The drive for optimal patient outcomes and lowering cost is changing the way providers deliver healthcare, and poses a unique set of challenges for orthopedic surgeons moving forward.
Here are four challenges orthopedic surgeons will face next year:
1. Meeting patient demands in a diminishing surgeon workforce. The number of patients requiring total knee and hip replacement is increasing quickly. The National Institutes of Health estimates demand for total hip arthroplasties will jump by 174 percent by 2030, hitting 572,000 procedures. The number of primary total knee arthroplasties is expected to grow by 673 percent, reaching 3.48 million procedures by 2030.
However, dwindling reimbursement is one of the factors deterring people from pursuing a medical career or may play a part in the type of medicine they pursue. Medical Student Education published a studying finding 15 percent of fourth-year medical schools reported payment as the primary factor driving their career selection.2
The Association of American Medical Colleges found the United States will face a shortage of between 61,700 physicians and 94,700 physicians by 2025. By 2025, there will be a projected shortage between 25,200 surgeons and 33,200 surgeons.
"Even if the current number of TJRs stayed the same, the need would outstrip the number of surgeons," says Richard Berger, MD, of Chicago-based Midwest Orthopaedics at Rush. "It is getting harder to get skilled people into doing TJR, especially if you have a more complex case."
For general orthopedic procedures, Ira Kirschenbaum, MD, chairman of orthopedics at Bronx-Lebanon Hospital Center in New York, notes if orthopedic surgeons don't rise to the challenge of meeting the population's musculoskeletal needs, other providers will step in, such as physician assistants, podiatrists or family medicine physicians.
"We are having an older baby boomer population and we don't know if there will be enough operating rooms and orthopedic surgeons to handle the needs of this population," he says. "If orthopedic surgeons don't meet these needs, allied professionals would have their scope of privileges expanded, allowing them to perform general orthopedic procedures. It wouldn't be the first time the world responded to a shortage."
Subspecialization amongst orthopedic surgeons is an increasingly common practice, which Dr. Kirschenbaum argues may add to this shortage of surgeons managing musculoskeletal diseases.
"If someone only wants to do shoulder surgery, who will do elbows and hands?" Dr. Kirschenbaum says. "We shouldn't just be proceduralists. Uber-specialization has hurt our ability to manage primary musculoskeletal conditions."
2. Limited face-time with patients. An Annals of Internal Medicine found physicians in ambulatory settings spend 49.2 percent of their time on EHR and desk work during office hours, leaving physicians limited facetime with patients. The study also found when physicians were in the examination room with patients, they spent 52.9 percent of their time on direct clinical facetime and 37 percent on EHR and desk work. Value-based care places more focus on the patient, and orthopedic surgeons face a juggling act to comply with reporting requirements while also giving patients ample one-on-one contact.
"With the government, once a policy is in place, it is not going away. There is new paperwork on top of old paperwork and that old paperwork doesn't go away," Dr. Berger says. "While new guidelines may have the best intentions, they oftentimes are not very helpful and add more bureaucracy."
3. The need for orthopedic surgeons to fulfill leadership roles. Hospital employment is rising, and health systems are transitioning physicians into integrated care delivery systems. From July 2012 to July 2015, the percentage of hospital-employed physicians increased almost 50 percent. There were 67,000 hospital-owned physician practices in 2015, up 86 percent from 2012. The shift to an employment model poses both a challenge and an opportunity for those orthopedic surgeons looking to take on a leadership role and actively participate in an organization's direction moving forward.
"Not everyone will want to be a leader," Dr. Kirschenbaum says. "We need to find those surgeons not only with leadership skills, but find the people in our specialty who are the right leaders and educators to help everyone through these changes."
Leadership is not necessarily taught in medical schools, and many physicians have to take on a dual role as a practitioner as well as a business-oriented individual. More physicians are going to business school to obtain the background information necessary to run a practice and succeed in the ever-competitive healthcare arena.
"Doing 500 cases a year and having someone pay you to do these cases doesn't make you a good businessman," Dr. Kirschenbaum says. "Business and leadership are a science and surgeons need to get these leadership skills. Orthopedic surgeons have a lot to contribute and our absence in leadership roles would have a devastating effect on orthopedic surgeons and care coordination."
4. Healthcare is plagued by uncertainty. The changes sweeping the healthcare industry leave many orthopedic surgeons unsure of how to proceed. With the rise of employment and push for reporting, uncertainty masks the role of the physician.
"Healthcare used to be simple," Dr. Berger says. "Patients walked in, you helped them and did a good job and that was it. Now, doctors are going to have to be more business-minded and interact with many layers of bureaucracy. Gone are the days of just helping the patient."
Dr. Berger says our nation's legislators need to act now to ensure the United States remains on the forefront of medicine. People from around the globe come to the United States, seeking a medical education and a career. However, declining reimbursement and mounting regulation are dissuading many from pursing a medical degree here, which could serve to our nation's detriment.
"I hope there is a light at the end of the tunnel and we can rectify it. Someone in charge should realize we should preserve our healthcare system, which is currently the best in the world. Patients are starting to understand how crucial this is and I hope we can convince elected officials before it is too late," Dr. Berger says.