Why orthopedic surgeons are leaving the field

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Orthopedic surgeons are facing several challenges that could be leading them to step away from the field.

Four surgeons recently spoke with Becker's about these challenges, which include low reimbursements, staffing shortages and administrative burdens. 

Editor's note: Responses were lightly edited for clarity and length.

Question: What are some factors that may contribute to orthopedic surgeons leaving the field?

Paul Kosmatka, MD. Division Chair of Musculoskeletal and General/Trauma/Plastic Surgery & Medical Weight Management at Essentia East (Duluth, Minn.): There are many factors that contribute to an orthopedic surgeon's decision to leave the field. One common thread is a feeling of being devalued for the work that a surgeon does. This can be in the form of decreased reimbursement from payers and pay that isn't keeping up with the cost of inflation. It can also be from increasing time spent on non-patient care activities, i.e documentation and paperwork. Finally, we are increasingly being asked to help solve the problems that we've hired administrators to address. In summary, it seems we are spending more time doing things that don't require a surgeon's level of expertise to address, and we are getting paid less for the time we do spend being a surgeon. In the end, this becomes less and less attractive over time. That being said, it's still a very rewarding job, and when I keep in mind why I went into medicine in the first place, all the above doesn't make me want to leave the field.

Jakub Sikora, MD. Orthopedic Spine Surgeon at MountainStar Medical Group (Salt Lake City): Issues that I have seen [make] fellow orthopedic spine surgeons leave the field have been due to an imbalance in the work done versus work paid. We now live in a time when surgeons are expected to do more unreimbursed work outside of the operating room. This can come in the form of time spent with documenting above and beyond on the electronic medical records, spending excessive amounts of time with insurance companies that are denying imaging or procedures for ludicrous reasons, the government’s new roll out of the [Merit-based Incentive Payment System] which is giving everyone stress, all in time when reimbursements are going down and hospital [Diagnosis Related Group] codes are going up. Many retiring surgeons feel like a pawn with a loss of autonomy and a loss of voice.

Austin Stone, MD. Orthopedic surgeon at UK Healthcare (Lexington, Ky.): Orthopedic surgeons are increasingly burdened with insurance prior authorizations, denials and peer-to-peer reviews, which increases surgeon frustration and staffing overhead. Hospital electronic medical record demands and documentation burden continue to be a significant contributor to surgeon burnout. Persistent operating room nursing and hospital staffing shortages add to the challenges in delivering efficient care. 

Jonathan Vigdorchik, MD. Orthopedic surgeon at Hospital for Special Surgery (New York City): Orthopedic surgeons have always had what we believe is the best speciality with the highest job satisfaction. However, decreasing reimbursement and increased administrative burdens may cause joint replacement surgery to become a "volume business," which contributes to physician burnout due to the increased amount of work and loss of satisfaction when caring for patients. We all go into medicine to take care of patients. When we are forced to limit appointment time to 5 or 10 minutes, we lose that personal touch in our practice, and this may contribute to surgeons leaving the field or less people interested in the speciality.

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