Orthopedic and spine surgeons say a growing financial squeeze is reshaping how and where musculoskeletal care is delivered in the U.S.
As reimbursement declines and the cost of staff, implants, technology and operating rooms rise, many physicians warn that the pressure is accelerating consolidation, pushing more procedures to outpatient settings, and threatening the sustainability of independent surgical practices.
The result, surgeons say, could fundamentally change who controls orthopedic care and how patients access it.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: What is the biggest financial pressure facing orthopedic and spine surgeons right now, and how is it affecting your practice?
Todd Albert, MD. Surgeon-In-Chief Emeritus at Hospital for Special Surgery (New York City): The central financial pressure is the structural mismatch between reimbursement and inflation in surgical practice costs. It is pushing orthopedics toward consolidation, ASC ownership, operational efficiency and new payment models.
Adam Bright. MD. Owner of Schofield, Hand and Bright Orthopaedics (Sarasota, Fla.): Orthopedic and spine surgeons continue to struggle with declining reimbursement. While office visits have almost kept pace with the rising cost of office space and staff and IT expenses, surgery fees have gone down substantially.
Many surgeon practices have been bought by venture capitalists and hospital systems, allowing corporate America to take over healthcare from private-practice surgeons, most of whom feel threatened by this climate and fear that their autonomy and patient care priorities will be lost in this shuffle.
Tan (Dan) Chen, MD. Orthopedic Spine Surgeon at Inova Orthopaedics and Sports Medicine (Fairfax, Va.): The biggest financial pressure today is the gap between declining reimbursement from Medicare and insurance companies and the rising cost of delivering care.
Even within hospital employment models, these pressures affect resources, staffing and efficiency expectations. As reimbursement decreases while operational costs increase, health systems often place greater emphasis on productivity, efficiency and moving appropriate procedures to outpatient settings. Despite these financial challenges, the focus remains on maintaining high-quality care and achieving the best outcomes for patients.
Shehzad Choudry, MD. Director for Interventional Spine and Pain at Orlando (Fla.) Health’s Interventional Spine Pain Department: As an interventional pain physician, the financial impacts in 2026 — and upcoming in 2027 — are quite profound. Primarily, reimbursement cuts by Medicare coupled with rising cost of staff, equipment and implants result in razor-thin margins. We are always looking at ways to increase efficiency and alternative revenue sources.
Christopher Dodson, MD. Head of Orthopedics at the Vincera Institute (Philadelphia): The biggest financial pressure right now is ongoing cost inflation and margin compression as reimbursement hasn’t kept pace with rising staffing, supply, implant and facility overhead. The positive is that it’s accelerating smarter care design.
At the Vincera Institute, our integrated structure, imaging, surgical, clinical and physical therapy expertise in one system, helps us deliver excellent care despite these pressures by streamlining coordination across the full episode of care and staying relentlessly focused on outcomes.
Sean Gipson. CEO and Division president of ASCs at Remedy Surgery Center (Hurst, Texas): The biggest financial pressure I find facing orthopedic and spine surgeons today is the widening gap between reimbursement and the actual cost of delivering care. While physician reimbursement, particularly from Medicare, has declined in real terms over the past several years, the cost of operating a surgical practice and ASC continues to rise. Labor shortages, higher wages for specialized surgical staff, increasing implant prices and growing anesthesia costs are all putting significant strain on my margins.
In our ASC, these pressures are felt on a daily basis. Orthopedic and spine procedures rely on highly trained teams and advanced technology, both of which require a substantial investment. Yet reimbursement has not kept pace with inflation or the real cost of providing care. ASCs remain one of the most efficient and cost-effective sites for surgical procedures, but if reimbursement models do not better reflect that value, it will become increasingly difficult for independent centers to sustain growth and expand patient access.
Christopher Gross, MD. Professor of Orthopedic Surgery, Director of the Foot and Ankle Division and Fellowship Director at the Medical University of South Carolina (Charleston): The single biggest financial pressure is Medicare reimbursement erosion, and it is not a single event; it is a slow bleed that has been accelerating. When adjusted for inflation, foot and ankle procedure reimbursements have declined by around 35% for arthroplasty and fusion procedures from 2007 to 2025. We are doing more complex surgery, on sicker patients, with more expensive implants, and getting paid less in real dollars every single year.
Brandon Ortega, MD. Orthopedic Spine Surgeon at Long Beach (Calif.) Lakewood Orthopedic Institute: The most significant financial pressure facing orthopedic spine surgeons right now is the continued erosion of reimbursement rates, which simply haven’t kept pace with the rising cost of delivering care. As payers cut what they pay for complex spine procedures, we’re being asked to do more, more documentation, more prior authorizations, more administrative burden, for less. Over time, this threatens not only the sustainability of our practices but, more importantly, our patients’ access to timely, high-quality surgical care.
Oliver Tannous, MD. Orthopedic Spine Surgeon at MedStar Washington Hospital Center (Washington, D.C.): The biggest financial pressure right now is declining reimbursement combined with the transition to value-based care.
Surgeons are being asked to assume more responsibility for outcomes and total episode costs while professional fees continue to fall. In practice, this means many surgeons are becoming more cautious about taking on complex or high-risk cases. As a result, these patients are increasingly being referred to tertiary care centers, where we are seeing a growing concentration of medically complex cases that may ultimately create new financial pressures as these systems are held accountable under the same value-based care models.
Vijay Yanamadala, MD. Neurosurgeon at Hartford (Conn.) HealthCare: The biggest financial pressure on spine surgeons is straightforward: Reimbursements are going down while costs are going up. CMS rates have declined in real terms for years, while OR time, implant costs and administrative overhead have all risen. The unsustainable response is to chase volume, more cases, faster. But that’s exactly the wrong direction for a specialty where the most consequential decision is often the one not to operate.
That’s why I think spine surgeons have a responsibility to be stewards of a system under strain, to ask harder questions about who truly needs surgery and to use technology to reduce waste without sacrificing the judgment that defines good surgical care. The financial pressure is real, but the answer can’t be more surgery. It has to be smarter care.
