James Ficke, MD, has led through change — on the battlefield, in the operating room and now at the helm of one of the nation’s most respected orthopedic programs.
As chair of orthopedic surgery at Johns Hopkins Medicine in Baltimore, the retired U.S. Army colonel has spent more than a decade building a department defined by value, collaboration and purpose.
“I didn’t have an MBA,” Dr. Ficke said. “I surrounded myself with people who are very smart. I wanted to understand the rules — and then play to win.”
That philosophy has shaped how he approaches Maryland’s unique all-payer model, which reimburses hospitals at the same rate regardless of insurer. It’s a system that rewards efficiency but challenges innovation.
“It definitely impacts how we can innovate, because I’ve got to pay all the bills — all the staff salaries, all the overhead — and still deliver value,” he said.
To meet that challenge, Dr. Ficke reorganized care around specialized centers of excellence for high-volume procedures such as joint replacement, spine and orthopedic oncology.
Concentrating those cases has allowed his team to better control outcomes and costs.
“If I focus all of my total joints into one location, we can manage volume, manage quality and safety and give patients and our partners a package that’s value for everyone,” he said.
He credits leaders across the system, including Adam Levin, MD, vice chair for operations, and Amit Jain, MD, director of value based care, with advancing that vision.
Together, they’ve built a multidisciplinary model where each hospital plays to its strengths — from trauma to cancer to reconstructive surgery — while collaboration drives improvement.
However, sustaining academic research has grown increasingly difficult. Federal funding delays have forced departments to rely more heavily on clinical revenue.
“Research right now is not being funded sufficiently,” Dr. Ficke said. “That has a stifling effect.”
Even so, his team continues to publish on value-based models and pursue groundbreaking techniques like osseointegration, which allows prosthetic limbs to anchor directly to bone.
“If a patient can’t fit a socket, this gives them the ability to walk again,” he said.
Technology has also become a key part of his access and workforce strategy.
Johns Hopkins’ orthopedic clinics now use AI-assisted scheduling through MyChart and an AI-powered scribing tool that streamlines documentation. Dr. Ficke said those tools have helped clinicians spend more time with patients.
“It doesn’t write orders for you, but it does about everything else,” he said. “Clinicians can get their notes done on time and focus on care.”
For a leader shaped by military service, communication remains his most consistent tool.
“Listening — really hearing what people are saying — is something I’ve practiced my whole life,” he said.
He believes that good leadership requires both humility and action.
“People need to be heard, and then they need to see action. If they don’t see action, that’s where we fail as leaders.” That same mindset extends to patient care.
“We lead by treating people with humility and respect,” he said. “The idea of treating others like they’re a member of your family — that’s not artificial. That’s real.”
Looking ahead, Dr. Ficke is closely watching reimbursement and policy shifts he believes could reshape how care is delivered.
“Our economy may be okay, but reimbursements are not,” he said. “It’s becoming acceptable not to think about the clinicians.”
Despite the uncertainty, he remains focused on the core values that have guided both his military and medical careers.
“I ask all of our clinicians to fill their ORs to the maximum they can,” he said. “Our nurse practitioners and PAs are the backbone of basic orthopedics — we just have to know what makes them happy, what makes them want to come to work and then we give that to them the best we can.”
