In July, surgeon Valentin Antoci, MD, was named division chief of arthroplasty of the department of orthopedics at Lifespan and the Warren Alpert Medical School of Brown University, both based in Providence, R.I.
Dr. Antoci, who practices at East Providence, R.I.-based University Orthopedics, spoke with Becker's about his goals for the department, his future research endeavors and the challenges of finding and retaining orthopedic talent in a small state.
Question: Tell us a bit about your new role at Lifespan.
Dr. Valentin Antoci: I am following in the footsteps of John Froelich, MD, who was the previous chief of reconstruction. I am now in the position, overseeing the division of hip and knee arthroplasty and hip and knee replacement. We have, at this point, 10 different surgeons within the system that are performing joint replacement procedures. We have a robust academic, educational and clinical position and are trying to oversee service lines across four hospitals at this point. The goal is really to try to optimize patient care and research and understand better, newer technology when it comes to reconstruction and replacement, and increase efficiency and throughput and provide better patient access.
Rhode Island is a small state and there are only about 80 orthopedic surgeons statewide. Considering that, access is somewhat limited. We are also competing, to a certain extent, with Boston to the north and the Yale system to the south. We want to show patients you don't have to go to Boston to get great reconstruction and total joint care. Most of our surgeons provide great total joint reconstruction. Our referral basis goes as far as Cape Cod, picking up a good portion of Connecticut as well. We are the only place in the area where all of our total joint replacement surgeons are fellowship trained. We really bring up world class and high level experience right here in Providence. For a small state and small city, we really do very high level complex surgeries, especially revision. At my practice alone, about 20% of my cases have been referred from the community where their primary total joint replacement was done elsewhere and when patients need more complex care we are the only referral place in the area.
Rhode Island Hospital is a level 1 trauma center, so we also pick up a lot of trauma cases. From an academic perspective, our lab is one of the top NIH-funded cartilage labs in the country. We have a lot of exciting research that I am involved in, specifically focusing on cartilage regeneration and infection. My background is in orthopedic infection and management of infection cases. I am trying to look at the possibility of not just using new technologies, but also developing new technologies. From an educational standpoint, we are part of Brown's residency program. They have six residents per year and a trauma fellowship of six fellows. We also have two total joint fellows upcoming in the program. The goal is not just to provide patient care, but to develop the next generation of surgeons who can provide similar complex care not just for our community but to send to other major states. We're trying to really educate and not just do surgery. We also have medical school students rotating and participating in research and a number of surgeons, including myself, have a tight connection with the school of engineering at Brown University. These relationships give us a cutting edge in terms of patient care. The more we get educated, the more we educate our people, which all translates into superior patient care.
Q: What are some of your main goals for your first year in the new role?
VA: My personal goal is to continue providing patient care to the highest level that I can. To me, that is allowing for access. One of the issues we've had as a department is there is a high demand for adult reconstruction. A lot of us cannot get to patients, sometimes for months. Anything we can do to expedite that and grow the department will be important for more patients to have total joint surgeries within our system.
My priority is how do we get more efficient while also increasing overall quality. I want to bring academic recognition to the division.Last year, with the efforts of Dr. Eric Cohen and Thomas Barrett, the division started the New England Arthroplasty Conference, something we want to run yearly as part of Brown and as part of a New England consortium, to really become an academic center for total joint and adult reconstruction. I want to continue to nurture that academic growth.
In general, for my own interest, I am interested in research and technology. We have really been working with artificial intelligence and I am really interested in how that is going to impact orthopedics as a whole. Personal projects include AI and better ways to screen patients and questionnaires for intake that ultimately would define which patients should be prioritized versus patients that can benefit from physical therapy. We have been developing algorithms for that. AI will change the whole game in terms of patient access.
From a medical perspective, we are burnt out by the amount of paperwork and procedural hoops we have to jump through. AI can be optimized and automated to allow us to focus more on patient care over computer work. We have been working with an AI-driven scribe system, allowing us to bring a phone into the room and have AI listen to the conversation with a patient and produce good quality notes. I'm excited about the future.
Q: What are the main trends you are keeping an eye on in the industry right now?
VA: Total joint care has been evolving from a robotics perspective. What we have done in the last few years is bring in several physicians using Stryker and Zimmer Biomet robots that are available to our patients within the division. At a national level, this is set to be a trend. The latest development I've been focusing on is using sensors within implants so you can literally monitor patient progress objectively. When we do a knee replacement, followup is largely subjective. With an accelerator within the knee replacement, that can provide the next step of tracking patient function long term. CMS and Medicare has been noticing that, too, and they have opened billing opportunities from that perspective where you can review data and be reimbursed for that time. This will allow close follow up of our patients. That, along with patient reported outcome measures, may drive better outcomes.
Q: Is there anything else you want to expand on?
VA: University Orthopedics was previously focused on national exposure in spine, hand, sports, and shoulder, and I think now adult reconstruction has really been growing its reputation nationally. It's setting up the stage for being a world-class program. When I came here, there were three senior orthopedic surgeons focusing on adult reconstruction and I was the fourth one to be in the program, and we have expanded since then. I think it's a phenomenal growth that mimics national demand. The benefit of that growth is we also have a lot of younger, high-energy surgeons who are also producing not just phenomenal clinical work and patient care, but a lot of publications and a national presence.