Success in sports medicine today isn’t just about surgical precision — it’s about preparation, adaptability and the ability to connect.
For Nicholas Lemme, MD, a sports medicine surgeon at University Orthopedics in East Providence, R.I., those traits are what separate sustainable practices from the rest. A strong foundation begins long before entering practice.
“It starts even before you go into practice,” Dr. Lemme told Becker’s. “You have to make sure you get the right training in residency and fellowship, and be comfortable treating a wide range of pathology and complexities. That early experience gives you the confidence to adapt.”
That versatility, he said, becomes crucial as cases grow more specialized.
Dr. Lemme said new surgeons should avoid narrowing their scope too soon, noting that much of the job involves helping patients find nonsurgical solutions as confidently as surgical ones. For him, the technical side of medicine is inseparable from the human one.
“If you treat everyone like a family member, they’ll come back — and they’ll send others to you,” he said. “Taking time to listen and make people feel understood is just as important as any surgical skill.”
That kind of care is increasingly tested by the growing financial and operational strain across healthcare.
“Insurance companies are finding more ways to reduce reimbursements or deny surgeries,” he said. “They’re using AI to downcode or refuse procedures, so practices have to stay just as advanced in their documentation and understanding of those systems.”
Staffing shortages, especially in anesthesia, compound those challenges.
“There’s a constant fight to get enough OR time,” he said. “Anyone entering practice now should have honest conversations about those limitations before committing. I’ve been fortunate to have dedicated block time, but that’s not the case for many.”
The business side of orthopedics has also undergone dramatic change. Private equity firms continue to buy large orthopedic groups — a trend Dr. Lemme said can create uneven outcomes.
“It’s financially beneficial for senior partners, but younger surgeons often lose autonomy without gaining anything financially,” he said. “It changes how you practice and adds more stress.”
He noted that, so far, there hasn’t been a successful “second sale” of an orthopedic practice after a private equity acquisition.
“Some think these firms might sell to insurance companies next,” he said. “It’s still unclear how that plays out.”
For groups that remain independent, consolidation has become a different kind of strategy — a way to grow without giving up control. Many are consolidating to gain economies of scale and strengthen negotiating power with payers, an approach Dr. Lemme sees as more sustainable than private equity ownership. It allows practices to expand resources and efficiency while preserving day-to-day autonomy.
Technology is also reshaping the landscape, from augmented reality and robotics in the OR to AI tools that assist with clinical documentation.
Dr. Lemme said these innovations are improving steadily and hold promise for better outcomes, but cost and access remain major barriers.
For now, many of the most advanced systems are feasible only in select practice settings. His own group recently implemented an ambient AI platform that listens during patient visits and automatically creates documentation — a change he said has streamlined workflow and improved accuracy.
Yet that same technology, when used by insurers, has made reimbursement battles tougher.
With so many tools hitting the market, he believes it’s vital to separate true progress from hype. Evidence, he said, should guide adoption — not marketing. New systems must actually improve patient outcomes without driving up costs or creating new inefficiencies.
For younger surgeons, his advice is both practical and personal: stay prepared, keep learning and lead with integrity.
“People recognize when you’re doing the right thing,” he said.
Just as important, he added, is maintaining perspective. The drive to build a practice can easily consume everything else, but long-term success depends on balance.
“If you let your family and hobbies fall by the wayside, you burn out fast,” he said. “That balance is what keeps your career sustainable.”
