, it, outside of academia, much of the research that still comes out of, still comes out in arthroscopy is private practice. And, you know, for example, if you look at your career and, you know, what you've accomplished with, you know, all the innovation that you've developed, and that required a significant amount of research on your part to do that, and you did that in a private practice setting. So that, so I think that's number two is learning and a, you know, a sort of a dedication to being better and excellent, technically. I think the third- In your presidential address, I meant the pursuit of excellence. Yeah, pursuit of excellence, right. I mean, I think that was, when I really thought back and thought about the value of Anna, that was it. I mean, it was like, how are we going to become the best orthopedic surgeons we could be, right? And maintain that, right? I mean, it's not easy to maintain it. I mean, we all know good and great orthopedic surgeons in the community who have sort of, they've remained static. They sort of have still, they've still practiced the way that they learned. You know, I don't know that that's sort of true now. You know, this, I'm talking about my experience over the last 30 years or so. You're just doing the same old thing. The impact that Dick Casperi, I think, had on both of us, not where the ball is, but where the ball is going to be. Right, right, yeah. So, you know, when I retired, I was a better orthopedic surgeon than when I started. I was much better. And I did things that I never did when I started orthopedic surgery. I did procedures that I never would have contemplated. Nobody taught me how to do them. I taught myself and I visited, you know, the guys who are great at it in the country to learn what they were doing. I, you know, attended all the meetings and learned techniques too. So, yeah, I was a much better orthopedic surgeon when I retired than when I started. And I think that's because of Anna. Right, right. And- You mentioned some of the impactful innovations that you've experienced. Talk a little bit more about that. What are some of the most, you think most impactful innovations that you've experienced in your tenure in orthopedics? Well, I think the biggest innovation, of course, is knotless technology, I think, is a huge innovation. Right? It's applicable to just about everything we do. If you look at just about every orthopedic, major orthopedic surgeon, there's some kind of knotless technology involved in it. And I was really interested in it because, you know, knots are, and I studied knots, because knots are, you know, tied by individuals and they're not, to point a pun, they're not consistent, right? You know, perhaps 10 to 20% of all knots are not of really good quality, even if you're a good practitioner. So if you can mechanize that and standardize it, you know, you may take some of the reasons for failures of these procedures out of the picture. So I think that's a major innovation. I think all arthroscopic rotator cuff repair changed my practice in a huge way, right? So we went from open to the mini open, and the mini open had a significant morbidity. I mean, there was a lot of, it was 5% stiffness, 5% infection rate, not 5%, but 1% infection rate, 5% stiffness rate with mini open rotator cuff repair. So doing it all arthroscopic, the morbidity of rotator cuff repair has significantly been decreased by doing it all arthroscopic. And, you know- Bringing emotion back, I mean. Right. The trend from meniscectomy to meniscal repair, that's a huge game changer, right? I mean, and the decrease in the amount of meniscectomies that are done. I used to do like a hundred, I was a shoulder guy, but I probably did a hundred meniscectomies a year. When I ended my practice, I was doing about eight. I mean, really, because most of those patients were treated non-operatively, you know, with injection therapies, et cetera, or they got a repair, right? I mean, I was kind of pushing the envelope on repair, especially in, you know, younger patients, you know, willing to accept a little bit of a higher reoperation rate if the tear didn't heal. But if they had that meniscus, you know, the thought process is that their joint will be better preserved than if they didn't have it. So that's a huge innovation. And I think, you know, the thing that really got me excited over the last 10 years was the addition of biologics into orthopedics. Back to the knotless thing. So you were doing, you know, your focus was traditional suture, knotless configurations. I went the way with the, we did that suture welding. We had an ultrasonic suture welder that was developed by a company called Axia that I thought was really, really interesting. And I did probably close to a thousand of those. And it was not adopted widely because of some of the technical aspects of using monofilament. You know, one suture you could use, right? Correct, right. So, you know, really only was applicable to monofilament and orthopedic surgeons have really migrated away from monofilament for a lot of different reasons. But anyway, so, but that, I did that. Kind of interesting that evolution that we went first to, from standard sutures to absorbable sutures. And then now we've kind of migrated to the high strength sutures. And now we're, I'll tell you what, we're going through, going to go through a new migration now too. And that's part of this biologics, right? So the, I think now the biologics and their application in orthopedic surgery is I think the most promising thing that's occurred in certainly in the last couple of decades. You know, whether you're talking about cellular elements or the new grafting implants that I'm very interested in, collagen implants that have, I think, really improved our ability to heal tissues that are inherently difficult to heal, right? So the problem with the rotator cuff is not so much our mechanical treatment of the disease, which I think we've sort of conquered, right? You know, we're real good at the biomechanics and, you know, double row transoxies equivalent, whatever. I mean, those things, those constructs are stronger than the tissue we're healing. The problem is getting that tendon to heal. So I think if you look at the literature, I think it's pretty clear that the healing rates with some of these implants are really improved. There's some randomized clinical trials that demonstrate that now, and there's going to be an explosion of these types of implants. There was one, now there's three, right? So, you know, there's gonna be more, right? And, you know, the ones that are on the market now are not the final iteration either. They're gonna be designed specifically to improve healing. And eventually I think they're gonna be married to cellular elements also to really facilitate healing. So that's, I think, that's really promising. And that has applicability, not just in cuff, but in all the situations where we have difficult healing, right? Meniscus repair, ACL reconstruction with, you know, with the new Bayer implant too, right? So these are things that the next 10 years are gonna be all about healing. The first- Is that the advice you'd give to incoming ANA members as the role and the potential for the future in those areas? Oh, absolutely, yeah. Become involved in the Biologic Association, which is a great consortium of societies dedicated to improving the biologic environments of the patients we're treating. I mean, we have not harnessed this technology yet at all. And I think if you're interested in improving orthopedics, that's the place to really concentrate. I think the first- That's where the most impactful innovation will be in the next few years? Absolutely, yeah. Absolutely. And, you know, if you look at, you know, when we started out, you know, 30 years ago, when 30, 35 years ago, when arthroscopy specifically was sort of in its just beginning, it was really a completely a mechanical pursuit, right? It was how are we gonna get these tissues, these anatomic structures reconstructed, and how are we gonna hold it together while it heals, right? Now it's, okay, we get that figured out. Now how are we gonna improve healing rates? Because as everyone knows, you know, healing rates, you know, you could get a recurrence rate on rotator cuff repair of as low as, you know, 20%, depending on how you look at it with MRI or whatever. And, you know, the size of the tear, the comorbidities of the patient, you know, all those affect the healing rates. And so, you know, it's not that every cuff that doesn't heal or re-tears does poorly, but the ones that do poorly are not healed. So that's, I think, the most exciting. And even though I'm not doing clinical medicine any longer, I'm still involved in that research, because I think that that's really- It offers a lot in that area. Oh, yeah, I mean, it's just, you know, like I said, that's so that if anybody's interested in that, I would say, go, you know, really pursue that. And, you know, and because it's really a clinical, it's a translational pursuit, right? So it's taking things that are sort of in the maybe in the laboratory now, but translating that into clinical practice. And every orthopedic surgeon out there is in a clinical practice and can apply these, you know, these treatment paradigms to their patients, you know, as long as safety and efficacy are proven. And, you know, sometimes if you're out in research, you know, all you need first is the safety. And, you know, you can do the research to prove the efficacy, as long as you're in an environment where, you know, that's possible. But you- I want to change the direction of the conversation a little bit, because we, you know, I think you've certainly expanded on the great progress that the Orthopedic Association affords us, but there are also other aspects of being an ANA member that I'm sure you'd agree provide great value, not just the technical side and the educational aspect, but talk about some of the other, your favorite aspects and some of your favorite memories of being involved with ANA, and keep them G-rated if you could. But, you know, I think you'd agree that it's not, the association is not just about innovation. Certainly that's what binds us and we want to advance our field, but the relationships that you've developed, some of the favorite aspects that you've had, and some, maybe some memories you've had of being an ANA member. Yeah, I think one of the other aspects, I think that we haven't really talked about is the advocacy aspect, which, you know, Bill Beach really sort of started and I picked up that ball and now Eric Stiefel is running with it better than both of us combined. And I think ANA was really the first subspecialty organization to say, you know, we really need to support our members not only clinically, but, you know, in a practice management way also, because there are some significant challenges out there and we need to, you know, give them, you know, alternate, you know, options to deal with them. And I think the arthroscopy association- That's the technical side of medicine. Yeah, the arthroscopy did, I mean, everybody's doing it now. We did it first, right? We did it first. And then everybody realized that- Practical manner tend to be intervened. Yeah, we did it really well. And everyone has adopted that now because they realized that, hey, it's on an equal par with ensuring clinical excellence. I mean, if you don't have a practice to practice in, then you can't deliver high quality healthcare. And if you're really unhappy in your practice, then you can't deliver quality healthcare. And, you know, there's a lot of things contributing to unhappiness amongst doctors now. And interestingly enough, the practice that has the highest satisfaction rate in all of medicine besides plastic surgery is orthopedic surgery. So, and I think that has to do with, you know, our focus on making sure that our practice environments are conducive to delivering high quality care in an efficient manner. I think that, you know, on the social aspect of things, you know, certainly- That's been a big part. Yeah, I would consider, you know, the people I know through Anna is sort of a second family. I mean, Nick Scaglione was the first one who sort of brought that concept to me. It says, I'm my Anna family, and he meant it. And it certainly I think is true. The men and women that I know through Anna I think are some of the best people I've ever met. I'm blessed to have, you know, many great, deep and abiding friendships in my life. You know, whether it's, you know, high school kids I grew up with or my college friends or my friends from Block Island, Rhode Island. But I think that the Anna folks are the, are right up there. They're, you know, what I've never met. What about some of your favorite memories with during your involvement with Anna? Oh, favorite memories. I mean, what, the golf tournaments? I mean, some of those golf tournaments were, especially the ones that Greg ran, they were awful fun. You know, Ray Fuchikawa and those guys. Stevie Orr, I mean, just tremendous fun. You know, spending time with, you know, going out after meetings with, you know, you or Sal Corso and, you know, trying to stay out of jail if we could would be good. You know, I think, you know, all the times I spent with Mark Alsomire, I mean, we were sort of inseparable for many years at the Anna meeting. Having all sorts of fun, you know, then. To be able to share a professional pursuit and to try to develop our profession, but also have socialization. Yeah, I mean, you know, just beyond fun, trips that we took. You know, whether it's, I mean, the outgrowths of Anna, the Caspari Fellowship trips that we took. Whether it's, we went to St. Thomas. Cabo was memorable. Cabo San Lucas, you know, we were in the Tetons and Jackson Hole one year. I mean, just, you know, just Hawaii we went, which was the last one that Dick was part of. I mean, all the great, I mean, just great, lots of fun. And one of the great things about Anna was that they always tried to have it in a, you know, a kind of a nice place where we could have some fun. You know, in addition to doing some learning and sharing some educational experiences. I mean, it was all about, you know, playing golf or having, playing some tennis or going out. It's just like. We have to keep it, keep it rated, you know, PG here. But we did have a lot of fun. And, you know, certainly. The Association has been, you know, is fortunate to have you as one of their presidents. And so I'd like, you know, I think you may have answered some of this question. But maybe you could share with us some of the things, some of the advice you might give to any incoming president as to how they can better the organization. And, you know, advice that they might benefit from. Sure. So one, you need to take inventory of all the current projects that aren't done. Because, you know, you can't, you can't finish the projects in one year. So these, you know, we have some projects like the Copernicus project has been going on for over 10 years, right. Because it's complicated, really valuable, but needs to be nurtured. So you need to take an inventory of all the ongoing projects and prioritize, you know, how you're going to approach those and continue those. Then you need to pick one thing that you want to do that you can try to bring to the finish line in, you know, as short a period of time as you can. You know, we picked the, you know, the Innovation Center, right. And so, you know, once again, you know, sometimes some things work, sometimes they don't. I don't think that we really made a whole lot of headway with that, but that was a pursuit. And, you know, we learned a lot of stuff doing that. But I think if you pick one thing and try to, you know, a new thing, right, not just, you don't want to be just a caretaker of what the association is doing. I mean, Anna is not about caretaking. It's about, you know, doing something different. So pick one thing, start that, and, you know, your personality will be imprinted on that because you picked it. And then go forward with it. And, you know, and, you know, try as hard as you can to bring, you know, it's going to take more than just your presidential year to get it done. And maybe it gets done, maybe it doesn't. But it's a, you know, it's, I think it's a worthy pursuit to keep the organization not just current, but thinking toward the future. So you've obviously contributed a lot to the Arthroscopy Association. And I'm sure you've learned a lot during your tenure there. What would you say would be some of the favorite lessons that you'd want to pass along to the future leaders of the Arthroscopy Association? One, have fun, right? I mean, you can't beat fun. And make it fun, you know, make. Friendships that we develop, right? Right, yeah, but, you know, run your board so that the board has fun. I mean, you want a board that's engaged and productive and they all have real jobs back home. So you got to make it fun. You got to, you know, make sure that the workload is distributed in such a way that it's conducive to camaraderie, productivity, and a feeling of accomplishment, all which lead to, I think orthopedic surgeons think that's fun, right? So, you know, nothing better than being productive and accomplishing things and having fun in the process. So that's what I'd recommend, you know, that's how you conduct your board meeting, you know, in such a way that it's conducive to that. You know, you don't want to be too authoritarian. You know, this is a volunteer organization, but you want to be focused, right? So I think the biggest challenge for a president or leader is to focus those 18 people in a way that you're leading that focus, right? So I think, because everybody's, you know, another thing about orthopedic surgeons is they're not shy, right? And so they all have their own opinion and most of those opinions are pretty strong. And so you need to channel that energy without ruffling feathers, right? So, you know, nobody's input is discouraged but you need to channel and focus all of that energy in a linear fashion. We kind of grew up in an age when arthroscopy was really exploding and the techniques, as you mentioned, were converting from open procedures to arthroscopic procedures. And what would you say to potential new members, though, who are kind of on the fence about whether to join the Arthroscopy Association as to why there's still potential in the future and what they should be looking forward to and the direction that the organization should go? John Kelly, join ANA and operate like a champ, right? I mean, if you want to improve your skills, if you want to maintain, if you want to be associated with the best arthroscopists in the world, then join ANA. If you want to maintain, not just maintain, but if you want to develop your skills as a physician and surgeon, join ANA. If you want to continue your education as a physician and surgeon, join ANA. The educational content from the journal to ATEC, to Asmar, to our courses, to the webinars are all excellent and all very geared toward the practicing orthopedic surgeon, right? So it's all germane to what you do in the office. And I mean, I still read, I get the journal right here, right? Right on my desk. It's always right there, right? Because I can't- In regards to digital, reading a digital? It's so thick now that I can't get through the damn thing. That's why I've switched to reading it digitally. I do the digital whenever I do any writing. The digital is all of me. Like the digital is in research now has really been facilitated, of course, by the digitization of information. And it really, it's much easier to write papers now. So whenever I'm doing that, I do that digital. But whenever I just want to read what's coming down the pike, this is it. And that's not a prop. I didn't bring that out just for this interview. This is, I got two of them here. I mean, you can't pick up three of them. There are two. So- Before we close, are there any parting words of wisdom you'd want to pass along to the next generation of arthroscopic surgeons? Be patient-focused. It's all about the patient. That's all I'd have to say. Figure out, making medicine better in the next 10 years is going to be about improving access to care, improving outcomes of procedures, and also by actually measuring that, and take control of the orthopedic environment. In other words, don't let other people control what we do better than they do. Nobody takes care of patients better than we do. Nobody. Not hospitals, not health systems, not the government, orthopedic surgeons. And that's not just me saying that. There's research to prove that, right? That outcomes are better in settings where the orthopedic surgeon controls everything from the costs to the HR elements, to the procedures, to the implants, et cetera. That's out there. So that's what I would recommend. I'd say, you know, take control. And that also means taking control of the economics too. And, you know, a lot of people aren't in an environment where they think they can't do that, but even if you work for a hospital, you could still do that, right? You got to convince the health system and the hospital that you'd do a better job, and you're going to, you know, and let us run it, and gain share us to do that. So that's going to be the next, you know, everybody's worried about, you know, Medicare decrease, you know, the cost, everything's coming down, right? Well, figure it out, right? Figure it out. There's ways to take care of patients that's cheaper. You know, it doesn't look like what we're doing now, but you could still deliver good care that way, right? I've actually written some stuff on that. And you could say, you know, if you, for example, if you develop a practice paradigm where orthopedic surgeons don't really see the patients so much, they operate, right? The patients are seen by mid-levels, et cetera. You could save 30% cost just by doing that. Now, is that for everybody? No, but let's say, how about Medicaid? You know, you don't want to take care of Medicaid patients? Well, because it doesn't reimburse that low. Well, figure out a way to do it. You know, there's gotta be a way, you know, because the economic pressures that we face now are not going away. They're gonna be there for a long time, probably forever. So figure it out. What we do is in demand, right? And the incidence of orthopedic disease is going up. You're right, the pressures just are different. They change, but we had economic pressures back, you know, back in the day. But we didn't have to figure out, you know, whole different ways of taking care of people, right? I think we got to do that now, right? If you're looking at things like cytosurface migration and total joints and spine to the ASC, that's not gonna be the end of it. It's gonna be, okay, eventually, instead of seeing patients on a per patient basis, we're gonna have to take care of, we're gonna have to assume responsibility for a population of patients, right? Because that's the only way we're gonna regain control. If we don't do that, then what's gonna happen is we're gonna have what we have now, which is a bunch of people who don't know what they're talking about and don't know how to take care of patients telling us how to do it. Now, that to me, that's why everybody's burned out is because they're frustrated with it. Well, Lou, I'm sure we could go on and talk. I've known you for over 40 years, but like we could, you know, and I always, we never seem to run out of things to talk about. And it's always a pleasure to hear you. It's an interesting way to make a living. Yeah, it sure is. You wanted us to limit this to about an hour. So I think we have to have some closing remarks. And, you know, I guess I would just say it's been an honor to be your friend and your colleague for almost 40 years now, Lou. Unbelievable, isn't it? I've learned a lot from you and I've enjoyed our friendship and the collaboration that we've had over the years. And, you know, I would kind of answer the question about some of the future of Anna and why people should join is the relationships. Not only do you educate yourself and learn from one another, but the friendships that develop out of this association. Without a doubt. You know, that's an important part of life. You know, deep and abiding friendships are one of the most important aspects of a well-lived life. And so, you know, you can't have enough good friends. And, you know, good friends that are pursuing the same thing you're doing, that is a really interesting dynamic, right? You know, I mean, it puts you on the same page with them in a way that you're not with your other friends, right? You know, their experience is yours, whether they're black, white women, whatever. It doesn't matter. Wordspeak surgeons are, their minds operate in a similar fashion. So it's really, I mean, I think it's fun to be around people who think like that. Yeah, we share challenges and we share successes. And that's a- And all the challenges, right? It's not all fun and roses, right? I mean, a lot of it is really, really, really difficult, right, and risky. And that's what makes it so, I think, compelling is that. But, you know, when you have that shared experience, I mean, you know, that leads to some really deep relationships, which is great. I mean, it's fun. Yeah, I remember our common mentor, Dr. Caspari, used to say that, you know, anyone can get into trouble, but what you need to learn is how to get out of trouble. Get out of it, right. And that's something that we learned from one another is- Well, one last thing, though. We've had other shared mentors also. And the way you approach young people, you can be engaging and open-minded and show them the way that things could be. There are some who aren't like that, right. And they don't have the gift of, what is it? It's a generosity of spirit that's required to bring along the next generation. So if you're involved in teaching young people, I think that's essential, right. You gotta have an open and generous spirit, which, you know, it's just something that God gives you or doesn't. I guess you could develop it, but, you know. It's always a pleasure to talk with you, you know, and we could talk all day. I think they wanted us to wrap it up in about an hour. All right, well, Ray, thanks a lot. It was fun. Want to give you the opportunity to have your parting words and words of wisdom and advice that you want to give to the next generation and some final thoughts, and then we can close. Yeah, go visit Ray Thal and learn how to do stuff the right way. That's my, those are my closing thoughts. Come on, come on, you can do better than that. Be like Ray. Come on, be like Lou. Lou, you've made tremendous contributions. Just like I said, I would say, you know, as an orthopedic surgeon, just I would concentrate on the patient. Each patient one at a time. That's all I got to say. All right, well, Lou, thank you. And it was always a pleasure to talk with you and we'll see you soon.

orthopedic surgery

Arthroscopy Association

career advancement

patient care

surgical innovations

biologics

mentorship

professional development

collaboration