VA Orthopedist’s Passion Improves Experience and Outcomes for Complex Patients
July 26, 2019
“If the University of Minnesota is like a crown, then the VA is one of the jewels in the crown,” says V. Franklin Sechriest II, MD, adjunct associate professor and chair of orthopedic surgery at the Minneapolis Veterans Affairs Medical Center (VA). “When I am asked for my job description, I always reply, ‘I have the privilege of taking care of the best patients, training the best residents and medical students, and positively impacting the largest health care system in the world… I work at the Minneapolis VA Medical Center.’”
Sechriest’s office walls are covered with certificates, awards, and photos not only from his orthopedic career, but from his time spent serving in the U.S. Navy. His pride in the VA facilities, care for patients, and resident education is profoundly evident. During a tour, he emphasizes that the work being done at the VA is not about any single person, but about the mission of the VA to serve and honor men and women who are America’s veterans.
Orthopedic surgery residents at the University of Minnesota began rotating at the VA in the decade following World War II, when millions of veterans returned home and overwhelmed the existing system. At that point in time, the VA began partnering with universities across the country to satisfy growing patient needs which in turn enhanced patient care. To this day, residents are a vital part of how the VA functions and have to have a high degree of autonomy.
While VA staff are responsible for the care provided to each patient, “the residents make decisions and the staff supervise,” Sechriest explained. “I always say that the level of resident autonomy here is only exceeded by the level of supervision. The U.S. Department of Veterans Affairs has clear guidelines regarding expectations and responsibilities of VA staff who have the privilege of supervising residents. Our staff adhere to these guidelines. This is not a place where residents are operating in a vacuum. The missions of patient care and resident education are mutually enhancing.”
A lot has changed at the VA over the years. Originally, the Minneapolis VA and the University of Minnesota had separate residency programs. It wasn’t until 1988 through the leadership of former department chair Roby Thompson Jr., MD, and VA chair Robert (Bud) Premer, MD, that they merged. This was advantageous for both programs since the University residents had more hands-on operative time at the VA, and the VA residents saw a greater variety of musculoskeletal tumors, spine, and pediatrics.
When Sechriest was appointed head of orthopedics at the Minneapolis VA in 2015, several strategic priorities emerged. The first he illustrated with a story. A patient who had fallen came in seeking urgent care suspecting an orthopedic injury and waited in the Emergency Department to be seen. He eventually knocked on Dr. Sechriest’s office door and asked if someone could help him. Although this type of patient encounter was completely outside of any standard operating procedure, Sechriest agreed to see him right away.
“When we did an x-ray, we found that in addition to fractured ribs, the patient also had a collapsed lung and had to be transferred to the ICU immediately,” he recalls. “That solidified the need to reduce patient wait times and increase efficient access to care in my mind. Some of our patients are so tough, they may not outwardly show the severity of their conditions. This event also led to my consistent message to fellow staff and residents to take every opportunity to go above and beyond to serve our patients.”
At the time, there was only one full-time orthopedist. Now, there are five full-time and 12 part-time orthopedic surgeons, which has allowed most patients to get same-day access to an appointment to see an orthopedic surgeon. This change has been increasingly important since recent legislation has provided veterans with expanded options to see a non-VA physician. Sechriest says that his renewed focus on customer and patient service has been crucial. Apart from increased staffing and improved patient access, he invested in updating outdated orthopedic equipment.
“When I walked in and saw the same fracture table that I used 20 years earlier, I said ‘get that thing out of here,’” he recalls. “We give our veterans the best money can provide.”
During his tenure, the orthopedic department has maintained its excellent training environment and mission-driven surgeons and educators, but have brought to bear the resources that the federal government can offer on equipment, facilities, and technology.
The VA, with its challenging population of medically complex patients, helped to change one of Sechriest’s definitions of surgical success, which used to be curing a total joint infection and giving the patient a leg to stand on. However, he found that wasn’t always the patient’s definition of success.
“All they knew was that they had a knee replacement, it got infected, and they had seven surgeries,” he explained. “Now their knee is stiff, chronically painful, and they are miserable. To them that’s not successful.”
Sechriest explained that he now has the wisdom and experience to know which patients are more likely to have a good outcome and to look at patient health holistically. Patients within the VA health care system are generally older, more likely to be diagnosed with many health conditions, and less healthy than veterans who do not rely on the VA system. Thus, the patient population can be challenging from a medical standpoint.
“One of the greatest strengths of the Veterans Health Administration is the truly integrated care we provide. You are in a perfect spot to pick up that phone, talk to the primary care provider, talk to the mental health provider, talk to the social worker, and organize holistic care so that if the surgery does happen it is more successful,” he added.
He emphasized that taking other aspects of a patient’s health and environment into consideration while planning a surgery is vital to improving patient outcomes. Although his passion for orthopedics and patient care is evident, his career in orthopedics was a matter of serendipity. While completing an orthopedic rotation as a general surgery resident in 1995, he worked extensively with former chair and spine surgeon James Ogilvie, MD, and enjoyed the experience. As he moved further into his training, however, his passion for general surgery dulled.
“It was upsetting because I wanted to be a general surgeon for my entire life,” he recalls. One night on an elevator going to the SICU, Sechriest ran into Kirk Wood, MD, an orthopedic spine surgeon. “He asked how I was doing, and I said ‘not so good,’” he recalls. “Kirk then told me that there was always a job for me in orthopedics if I wanted it.”
Sechriest decided to take him up on the offer. Since there were already residents waiting to start in the Department of Orthopedic Surgery and he only had general surgery experience, Wood recommended that he take some time to deepen his orthopedic knowledge. Sechriest spent two years in a laboratory working with Freddie Fu, MD, who is now the chair of orthopedics at the University of Pittsburgh. Sechriest graduated from the University of Minnesota Department of Orthopedic Surgery residency program in 2003. Looking back, he says that department chair Denis Clohisy, MD, and former chair Marc Swiontkowski, MD, were instrumental in his education.
“I can remember being out on a ship off the coast of Banda Aceh, Indonesia, and emailing Denis Clohisy about a proximal humerus sarcoma, which he advised me how to handle, and I did,” he says. “I was scared out of my mind doing a sarcoma surgery on a ship, but I was the only orthopedic surgeon the patient was going to meet in the context of a natural disaster."
He often shares this story with residents to illustrate the value of the University of Minnesota’s orthopedic surgery residency.
“I explain to them that they’re coming from the same program that I came from, and are exposed to incredible world-class talent,” he says. “You’ll never get the clinical or surgical volume you need to be comfortable in knowing or treating everything orthopedic, but one thing you will have is the qualifications. When I left this residency, I was qualified to be a combat surgeon. I even did spine surgery at sea, because I had to. Was I comfortable? No. I was scared out of my mind, but I had seen masters do it and knew how it should go.”
He says that he also relied on his extensive orthopedic trauma training from HCMC staff (like Richard Kyle, MD, Tom Varecka, MD, David Templeman, MD, and Andy Schmidt, MD) to successfully manage marines with complex combat extremity injuries sustained during the Iraq & Afghanistan Wars. Sechriest continues the legacy of excellent resident education while leading the VA’s orthopedic team.
“What I’m most proud of is that the residents have seen the value of mission-driven care,” he says. “They also see some of the profit-driven care, but here we have no incentive to do anything but what we think is absolutely right, there’s no profit power behind it. It’s really pure medicine.”
“You’ll never get the clinical or surgical volume you need to be comfortable in knowing or treating everything orthopedic, but one thing you will have is the qualifications. When I left this residency, I was qualified to be a combat surgeon. I even did spine surgery at sea, because I had to. Was I comfortable? No. I was scared out of my mind, but I had seen masters do it and knew how it should go.” - V. Franklin Sechriest II, MD