Abhiram Bhashyam, MD, PhD Joins Hand and Arm Service at Mass General

Abhiram “Abhi” Bhashyam, MD, PhD is a hand and upper extremity surgeon in the Department of Orthopaedic Surgery at Massachusetts General Hospital. In addition to medicine, he has studied engineering, math and public policy. His research interests include upper extremity trauma as well as patient financial burden and opioid prescription use amongst orthopaedic patients. He received his medical degree from Harvard Medical School (Harvard/MIT Health Sciences and Technology Program) and completed the Harvard Combined Orthopedic Residency Program at Mass General Brigham, where he served as a chief resident.

Dr. Bhashyam completed a Hand and Microvascular Surgery Fellowship at the University of Washington's Harborview Medical Center and at Seattle Children's Hospital before returning to Mass General as an attending surgeon. He completed a bachelor’s degree at Johns Hopkins, earned a master’s degree in Public Policy from the Harvard Kennedy School of Government and completed his PhD at Utrecht University. Here, Dr. Bhashyam shares why he chose to join the Mass General faculty.

Q: What is your background?
I grew up in Pittsburgh, Pennsylvania and was always interested in engineering and math. The application of engineering to medicine and its potential to change lives sparked my interest while I was at Johns Hopkins, so I enrolled in pre-med coursework.

In medical school, I initially thought I was going to be a lung doctor, and focused my research on aerosols and aerosol medication delivery to babies using nasal cannulas and nebulizers. But then, during my third-year clinical rotation at Mass General, I enjoyed learning about orthopedics because it was a combination of engineering and medicine, so I made the decision to specialize in orthopedics. During that time, I also became interested in medical education and global orthopedics related to public policy, and so I took a year “off” to get a master's degree in public policy.

During my residency at Mass General, I discovered a love for hand and upper extremity surgery because it combines many of my interests: orthopedics, plastic surgery, trauma, joint replacement and arthroscopy. I’m particularly interested in complex reconstruction for upper extremity trauma, which can involve injury to bones and soft tissues, like nerves and arteries.

Q: Your academic interests seem very eclectic – you explored other avenues before deciding to be an attending orthopaedic surgeon.
Yes; I also received my PhD in clinical outcomes research and surgical education, and I am interested in developing surgical education programs in low- and middle-income countries. One of my areas of focus is asynchronous learning, particularly education and skills training for adult learners.

I got interested in studying patient financial burden after talking to patients in clinic and hearing them struggle with unanticipated medical costs. Patients would mention rationing their budgets between paying for food versus paying their medical bills or having to decide between buying antibiotics to treat their infection versus paying for daycare - which is a decision that I would hope no one would ever have to make. I found that it's hard to convince people that there’s a real, systemic problem there; if they see it happen to one person, they’ll think it's just a one-off. Our research shows that, even in a state like Massachusetts, where we have a very high percentage of the population insured, lack of adequate health coverage is still a problem. We estimate that financial distress is a problem for one in five orthopaedic trauma patients--so it’s not a small problem.

Q: How does it feel to come back and work with your former residency mentors?
My residency at Harvard was an amazing opportunity to learn from world-class surgeons every day, and I’m fortunate that many became close mentors. I’m even more fortunate to have the opportunity to come back to Mass General to continue learning from and working with them. Mass General surgeons like Mitch Harris, MD, Chaitanya Mudgal, MD and Neal Chen, MD have been key mentors of mine throughout residency and beyond, both in terms of work and life.

Through my interest in clinical outcomes and public policy, I have also been fortunate to work with mentors at other institutions affiliated with Harvard. For example, I have done a lot of collaborative work with Michael Weaver, MD, chief of orthopedic trauma at Brigham & Women’s Hospital, and Edward K. Rodriguez, MD, PhD, chief of orthopedics at Beth Israel Deaconess Medical Center, through the Harvard Orthopedic Trauma Initiative, and I look forward to continuing those professional relationships.

Another key mentor for me is George Dyer, MD, director of the Harvard Combined Orthopedic Residency Program and an attending surgeon over at the Brigham. He and I have worked together since I was a medical student. At the beginning of the COVID-19 pandemic, we focused on facilitating remote learning and came up with an asynchronous online learning platform for teaching basic orthopedic resident skills to interns. That collaboration resulted in a paper and an online teaching module on the Harvard orthopedics website, which has been a useful resource for other educational programs nationally.

Q: On the clinical side, what do you want patients to know about you and the services you offer at Mass General?
I think my philosophy is that patient care is a partnership -- it's teamwork between me and the patient. Very rarely is there a “right answer” that's correct for all patients. A lot of it is figuring out, not just the injury, or what's happening with the patient's hand, but what's going on with their life and their personal circumstances, and trying to work together to come up with a treatment plan that works for them, whether that's surgical or not. And, if it's a surgical plan, I need to make sure that the surgery can really help them, and it's done in a way that can improve their quality of life.

Say you have a trauma to your finger, and, after it heals, you end up with stiffness. A surgery designed to restore more motion in the finger can be very technically complex in the operating room, but the real challenge with that is actually the postoperative recovery. I typically tell patients that if they want to go forward with that type of surgery, their finger has to become a major focus of their life, and so that ends up being a discussion more about what's happening in a patient's life beyond a stiff finger. It's important to time a treatment plan appropriately and intervene when procedures would be most beneficial.

Q: Could you talk more about treatment plans for hand? What happens after surgery?
We're lucky here at Mass General to have strong and active relationships with our team of hand therapists. There's always a hand therapist onsite to help patients with pre- and postoperative optimization and even nonsurgical management. If I have any questions, I can just walk down the hall and ask them, which I’ll often do as I’m developing a treatment plan with a patient.

Q: What were some of the main reasons you decided to become an attending surgeon at Mass General?
One reason is my colleagues; Mass General is filled with bright, smart, creative people, which makes for a great learning environment. Maybe my greatest passion in life is learning. I joke that, "I was built for school," as I love learning new things every day, and coming back to Mass General is a wonderful opportunity to continue learning from colleagues, including some amazing residents and fellows. In addition, we in the Hand service work closely with Plastic Surgery at Mass General, so I love getting to interact with colleagues who approach hand surgery from different vantage points.

Finally, there are many nonclinical reasons why I love Boston; it’s such a hub for education and innovation. Also, my wife works on climate change, and she had the opportunity to get an amazing job here on the East Coast. So, it's a great fit all around.