‘Get on the telehealth bandwagon’: Dr. Richard Berger’s advice for practices addressing backlogs

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The number of orthopedic and total joint replacement cases is expected to rise, according to Richard Berger, MD.

Dr. Berger, of Midwest Orthopaedics at Rush in Chicago, said practices will have to onboard telehealth and improve surgical efficiency to prepare for the uptick. He also told Becker's Spine Review his advice for surgeons wanting to try new surgical technology and his outlook on robotics in orthopedics.

Note: This conversation was edited for style and length.

Question: Can you quantify the rise in total joint cases you're seeing at your practice?

Dr. Richard Berger: So, I'm going to go back a year ago. First, we were closed for two months. Then we slowly started opening up, and there was a backlog of patients. We tried to get more patients in and operated on weekends, and we kind of got through that a little bit by adding extra days.

Now, people have gotten vaccinated and feel more comfortable with going to the hospital, and patients are starting to come more and more.

I'm seeing a ton of patients now, and it's just getting busier and busier. We're staying late. We're seeing more patients than we ever have. So I do about 1,500 cases a year; that's 120 cases a month, and even with that, I can't keep up right now. My normal backlog is probably about two months. We're running at about twice that — I'm almost at four months.

Q: How do you think this rise will affect how surgeons are trained?

RB: It makes it hard. For the past year, residents and fellows were seeing less cases for a whole year. The fellows this year got to see a lot less cases, and they do more than they normally do. Luckily, a residency is five years, so that will kind of balance out a little bit between a little bit less last year and a little bit more this year. I think in the long term it's going to be okay. But if you just look at joint replacement in general, as baby boomers are getting older and needing more joint replacements, there's going to be a shortage of joint replacement surgeons.

Q: What advice do you have for practices that might not be as prepared for the uptick in orthopedic cases?

RB: One, get on the telehealth bandwagon. It's a great way to help people, not just in your office, but at home. You have to remember that we're talking about patients who have hip and knee arthritis. It's hard for them to get around to begin with and really hard for them to get to your office, and lots of people aren't getting treated because they can't get to the office.

Number two is, you're going to have to figure out how to be more efficient in the operating room. But not doing the surgery faster; the surgery is the important part. All the stuff that goes around the surgery, what's done in between cases and how to make that go more smoothly. There are lots of techniques that busy centers like ours use, which makes the turnover of cases easy. We use case carts where everything you need for the case is in a cart, and that makes the entire procedure so much faster in between cases.


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