The Picture of Success: Dr. Timothy Hosea
His dad feared he might end up a rowing bum. Instead, Dr. Tim Hosea, an orthopaedic surgeon with the St. Peter’s University Hospital in New Brunswick, New Jersey, grew up, grew in experience, and became the team doctor for the U.S. Olympic Rowing Team.

Paddling His Way through Life
Raised in Grosse Pointe, Michigan alongside his three brothers, Tim Hosea learned about self discipline at an early age. “Our dad was an executive for General Motors and our mom, coming from a family of all daughters, learned to feed and control the rambunctiousness of four boys. As members of an Irish German family, my siblings and I were expected to work hard and pull our own weight. There were a number of engineers in our family, so I decided to see if I was up to that challenge. I went to the U.S. Naval Academy to fly jets, but soon found out that I was too large physically to be comfortable in a jet.”

However, he discovered that his physicality fit well in a different kind of seat: a rowing shell.

With his jet pilot odyssey altered, Tim Hosea transferred to Harvard in his sophomore year of college. “Although I did take premed courses at Harvard, I majored in English because I knew I would have enough science later, and thought that I might as well read ‘the great books’ while I could. Taking this unusual path has resulted in developing a wide variety of interests and improved my ability to interact with patients and discuss any number of subjects with them.”

And if the patients didn’t want to discuss Shakespeare, Dr. Hosea could always talk to them about crew. “I continued rowing at Harvard, but after awhile injured my back. I was so lucky to meet and be treated by Dr. Arthur Boland, someone who has been my mentor ever since. A wonderful, compassionate human being, Dr. Boland was a stellar athlete. I knew instantly that this was someone I wanted to emulate.”

This also came as a great relief to Tim Hosea’s father.

My dad was really concerned that I would end up as a ‘rowing bum,’ and was so thrilled when I applied to medical school.

Medical Training
Taking up the medical mantle, Tim Hosea began his studies at the University of Cincinnati College of Medicine in 1975. “The admissions director was an Ivy League veteran with the attitude that if we jocks would just channel our athletic energies into medicine then we would be excellent doctors. There were 192 of us, with about 100 from Ohio and the others from Ivy League or Division I athletic programs. While there, I did a rotation at Harvard, during which time Art Boland let me housesit. Spending time at the Harvard affiliate, the Peter Bent Brigham Hospital (now known as the Brigham and Women’s Hospital), exposed me to top quality professionalism and a terrific bunch of people.”

At Cincinnati, he spent two years working with Dr. Frank Noyes, getting “under the skin” and “behind the scenes” of orthopedic research, things which would give him a more sophisticated understanding of his chosen profession. “After finishing medical school in 1978 I went to Peter Bent Brigham Hospital for two years of general surgery. We didn’t do much in the way of orthopedics, but we certainly learned how to take care of patients.”

“Today’s orthopedic residents do not receive the depth of experience in general surgery and the related specialties, but rather concentrate on the aspects of medicine related to orthopedics. Although they say that there is not enough time in a training program for this in depth experience in patient care, I think it is important to have a working knowledge of your patients’ medical issues because there is a chance they will influence your decisions and the results of your work. You should not simply get a consult, but should know something about the pathophysiology of the person’s condition.”

In 1980, Dr. Hosea entered the combined Harvard Orthopedic Residency Program. “I did my orthopedic residency at Harvard, and was pleased to find that it was a truly well rounded program. We were able to work closely with the best and the brightest of all the Harvard hospitals, and learn a variety of approaches to orthopedic problems. Boston itself was unusual in the collegiality among attendings, something that didn’t seem to be present in other cities. We had heard lots of negative stories coming out of other cities, so we were really happy to have a great atmosphere in which to work.”

Advice from His Mentors
That atmosphere included savvy senior surgeons. “Dr. Drennan Lowell, a joint replacement specialist at Brigham, was one of the innovators in hip replacement. He displayed meticulous attention to detail as he worked on evolving the techniques. Dr. Bert Zarins of Mass General taught me how to focus and how to approach patients. Interestingly, he said that we should treat each patient as if he or she were a member of the carriage trade, i.e., treat them all as if they were the President.”

Undertaking a fellowship with Dr. Art Boland, Dr. Hosea would watch a master of common sense and patient care at work. “Dr. Boland always displayed great surgical judgment and technical skills. One of the most important things I learned from him was that when patients have a non life threatening issue and they can’t make up their minds about what to do, you should say to them, ‘Is this a nuisance or disability?’ That inevitably helps focus their thought process.”

Dr. Hosea also learned how to tackle decision making on the field. “I worked alongside Dr. Boland as he cared for the Harvard athletic teams. It was a real eye opener to see the interactions between the doctors, the athletic trainer, and the coaching staff. The trainers were often on the firing line and our job as physicians was to ensure that we backed them up and gave them as much information as possible.”

To those who might consider such work, Dr. Hosea, now the doctor for the U.S. Olympic Rowing Team, says,

Working with teams requires a different skill set. You must interact appropriately with coaches whose agendas are often different than your own. But as the coaches develop confidence in your skills, you can establish a comfortable working relationship with them. The athletic trainers are often stuck in the middle and require a supportive medical staff to make their job easier and enable the medical team to provide the best care for the athletes.

Finishing up his fellowship in 1985, Dr. Hosea headed to New Jersey. “My wife is from Princeton and I was lucky to be able to join a practice there and take care of intercollegiate athletes. Our practice had an established orthopedic residency affiliated with UMDNJ-Robert Wood Johnson Medical School. This provided me with the opportunity to teach and try to be the example my mentors were to me for the next generation of orthopedic surgeons.”

Research, Education and Gold Medals
“Working with industry” usually means being with people who know something about tibial plates or pedicle screws. For Dr. Hosea, however, it meant joining forces with “Detroit.” “My research into the biomechanics of the back, work that I had begun as a resident, led to consulting with General Motors on the design of car seats. We determined that there is only a limited range of motion that a car seat and lumbar support needs to cover to have the least amount of spinal load. Interestingly, you don’t need an extreme amount of lumbar support.”

Dr. Hosea also imparts knowledge in the educational realm.

“I teach residents, something I find to be very rewarding. Today’s residents are as motivated as we were, but because of their training programs, they are more focused on the orthopedic aspect of the patient instead of the whole patient. With regard to decision making, we have noticed that they lacked exposure to outpatient experiences and the thought processes of the orthopedists, so we have started providing them with more outpatient experiences.”

On the research front, Dr. Hosea is involved in helping rowers work with their oars and work out their back problems. “We are seeing more and more adolescent and young adult rowers with disc disease. My colleagues and I are documenting this and working the patients up aggressively with MRI’s and X-rays. We have an IRB approval and are in the process of collecting data. To alleviate their pain, we advise the patients to work on their core strength and crosstrain so they don’t aggravate their injuries. We also tell them how to appropriately use the ergometer rowing machine, and how much resistance to use. The good news is that we can reassure these young athletes that even though rowers have more back problems amongst the intercollegiate population, this reverses later in life. We think this is because rowers tend to stay in shape, refrain from smoking, etc.”

In 2000 Dr. Hosea was called upon to not only look after rowers on the international stage, but cyclists, equestrians, and a host of others. “I served as a physician for the 2000 Olympics in Australia, an exhilarating, yet exhausting experience. During the six weeks I was gone, I took care of rowers, canoe-kayakers, and cyclists. One of our rowing athletes had a lumbar disc problem a week before the Olympics began, and I had to call a hospital in Yamba, Australia, the site of our training camp, and ask for the labor and delivery nurse who gave the best epidural at her hospital. He got it…and he medaled.”

To those who may be working with Olympic athletes for the first time, Dr. Hosea advises,

Any complaint is a major issue for them and should be taken seriously. The Olympic games are what these athletes have been working toward all of their lives…nothing they mention should be denigrated.

And his most interesting day at work? “We recently had a situation where a female athlete was in pain and had a history of medical problems. Our medical doctor thought she shouldn’t play, but she was adamant; the coach sided with the player. So I went to the president of the club and he stepped up and said that she could not play. Such a decision is best left to the medical staff…fortunately the president supported us.”

For support on the home front, Dr. Hosea turns to his wife and three daughters. “I have been married to the same dynamic wife for 34 years. We live on a farm and she is the one who keeps it running. We had a particularly exciting event a couple of months ago when I delivered my first foal. My daughter and I happened to be around when the horse started labor, so we helped her out.”

Dr. Tim Hosea…delivering whatever is necessary to get the job done.

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Elizabeth Hofheinz, M.P.H., M.Ed. • Mon, Aug 31st, 2009

Orthopaedics This Week