Fewer surgeons, more assistants: 7 predictions for orthopedic surgery

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If the past decade is any indication, the field of orthopedic surgery could look dramatically different in 2031 than it does today. According to these seven orthopedic surgeons, some of the most likely changes include shifting roles for clinicians.

Note: The following responses were lightly edited for style and clarity.

Question: What is one bold prediction you have about how the orthopedic field will change in the next decade?

Don Buford, MD. Texas Orthobiologics Institute (Dallas): Over the next 10 years, the use of orthobiologics in orthopedics will grow rapidly. As mounting clinical research shows that these procedures are safe and cost effective for many orthopedic conditions, doctors will increase the use of these injections instead of medications, steroids or even some surgical procedures.

Well-informed patients with orthopedic conditions such as arthritis, back pain or sports injuries have already started requesting treatments such as platelet-rich plasma injections instead of steroids, viscosupplementation (a fluid-injection treatment for arthritis) or medications.

Sergio Mendoza-Lattes, MD. Duke Spine Center (Durham, N.C.): The field of spine surgery will be completely taken over by neurosurgery. We are training an increasing number of neurosurgery residents to perform procedures that in the past were — and currently in most of the world, still are — in the hands of orthopedic surgeons. This includes adult and even pediatric deformity surgery, trauma surgery and surgery for degenerative disorders. 

I personally think that the ideal pathway should be a combined training program that provides a more holistic approach, including the understanding of hip disease, shoulder disease, peripheral nerves and many overlapping disease processes that are in the differentials of many patients seen daily in the spine clinic.

Davis Hurley, MD. Orthopedic Centers of Colorado (Denver): We will continue to see exponential growth in orthopedic procedures shifting to the ASC setting and away from traditional hospital settings. We know that shifting cases to ASCs remains the single biggest opportunity to reduce the total cost of care and realize the quadruple aim of quality outcomes, a better experience for patients and providers, all at a lower total cost of care. For context, Orthopedic Centers of Colorado has performed 67 percent of our cases in ASCs so far this year. Our partner, Surgical Care Affiliates, has experienced significant growth in spine and total joints in its ASCs, including a 29 percent growth in total joints in the first four months of 2021 alone. 

There are several reasons for this growth trend, and it comes down to more holistic support that helps practices like OCC remain independent within things like access to value-based care models, patient referrals, capital investment and other solutions to manage and optimize our business.

Marc Rankin, MD. Summit Orthopedics (Washington, D.C.): Quite simple: Data and health informatics are leading the way. Together with electronic health records, AI and robotics that are ostensibly facilitating more precision-guided surgery, but in actuality learning our movements, the few orthopedic surgeons left in 10 years will be relegated to supervisory roles of the cost-effective physician associates. Even the physician associates changed their name in preparation for the public to become accustomed to their increasing scope of practice.

Frank Kolisek, MD. OrthoIndy South (Greenwood, Ind.): My answer is that there will be fewer orthopedic surgeons delivering orthopedic care and more physician extenders delivering orthopedic care. This can work as the surgeons will spend more time in the operating room and less time in clinic. The physician extenders will pick up the extra office time that the surgeons currently do. 

One can make the argument that this is a good thing, as it allows surgeons to do more surgeon work and nonsurgeons to do more of the non-surgeon work. Furthermore, if orthopedic surgeons spend 50 percent more time in the operating room, then in theory we would need 50 percent fewer surgeons to get the same amount of surgery done, so there should not be an access problem for patients with the physician extenders picking up the slack in the office. 

Bruce Gomberg, MD. Northern Light Health (Falmouth, Maine): We will cease being surgeons and start becoming information managers.

Rick White, MD. Marshall Orthopedic & Sports Medicine (Mo.): The orthopedic field will continue to change, as regulations and oversight will continue to increase. This will become the standard. In addition, new novel treatment options will become the norm. Physician extenders and other providers will continue to gain privileges and contribute more to the treatment of musculoskeletal care.

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