Every physician's career comes with twists and turns. In orthopedics, early career and established surgeons have encountered surprises ranging from shifting healthcare business models to unparalleled new responsibilities as physicians. Below, four surgeons discuss some of their biggest challenges.
Ask Orthopedic Surgeons is a weekly series of questions posed to surgeons around the country about clinical, business and policy issues affecting orthopedic care. We invite all orthopedic surgeon and specialist responses.
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Editor's note: Responses have been edited for style.
Question: What has been the most surprising aspect of your career?
Dr. Scott Sigman, MD. MD, of Rochester, N.Y.-based OrthoLazer Orthopedic Laser Centers: Having now been in practice for over 25 years, I am most surprised by the unsettled foundation of the business practice of healthcare. For the first 20 years of practice there were subtle, incremental changes in how healthcare was delivered. The process of accommodation was reasonable and affordable.
The post-pandemic era in particular has created opposing forces and confusion in the marketplace. Large hospital systems are growing and are attempting to move into local communities to capture outpatient surgical volume and ride the wave of ASCs. Commercial insurers are further ratcheting down payments, including Blue Cross Blue Shield of Massachusetts, which recently sent notice that they will no longer pay for X-ray interpretation in our offices.
For these reasons and more, our private practice decided to align with private equity. By partnering with other like-minded innovative orthopedic practices we can develop economies of scale, best practices and have the financial backing to expand and compete and thrive in the marketplace.
Michael Gitelis, MD. Gitelis Orthopedics (Deer Park, Ill.): Five years ago, I began learning about biologics. After studying for five years, I’ve become very knowledgeable. Biologics, if used correctly, are the future and now are morphing into senolytics. It has been a very rewarding, learning addition to my orthopedic practice.
Arun Hariharan, MD. Pediatric Orthopedics of Southwest Florida (Fort Myers): My career as an attending orthopedic surgeon is fairly young, so there have been many surprises. The most surprising thing has been the increased sense of responsibility. As a resident and in both my fellowships, I was fortunate to train at institutions that gave me significant independence, but the level of responsibility now is unparalleled. I feel personally responsible for not only the well- being of each of my patients and their outcomes, but also my staff members, my operating room team and even my partners. Along with this comes a greater sense of joy and pride. Each success story feels all the more successful. Each well-executed operation feels like a win for the entire team.
Jason Weisstein, MD. Yavapai Regional Medical Center. (Prescott, Ariz.): The most surprising aspect of my career so far has been the dramatic change in length of stay for the same surgeries that I was taught during residency training. Joint replacement patients used to stay in the hospital three to five days or more, whereas nowadays length of stay is significantly shorter, with a good percentage of patients going home the same day.