B. Clay Dorenkamp, DO, believes one of the biggest problems in healthcare is happening in places patients never see.
The public conversation around AI in medicine has largely centered on dramatic predictions, algorithms outperforming physicians, robotic surgery systems replacing surgeons and generative AI reshaping clinical decision-making.
But inside busy orthopedic clinics, Dr. Dorenkamp says the reality looks far less futuristic and far more operational.
“This is not where medicine is broken,” Dr. Dorenkamp said. “Where most of the friction in healthcare is coming from is everything the patient doesn’t see.”
For the Lansing, Mich.-based spine surgeon at Michigan Orthopedic Center, the real strain on modern orthopedic care is not necessarily diagnosis or surgery itself. It is the growing maze of administrative tasks, fragmented communication and back-office workflows surrounding every patient encounter.
A patient calls about a missing prescription. A voicemail gets transcribed incorrectly. A referral lacks imaging. A medical assistant spends hours chasing incomplete information. A surgeon reviews a message only to realize critical details are missing, triggering another round of callbacks that can stretch over days.
Every patient, Dr. Dorenkamp said, generates “a mountain of paperwork and next steps to do.”
That is where he believes AI may have its most immediate impact on musculoskeletal care, not replacing physicians, but helping orthopedic practices untangle the operational chaos surrounding them.
The ‘friction’ patients never see
According to Dr. Dorenkamp, one of the biggest misconceptions surrounding AI in healthcare is the assumption that its primary value lies in replacing clinical judgment.
He points to headlines claiming AI tools outperform physicians diagnostically and says they often miss the deeper structural problems burdening healthcare systems today.
“Yeah, it’s nice to have tools that help surface research and provide up-to-date recommendations,” he said. “But, really, where most of the friction in healthcare is coming from is everything that happens from when the patient leaves your clinic until the next time you see them again.”
Inside orthopedic practices, that friction accumulates quickly. Clinics handling thousands of patients every month also manage thousands of calls, refill requests, scheduling questions, insurance issues and referral coordination tasks. Patients bounce between voicemail systems, missed callbacks and incomplete triage conversations.
“You get caught in this circle, and you can’t break free from it,” Dr. Dorenkamp said. The communication breakdown becomes even more complicated when clinical triage is involved.
Patients often leave open-ended voicemail messages missing important details. Providers review incomplete summaries and request additional information. Staff call patients back, only to reach voicemail again. Patients return calls later with partial answers, restarting the cycle.
In some cases, Dr. Dorenkamp said, relatively simple medical questions can take multiple days to resolve.
Why orthopedic practices are focusing on ‘agentic AI’
Dr. Dorenkamp believes much of the public still views AI primarily through the lens of ChatGPT.
But inside healthcare operations, he said attention is increasingly shifting toward what many in the industry call “agentic AI,” systems designed to complete tasks, organize workflows and coordinate information rather than simply generate text.
“The world didn’t really know about AI until these large language models came out,” he said. “But where this really starts helping healthcare is handling all the things in the middle.”
In orthopedic care, that may include helping practices organize referrals, collect intake information, coordinate imaging, prioritize urgent calls and streamline patient communication. Dr. Dorenkamp emphasized that he does not believe AI should independently provide clinical recommendations to patients.
Instead, he sees the technology as a tool to gather better information earlier so physicians and staff can make decisions more efficiently.
“Our goal is to ask the right questions at the right time and get the information to the right person faster,” he said. He described how AI-assisted intake systems could eventually help identify whether a postoperative patient reporting swelling after surgery is experiencing a routine recovery issue or symptoms requiring more urgent attention.
The technology would not make the clinical decision itself, he said, but it could help surface higher-priority cases sooner than current systems allow.
“If 50 people call between 8:00 and 8:05 in the morning, right now the person who called first gets handled first,” he said. “But the person who called last might actually be the one who needed attention first.”
The pressure facing independent orthopedic practices
For Dr. Dorenkamp, the administrative burden surrounding orthopedic care is also deeply tied to the financial pressure facing independent physician practices. As reimbursement declines and operational complexity increases, many groups are struggling to maintain staffing while staying financially viable.
“That’s really what’s been killing private practice in the last five to 10 years,” he said. “This increasing burden of back-office procedures that need to happen.”
Importantly, he does not believe AI will replace healthcare workers. If anything, he said, orthopedic practices need experienced staff more than ever.
Instead, he hopes technology can reduce repetitive administrative work and allow employees to focus more directly on patient care.
“Our goal is not to replace anybody,” Dr. Dorenkamp said. “Our goal is to maintain the level of staff we’re at without continuing to expand.” Ideally, he said, that could also help reduce burnout across healthcare teams already stretched thin by growing administrative demands.
“It allows you to give them the tools they need to take care of patients,” he said. “Hopefully, we get happier, more productive staff that we’re able to retain because they like their jobs and they’re not feeling stressed out and burned out like everybody else in medicine.”
The AI mistake orthopedic groups could make
As orthopedic organizations rapidly adopt AI tools, Dr. Dorenkamp worries the industry could make one major mistake: using the technology primarily to increase patient volume rather than improve care. “That’s ultimately the pitch that comes through most health tech salespeople right now,” he said. “‘Use our AI scribe and you’re going to see five more patients a day.’”
He believes the greater opportunity is using AI to improve care coordination, reduce administrative strain and give physicians more time to focus directly on patients. “I want to use this so I can work efficiently through the day, take care of my patients safely and service my community as a whole,” he said.
He also worries insurers and payers could eventually respond to efficiency gains by further reducing reimbursement, a trend he says physicians have already experienced as surgical procedures became faster and more standardized.
“We’ve gotten better at doing these procedures, so reimbursement goes down,” he said.
Ultimately, Dr. Dorenkamp believes AI represents less of a technological revolution than an operational crossroads for healthcare itself.
“We have a very unique generational opportunity here,” he said. “Let’s do it right.”
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