Q&A with John M. Flynn, MD

Our clinical volume has exploded, despite very flat pediatric demographics in the Philly region during the past 30 years. Annual surgical cases have increased from 1,031 to 4,000+, and outpatient visits skyrocketed from 6,573 a year to 77,263. This growth is largely due to the regional and national patients we attract to our world-renown programs for spine and thoracic insufficiency syndrome, hip preservation, musculoskeletal tumors, brachial plexus injuries, hand and arm disorders, limb preservation and reconstruction, and our Sports Medicine and Performance Center.

To offer this wide variety of services, serve this huge increase in patients and continue our research efforts, we’ve grown our faculty from three to 32 full-time physicians.

Q: In addition to incredibly busy careers as surgeons, many on your team also pursue research. What are some of the research efforts you are most proud of from the past 30 years?

Some of the research from our team that I’m most proud of includes:

• Developing the use of text messaging to communicate with patients and their families about post-operative pain and opioid usage, culminating in a national award-winning study of opioid vs. non-opioid analgesia following surgical treatment of supracondylar fractures. This line of research has helped, and maybe even curtailed, the use of opioids for these very common fractures across the country.
• Research on fibrodysplasia ossificans progressiva (FOP) that led to the identification of palovarotene (SohonosTM) that was approved by the FDA three years ago as the first-ever treatment for FOP.
• Proving that image-guided navigation, rather than “freehand” screw placement, enhances safety and reduces radiation exposure in pediatric spine surgery. Navigation has become the new standard of care.
• Research showing that early treatment of pediatric ACL injuries reduces the risk of lifetime knee arthritis.
• Demonstrating that dedicated spine teams make scoliosis surgery safer and faster. This has become the standard of care nationwide.
• Determining how to prevent babies who fail a Pavlik harness from needing a body cast, by using an Ilfeld brace instead.
• Showing the value of a dedicated trauma room each day, becoming the standard of care at children’s hospitals across the country.
• Developing a radiation-free imaging modality – diffusion magnetic resonance imaging (dMRI) to measure and quantify respiratory function.
• Investigating hereditary multiple osteochondromas (HMO) and identifying cellular mechanisms of tumor initiation. We are currently testing potential therapeutic targets. Studies have revealed tumor gene variants with potentially critical diagnostic and prognostic value.

Q: Why is it so important to carve out time and energy for research? How do you help your team do that?

A: As long as children have unsolved musculoskeletal problems, we are obligated to search for treatments and cures. CHOP’s Orthopedic Center has so many national thought leaders and such a strong translational research lab that we are uniquely positioned to improve care. We give our faculty tremendous autonomy in their schedules and incentives for Penn faculty promotion. They are driven to advance our field. 

We promote mastery for our faculty by providing lots of research assistance and an annual Faculty Grant Contest that provides seed money to start many impactful projects every year.

Q: What have been the most profound changes in care and treatment for children with bone and joint conditions over the past 30 years? How has CHOP played a role in these advancements?

A: CHOP Ortho has played a huge role in so many care improvements over the past 30 years. The following are just a few examples:

• We advanced fracture care to allow rapid mobility, better healing and a quicker return to activities. Femur fractures used to be treated with traction and body casts; today, we use internal fixation.
• We pioneered image-guided navigation in pediatric spine surgery 20 years ago, making spine deformity correction surgery dramatically safer here and, by sharing what we learned, safer across the country.
• We advanced limb salvage treatments for tumors, preventing amputations, saving lives and enhancing quality of life for patients.
• We initiated a dramatic reduction in the use of narcotics for patients after orthopedic injuries and surgeries.
• Our dedicated spine teams have made scoliosis surgery quicker and safer for children.
• We pioneered thoracic insufficiency evaluation and treatments, saving lives.

Q: Why did you choose to specialize in pediatric orthopedics and orthopedic surgery?

A: As a high school and college athlete, I saw orthopedists more often than my primary care doctor. I loved how they could fix problems for people. I loved how visible the results of their work was on X-rays. In my orthopedic training, as soon as I did my first rotation at Boston Children's Hospital, I knew I wanted to spend my life caring for children. The impact is so profound: The fracture you fix, the spine deformity you correct, the baby’s hip you put back in the socket, the bone tumor you resect. Your work can positively transform their health and function for a lifetime. I also loved helping the anxious parents on their care journey.

Q: What are you most proud of in your career? Why?

A: I’m most proud of having had such a positive impact caring for so many children. For example, I will see a 24-year-old return for her 10-year follow-up appointment after her scoliosis correction and she says: “You know, it doesn’t even feel like I had surgery” and “I went into nursing because my experience at CHOP was so amazing.”

I’m also proud of the legacy of trainees I’ve worked with over the years who are now great physicians caring for others and having a meaningful impact on our profession. Starting the Benjamin Fox Orthopedic Research Scholar Award and the Medical Career Design Fellowship and watching the positive impact on those Fellows and CHOP Orthopedics has been wonderful.

Finally, I’m proud to have helped recruit, mentor and promote such talented Orthopedic faculty who have advanced us from 3rd best in the region, to #1 in the nation.

Q: You’ve been a transformational leader in the field of pediatric orthopedics, spine, thoracic insufficiency and trauma for decades. What makes an effective leader in healthcare?

A: From what I’ve seen, the most effective physician leaders minimize their ego and maximize their hard work and fun. Physicians like leaders with humility and positive energy. In politics or industry, people “campaign” to become leaders; they think they deserve to be in charge. 

The best physician leaders are asked, or encouraged, to take charge because they’ve demonstrated they will work hard to get things done. They’re organized and communicate well. They collaborate well and are great at imagining the future state of the organization, then launching into creative problem-solving leading to a successful future. 

Q: How has your leadership impacted the care we deliver at CHOP today? Where do you believe you’ve made the greatest impact?

A: My greatest impact has been to help recruit and retain incredibly talented physicians and create the environment in our division that they need to thrive. That environment includes tremendous autonomy and resources to grow into national thought leaders. Together, our team has greatly expanded the number of children we care for and the quality of care they receive. All this hard work is done in a very positive culture that makes it fun to come to work.

Q: In addition to being dedicated to your career, you are dedicated to your family: How has this made you a better doctor and leader? 

A: I’ve always been a family-first guy. My wife, Mary, and I have been together since we met in the first week of college at Johns Hopkins University. We have four wildly happy and successful grown children (including my oldest daughter Erin who was one of CHOP’s Pediatric Chief Residents in 2022-23), and two grandchildren. I have been a better doctor and leader because I worked to keep “the first things first” and be a role model of that philosophy for the surgeons we train, my colleagues at work and the families we care for.