Latest / Becker’s Healthcare - Clinical Leadership Podcast / Dr. Jason Koh, Endeavor Health Orthopaedic & Spine Institute Director and Chief Medical Officer of the Chicago Fire Major League Soccer Team

Transcript

Dr. Jason Koh, Endeavor Health Orthopaedic & Spine Institute Director and Chief Medical Officer of the Chicago Fire Major League Soccer Team · Becker’s Healthcare - Clinical Leadership Podcast

• 0:00
  - Welcome back to the Becker's Healthcare Podcast,
• 0:02
  devote to the people who power US healthcare.
• 0:04
  I'm Molly Gamble at Becker's
• 0:06
  and delight to have you join us for another episode filled
• 0:08
  with insights from healthcare leaders.
• 0:10
  Today I'm spending some time with Dr. Jason Co. Dr.
• 0:13
  Co serves as the director of the Orthopedic
• 0:15
  and Spine Institute and Endeavor,
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  formerly North Shore University Health System, chairman
• 0:21
  of its Department of Orthopedic Surgery,
• 0:23
  and also Chief Medical Officer
• 0:24
  with Chicago Fire Major League Soccer team.
• 0:27
  Dr. Co, welcome to the podcast.
• 0:29
  Thanks for being my guest today. How are you?
• 0:31
  And where does the podcast find you?
• 0:34
  - Well, Molly, uh, thanks a lot.
• 0:35
  Uh, I'm excited to be here today. I'm doing great.
• 0:38
  Um, I'm particularly looking forward to this season
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  because the Chicago fire have their home opener coming up,
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  and the team is looking great.
• 0:47
  Oh. So we've had a good team last year
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  and made some key additions,
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  so we're looking forward to a great season.
• 0:53
  - Terrific. That's wonderful to hear.
• 0:54
  I, I think Chicago sports fans, we, we,
• 0:57
  that's welcome news, Dr.
• 0:59
  Co. So thanks for, for listeners in the area, um, some,
• 1:03
  something to look forward to.
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  But speaking of the Chicago Fire, I think
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  as my introduction just highlighted, you wear many hats
• 1:09
  as an orthopedic surgeon team, physician leader.
• 1:13
  Can you walk us through your role
• 1:14
  so our listeners can just better appreciate your
• 1:17
  perspective today?
• 1:21
  - Sure. Um, well, I mean, you started
• 1:23
  with orthopedic surgeon and I think that's part of, uh,
• 1:26
  my definition.
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  Um, for me, uh, I went into orthopedic surgery
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  to help people get better.
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  Uh, I keep people active and pain free,
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  and that really informs a lot of my goals.
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  The, uh, I'm a practice reading orthopedic surgeon.
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  I typically do, uh, over 300 to 400 surgeries a year,
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  uh, see lots of patients,
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  and it's a true source of, uh, enduring joy
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  and satisfaction in my life to be able
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  to help people get better.
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  Uh, with regards to that, um, it's allowed me
• 2:00
  to become very effective as a team physician.
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  Uh, being an orthopedic surgeon, assessing patients, uh,
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  helps me assess injured athletes,
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  whether they're professional or recreational.
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  Um, it does make me think about things in a,
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  a different way in terms of where the individual is in terms
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  of their team, the timing of sport.
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  Uh, we're always focused on the athletes first. Mm-Hmm.
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  . And then finally, as a leader, uh,
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  I've been running the Department of Orthopedic Surgery at,
• 2:32
  uh, endeavor, which was formerly North Shore
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  and now for a dozen years.
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  And we've become the busiest orthopedic department in
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  Chicago, uh, the market leader in terms of the number
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  of cases that we do at our dedicated
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  orthopedic and spine hospital.
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  Uh, this requires obviously a coordination of a number
• 2:51
  of different moving parts,
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  but again, having worked with teams, having been on teams,
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  I think that, uh, that's informed me in terms
• 3:01
  of my management style
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  and bringing people together to work towards a common goal.
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  And in this case, a common goal is, uh,
• 3:08
  outstanding orthopedic and spine care. Mm-Hmm.
• 3:11
  - . Mm-Hmm, . Well,
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  let's dive into some field notes.
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  If you'll share this with us in our listeners about
• 3:16
  interesting trends you're detecting right now in the fields
• 3:19
  of orthopedic surgery and sports medicine.
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  Is there anything up and coming
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  that listeners should be keeping an eye on
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  or things that maybe you're seeing intensify compared
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  to the past couple of years?
• 3:32
  - Absolutely. So one of the things that's happening is that
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  orthopedics and spine surgery has gone
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  through amazing advancements in technology.
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  And the technology is,
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  includes both improvement in surgical techniques,
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  but also other aspects such
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  as rehabilitation, pain management.
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  And this is some of what we focused our
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  work and research on.
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  So at this point in time, we're seeing the majority
• 3:57
  of our patients have, for example,
• 3:58
  joint replacements on an outpatient basis.
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  Uh, patients are able to, uh, have procedures that are
• 4:06
  so minimally invasive and recover so quickly
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  and have, uh, great pain control so that they're able
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  to go home the same day, um,
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  and, uh, they're able to return back to their normal life,
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  uh, a lot quicker than they were before.
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  So, uh, that's a trend that we continue to see develop.
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  Um, this is supported in many ways by the use
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  of increasing technology, uh, around, uh, computer assisted
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  or robotic surgery.
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  Um, and, uh, for example, the, uh, probably 90 plus percent
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  of the joint replacements done at our Orthopedic
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  and Spine Institute are, uh, done with the assistance
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  of either robotic or computer assisted, uh, tools
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  that allow us to sort of, uh,
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  really truly measure much more precisely than we are
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  with manual tools.
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  Some of the other things that are happening in sports
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  medicine is, uh,
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  continuing interest in regenerative techniques
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  and regenerative medicine.
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  Uh, we're doing research
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  and using, uh, harnessing the body's, uh,
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  own regenerative capabilities in implicit in the blood
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  or, uh, bone marrow to help patients, uh, heal
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  and restore back to normal function.
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  And then also in, uh, sports medicine in general,
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  we really try to approach our athletes from a
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  multidisciplinary approach.
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  And so that means, you know, keeping track
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  of things like sleep timing and nutrition,
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  and how we taste the intensity of training
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  and workload, uh, on our athletes.
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  So these are some of the exciting things
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  that I see happening right now.
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  - I mean, these are big shifts that you just touched on,
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  and I'm curious for either more
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  and more joint replacements moving to the outpatient setting
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  or the regenerative medicine up uptick in the growth of
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  that option for athletes especially.
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  Is there anything around patient expectations
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  and the management of those expectations
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  that you found yourself needing to rely on more
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  as these things take off
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  and grow in their frequency or popularity?
• 6:10
  - Absolutely. I think one of the things is, uh, it is, uh,
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  since the field is changing
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  and continuing to develop, uh, is about, uh, providing,
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  uh, patients with the knowledge that there are lots of ways
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  that we can help them, uh, in a less invasive way that, uh,
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  allows them to be pain-free
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  and restored to full function much quicker than they
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  might've thought before.
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  As you know, I mean, our population, uh, there's a,
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  a large number of, uh, older, uh, athletes
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  and older people who are part of that baby boomer,
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  uh, generation.
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  And the expectations that they have, uh, for themselves is
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  to stay active longer.
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  Uh, they've had active lifestyles.
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  They want to continue
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  to maintain their health and independence.
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  And so I, it's part of our role to help make sure
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  that they're able to maintain that.
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  - Well, let's dive into that more
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  because my, my next question was about patient populations
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  and orthopedic surgical needs among varying demographics.
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  Are there any shifts worth, worth mentioning?
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  You already talked about in the large number of older adults
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  and older athletes who wanna stay active for much longer.
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  I think you can even see that in some sports
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  like golf, for instance.
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  Um, you see some of the, the ages of these players are,
• 7:36
  what about younger patients?
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  Are you seeing more need for orthopedic surgery
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  among any younger patients?
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  That's worth pointing out.
• 7:46
  - Absolutely. I, one of the things
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  that we're seeing nowadays, uh,
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  and has been an area of some concern for orthopedic surgeons
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  who do sports medicine, is the increasing sub-specialization
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  of kids at a younger and younger age.
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  Uh, this idea that, you know, you could be a kid
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  and you could play, you know, baseball during one season
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  or football during another,
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  or, you know, soccer and basketball.
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  Uh, now there's some increased number
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  of folks who are just doing one sport, uh, 365 days a year.
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  And what that can lead to is over training,
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  overuse injuries.
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  Uh, and sometimes, you know, frankly, burnout on, uh,
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  on the psychological side, um, we encourage, uh, kids to,
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  uh, pursue a variety of different sports
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  and to have a variety of different interests.
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  And one of the things that actually,
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  if you take a look at the professional level, is that
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  in such areas like, uh, major League Baseball
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  or the NFL mm-Hmm, , um, many of these people,
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  uh, have had, uh,
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  played multiple sports throughout their high school careers.
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  The, uh, super Bowl winning, uh, quarterback,
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  Patrick Mahomes was a outstanding baseball player
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  before, uh, he decided to pursue his career in football.
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  So I think the idea that there's, uh,
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  people should explore different sports and, uh, practice
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  and try doing cross training in different areas,
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  it will help avoid some
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  of these overuse injuries that we're seeing. Mm-Hmm,
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  - , that's really interesting.
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  And is that typically like high school age, you start
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  to really notice that increasing sub-specialization
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  where they're really leaning into one specific sport?
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  Or is it even younger than that?
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  - Well, we used to see it in high school age students,
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  but now we're starting to see, uh, kids
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  who are even younger than that, um,
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  getting specialized in one sport right away.
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  And so, uh, one of the things that our, uh,
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  professional organizations like the American Academy
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  of Orthopedic Surgeons
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  and the American Orthopedic Society
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  for Sports Medicine are focused on is, uh, injury prevention
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  and trying to allow kids to have time to,
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  for their bodies to grow and recover.
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  Um, these are growing developing bodies.
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  Uh, they respond to different stresses differently.
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  And if people are overtrained, then uh, injuries can occur.
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  So for example, uh, you know, I've taken care of, uh,
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  major league baseball teams,
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  and, uh, what we're seeing is actually that, uh,
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  elbow injuries to the ulnar collateral ligament are
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  happening in younger and younger kids at this point in time.
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  What used to be the Tommy John operation
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  for Major League baseball players is now happening, uh, uh,
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  in college
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  and high school athletes as a result
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  of some of this overuse.
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  - Wow. Wow. I've heard, I mean, I've heard of Tommy, Jenn
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  and I always equated that with pretty
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  like long standing athletes, those
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  who had been playing for quite a while.
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  So for now, an athlete in high school in their teens
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  to be undergoing that, that's a pretty big shift.
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  - It is, and I think it's
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  because of the fact that we're seeing, uh, more
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  and more, uh,
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  athletes really focusing on just one sport all the time.
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  And, uh, so what we're trying to do as, uh,
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  orthopedic exploits medicine community is sort
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  of provide the idea that, um, people can fatigue.
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  You might be very strong,
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  but if your body fatigues,
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  then it puts more stress on the other
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  tissues around the joint.
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  - Mm-Hmm. . Mm-Hmm. .
• 11:40
  You know, one other thing I wanted to ask you about Dr.
• 11:42
  Co is any thoughts on the growth
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  of GLP ones and weight loss?
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  And I know there's a lot of caveating around that in terms
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  of making sure we're speaking realistically about the
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  potential for those drugs.
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  Obesity is gonna be a big problem public health wise
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  and a priority for years to come.
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  But are you seeing or hearing anything from patients about
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  just having that tool being available
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  to them in terms of weight loss goals?
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  Is it affecting anyone's needs
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  for orthopedic surgery or the recovery?
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  - Well, I think like many things, there's, uh,
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  pluses and minuses.
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  Obviously, these new medications are able
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  to really help people improve their overall
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  cardiovascular health.
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  Um, uh, I've seen patients who, uh, have
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  gone off, uh, needing, uh, insulin
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  or different kinds of cardiac meds.
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  And so their overall health improves.
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  This allows them in many ways to sort of be more comfortable
• 12:44
  and physically, uh, active
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  because they're not carrying around an extra, uh,
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  20, 30, 40,
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  or a hundred pounds of weight, um, which can be,
• 12:55
  uh, very painful.
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  What ends up happening for, uh, many obese patients is that
• 13:01
  that extra load causes extra forces on the joints
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  and clearly contributes to joint pain and discomfort.
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  On the other hand, one of the things
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  that we are concerned about is the fact
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  that when this rapid weight loss occurs, significant portion
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  of that actually comes from muscle mass.
• 13:20
  Hmm. And so the, uh,
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  body stores the glycogen primarily in the muscles.
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  That's the first place the body goes to get energy.
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  And so with these medications, um, it starts, uh,
• 13:34
  burning some of the muscle before it gets to the fat.
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  Uh, so I think one of the critical things is,
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  although people may be losing weight,
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  that doesn't necessarily mean that they're going to be
• 13:46
  more fit Mm-Hmm.
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  , uh, in terms of strength and endurance.
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  And so, uh, I think it's very important
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  that the message is not only, you know,
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  there is some advantage in losing weight in terms
• 13:58
  of overall fitness and, you know, perhaps endurance, uh,
• 14:03
  since you're not carrying around as much,
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  but without a thoughtful program where you're going to
• 14:11
  actually have to do some work to maintain muscle mass,
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  will mean that you need to continue to
• 14:17
  maintain your activity level.
• 14:18
  Hmm. Um, I do think that's one thing that's, uh,
• 14:21
  very interesting nowadays.
• 14:23
  And, uh, you know, Peter Atia
• 14:25
  and others are, uh, discussing this,
• 14:27
  but the idea that you wanna maintain a certain amount
• 14:31
  of strength and muscle activity
• 14:34
  and endurance, uh,
• 14:36
  over your lifespan is critically important for people
• 14:39
  who are getting older to maintain an active and functional
• 14:43
  and independent lifestyle.
• 14:45
  - Right, right. No, I mean, that's so true.
• 14:48
  Even, even just my question, you know, when we talk about
• 14:50
  or see headlines
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  and the high level discussion about weight loss, I think
• 14:54
  so often we fail to make those distinctions between,
• 14:57
  like you said, fat and then muscle mass.
• 14:59
  So a really important thing for us to keep in mind, um,
• 15:02
  you know, in your opening remarks,
• 15:04
  and you were kind of talking us about,
• 15:05
  talking to us about your role as Dr.
• 15:06
  Co, you had made mention of your role as a team physician.
• 15:10
  You're the top physician for Chicago Fire in that role,
• 15:13
  you are the coordinator of an entire multidisciplinary team.
• 15:17
  Um, I, I wanted to ask you, you know,
• 15:19
  I think your contributions to the team are very clear,
• 15:22
  but I'm also curious how serving
• 15:24
  as a team physician has changed
• 15:26
  or shaped you, you know, what, what lessons
• 15:28
  or major lessons have you walked away
• 15:30
  with from these experiences being close
• 15:32
  to athletes and teams?
• 15:35
  - Absolutely. Um, first of all, uh, I would say, uh,
• 15:40
  it's a real privilege to take care of
• 15:43
  athletes performing at this level.
• 15:44
  Uh, professional athletes have, they're special people.
• 15:49
  They have a unique combination of talent, um, ability,
• 15:54
  dedication, art, and actually a lot of resilience.
• 15:59
  Um, if you take a look at, uh, what they're like,
• 16:04
  I mean, these are people who are in
• 16:06
  performing at the highest levels,
• 16:08
  but many of them over the years, particularly the veterans,
• 16:12
  uh, have accumulated some, uh, injuries
• 16:15
  and other, uh, areas of damage, uh,
• 16:18
  but continue to stay active.
• 16:19
  And to me, that's actually very inspiring that, uh,
• 16:23
  we all can stay active.
• 16:24
  That, um, even older patients who may have some arthritis
• 16:28
  or some other injuries
• 16:30
  or, uh, damage, uh, still will be able to remain active,
• 16:34
  remain pain-free and very functional.
• 16:38
  So some of the other things are, uh, again, being
• 16:41
  a team physician, you actually are part of the team.
• 16:44
  And you realize as a team member, you can serve,
• 16:50
  you may be really outstanding in one role.
• 16:51
  You can help in others, in others, uh, areas.
• 16:54
  Uh, you need the help of your other teammates.
• 16:58
  And the way I approach this in the team physician role
• 17:02
  and the chief medical officer role is I have outstanding
• 17:05
  colleagues who, um, like Julian Bales,
• 17:08
  who's a world class expert in concussion.
• 17:11
  Uh, we have world class experts in sports cardiology
• 17:15
  and expert exercise induce asthma.
• 17:17
  Uh, I'm able to identify some of these things
• 17:20
  and then help direct, uh, our athletes to those areas.
• 17:24
  And so, uh, to me, it's always, uh, a great
• 17:29
  experience to be working as part of a, a team
• 17:32
  of really outstanding providers.
• 17:34
  Uh, it's also, um, I'm humbled
• 17:37
  by the people I get to work with.
• 17:39
  Mm-Hmm.
• 17:41
  - In that role, in that overseeing this multidisciplinary
• 17:44
  fantastic team.
• 17:45
  As you just touched on, you know, I think about one
• 17:47
  of your earlier remarks about high school students when they
• 17:50
  have this subspecialization like you were describing,
• 17:53
  it can be increased risk of burnout.
• 17:55
  Is there anything that, and I know you're an orthopedic
• 17:58
  surgeon, I don't wanna go into another specialty in any way
• 18:01
  that would make you feel like you're speaking out of, out
• 18:03
  of turn here, but the link between an injury and depression
• 18:08
  or the, the emotional side effects of being out of a game
• 18:13
  or out of the sport for a, a period of time.
• 18:15
  Is there anything you can share
• 18:17
  with our listeners about that link?
• 18:19
  And as the leader of the multidisciplinary team like you
• 18:21
  are, how you make sure that when we're talking about health,
• 18:24
  it's not just the muscle or the tendon,
• 18:27
  but also, you know, the, the whole athlete
• 18:29
  and any sort of emotional
• 18:30
  or mental effects that might come with that injury?
• 18:34
  - Absolutely. So, obviously, um,
• 18:38
  and, uh, I think many of us have had some sort
• 18:41
  of musculoskeletal injury, uh, during their life
• 18:44
  or some, uh, limitation, whether it was like a, a
• 18:48
  bad sprained ankle or severe back pain
• 18:51
  that impacted our ability for daily living.
• 18:53
  Uh, it for an athlete, uh, these can be very, uh,
• 18:58
  not only physically, but also emotionally devastating,
• 19:01
  and it can take a long time for people to recover from that.
• 19:04
  Mm-Hmm. , and one of my, uh, good friends, uh,
• 19:08
  actually, uh, from Sydney, Australia, uh, did a look.
• 19:12
  I did a study looking at essentially the psychological
• 19:15
  profile of people with ACL tears
• 19:18
  and, uh, a significant number of them.
• 19:21
  Um, even at a year, about close to 30%, even at a year,
• 19:26
  I still had some essentially, uh, inhibition
• 19:31
  and concern related to their knee
• 19:34
  and their return to ability, their ability
• 19:36
  to return to sports activity.
• 19:38
  Uh, these kind of injuries are significant.
• 19:41
  Um, and it does take time for people to go through that.
• 19:45
  Um, uh, one of the advantages, again, of being part
• 19:48
  of a a team is that, you know, if we have athletes
• 19:53
  who have, um, are having anxiety
• 19:56
  or, uh, concern dealing with these kind of issues, um,
• 20:00
  that goes beyond the kind of, uh, empathetic care
• 20:03
  that we can provide, um, is to also have them meet
• 20:07
  with frankly, uh, health professionals that are, uh,
• 20:12
  certified and specialized in these
• 20:13
  kind of mental health issues. Mm-Hmm. .
• 20:16
  - Mm-Hmm. . - Well, thanks for speaking.
• 20:19
  I, I was curious about that.
• 20:20
  Uh, and that's great to, I mean,
• 20:21
  I'm sure there's great resources available
• 20:23
  to the Chicago fire athletes and then some, um,
• 20:26
  but when we talk about injuries, I know even just
• 20:29
  as non-serious athletes like you were saying, Dr.
• 20:32
  Co, that can be really
• 20:33
  devastating to people and set them back.
• 20:35
  Um, so it's, it's great to hear
• 20:36
  that there's resources available,
• 20:38
  and I appreciate you mentioning
• 20:40
  to your colleagues research. That's fascinating.
• 20:43
  - I, I mean, and,
• 20:44
  and certainly what I want to say is like,
• 20:46
  we have a great team assembled to care for the Chicago fire,
• 20:50
  but, um, I grew up in this community.
• 20:53
  I live in this community. I have kids who played sports.
• 20:56
  Uh, I understand that all
• 20:59
  of our active patients have these kind of needs.
• 21:01
  And so what we've been really trying to do
• 21:04
  with our comprehensive sports medicine program is bring
• 21:08
  that kind of professional level care
• 21:11
  and comprehensive ability to address all the needs
• 21:15
  of our athletes, uh, to recreational athletes,
• 21:18
  whether they're in, um, high school or college
• 21:22
  or senior level,
• 21:23
  or even just older people who are playing pickleball.
• 21:26
  And, uh, so our, our thought is
• 21:31
  we approach our, uh, athletes, whether they're
• 21:35
  of any level as we would approach.
• 21:37
  And so, uh, bringing that kind of comprehensive approach
• 21:41
  that's not just around purely orthopedic surgery
• 21:45
  or, um, uh, other types of rehabilitation,
• 21:49
  I think really helps best address the needs of, uh,
• 21:52
  our people who wanna stay active.
• 21:54
  - Mm-Hmm. . Mm-Hmm. .
• 21:56
  - Well, this has been just such a dynamic conversation.
• 21:58
  I've learned a lot from you in a
• 21:59
  relatively short amount of time.
• 22:01
  Dr. Co, is there anything you'd like
• 22:03
  to leave our listeners with?
• 22:04
  Any closing thoughts?
• 22:07
  - Sure. I think, first of all, on, uh, we're thrilled
• 22:11
  to help people stay active.
• 22:13
  Our goal is to keep people moving active and pain-free.
• 22:18
  Uh, the more we learn about, uh, aging
• 22:23
  and life is that staying active is important
• 22:27
  to staying active
• 22:28
  and independent, independent for many years.
• 22:31
  Um, uh, one of the key things is
• 22:34
  that we see this aging demographic.
• 22:36
  Um, but I think the expectations of people now in their,
• 22:41
  uh, you know, sixties
• 22:42
  and seventies is in many cases,
• 22:44
  they're gonna keep playing tennis.
• 22:45
  They're gonna keep playing golf.
• 22:46
  They're still gonna, uh, uh, you know, wanna run or jog
• 22:51
  or play pickleball and be physically active.
• 22:53
  And I think, uh, part of our goal is to try to, uh,
• 22:57
  help people maintain their level of activity, their quality
• 23:01
  of life, their independence, um, at every step of the way.
• 23:05
  So keep moving, uh,
• 23:08
  and, uh, we're here to help you stay that way.
• 23:12
  - Great. Well, listeners, this has been Dr.
• 23:13
  Jason Coe, director of the Orthopedic and Spine Institute
• 23:16
  and Endeavor, chairman of its Department
• 23:17
  of Orthopedic Surgery, and Chief Medical Officer
• 23:20
  with Chicago Fire.
• 23:21
  Dr. Co, thank you so much for being my guest,
• 23:24
  - Molly.
• 23:25
  Thank you very much.