Richie Edeen, MD is the fifth generation of his family to grow up in the area of Vail, Colorado.  After high school, he attended the University of Colorado, where he worked as a student athletic trainer. From there, he moved to Austin, TX, where he worked as an athletic trainer for the University of Texas and planned on starting a career as an athletic trainer. It was the early passing of his father that pushed him to apply to medical school in the hopes of becoming a cardiologist.  However, coming from a family of builders and engineers, he realized he was better suited for orthopaedics.  He enrolled at the UT Health Science Center San Antonio in 2008 and remained in San Antonio for his orthopaedic training. 

TOA: You were one of TOA’s most active residents during your residency by attending all of TOA’s annual conferences and promoting TOA to other residents.  Why did you take such a strong interest in TOA during your residency?

RE: As an athletic trainer, and as a medical student, I was fortunate enough to serve on both regional and national levels as a representative of my peers. I learned there that it is easy for a group to become isolated and live in a bubble and not knowing what other good (or bad) things that their peers were doing elsewhere. It was also a great opportunity to see people I was meeting from around the state over the past few years, former residents from our program, and not to mention, pretty nice places to stay for a couple days.

TOA: When you complete your fellowship and hopefully move back to Texas, what are your personal plans for TOA involvement in the future?

RE: I hope to get involved in whatever capacity both the TOA and orthopaedics in general will have available for me. I plan on practicing for many years to come and I plan on having a say in the events that are going to impact my career. You can’t complain sitting idly by on the sidelines. Early on, I hope to just be able to listen, learn and help out where ever I am needed. As time progresses and I begin to learn more about the business and politics of orthopaedics in Texas, I will get more involved.

TOA: Describe your fellowship and your potential plans following your fellowship.

RE: I am completing orientation this week, and will begin work next week as one of the Cincinnati Sports Medicine/Noyes fellows. He’s still very active and still very busy. The last five years in San Antonio, I was fortunate to learn from some true legends in Orthopaedics and am looking forward to continuing this trend.

TOA:  How are orthopaedic residents in Texas approaching future practice opportunities?  

RE: This is a tough one to answer without using a bunch of cliches. We have all seen the large shift in orthopaedists taking hospital employment jobs in the recent years. While the reasons for this are multifactorial and often discussed, it appears to be especially appealing for many of my peers lately.

For me, I think hospital employment is going to allow me to focus on operating and taking care of patients, without having to focus on some of the business aspects that come with group or private practice. Also, with the rules and regulations that are being put in place regarding PQRS, MIPS, MACRA, etc., hospital employment in the kind of rural setting that we are considering allows us to navigate with the hospital, as opposed to on our own, which likely could lead to not being fully compliant. I realize that we may be leaving some things on the table and know the headaches that may be in store working for someone else.

I tell myself that the good side is that if I plan on a long career, and I realize that hospital employment is not working out for my family and me, we will work to make the changes that we think are necessary. Not having control of the situation is my biggest fear going into practice in this type of setting. I grew up in a “If you want something done right family,” so I know that it’s going to be a little hard to accept not being to able to make changes that I want to make when I am a cog in the system. Knowing all this though, I think that the upside outweighs the drawbacks, which is why we are excited about starting practice.

Based on the [recent orthopaedic residents] who I know, it seems that geography is still the primary driving force behind the type of practice people are looking at. Out of my recent orthopaedic residency class, three of us are doing sports medicine fellowships, while another is doing a hand and upper extremity fellowship. However, we all plan on careers surrounding a lot of general orthopaedics.

The other two residents went straight into practice in Colorado and New Mexico. The jobs that we have all been considering seem to vary between medium-sized groups and hospital employment. Out of the six resident, none of us were looking into academics too closely, for no particular reason. Many of us agree with the appeal of hospital employment for the reasons that I’ve listed above. We have had a lot of opportunity to learn about different practice types throughout residency, from the TOA, faculty who worked in both academic and private settings, and the private practice surgeons in the community. We were lucky to see how a top tier large group practice and surgical center operated with The San Antonio Orthopaedic Group.

All of the residents with whom I have talked to from across the state say they wish they had more training on the business and billing side of orthopaedics. I think as a whole that is a significant lacking point of the orthopaedic curriculum, as the surgicaal and patient-treatment aspects of orthopaedics have become pretty centralized. Forcing the residents to become involved and have stake in the billing and coding process would be a good place to start.