1. There are approximately 25,500 orthopedic surgeons practicing in the United States, according to the American Academy of Orthopaedic Surgery.
2. Adult knee surgery is the most popular subspecialty within orthopedics, with more than 34 percent of all orthopedic surgeons practicing this area of orthopedic medicine. Here are the top 10 orthopedic specialty areas, with the percent of AAOS members with fellowships in that area, according to the AAOS report Orthopaedic Practice in the U.S. 2008. Note: Surgeons may have selected more than one specialty area, so percentages do not total 100 percent.
• Adult knee (34.4 percent)
• Arthroscopy (34.3 percent)
• Sports medicine (33.4 percent)
• Total joint (28.4 percent)
• Shoulder (25.1 percent)
• Adult hip (24.9 percent)
• Trauma (16.5 percent)
• Hand (15.4 percent)
• Adult spine (11.0 percent)
• Foot and ankle (10.2 percent)
3. Private practice makes up the majority of orthopedic practice settings. Orthopedic private practices make up 73.5 percent of all orthopedic practices. The remaining practice types are split between the following practice settings: academic institution (8.5 percent), hospital/medical center practice (6.7 percent), academic private practice (3.5 percent), military practice (2.1 percent), pre-paid plan/HMO practice (1.9 percent), public institution, non-military (1.2 percent), other setting (1.9 percent) and locum tenens, (0.6 percent), according to Orthopaedic Practice in the U.S. 2008.
4. The majority of private orthopedic practices are group practices focused only on orthopedics. Of private practices, 44.3 percent are in orthopedic group practice, 20.9 percent are in solo practice and 8.3 percent are in a multi-specialty practice, according to Orthopaedic Practice in the U.S. 2008.
5. Orthopedic surgeons perform an average of 32 orthopedic procedures each month, according to the Orthopaedic Practice in the U.S. 2008 report. Among the most frequently performed procedures, arthroscopy of the knee was reported by more surgeons than any other procedures and with greater frequency, according to the AAOS's 2005-2006 census. Data was not collected on procedure frequency in the 2008 report.
6. Most orthopedic patients are enrolled in managed care plans or pay privately for their procedures. Orthopedic surgeons report that more than 50 percent of their patients are either enrolled in managed care plans (30 percent) or pay privately for their procedures (21) percent, while 32 percent of patients are covered by government payors, primarily Medicare. Workers' compensation patient payments accounted for approximately 12 percent of the patients, according to Orthopaedic Practice in the U.S. 2008.
7. Orthopedic surgery is the top-paying medical specialty. Orthopedic surgeons earn more than any other type of physician, with an average salary of $481,000 during 2008-2009, according to Merritt Hawkins & Associates' 2009 Review of Physician and CRNA Recruiting Incentives.
8. Orthopedic practice administrator salaries vary widely but are similar to the salaries of administrators of other types of physician practices. Based on nationwide surveys of orthopedic practices, the Health Care Group in Plymouth Meeting, Pa., reported that salaries for orthopedic administrators ranged from $50,000-$158,371 in 2008. Administers earn more as their experience and practice size grows. Based on comparisons of Health Care Group and MGMA data, salaries of orthopedic administrators appear to be in line with what administrators in other specialties earn.
9. A shortage of orthopedic surgeons performing joint replacement is expected in the next several years. According to two new studies presented at the 2009 AAOS Annual Meeting, the number of patients requiring hip or knee replacement surgery is expected to soon outpace the number of surgeons available to perform such procedures. If the number of orthopedic surgeons trained in total joint replacements continues at its current rate, in 2016, there will not be enough physicians to complete 46 percent of needed hip replacements and 72 percent of needed knee replacements. According to the authors of both studies, this shortage could be halted by improving reimbursement rates for total joint replacement, which has consistently decreased over the last several years.
10. Medicare professional fees for orthopedic procedures are, on average, more than 40 percent less than the average commercial payments. Medicare pays physicians significantly less than commercial payors for performing orthopedic procedures, but the differences between the two payors vary by procedure. For example, the Medicare allowable for a shoulder arthroscopy with lysis and resection of adhesions (CPT 29825) is $593 while the average commercial payment for the procedure in $1,350 — a payment of more than double the Medicare allowable. The Medicare allowable for shoulder arthroscopy; capsulorrhaphy (CPT 29806) is $1,071, and the average commercial payment is $1,285 — only 16 percent more than the Medicare allowable.
11. Spine in the most highly reimbursed subspecialty within orthopedics. Because of the increased difficulty of spine cases and the time needed to complete them, spine procedures receive, on average, the highest reimbursements of all subspecialties of orthopedics. An anterior discectomy with decompression of the spinal cord and/or nerve roots (CPT 63075) has an average commercial professional fee payment of $5,708, one of the highest average payments for all procedures within all subspecialties of orthopedics.
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