On March 4, Antonia Chen, MD, chair of the Department of Orthopaedic Surgery at Dallas-based UT Southwestern Medical Center, stepped into the presidency of the American Association of Hip and Knee Surgeons. In doing so, she became the youngest leader and only the second woman to hold the role in the organization’s 35-year history.
She takes the helm at an inflection point.
Joint replacement is one of modern medicine’s clearest successes, as it is reliable, life-changing and in growing demand. Yet the system surrounding it is under increasing strain, shaped by declining reimbursement, rising administrative burden and a workforce quietly reaching its limits.
“The hardest part of this is I wish we could just tackle every single front at the exact same time,” Dr. Chen said.
Instead, she is starting with something less visible, but more foundational: burnout, not as an individual failing, but as a structural one.
A system that keeps asking for more
The economics of hip and knee replacement have steadily tightened.
“Over the last 20 years, orthopedic surgeons who do hip and knee replacements have been cut by 55% overall,” Dr. Chen said. “Doctors have been cut by 35%.”
The response has been gradual, but cumulative: Do more cases, move faster, absorb the difference.
“To make up for the cuts, more and more surgeons are just trying to do more surgery,” she said. “That leads to burnout. That leads to lack of well-being.”
What is changing now is not just the pressure itself, but how the next generation is responding to it.
“A lot of medical students are saying, ‘I’m going to do a residency, but I’m probably not going to practice,’” she said.
The implication is not immediate, but it is difficult to ignore.
“You see younger and younger people leaving the field of medicine,” she said. “What’s going to happen in 10, 15, 40 years from now when I need a joint replacement? There’s not going to be anyone in the workforce to do them.”
Why burnout persists
Burnout is one of the most widely discussed issues in medicine. It is also one of the least effectively addressed.
Dr. Chen is direct about why.
“I don’t want just another meditation app, because I don’t have time to do a meditation app,” she said.
The problem, as she sees it, is not a lack of awareness. Rather, it is a mismatch between the scale of the issue and the solutions offered. Surgeons are being asked to solve systemic pressure with individual resilience.
Her first step as president is deliberately simple: Ask surgeons, concretely through a survey, where the strain is coming from.
“Where are your pain points? Rank your problems,” she said. “Because burnout is something different for everyone.”
From there, the focus shifts to intervention, not programs that sit alongside the work, but tools that reshape it.
That may mean reducing documentation burden, improving operating room efficiency, or creating peer networks where surgeons can speak openly about challenges that have long been internalized, she said.
Innovation, and what counts as progress
Even as the workforce faces mounting strain, the field itself continues to evolve. Robotics, new implant designs and biologics are expanding what is possible in joint replacement, often faster than long-term evidence can keep pace.
For Dr. Chen, the guiding principle is clear.
“Outcomes should drive everything,” she said.
But not all innovation can be measured in the present. Some technologies are as much about future insight as immediate improvement.
“The benefit of it is it collects a lot of data that we didn’t have in the past,” she said. “We won’t know for years how useful that data is.”
The tension lies in the gap between early adoption and long-term validation.
“The hardest ones are new technologies that may have good short-term outcomes, but we don’t know the long-term outcomes,” she said.
In those cases, the boundary remains unchanged.
“If there’s anything we’re doing that’s hurting our patients, we should immediately stop doing it.”
The work behind the procedure
Much of Dr. Chen’s efforts early in her presidency are focused on how the work of joint replacement is understood and, in many cases, underestimated.
The AAHKS, which represents more than 5,500 surgeons and care professionals, has increasingly focused its advocacy on administrative burden and reimbursement. One of the most visible pressures is prior authorization, which has expanded in both scope and complexity.
“We have to deal with more and more paperwork, hiring people and paying money for them to battle insurance companies,” she said.
But the more fundamental issue, she said, is how narrowly surgical work is defined.
“If you take the entire continuum of care and divide it by the amount of money I receive for that joint replacement, I make less than $100 an hour,” she said. That figure reflects not just time in the operating room, but everything surrounding it, optimizing patients before surgery, coordinating care and managing recovery.
To shift that understanding, the organization is relying on one of its most effective tools.
“Our biggest leverage is data,” she said.
A system out of alignment
As payment models evolve, so do incentives, often in ways that create friction rather than alignment.
In earlier bundled payment models, surgeons directly benefited from efficiency gains. Increasingly, those gains are redistributed, disconnecting effort from reward.
“We’re all fighting for the same pie, but we don’t want to fight each other,” Dr. Chen said. “I want the pie to grow so we all grow together.”
Instead, she sees a system that often pits stakeholders against one another, surgeons and hospitals, specialties against each other, private practice against employed models.
“We need to align our goals appropriately so that we’re moving in the same direction,” she said.
Without that alignment, even well-intentioned reforms risk creating unintended consequences for both clinicians and patients, she said.
Planning without a map
For surgeons, uncertainty is more than an inconvenience; it runs counter to the way they are trained to operate.
“We have no idea what the government is going to do next,” Dr. Chen said.
Policy shifts, reimbursement changes and evolving regulations introduce a level of unpredictability that is difficult to plan around.
“As surgeons, we like to know exactly what’s ahead of us, and we like to be able to do predictable things,” she said.
That predictability is becoming harder to maintain. What remains within the profession’s control, she argues, is internal cohesion.
“The biggest thing for us is not to become fragmented,” she said.
Competition within the field, over technique, technology or approach, can erode a shared sense of purpose.
“We spend a lot of time competing against each other instead of building one another up,” she said.
What remains unchanged
For all the uncertainty shaping the future of joint replacement — financial, political and technological — Dr. Chen returns to a point that is both simple and grounding.
“What matters at the end of the day is we give patients the gift of mobility,” she said.
It is a reminder of what has not changed, even as nearly everything around it has.
And for now, it may be the clearest way forward for orthopedics leaders.
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