And welcome to Forum 360, where we consider topics with a global outlook and a local view.

I'm your host, Bill Steven Saus, and our guest today is Dr.

Gordon Bennett, M.D.. He is an orthopedic surgeon in Northeast Ohio.

And we are going to be talking about practicing and now he's practicing again in a physician owned hospital, which is Western Reserve Hospital.

Our host TV studio is HCTV in Hudson, and he has his offices in Hudson So, we have you with us today, Dr.

Bennett, it's good to be with you.

- Pleasure.

- You are a board certified orthopedic surgeon through the American Orthopedic Association.

And you've been practicing since, you graduated from medical school in 1982.

- Correct.

And tell us a little about where you you came from, you're international because you came from Canada, from your, from the province of Saskatchewan.

- Correct.

Yeah.

I grew up in a really small town in Saskatchewan.

Marquis, Saskatchewan.

Six grain elevators and I think there was three people in my grade.

And I grew up there and went to medical school at the University of Saskatchewan, which is in Saskatoon, Saskatchewan, Canada.

And finished up my time there and then I was scheduled to do my orthopedic training in Montreal, Quebec, and they required a one year internship.

And so myself and about 30 of my classmates all needed internships.

And so myself and one of your friends, George (unknown), we came down to Akron, Ohio, and did our internship at Saint Thomas Hospital.

- A hospital that, very old and very... For many years, it was the home of the AA, Alcoholics Anonymous.

And it is no longer.

- It is no longer.

- They had to, they, raised it and tore it down and it's sad.

So, Dr.

Bennett, you and your friend Doctor (unknown), who you went to medical school with in Saskatchewan, came to Akron.

Then you went to Akron General, correct?

- Yeah, I was matched to go back to McGill and Montreal, but I met my wife and the orthopedic programs in Akron.

There was two of them at the time, Akron General, and Summa.

And I matched into the Akron General program and I stayed and I did five years at Akron General and thoroughly enjoyed it.

And then I finished up there and I did a one year foot and ankle reconstructive surgery fellowship in Dallas, Texas.

- Right.

You did have to eventually go back to Canada for a period of time, correct?

Talk about the fact that you became naturalized.

You you went through the process of the immigration process, right?

- Yeah.

I... When Canada does a really nice job of educating their students, so I had no debt at all.

But one of the things I had to do when I came to the United States to train is that I had to sign what's called a home government letter.

And that required me to return to Canada for 2 or 3 years.

So after my fellowship in Dallas, I went to Vancouver on the West Coast, to Canada.

Lived there for three years, and at that time realized that we were probably going to end up back in Ohio.

So I applied and went through the whole route of immigration and naturalization.

- Wonderful.

And became a citizen.

And after a few years of practice, you started working with another organization called the Crystal Clinic, out in the Fairlawn area.

Tell us a little about your getting to that location and what you learned there and how you practice there.

- Yeah, my first ten years in the 90s, I was at Akron General where I trained, and I was the residency education director there teaching the residents and such, and I enjoyed that.

But after doing that for ten years, I decided I wanted to have a taste of private practice.

So I joined the Crystal Clinic group, which initially when I joined, I think was 15 doctors, and I think now is around 45 orthopedic surgeons.

- Multiple buildings.

- Multiple buildings.

We built a hospital in the final couple of years of my practice there and thoroughly enjoyed my 21, 22 years there.

And then I was out of medicine for a year or so.

I had a health issue, a lung issue that got better, but I retired.

And then once I got well, I was bored.

So my good friend, Robert Kent, who is the physician director of Western Reserve Hospital, said, “Well, we'd like you to come back and work for us.” So I did.

- And it started you back into practicing locally.

- Yeah.

Which is great.

I love it.

- Now, you you occasionally travel, you talked about going, you know, for the American Orthopedic Association and also for foot and ankle.

You're involved in medical journals?

- Correct.

- You do editing?

- Yeah.

I'm the associate editor for Foot and Ankle International, which is the big orthopedic foot and ankle journal.

- Now, why did you pick foot and ankle as your specialty?

- It's funny.

When I was a fourth year resident at Akron General, we would always have visiting professors and really prominent foot and ankle specialist from the Mayo Clinic named Ken Johnson came.

And he was so impressive that in the three days he was here, four of the residents in town eventually did, went and did foot and ankle fellowship.

- Very good.

- So nobody did it at that time, you know?

And so we all kind of got the bug and here we are.

- Now, you were talking off camera, we were chatting about sports medicine and how sports causes a lot of injuries, but, you thought and based on your research, that ankle injuries are not as prominent as some of the other parts of the structure of the bones.

- So the ankle is the most commonly injured weight bearing joint, but most of them get better without surgery.

So there's 20,000 ankle sprains per day in the United States.

Up to 10% of all ER visits are ankle sprains.

But most get better.

But when they don't get better, or if you actually break your ankle, then that requires a surgeon's touch.

- Now, you have, I know your assistant, Corey.

- Yeah.

- And he at the Western Reserve Hospital helps you plan out and get your patients ready.

What's typical now in a physician's own hospital that you have, you have the hospitals in Cuyahoga Falls, your main office is in Hudson.

Tell us a little bit about the typical week when you are working and doing surgeries, as well as consulting with your patients.

What is a typical week for an orthopedic surgeon?

- So for me, it's, we have an active residency education program at the hospital.

So we have two doctors per year training to be orthopedic surgeons.

So we're at the hospital a fair amount, but my personal practice, I'm in the office all day Monday and all day Tuesday.

You see patients, new patients, follow up patients, post-surgical patients during that time.

I’m in the operating room all day Wednesday at the hospital.

And then I'm back in the office on Thursday and then Friday is more of an education day.

We have grand rounds and more resident education stuff on that day.

- Now you're talking about, you’re trying not to have to do invasive surgeries.

You're try to provide other ways of getting that foot and ankle back together.

What are some of the other things you do.

You always hear about rights, you know?

- Yeah.

Which is, you know, you can tell me.

- Right.

So... So the way it works with anything in the orthopedic realm is that you've always got three options for how to treat somebody.

You can do nothing and have them just put up with it, which they wouldn't come to see if that was the case.

You can do conservative care, which is typically anti-inflammatories, physical therapy, bracing, activity modifications.

- Sure.

Yeah.

- Probably 80% of people get better to some extent with that, injections.

It's the people that don't get better or have something that you really can't fix non surgically that you then go to the next step and recommend surgery.

- Now do you, medication.

Pain medication is obviously a concern.

I know at Western Reserve Hospital they have a pain medicine group.

- Right.

They do.

- And do you work with that type of colleagues, that group, trying to, you know, get them... - Let's eliminate that pain for maybe severe.

- Most people respond well to non-steroidal anti-inflammatory is your Advils and Aleves and things like that.

People that have chronic pain, people that have acute pain, they'll be on short term narcotics, but we don't keep them on them for very long and if they do need it longer term, our pain management people are fantastic for that.

- Now, typical injuries for the foot and ankle, Achilles tendon.

- Achilles is common.

- And sprains.

- Ankle sprains.

- And which I've had over the years.

And stress fractures.

A little bit about that.

Where the bone breaks, there's a little bit of stress.

What happens?

How do you make sure that that, the foot or the ankle heals properly.

- Yeah.

So bones are extremely resistant to injury.

So you can injure, you can have an acute injury where you twist it and fall and hurt it that way.

Stress fractures are more of an overuse syndrome.

It's kind of like a paperclip.

You can bend a paperclip five times and it looks like a normal paper clip.

You can bend it one more time and it cracks.

And most of those again will get better with conservative care, unless it's in a location where they require surgical treatment.

- And, you know, some athletes, you know, the constant pounding.

- Correct.

Of the foot or, you know, that type of it.

So you have to, basically, sometimes the athletes don't like the heroin.

Dr.

Bennett's telling them, you might have to take some time off.

- Correct.

- Take a season off.

How do they react?

- They don't love it.

And especially if you do an operation and, you know, everybody has heard of anterior cruciate ligament injuries in the knee, shoulder surgeries and then a lot of the stuff we do on foot and ankle, typically if you have a major injury that requires surgery, you're talking a year.

Most people are half well at three months, usually about 75, 80% well at six months.

And you'll improve a little bit for a year.

And athletes need to be as close to perfect as they can be to participate.

So that's why it takes so long.

- Now, obviously we have other accidents.

We have, you know, automobile accidents where, you know, the ankle and the foot are, you know, abruptly breaks and there's trouble.

What are some of the non sports injuries that you typically see?

- Industrial injuries, injuries that work, injuries around the home.

Unfortunately, older people can fall on a rug, fall down the steps, hurt themselves that way.

And then, you know, the weekend warriors, you know, the people that are out there, you know, playing pickleball, which has become a real popular sport nowadays.

But... - So some type of collision?

- Some, yeah.

- Or slide on some ice.

- Correct.

- That can do it.

And tendinitis, and what about the -itis?

I was talking to some other orthopedic surgeons.

They said, you know, -itis, you know, that if you get an itis here, you might get some there.

It's systemic, right?

- Right.

It can be sure.

So and -itis basically means inflammation.

So if it's tendonitis, it's inflammation of a tendon.

If it's synovitis, it's inflammation of a joint.

- Right.

- And those can either be due to injury or a lot of times overuse or a lot of times people just aren't really as fit as they would like to be and they'll do something and they'll injure a tendon or injure a joint.

- What about prosthetics and joint replacements and that type of thing?

Has that really come along?

- It's incredible.

Really back, I started my training over 30 years ago, and we were just starting to do hip and knee replacements then and those have come a long ways.

Shoulder replacement surgeries taken off in the last 10 to 15 years for, especially for rotator cuff problems and probably in the last ten years, ankle replacement surgery has become extremely popular and that the results are fantastic.

We use 3D printed technology to get the implants in the right position.

- So everything is technologically... - The technology is taken off.

Right.

It really is good.

- You're with Forum 360.

I'm your host, Bill Steven Saus, and our guest is Dr.

Gordon Bennett, M.D., a specialist in ankle and foot surgery.

And he is certified with the American Orthopedic Association.

He is what they call a FAOA Designee.

And we are thankful that he is with us to talk about practicing in a physician's own hospital.

Dr.

Bennett, Northeast Ohio has quite a few major hospitals that some are nonprofit, some are profit.

Tell us a little about the, how you handle physician owned facilities.

At Crystal Clinic you saw that.

And then when Dr.

Kent asked you to come back and practice, you came to a physicians owned hospital.

Uniquely, they say it's one of the best in the area.

Northeast Ohio.

So tell us, what is it like to work in a physicians owned hospital?

Practicing?

- First of all, the real nice thing about it is the fact that your mentors or your bosses, if you will, are physicians.

So you speak the same language, your colleagues and oftentimes friends.

And that doesn't mean that the ones that aren't physician owned that it's adversarial because it typically isn't.

Their doing their thing.

It's just I think that there's less of a language barrier, more collegiality.

And you’re working basically with friends and trying to get the best quality of medicine you can for your patients.

- And you're talking about being a teaching hospital.

You help teach the residents.

- Yes.

- How do they participate in your area, in the orthopedics department.

- So they're learning and obviously it's a five year program for most of the surgical specialties.

So they go through a whole application process where they have to apply for the program and then once they're in and they're your people, your job is to train them to the point where when they're done, they will be a functional, excellent practicing orthopedic specialist that you would let operate on you or your family.

- So how do they, let's say you were in the, in the operating room in the O.R.. How would— Who is your staff and who do you depend on when you're in that environment?

- You depend on everybody.

So in the operating room, the person in charge is the circulating nurse, they're the people that make sure that everything works properly.

You have a scrub technician or a scrub nurse that helps you.

You've got your anesthesia staff.

And then, you know, you have to have an assistant.

And in a teaching hospital, the assistant is usually a resident.

And the residents are giving, they're basically given staged responsibility.

So as an intern, they'll start off holding rakes and helping you.

And then as they progress, in orthopedics, they progress to drilling and putting in screws and helping you with the operation.

Now my hand is on theirs for the operation and the, you know, I can't remember ever not being in a room when a surgery was going on because you're teaching them, you have to watch them like a hawk.

- Right.

And you remember at Akron General when you were younger you had to learn it.

Did you have mentors that you still talk about?

- 100%.

Yeah.

A lot of them have retired and moved on in life, but, the people that teach you, you'll remember for the rest of your life, and then how they taught you a lot of times is how you teach the people that you're educating.

Now, you had a fellowship at the University of Texas in Dallas, the Southwestern Medical Center, to get you more involved in the foot and ankle area.

Talk about a fellowship.

How do young doctors get involved in a fellowship such as yours?

- Yeah.

So your five years of orthopedic surgery is a general thing.

You do pediatrics, you'll do hips, knees, shoulders, back, all that kind of stuff.

- Just in general.

- Just general stuff.

And then probably, it probably became very popular, probably 20 to 30 years ago, that people wanted to become really good at one area.

So we're all orthopedic surgeons.

We're all, I know enough about the hip and knee and shoulder to be dangerous.

But, at that point in time, nobody was doing foot and ankle work in orthopedic surgery and so Dallas happened to have three people that were that's all they did is foot and ankle work.

And so a fellowship is basically a one year time where you study and learn and do nothing but that specialty.

And that's what I did for the year in Dallas and then since that time, my practice has been probably 80 to 90% focused on just foot and ankle work.

- Now, as far as ankles and feet, footwear is important.

And I don't know if you've written about that in some of your journals, but, you know, to make sure that the people are wearing the best footwear.

- Correct.

- And especially in sports, where, as you talked about with you as a young man played Hockey in Canada and even thought about, you know, getting more involved in hockey, but you decided to do medicine instead.

But, when you said the hockey players probably have the best type of, in sports, they have good shoes and footwear, correct?

- Right.

That's accurate.

- And then, but some of the other sports, soccer and baseball and basketball, not so much.

So, what would you tell young folks to wear?

How do they define the best shoe?

- Yeah.

So footwear has improved dramatically over the past 5 to 10 years.

You've got so many different brands, but most of the shoes now, first of all, you have to make sure it's got the right length and width and, you know, that's if you go to a good place that's easy.

But as far as athletic footwear, there's so many good brands now Hoka, New Balance, Brooks, Skechers, I mean, it’s just a matter of going to a place and finding good footwear that works for you.

The soccer players like shoes that are skin tight and have very little support.

The basketball players have much more supportive shoes.

And then in an ice skate, you're locked into like a ski boot almost, so.

And how about some of the injuries of, well, skiing and some of the winter sports.

You know, where twists can occur.

You can, you know, crash, you know, off the slope.

Have you had to do some of these, I would say probably not necessarily skiing injuries, but, where you get called, the emergency room has somebody brought in from an athletic event?

Have you and your team been called in for those kind of weekend events?

- Yeah.

Very frequently.

So almost all the local high schools and college teams have orthopedic doctors at the event.

- A designated— - Designated for that event.

All the schools in town essentially have that.

And so especially for football games in particular, because of the high energy and collisions and such, there's a doctor on the field.

And if there isn't for, say, some of the soccer games or baseball, there will be a trainer, a certified athletic trainer there.

So if somebody, God forbid, does get hurt, they can get evaluated properly and then treatment is then carried out, you know, very basic first aid treatment on the field.

And if they need to go to the hospital, they're shipped off to the hospital.

- So surgery doesn’t have to be immediate?

You can evaluate and they would remediate somehow until you can find them the right date or, you know, convenient time to get the surgery done.

- Yeah.

So evaluation and initial stabilization treatment is immediate.

Unless the bone is sticking out through the skin, which is called an open injury.

Those most injuries don't have to be done that day.

They can be stabilized and then done on a day that's best for the patient and best for the treatment team.

Now if you as a physician owned hospital, how do you and your team, you know, we need certain provisions, we need certain technology.

Since you and your fellow doctors at Western Reserve physicians group, since you own it, do you go and meet together and say, here's what we need or should we?— How do you plan these things?

Meetings?

Is there a pecking order as to who's in charge and so forth?

Like, Dr.

Kent is the CEO.

Tell us a little bit more about Western Reserve and how they do things there.

- There's always a pecking order.

The physician's own (unintelligible).

- Yeah.

So basically, if you want something really bad, a new piece of technology, like for example, I do ankle replacements that I've done those for frequently for the last ten years.

That's special technology.

So you basically have to go in front of a committee and say, this is something that has been really studied and worked out well.

This is the cost.

Is the cost benefit ratio to the patient and the institution appropriate.

And if it is, it'll go through the committee and you'll be allowed to use that technology.

There's a bunch of stuff out there that is expensive that hasn't been proven to be effective.

Classically, some of the stem cell treatments and stuff like that, which in theory are fine but don't have a lot of research behind them.

They're expensive and therefore you might have to fight real hard to get that approved.

- What about some of the really serious problems for seniors?

Osteoporosis and some of that where the bones are more brittle.

You notice that when you've talked about athletes that even they're in their 50s, 60s and 70s might still be out there trying to play sports.

Do you see a little more involvement of seniors getting more treatment?

- I think that's true.

I think, you know what happens.

The good news is, is that, with good medical care and taking care of yourself, people are living longer, they're more active for longer periods of time.

We all lose about 1% of our bone mass per year.

So one of the things that happens as we get older, we all lose our bone mineral.

And so things break easier.

And so it's good to keep active but you also have to do so in a way that's a little bit more low impact than it was when you were 20 or 30 years old.

- Now is there an advantage you think, being in a physician owned hospital practicing there?

Is there an advantage that it is not as large?

You know, both physical clinics are now expanding, but at one time it was smaller.

Do you see the the more intimate getting involved patient, physician relationships better at the smaller hospital?

- It's certainly a lot easier to take care of people in a more, you know, in a closer environment where you don't have to go through all the bells and whistles to get things done.

The nice thing about Western Reserve is that, you know, uniformly your fellow doctors are excellent.

They're nice, they're collegial, they're well-trained.

And then our staff, our technicians from, from A to Z are all super nice.

They're happy.

They like being at work.

- Right.

There's a constancy.

Everything is... Yeah.

- Yeah.

It's just a very, very friendly and enjoyable environment to work in.

And the patients see that and they like it.

We hope that, the people that have been watching on PBS Western Reserve appreciate what we've learned today from Dr.

Gordon Bennett.

We've got about a minute left.

Is there anything you want to say to a young man or woman that wants to think about orthopedic surgeons?

We got about 30 seconds.

- Well, first of all, it's... I'm so happy I did what I did.

So if you truly like science, like to get educated and, like working with people, I can't think of a better field to get into than medicine.

- Very good.

And finding the right medical school and so forth.

Obviously, you and your colleagues provide information.

You can go to your website, WesternReserveHospital.org, look up orthopedics, you'll see Dr.

Gordon Bennett and of course, if you have any other questions, he's available, you know, for consulting, if people that want to visit the hospital, and learn more.

Thank you, Dr.

Bennett, for being a part of Forum 360 and imparting your wisdom.

- Pleasure to be with you.

- Thank you.

- Thank you.

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