'This system is unsustainable': Why orthopedic surgeons do not feel fairly compensated


Three orthopedic surgeons recently connected with Becker's to discuss whether they feel fairly compensated in their profession. 

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.

Next question: What should orthopedic leaders avoid to be successful?

Please send responses to Riz Hatton at rhatton@beckershealthcare.com by 5 p.m. CST Thursday, Feb. 9.

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

Ramy Elias, MD. Medical Director for the Center for Advanced Orthopedics & Sports Medicine at Cerritos (Calif.) Surgery Center: I would say definitely not. Medicare has continued to cut our reimbursement year after year despite our cost of doing business as an independent practice having gone up significantly. At the same time, we are asked to do more and more uncompensated care. This has forced a record number of independent practices to close down or sell to private equity. When this happens, the cost of healthcare escalates and the patients suffer the most. We are also the only profession that provides a service without ever knowing if we'll get paid for it or not. This system is unsustainable.

Hooman Melamed, MD. The Spine Pro (Beverly Hills, Calif.): Not at all. Unfortunately, insurance companies are treating surgeons as commodities and they do not distinguish between experience, clinical outcome and patient satisfaction. I don't think a surgeon who is just starting our practice should be reimbursed the same as another surgeon who has been in practice for more than 20 years and they have excellent outcomes with superior results.

Just like in any other profession, the fee for that service is based on quality and experience, something which insurance companies completely ignore when it comes to the physician payments.

Also, why should hospital-employed physician reimbursements be three, four or five times higher than private-practice physicians? 

The standard of living, cost of running a practice, overhead, cost of living and everything else has gone up except physician reimbursements. Our pay has continuously decreased year after year whereas insurance companies profits have increased year after year and their own CEO and executives have been getting higher pay year after year.

Anthony Melillo, MD. Founder of Bay Oaks Orthopaedics & Sports Medicine (Houston): No. Each year, I and every other orthopedic surgeon get reimbursed less and less for the expert and demanding services we provide.

I'll perform a complex hip and/or knee reconstruction that takes two to three hours of operating room time. A procedure that takes years of training and experience to be qualified to perform, several hours of prep time and coordination with reps and staff, and make less money than my mechanic or accountant for less time, effort and societal benefit. This surgical fee also includes the 90-day post-op period/rounding on the patient in the hospital, too.

Understand that I'm an independent orthopedic surgeon and have been practicing for more than 28 years. I'm at my best in terms of experience, skills and judgment. Due to the falling reimbursements and significant increase in all overhead, I'm planning on retiring three to five years earlier than I expected. Sadly, I'm not alone.

Cuts in Medicare generate cuts in commercial insurance and just continue the downward spiral of compensation.

I ask you a simple question: Who do you want to operate on you or your family member: an overworked, relatively inexperienced orthopedic surgeon (ER night call, bonus driven, partnership driven) or a seasoned experienced surgeon who practices for the love of the work but desires a fair compensation to justify the time away from family or friends? I'm the latter, but the falling reimbursements are pushing me to rethink my past decisions on retirement.

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