How orthopedic practices can get ahead of workforce shortages


Healthcare workforce shortages have increased dramatically since the COVID-19 pandemic as hospitals and health systems across the country battle to attract and retain talent, including primary and specialty physicians, nurses and administrative staff.

By 2030, the shortage of physicians in the U.S. is expected to reach 121,300, with the orthopedic sector anticipating a physician deficit of 5,050 and neurosurgery expecting a deficit of 1,200, according to a report by advisory group Physicians Thrive. California, Florida and Texas, where orthopedic growth is booming, are the states expecting the most significant physician shortages through 2030.

The main reasons the projected physician shortage is so large for orthopedics stem from the number of surgeons approaching retirement and the rate at which America's older population is increasing.

According to the Census Bureau, more than 54 million adults ages 65 and older live in the U.S., accounting for about 16.5 percent of the population. And the older adult population is growing: By 2050, the number of adults 65 and older is projected to increase to 85.7 million — roughly 20 percent of the population.

"If you just look at joint replacement in general, as baby boomers are getting older and needing more joint replacements, there's going to be a shortage of joint replacement surgeons," Richard Berger, MD, of Chicago-based Midwest Orthopaedics at Rush, told Becker's.

Chief among the challenges for orthopedic providers today is addressing the macroeconomic forces that have led to workforce shortages, according to Ernest Braxton, MD, a neurosurgeon at Vail, Colo.-based Vail-Summit Orthopaedics & Neurosurgery.

"It is becoming more and more difficult to recruit and retain top talent," Dr. Braxton told Becker's. "There are shortages of operating room staff and nursing care, making it difficult to keep our operating rooms running at full capacity."

Compensation is also an important factor, and reimbursement from federal insurance programs such as Medicare and Medicaid has been steadily declining for years. This has led to many surgeons opting out of the programs altogether, which unearths further concern around patients' access to care.

Reimbursement cuts typically have a trickle-down effect on other providers — if orthopedic surgeons are not being paid adequately, that can precipitate to physician assistants, advanced practice registered nurses and other providers.

"Physicians have staff who are facing the reality of cost-of-living increases, which has resulted in the 'Great Resignation' of the labor force,'' Alex Vaccaro, MD, PhD, president of Philadelphia-based Rothman Orthopaedic Institute, told Becker's. "We have to advocate against proposed Medicare cuts to have an ample workforce available for our aging patient population."

Physicians will continue to advocate against further Medicare reimbursement cuts, but recent advances in telehealth may offer a more immediate solution to the issue at hand.

"Get on the telehealth bandwagon. It's a great way to help people, not just in your office, but at home," Dr. Berger said. "You have to remember that we're talking about patients who have hip and knee arthritis. It's hard for them to get around to begin with and really hard for them to get to your office, and lots of people aren't getting treated because they can't get to the office."

The bottom line is orthopedic surgeons will be pushed to become even more efficient in the clinic and operating room, "but not doing the surgery faster," Dr. Berger said.

"The surgery is the important part. All the stuff that goes around the surgery, what's done in between cases and how to make that go more smoothly," he said. "There are lots of techniques that busy centers like ours use, which makes the turnover of cases easy. We use case carts where everything you need for the case is in a cart, and that makes the entire procedure so much faster in between cases."

Inevitably, orthopedic surgeons will look for ways to make their surgeries more efficient, which will place increased emphasis on the medtech industry to create more minimally invasive technologies that result in fewer complications, less surgical time and faster recoveries. Robotics, augmented reality systems and other advanced imaging and navigation platforms are at the top of many surgeons' wish lists.

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