Dr. C. Lowry Barnes, an orthopaedic surgeon and professor at the University of Arkansas for Medical Sciences, spoke with us about his career, recent developments in orthopaedics and tips for good orthopaedic health. See our questions and his answers below. Barnes’ Q&A has been edited for clarity and style.
1. What is your full name and title?
C. Lowry Barnes, M.D.
Carl L. Nelson Distinguished Chair in Orthopaedic Surgery
Professor and Chairman Department of Orthopaedic Surgery
Director, Musculoskeletal Service Line
2. Can you tell me a little about what you do at UAMS?
Although I have many administrative responsibilities, I remain a very busy orthopaedic surgeon and specialize in hip and knee replacement. I operate two days per week and see patients all day Wednesday. Leadership and administrative duties are addressed on the other two days as well as before and after business hours on most days as needed. These duties include leading our orthopaedic department in areas of research, education and clinical care.
Fortunately, we have a great team of partners working together, making my job fun and the results outstanding. For instance, when I became chair about three years ago, our department was performing about 1,100 adult cases per year, and we now perform between 6,000 – 6,500 cases per year. Research output has grown similarly from 12-15 publications per year to around 90 per year. Our residents, orthopaedic surgeons in training, continue to excel, scoring in the 80th and 90th percentiles nationally over the past three years. We are obviously data-driven in our measurements of success in these areas but remain committed to a patient- and family-centered approach in the care of our patients. We have a team of surgeons who enjoy taking care of their patients, and it shows.
From a research perspective, we have been fortunate to combine our approach to improving bone and joint health through discovery with Stavros Manalagos, M.D., Ph.D. and the Metabolic Bone Disease team at UAMS. In addition, we work with Mark Smeltzer, Ph.D., an international expert in bone infection, in the microbiology department and Alex Biris, Ph.D., an international nanotechnology expert at UALR. We are especially excited about the work we have done with Kristie Hadden, Ph.D. in the area of health literacy and its effects on orthopaedic care. I report to Pope Moseley, M.D., Dean of the UAMS College of Medicine, and I have been pleased with the support he and his team have provided us.
The service line model allows a patient-centered approach to care. We work with rheumatologists, physical medicine and rehabilitation specialists, physical therapists, and hand therapists to improve the care of the patient with bone and joint issues. In addition to measuring quality and safety, we also look very closely at access to care and patient satisfaction. We are extremely excited that our orthopaedic floor at UAMS has been ranked as number one in the nation for patient satisfaction. I report to Richard Turnage, M.D, vice chancellor for clinical programs and Stephen Mette, M.D. chief clinical officer in this aspect of my administrative role. I appreciate the support they have provided, especially in establishing three off-site clinics for our patients and allowing us to continue to expand.
3. How long have you held your current position? 3 years
4. What did you do before? I worked in the private practice in Little Rock.
5. What led to your interest in orthopaedics?
I was very fortunate to meet and be mentored by Dr. Banks Blackwell, who was the premiere orthopaedic surgeon in Pine Bluff. He introduced me to the operating room, sharing his passion of orthopaedics. I quickly saw the immediate positive impact this specialty can provide to patients, and I was hooked.
Both of my grandmothers had joint diseases, one having rheumatoid arthritis and the other breast cancer metastasizing to her hip region. Unfortunately, I saw firsthand the challenges created with a less-than-specialized approach to these problems. Having had the opportunity to train with Dr. Carl Nelson, chairman of the UAMS Department of Orthopaedic Surgery from 1974 until his death in 2005, I was introduced to the concept of subspecialized training in joint replacement and was able to subsequently train at Brigham and Women’s Hospital, one of the Harvard hospitals in Boston.
6. When did you know you wanted to be a surgeon?
Although no one in my family had ever gone to college, I decided when I was around 6 that I wanted to be a doctor. I never wavered. I was introduced to the operating room by Dr. Clarence Rittelmeyer, a general surgeon in Pine Bluff, when I was 16, and I knew at that moment that I wanted to be a surgeon.
7. In addition to being a surgeon, you’re a teacher and researcher, correct? How do those interests fit together?
We are all learners if we intend to provide the best care to our patients. Research leads to new ideas and new solutions through discovery, and the ability to share these discoveries happens through education. Dean Moseley refers to our campus as a community of scholars, and we embrace that concept and take very seriously our mission to develop orthopaedic surgeons who are leaders in their communities and hospitals and seek ways to improve the orthopaedic health of their patients.
8. Why are you passionate about orthopaedics?
Like most in orthopedists, my passion is driven by my patients and their success. It is a gift and privilege to be able to assist others in getting back to doing the things they enjoy.
9. Why do you think it’s important?
It has been said that “Life is motion and motion is life.” Orthopaedics and joint replacement specifically restore motion and mobility.
10. What should people know about your field?
Not everyone with a bone or joint problem requires surgery. Not every X-ray or MRI finding requires treatment or surgery. We tell our patients, “We treat patients, not X-rays.”
The internet has a wealth of information about orthopaedics; some of it is good. If it sounds too good to be true, it probably is. For instance, too many patients are spending significant amounts of money for stem cell and other knee injections for severely worn out knees with little chance that these injections will benefit them significantly.
Arkansas is blessed with many highly qualified orthopaedic surgeons. Don’t be embarrassed by wanting a second opinion. A surgeon should not be intimidated by your wanting a second opinion.
11. Can you tell me about a recent development in your field? How will it impact people?
Bundled care and patient outcome data is changing our field for the better. Surgeons are expected to manage the care of their patients for 90 days after surgery in some programs and are financially accountable for this. This leads to better patient care in my opinion. It is imperative that we manage care appropriately.
12. I read recently that you expect most hip and knee surgeries to soon be out-patient procedures. Can you tell me a little about that? Why do you think that? How will it affect patients?
Medicare will soon remove hip and knee replacement from the “in-patient only” list, meaning that out-patient surgery will be reimbursed. Private payors will follow the Medicare lead. If appropriate choices are made regarding patient selection, the percentage of patients having surgery as out-patients will grow. Patients benefit by recovering at home. This is a natural progression. When I finished residency, joint replacement patients stayed in the hospital for an average of 12 days. Currently, 95 percent of our patients go home the following day without the need for in-patient rehabilitation, skilled nursing facility, or home health. Keeping patients safety at the forefront, we will initially and may always provide out-patient joint replacements at the hospital rather than an out-patient surgery center.
13. What’s a day in your life like – when do you get up? How do you spend your day?
I get up at 4:09 a.m. most mornings. Somehow, the alarm was changed from 4:10 to 4:09, and I just left it there. I am pretty much immersed in my job during the week with caring for patients in clinic and surgery, attending conferences and meetings, research and education. Fortunately, each day is a little different with differing challenges and solutions. I get bored easily and consider myself a builder and strategist. We are currently working on many projects to improve orthopaedics in our state and are very excited that we have received approval to increase our residency program by 50 percent, meaning that we can provide more well-trained orthopaedic surgeons for our great state.
14. What’s the best part of your job? The worst?
Best: Caring for patients. Although our department has associated missions of research, education and leadership development, we are doctors and surgeons first. Every aspect of our job is related to the patient – either treating the patient, teaching others how to care for patients, discovering new treatments for patients, or developing leaders who can help transform patient care.
Worst: Most everyone with whom I work knows that I am not a fan of meetings — especially those that are solely for information exchange since there are other, much more efficient ways to share information. I joke that I only like the meetings that I call.
15. Can you share any tips for orthopaedic health? Or any warning signs that might show that someone should see an orthopaedic specialist?
Stay active. Joints need motion, and bones need weight-bearing activities.
If you have joint pain that does not respond to over-the-counter medications and interferes with your ability to do the things you want to do, it is time to see a doctor.