Episode 100: JOEI: Helping Orthopedic Surgeons Learn and Collaborate

Scott Zeitzer catches up with returning guest Dr. Ira Kirschenbaum for the 100th episode of the Paradigm Shift of Healthcare. In this episode, Dr. Kirschenbaum shares a passion project of his: the Journal of Orthopaedic Experience & Innovation (JOEI). He stresses the need for continued open conversation between surgeons to help advance the field of orthopaedics.

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Full Transcript

Announcer: It’s time to think differently about healthcare. But how do we keep up? The days of yesterday’s medicine are long gone. And we’re left trying to figure out where to go from here. With all the talk about politics and technology, it can be easy to forget that healthcare is still all about humans. And many of those humans have unbelievable stories to tell.Here, we leave the policy debates to the other guys, and focus instead on the people and ideas that are changing the way we address our health. It’s time to navigate the new landscape of healthcare together. And here’s some amazing stories along the way. Ready for a breath of fresh air? It’s time for your Paradigm Shift.

Michael: Welcome to the Paradigm Shift of Healthcare. And thank you for listening. On today’s episode, Scott Zeitzer gets the chance to talk to returning guest, Dr. Ira Kirschenbaum, Chairman for the Department of Orthopedics at the BronxCare Health System.

Scott: This is our 100th podcast. I am welcoming my good friend Dr. Ira Kirschenbaum, who is the Chair of BronxCare. Ira, what is your formal title now that I think of it?

Dr. Kirschenbaum: Besides Grand Poobah?

Scott: Yes.

Dr. Kirschenbaum: I am the Chair of the Department of Orthopedics at BronxCare Health System.

Scott: There you go.

Dr. Kirschenbaum: I also have another title here, which is the Clinical Lead of Telehealth for the entire health system.

Scott: Which is pretty cool, but we’re not going to talk about that actually. We’re going to talk about how you’re the Head of JOEI, The Journal of Orthopaedic Experience and Innovation.

Dr. Kirschenbaum: Yes, absolutely.

Scott: I wanted to talk a little bit about JOEI. It’s something that I know is near and dear to your heart. And when you came up with this concept and we were first talking, and it was a while ago. I thought it would take off, but not to the level that it has.

So let’s go back. How long has JOEI now been? Let’s go over it since its inception and what’s happening here.

Dr. Kirschenbaum: There were two starts to the journal. And I do have to first of all give credits to Vinod Dasa, who was the first person who coined it JOEI, Journal J-O-E-I. He called it JOEI.

Scott: All right.

Dr. Kirschenbaum: So Dr. Vinod Dasa called it JOEI and it stuck. It’s stuck. There are two starting points to the journal. One was about 10 years ago, when the original inception came up, an original idea came to me. I thought to myself, I remembered when I was a 2nd or 3rd year resident, my mentor, Dick Rothman invited me to dinner at a meeting. It might’ve been OSC, it might’ve been AAOS. And at the dinner was Rothman, Leo Whiteside, Chit Ranawat.

Scott: Wow. So at this dinner, I just want to get this straight, you got Rothman, Ranawat, and Whiteside?

Dr. Kirschenbaum: Yes.

Scott: And you.

Dr. Kirschenbaum: No, and about six other people.

Scott: Okay. I’m still overwhelmed by the people at this table. Those are some heavy, heavy hitters. And they really were like some of the fathers of modern day orthopedics. So anyway, you’re at this table and things are opening up a little bit. They’re telling stories.

Dr. Kirschenbaum: So basically, I wasn’t there. And I’m just now an observer to the interactions. And the range of discussions went from medical things, about why are these controversies still repeating? And they went over some of them, to how they each got their start in orthopedics. How Leo came up with his original idea for the Dow-Corning knee or something. And how Rothman made his move from spine to joints. And how Ranawat came to this country with basically no money, and did, if I remember correctly, his first internship in an upstate New York convent hospital, if I get that correctly, and I think I’m remembering correctly.

So then fast forward about another eight or nine years. And I’m sitting and remembering that. So with that said, 10 years ago I was realizing as I was seeing more and more bivariate analysis, evidence-based medicines and claims data studies and claims data studies. And we looked at the claims data from the-

Scott: You look at the claims data, yeah.

Dr. Kirschenbaum: …State of the University of Minnesota and blah, blah, blah. I said, “Now, what would Ranawat say about this? What would Rothman say about this?” These are the guys who each did over clearly at the time probably over 20,000 joints a piece, whatever their number is.

Scott: Yeah. Their level of experience was just extraordinary, extraordinary.

Dr. Kirschenbaum: And they always thought about when they did things. They didn’t just do things. Each case, Rothman used to say, “Every time you go to the OR, make sure you do one thing better that day.” And keep on rotating it around. But anyway, make a long story short, I got 10 years ago, prior to JOEI, I came up with the idea called the Journal of Experience. I even have a mock-up of the page.

It was a very, very goofy image. And it never went anywhere because number one, I was really busy with this new position where I took over the Chairmanship of BronxCare, which was a whole another story for now.

Scott: Yeah. If anybody wants to hear the systems that Dr. K put in place and the workflow, and it’s a great podcast that if it’s not the first one, it’s one of the first few. And I do remember one of the takeaways from that was that I think you processed in one year the same volume as like the City of Cleveland or something and…

Dr. Kirschenbaum: Yeah, so we went from no orthopedic surgeon to right now, I believe we are the largest full-time faculty of orthopedics of any safety in our hospital in the country.

Scott: In, if I’m not mistaken, the poorest congressional district in the United States as well.

Dr. Kirschenbaum: Correct. So I’m trying to look. I say, “How am I going to do this and that?” And that kind of really pretty high end technology and can figure out ways to produce things and outsource things and blah, blah, blah, and all that stuff.

Scott: Technology is your friend.

Dr. Kirschenbaum: And at the time, the only thing that’s really available was CreateSpace from which then became Kindle Direct Publishing. There was something called MagCloud. MagCloud was making magazines. And I think it was owned by McGraw-Hill.

Scott: I’ll make sure you’re right about that.

Dr. Kirschenbaum: And it was 20 cents a page. And it was printing. But I just said, “I have, but then how am I going to run the reviewers?” The technology wasn’t there. Fast forward seven years later which was a year before JOEI, I have to come across a company called Scholasticahq, which is really a platform.

And you’d known me from that. We’ve talked about this the previous podcast. I’m a big fan of platforms. For example, we run a database on a platform called TrackVia, which is like salesforce.com, which is a database platform. We built our own database. But we built it from scratch, but at least we have a platform to build on. This is an academic journal publishing platform. It doesn’t tell you what to say. It doesn’t give you the articles. But it has a section to manage your reviewers, a section to manage your editors, which I am.

So now, as I always say, when you have any entrepreneurial idea and JOEI is an entrepreneurial idea, you need three things. You need the idea. You need the ability to make it. And you need a distribution mechanism.

Scott: Okay. Then you go for it.

Dr. Kirschenbaum: That’s it. So I had the idea for a long time, but I did not have the ability to make it.

Scott: And I’ll tell you something else too. You’re at a position in your career where you also had the time to develop it, to focus on it. And we had this online journal it’s created about a year ago, correct? Two years ago. How old is it now?

Dr. Kirschenbaum: March 14th, 2020 was the first article.

Scott: There we go. So we’ve got an online journal and Ira, you now have enough time to put some time into this. And I get back to that experience.

Dr. Kirschenbaum: I’ll take issue with that. I made time to do this.

Scott: Okay. Okay, you made time.

Dr. Kirschenbaum: So I took away from all the personal endeavors.

Scott: I sold for quite a while. I think my first job was actually being Dr. Ranawat’s sales rep for Johnson & Johnson. I would basically go genuflect and hand in the implants. It really wasn’t that much of an experience in terms of a surgeon-sales rep kind of a thing. It was more of just delivering the product.

Dr. Kirschenbaum: I understand that.

Scott: And I got to watch some surgeries that he did. Of course, he was a brilliant surgeon. The thing though was in that era, I remember, you’d go to the American Academy of Orthopedic Surgeons’ meeting and you’d have some key doctors that you worked with, you like them. And they had questions about the system. And you remember how exciting it was. If you were a Rothman hip user, to be able to go to what was then the Biomet Boot, not the Zimmer Biomet boot, showing my age. But you were able to go talk to Dick Rothman about like, “Hey man, what do you do if…” Or, “How do you set up your tables?” Or whatever that was. It wasn’t a double, triple case study blind, whatever. But it was just like, “What will you do?”

Dr. Kirschenbaum: And also he wasn’t high on the podium, far away from you.

Scott: Correct. He was right there.

Dr. Kirschenbaum: As a matter of fact, one of the names I originally wanted to call the journal was Rubbing Elbows.

Scott: Yep. I remember that.

Dr. Kirschenbaum: Just kidding around. And so when I had the idea to go ahead with the journal, I realized it had to be more than just experience. It was also about innovation. Because innovation became over the last 10, 12 years more codified as a discipline. [inaudible 00:10:27].

So my original name of the journal, believe it or not was Acta Experiencia. There’s a journal called Acta Scandinavia. And I figured we do Acta Experiencia. So I presented that. William Curtis is a great guy who started the Ortho Founders Group, and which I’m a member of. It’s membership is a lot. It’s about 150 orthopedic surgeons who are interested in entrepreneurial ventures and founding company. I presented it to the group.

And I think about 90 people were on the email’s chain then. 89 said Acta Experiencia was probably the worst name they ever heard. The only one who did it was me. And I was the 90th men. So we toyed around with a bunch of other ideas. And it wasn’t one person. It was a whole bunch of emails coming along. And we talked about this experience. It’s innovation. It’s this, it’s this, it’s this. So it became the Journal of Experience and Innovation. I could thank the Ortho Founder Group for the process of coming up with that.

Scott: We have JOEI. And how many people are on the platform now? How many people are actively engaged, like page views? Give me some stats here. Because I want people to understand.

Dr. Kirschenbaum: Aside from my immediate family?

Scott: Right. Aside from making your wife read it everyday. Yeah.

Dr. Kirschenbaum: Right. So first of all, let me talk about the editorial.

Scott: Go ahead.

Dr. Kirschenbaum: We have 92 people on the Editorial Board. And we have 30 surgeons on the Advisory Council. The Editorial Board are well regarded titans in their communities or in their academic centers. The Advisory Board are actually very unique group, which we started around five months ago, which are really, in my opinion, are those who are senior key opinion leaders in this country. And when I’d ask them to be editors, their responsibility is for twice a year to sit down with me and tell me where they think the journal should go. Because we knew that wisdom, you need that wisdom.

And so right now, we’re now into our two year anniversary. I guess we’re at 18 months or so.

Scott: Something like that. Yeah. That sounds better.

Dr. Kirschenbaum: March. Yeah. Maybe less, 16 months in. We just went over 60,000 page views and about 35,000 unique visitors. What I’m more proud about is we’re very transparent about our readership and who reads articles. So when you look at a lot of journals that you have, and we don’t compete with the standard journals. We’re different.

Scott: I wholeheartedly agree with that. Yeah.

Dr. Kirschenbaum: Yeah, listen, some of my favorite journals on orthopedics on the planet, JBJS and others and Clinical Orthopedics and Related Research, amazing journal, they are beasts. And they are beacons of excellence. We are not that. We are a different product, we just happened to be called journal.

What we do is we are issuing articles that have to do with clinical economic health policy or business experience in orthopedics.

Scott: And that’s the key point. You slowed down there. You said, “Experience in orthopedics.”

Dr. Kirschenbaum: Right. So what’ll happen is somebody will do 12 cases of using a certain device to fix a not so common injury. That, all the people need to know that information. Sure, he doesn’t have 200 cases, but all 12 cases did well and it’s a case series. And that is from experience.

Scott: Right. Take it for what it’s worth.

Dr. Kirschenbaum: That’s worth his experience. Yes. Take us for what it’s worth. It’s what we are. But the other thing we found is that, so I looked back at Journal XO, a well-known journal, and there were a thing called PlumX Metrics, which tells you how many people read the journal.

So I’ve looked at a journal from a month ago, and two months ago and three months ago. I found that a vast majority of the articles per issue had 35 to 60 page views. Now I don’t know if that’s high or low. Most people read page views because they’re writing an article on it. Then they go back and read the article because they’re citing it.

Now we have articles that sometimes have 35 page views. And sometimes it’s a struggle, our average page readership is about 200 page views per article. We have at least eight or nine articles that have gone over 3000 reads, 3000 page views. The other thing we do is we keep on bringing up previously published articles.

Scott: Uh-huh (affirmative). They can’t be too old.

Dr. Kirschenbaum: It’s not a used article, it’s a previously owned article that has revel events still. Like for example, one of my most popular articles was on a Deep Dive Analysis of Private Equity Innovation in the Orthopedic Business Space-

Scott: Yep, I know the article too well.

Dr. Kirschenbaum: …for Practices. A month ago, we had 2800 views. I posted it again, 2200 reads. We posted it again, within three weeks it had 3200 reads. 400 reads a repost a year later.

Scott: Yep. Because it’s still a credible piece of information that might have gone through somebody’s inbox, so to speak. Or I just didn’t have time to look. I also think you’ve picked up a lot of steam with JOEI. I also think the orthopedic community as a whole needs a place to take a look about what’s going on. Not just in the operating room, but the bigger picture, so to speak. So surely that’s important.

Dr. Kirschenbaum: Right. And it doesn’t have to be a 27-day article with 1300 graphs. It has to be accurate. It has to be accurate and it has to be clear and well-written.

Scott: No doubt about that.

Dr. Kirschenbaum: Yeah. But we’re not holding people to… When people ask sometimes, how should I write this article? Give me some guidelines on how to write the article. I said, “Do you ever hear the writer, Stephen King?”

Scott: Yeah.

Dr. Kirschenbaum: Because they say, “Yeah.” I said, “So if I was Steven King’s publisher, you think I’d give Stephen King guidance? I think he’s doing okay.” I tell them, “Tell your story.” Look quickly all the articles on the journal, see how people format it theirs. Because not every story has to get formatted exactly the same way. So we have an open format.

The other thing, which is very important actually is we’re, what I call a triple open access. I invented that term.

Scott: Okay. Wait, what is triple open acess?

Dr. Kirschenbaum: So open access journals mean that if you don’t have a subscription, you could read it. But here’s the catch on nearly every open access journal I know. There’s either an article submission fee, so when the author submits the article, the author has to pay the journal submission fee. And invariably almost 100%, there’s an article processing costs, APC. And that ranges from $1200 for Journal of Medical Orthopedic Surgeons to $4700 for Clinical Orthopedics. And that’s paid by the author.

So there is a financial barrier of entry for certain articles. And I’m not saying that’s inappropriate or not. I think that’s fine. I think if there’s no subscription, someone has to pay for the process of course. So we have no article process submission fee, no article processing fee and no advertisements. Amazing. So how do you make money?

Scott: That was going to be my follow-up question. So right now, just to lay this out, we’ve got frankly a pretty darn popular online journal that is getting as many or more views, online of course, of certain articles and submissions. And not only you’re getting lots of views and you’re getting a lot of interaction, there’s a lot of talk online back and forth after articles are posted, et cetera. How do you plan to make money with this? I would think that a medical device company or pharma company would want to somehow get in front of these people. Is that something you’re considering?

Dr. Kirschenbaum: Yeah. First of all, let me explain. The goal of the journal-

Scott: Go ahead.

Dr. Kirschenbaum: …is that it makes a dollar a year.

Scott: All right. It’s got a low barrier there. But go ahead.

Dr. Kirschenbaum: Low barrier. So for better or worse, because I have some pretty decent programming skills, I was able to leverage the Scholastica platform, which was not overly expensive. So I funded it myself in the beginning. The barrier to entry was not high. Reasonable price to do it. And I didn’t hire on stack a bunch of managing editors and everyone. I did it all myself. Because I’ve done this before. I edited Medscape. It’s fine.

And the other thing is we don’t have issues. We publish as we go along. So if I don’t have an article this week, I do it next week. You know what I mean?

Scott: Yeah, I get it. Yep.

Dr. Kirschenbaum: We don’t publish in print, so there’s no cost to print and mailing. So our model to fund the journal is all after publication activities. So we don’t invade the sanctity of the articles. We don’t put ads on the articles. You can make an argument or we also allow innovations from industry. So if a startup company has an amazing innovation, sure they could write it. They could submit that to the journal. Because the world wants to know about that innovation.

And everything gets peer reviewed. And so even if a company puts in an article, it’s a double-blind peer review. So the reviewers don’t know it’s a company that put it. But it’s a rare article from companies. But we have a couple that are innovations from industry.

What we do is we do four different things in the after the publication.

Scott: To potentially make money, go ahead.

Dr. Kirschenbaum: To potentially make some money. One, we run journal club. So we’ll take an article, we’ll do a Zoom journal club and we’ll have a sponsor for the journal club on that article. So a sponsor like company X, Device Designs of America…

Scott: That sounds like a good company. Go ahead.

Dr. Kirschenbaum: We’ll look through all the articles and say, “Boy, this one is something that we want to our heart.”

Scott: Near and dear and close to our hearts.

Dr. Kirschenbaum: We want feedback on that concept. And they will sponsor the journal club, which costs a certain amount of money to sponsor. They get two minutes in the beginning and they get two minutes and 30 minutes to say their work. They paid a flat fee to sponsor the journal club. And they are charged a fee for every healthcare provider that goes on for the journal club.

Scott: So some basic, “Okay, here’s the cost. And then depending on how many people join, you’ll pay X dollars on top of that.”

Dr. Kirschenbaum: Only for healthcare providers. And we have a registration. That’s it. That’s number one. Number two, we run article based panel discussions at conferences, focus groups. So we will take a hot article and get together 5 to 20 key opinion leaders. We did this at the last academy. And we will drill that article down all the way and ask key questions.

Scott: Kind of reminds me of that conversation they might’ve been having at that table.

Dr. Kirschenbaum: Right. Absolutely.

Scott: With all the guys.

Dr. Kirschenbaum: And we have a mix of primarily the niche is 70-30. 70% are busy, active community titans of their community. 30% are academics.

Scott: That is a great conversation. It reminds me of the heyday.

Dr. Kirschenbaum: Of the heyday. And then the third way is we have a followup of one of those panels by Zoom. So the same company could double dip and say, “We want to dive deeper with a bigger group. But we’ll do that by Zoom.”

Scott: Sure. Because the Academy is one of the largest, but there are lots of orthopedic meetings where you might get a subset of people who are alive. So you have that additional way to get to people, so to speak.

Dr. Kirschenbaum: Yeah. And the last revenue opportunity is a new product we just came up with. So I remembered a movie from 1981 called Dinner with Andre. It was an old, old, old noir-type movie, Dinner with Andre. So it’s Dinner with JOEI. And I got the idea again because Joe Zuckerman was a friend and obviously a giant in the field of orthopedic for generations [inaudible 00:25:20]. He was invited to our grand rounds, when we had the summer fellows from college, about 15 summer fellows who are pre-meds, and the whole staff, about 70 people in the room. And he and I just had a discussion. And it was electrifying. So we are going to really take people from the Advisory Group board, people who are around, maybe find Leo Whiteside. Maybe Richard Santore from California or Chit Ranawat, or whatever. And have dinner with so-and-so. It would be a Zoom meeting. And it would just be a discussion with sort of a Dick Cavett, [inaudible 00:26:01].

Scott: Yep. It just goes back to that same thing of look, there is, they call it the art of medicine for a reason. And there is no one way. There are some basic things like, “Hey, you need airway, breathing and circulation.” I get it. But moving pass the basics, there’s always an art. There’s always something that you can learn. That’s why Dr. Rothman said to you, “Son, because I’m sure you were much younger at the time, here’s the one thing I need you to do. It wasn’t about the incision. It wasn’t about the approach, blah, blah, blah. Just try to do one thing better.”

Dr. Kirschenbaum: And I have a 1000 Roth minutes.

Scott: My thing about this, and this is what I think the value to the orthopedic community and the value to frankly, whether it’s a medical device company, pharma company, whatever, is you don’t need a triple blind study on X. It’s like, “Look man, how do you handle X in an ambulatory surgical center versus a hospital?”

Dr. Kirschenbaum: Right. And keep in mind, we’re still peer reviewed. And there are some great…

Scott: That’s a very critical point. I don’t want to let you go without getting the domain name which we will have on the website of course and part of the podcast. But what is the domain name?

Dr. Kirschenbaum: www.journaloei.com

Scott: .com, all right.

Dr. Kirschenbaum: Journaloei.com.

Scott: Dr. Kirschenbaum, I want to thank you for joining me on the 100th podcast for the Paradigm Shift of Healthcare. It’s been a good ride. Thank you so much for taking the time to talk to me. And for everybody listening, again go online, listen and we’ll go from there.

Dr. Kirschenbaum: Thank you.

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