Shifting workforce dynamics, accelerating technology adoption and mounting financial pressure are testing the foundations of orthopedic care. Leaders from across the field shared what concerns them most about where the specialty is headed, and what’s at stake for patients and practices alike.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: What worries you most about the direction of orthopedic care over the next five to 10 years?
Kasra Ahmadinia, MD. Spine Surgeon at Advanced Orthopedics of Oklahoma (Tulsa): The accelerating consolidation of orthopedic practices into hospital systems and private equity platforms is the biggest concern, it shifts care from lower-cost ambulatory and office settings into hospital outpatient departments, where facility fees can double or triple the cost of an identical procedure.
Vertical integration also narrows referral patterns and erodes physician autonomy, often nudging clinical decisions toward higher-margin interventions rather than what’s genuinely best for the patient. Meanwhile, the federal moratorium on new physician-owned hospitals limits the competitive pressure that might otherwise check these cost increases. Without policy correction, patients face fewer choices, higher out-of-pocket costs and care pathways shaped increasingly by corporate rather than clinical priorities.
Travis Doering, MD. Orthopedic Surgeon at St. David’s HealthCare (Austin, Texas): What worries me most is the continued consolidation of orthopedic care into large health systems and private equity-backed groups, where volume metrics and contract economics increasingly drive clinical decisions. When surgeons lose the autonomy to practice at the top of their training, to offer the right procedure, at the right time, in the right setting, patients are the ones who pay the price. Independent practice is harder than ever to sustain, but I believe it’s one of the last environments where truly individualized, surgeon-led care can still thrive.
Bryan Edwards, MD, Senior Vice President and Chief Clinical Strategy Officer and Physician in Chief at Orthopedics and Sports Medicine Institute of Novant Health (Winston Salem, N.C.): My biggest concern over the next five to 10 years is maintaining the financial viability of ASCs in the face of rising inflationary costs and continued payer pressure. Orthopedic ASCs provide significant cost savings for both payers and patients, but sustaining that value will require reimbursement models that more appropriately share those savings and support long-term ASC viability.
Gerson Florez, MD. Orthopedic Surgeon and Director of Latin American Education and Outreach at Cleveland Clinic Florida—Martin Health (Stuart): What worries me most is the convergence of workforce strain and economic pressure threatening both access to care and the sustainability of orthopedics. A large portion of the workforce is nearing retirement just as demand for musculoskeletal care continues to rise, creating a growing imbalance between supply and demand.
Efforts to address that gap, through expanded training pathways and greater use of nonorthopaedic providers, may improve access, but could also dilute case volume, compress compensation and alter care models. At the same time, Medicare reimbursement continues to decline while surgeons are generating more work, and practice costs are rising far faster than payment rates.
The result is a ‘”race to the bottom,” where physicians are working more for relatively less pay under worsening margins. Growth in lower-reimbursed outpatient and ASC settings, combined with practice expense cuts, is also accelerating consolidation as independent practices are increasingly absorbed by hospitals, private equity and large health systems to remain viable.
Taken together, the next five to 10 years could bring higher workloads, reduced autonomy and declining financial sustainability for orthopedic surgeons, raising serious concerns about workforce stability and patient access to high-quality care.
Michael Gross, MD. Orthopedic Director of Union Middlesex Orthopedics (Woodbridge, N.J.): Several intertwined issues worry me. First, I worry spine care is adopting new technology too quickly without enough skepticism. Robotics, AI-assisted planning, biologics and advanced implants hold real promise, but they’re often implemented faster than evidence supports and at costs that strain health systems and patients. I’m also concerned that untested technologies and unsubstantiated claims are sometimes used as marketing by bad actors. As these tools become more common, we risk training surgeons to operate platforms rather than become deeply skilled clinicians, while financial incentives tied to technology adoption may influence decisions in ways that don’t always put patients first.
I’m also concerned about the growing gap between innovation and equitable access to care. As technologies become more sophisticated and expensive, we risk creating a two-tiered system where the latest advances are available mainly to well-insured patients while underserved communities fall behind.
At the same time, surgeon burnout, fewer trainees entering the specialty and growing administrative burdens threaten long-term access to high-quality musculoskeletal care. I also worry about pressure to move complex procedures into lower-cost ambulatory settings without consistently ensuring the infrastructure and support needed to protect patient safety and outcomes.
Finally, I worry about the erosion of the patient–surgeon relationship as administrative burdens, volume pressures and corporate management grow. When surgeons are stretched thin, shared decision-making suffers and there can be pressure to accept “good enough” care rather than continue investing in improvements that keep patients at the center.
Les Jebson. Administrator of the Orthopedics and Sports Medicine Network at Prisma Health (Greenville, S.C.): The primary concerns for orthopedic care over the next five to 10 years center on the economic sustainability of private practice, declining reimbursements and the continued effective migration towards health system employment and integration. An aging population of orthopedic surgeons will create further labor strains, and from a provision standpoint, how to effectively tackle the slew of historical total joint implants that will require revision surgery.
S. Babak Kalantar, MD. Professor and Chief of Spine Surgery at Georgetown University School of Medicine and the MedStar Orthopaedic Institute, and Co-Director of the MedStar Spine Center (Washington, D.C.): What worries me most is the combination of increasing operational pressure and the rapid push toward new technology.
Across healthcare, there’s a growing focus on efficiency, access and volume, which are all important, but it can gradually shift the focus away from thoughtful patient selection and surgical judgment. At the same time, we’re adopting robotics and new implant technologies incredibly quickly, sometimes faster than long-term outcomes data can fully validate them. After 16 years in practice, my biggest concern isn’t innovation itself, it’s making sure we preserve the culture and clinical judgment that allow experienced surgeons to know when surgery is truly the right answer.
Andrew Kersten, MD. Orthopedic Surgeon and Sports Medicine at EmergeOrtho (Asheville, N.C.): One of my primary concerns is the continued shift toward employment and consolidation within hospital-employed models, which can introduce additional layers of complexity and bureaucracy into orthopedic care.
Coupled with increasing prior authorization requirements, reimbursement pressures and administrative burdens, this trend risks compromising access, efficiency and innovation. It also contributes to higher overall healthcare spending, as care delivered in hospital settings is often significantly more expensive than equivalent procedures performed in outpatient ASCs. I am further concerned that this trend undervalues the demonstrated ability of physician-led private practices to deliver high-quality, cost-effective care, often with greater efficiency, lower site-of-care costs, improved patient experience and comparable or superior outcomes relative to hospital-based and employed models.
Earl Kilbride, MD. Orthopedic surgeon at Austin (Texas) Orthopedic Institute: Consolidation, mergers and takeovers have been the trend of the past few years. The independent physician is shrinking. When that happens, patients suffer.
Costs rise, especially in hospital employment, surgeries get pushed to the higher revenue inpatient facilities, access becomes communistic as health care systems spread patients to all providers regardless of patient requests. Fortunately, there has been a blip on the radar with orthopedic surgeons returning to private practice. The worry is that the systems and private equity will outbid the private practice for future providers.
Philip Louie, MD. Spine surgeon and Medical Director of Research and Academics at Virginia Mason Franciscan Health (Seattle): The biggest worry is that value-based care becomes a label for cost reduction rather than an actual method for delivering better outcomes per dollar.
The two are not the same, despite how people use those terms. Cutting implants and narrowing networks can lower spend without improving what actually matters to patients. True value requires measurement on both sides. That being said, patient-reported outcome measures that reflect function, episode-level cost and appropriateness frameworks that are able to identify unnecessary variability and waste.
The next decade will reward groups that measure what patients actually experience and care about and price what care actually costs. Everything else will hopefully be chalked up to “rebranding.”
Amit Momaya, MD. Chief of Sports Medicine at University of Alabama at Birmingham: The field of orthopedic surgery must continue to move towards value based care and reimbursements tied to outcomes. I continue to see many patients who receive non-evidence based surgical care or suffer from postoperative complications from the community sent to me. Many of these patients may have benefited from an alternative surgical approach or no surgery at all. It is concerning that the same patient with the same pathology can get such different treatment based on which orthopedic surgery office they show up to.
Brandon Ortega, MD. Orthopedic Spine Surgeon in Los Angeles: What worries me most is the uncritical enthusiasm around AI and technology as a substitute for surgical judgment. The tools are genuinely exciting, AI-assisted imaging, predictive outcome modeling, robotic guidance, but there’s a real risk that health systems deploy them to justify algorithmic care pathways that override the nuanced, patient-specific decision-making that defines good spine surgery. Technology should augment the surgeon-patient relationship, not flatten it into a protocol.
Sandeep Pandit, MD. Orthopedic Surgeon at Crovetti Orthopaedics and Sports Medicine (Henderson, Nev.): What worries me are the continuing cuts to physician reimbursement for high value procedures such as hip and knee arthroplasty. This race to the bottom could result in an unsustainable practice environment and cause diminished access for patients who would benefit the most from these procedures
Richard Salmony. Director of Advanced Practice—MSCC, Neurosciences, Orthopedics and Transplant at Duke University Health System (Durham, N.C.): I believe the best path to success for MSK care and all specialties for that matter is to continue elevating multidisciplinary care models that strengthen the surgeon-advanced practice provider relationship while keeping patient outcomes at the center.
To truly advance orthopedic care in 2026 and beyond, we must invest in smarter support systems, including better integration of technology and care coordination, to meaningfully reduce administrative burden. Compensation structures should better reflect the intensity, complexity and volume of work performed across the care team. Finally, eliminating unnecessary barriers, especially inefficiencies like the prior authorization process, will be critical to improving access, reducing delays and allowing providers to focus on delivering high-quality care.
James Sanfilippo, MD. Vice President of Clinical Operations for Musculoskeletal Medicine at Virtua Medical Group and Vice Chairman of Surgery at Virtua South (Marlton, N.J.): My biggest concern is the cost of care as we go into the next decade. We have an aging population that remains active into a more advanced age than previous generations.
This requires an increasing demand on orthopedic care, both operative and nonoperative. This high-quality care requires a workforce, medications, instrumentation and technology that continues to increase in price. Meanwhile, reimbursement to providers, suppliers and facilities has not been kept up. This has the potential to place those delivering care in a tough financial position and leave patients with fewer options for treatment. To solve this may require a redesign on how our orthopedic care is delivered to our community.
Jim Youseff, MD. Founder of Spine Colorado (Durango): What worries me most is the disconnect between innovation and implementation in spine care. We’re developing incredible technologies, AI-driven diagnostics, restorative neurostimulation, predictive analytics, but care delivery remains siloed. Patients repeat imaging, registry outcomes never reach treating physicians, and device performance data stays locked in manufacturer databases instead of informing real-time clinical decisions.
The irony is we already have the technical capability to solve this. What we lack is the infrastructure, interoperability and will to put patients at the center of care. Hospitals, payers, device companies and registries have built walls around “their” data, often citing privacy or competition, when the real barrier is inertia and misaligned incentives.
In spine care specifically, I worry we’re repeating mistakes from joint replacement: prioritizing procedural volume over functional outcomes, innovating devices faster than we can prove value and measuring success by fusion rates instead of patients returning to meaningful activity. We need a shift toward patient-owned data and accountability measured by what matters most, returning to work, avoiding opioids and living active lives. Until incentives align around patient outcomes, not just what’s billable or publishable, we’ll keep adding complexity without adding value.
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