Ten surgeons connected with Becker's to describe the future of orthopedics in one word.
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's next for artificial intelligence and augmented reality in the orthopedic industry?
Please send responses to Riz Hatton at firstname.lastname@example.org by 5 p.m. CDT Thursday, May 11.
Note: Responses have been lightly edited for length and clarity.
Brett Auerbach, DO. Orthopedic Surgeon at Guthrie Medical Group (Sayre, Pa.): Innovative. The future of orthopedic surgery will give rise to rapidly advancing technology. We will see the continued expansion of robotic-assisted surgery and artificial intelligence. There will also be an expansion in the indications and roles for orthobiologics for sports medicine and orthopedic surgeries. New technology will continue to emerge as the demand for orthopedic surgeries continues to increase.
Rey Bosita, MD. Spine Surgeon at Texas Back Institute (Plano): Uncertain. We face downward pressure on reimbursement from government and private payers, while facing the increasing economic burdens of increasing labor and technology costs just to keep the practices open, triggering many sales to private equity firms and partnering with hospital systems to try and find a safe harbor in the financial storms.
While this provides short-term windfalls for some surgeons, the end result is that the surgeons are no longer the owners of their practices and the level of control and personal investment is greatly decreased. Our surgeries are becoming more expensive in both the inpatient and outpatient settings as high-cost technology such as image guidance and robotic surgeries are used more often, along with continuing trends of using more expensive hardware and biologics. Clinical pathways, algorithms and AI will alter both doctor-patient and doctor-doctor relationships as healthcare becomes a commodity.
Furthermore, now that the USMLE Part 1 exam is pass-fail, residency programs are tasked with finding new ways to identify outstanding candidates for training the future surgeons. Orthopedic surgeons act as advocates for their patients with payers to get covered procedures approved while facing scrutiny from other doctors (not all are orthopedic surgeons). Our colleagues have also assumed leadership roles in medicine, but the level of influence is mitigated by fragmented factions preventing unity of thought and purpose among and within specialties.
As a specialty, we stand at a crossroads in healthcare: Some surgeons and patients may suffer as the landscape changes, but truly enterprising orthopedic surgeons will see this uncertainty as opportunity.
David Kalainov, MD. Medical Director of Musculoskeletal at Northwestern Memorial Hospital (Chicago): Consolidation. The U.S. healthcare system is accelerating away from fee-for-service and toward value-based care payment mechanisms. Effective participation in shared-savings payment models (CMS and commercial health insurers) often necessitates provider consolidation for economy-of-scale, data tracking and data reporting. In the not-too-distant future, payers, providers and suppliers will likely consolidate in new ways to maximize value.
William Kemp, MD. Neurosurgeon at Virginia Spine Institute (Reston): The future of spine surgery is mobility. Evidence-based medicine will ultimately show that in the right patient, preserving and restoring motion with disc replacement will ultimately prove to be a more effective long-term solution than fusion in spine surgery.
Jason Koh, MD. Chair of Orthopaedic Surgery at NorthShore University HealthSystem and Director of NorthShore Orthopaedic & Spine Institute (Skokie, Ill.): Innovative. Orthopedic surgery will continue to change and evolve to address the needs of our patients. Innovation will continue to occur in multiple areas, including surgical procedures, information analysis and care delivery. Increasingly, computer-assisted and robotic surgery can assist in planning and executing complex surgical procedures, and the technology is becoming increasingly less expensive, more accurate and available. The use of biologics and regenerative medicine continues to develop and hold the promise of restoring function without replacement. Artificial intelligence and machine learning are informing our ability to predict and potentially modify risk and patient outcomes. Finally, as demand for orthopedic services continues to increase in an increasingly challenging reimbursement environment, orthopedics will have to innovate around lower cost, higher efficiency care models of delivery.
Philip Louie, MD. Spine Surgeon at Virginia Mason Franciscan Health (Seattle): Outpatient. The past decade has shown us that orthopedic and spine surgery (in the properly indicated patient) can be performed in a safer, more efficient and cost-saving manner compared to the traditional large hospital setting. This migration of surgeries to the ambulatory surgery centers and other outpatient centers have been fueled by the innovation of several enabling technologies. With ongoing financial stressors of large hospital systems and patients' concerns with hospitals, the ability to expand technologies to aid safe surgeries in outpatient settings will be paramount. Understanding how this all plays out in a landscape trying to become more value-based centric will be interesting to be a part of.
Vivek Mohan, MD. Orthopedic Surgeon at Southern California Permanente Medical Group (Pasadena): Patient-driven automation of care.
Kevin Parvaresh, MD. Orthopedic Surgeon at Hoag Orthopedic Institute (Orange, Calif.): Regenerative. Regenerative medicine is a rapidly expanding field of medicine, particularly in orthopedics. The development of biologics to combat disease and accelerate healing is becoming more mainstream. There is a wide variety of uses for biologics ranging from treatment of arthritis to traumatic injury treatment.
Various clinical trials are currently being developed to determine specific indications for biological use. Formulation differences and preparation techniques are also being honed to better deliver biologics in a safe and effective manner. Government oversight is still a factor regarding ensuring patient safety.
Future biologics will be developed that can be individualized to patient pathology and goals. Current biologic research has shown promise and will continue to improve.
Arjun Saxena, MD. Adult Hip and Knee Reconstruction Surgeon at Rothman Orthopaedic Institute (Philadelphia): Bright. As orthopedic surgeons we have the coolest jobs in the world. We use power tools, advanced cameras and technology to improve the lives of our patients. We will continue to innovate and improve care for our patients; think of the advancements over the last 20 years. Being in academics, I have seen resident and fellowship applications; the young physicians and researchers are impressive, to say the least. I am confident we continue to attract the best and the brightest to orthopedic surgery. I am excited to see what the future holds!
Thomas Schuler, MD. Founder and CEO of Virginia Spine Institute (Reston): Miraculous! Technological advances are enabling specialists to heal people and restore their lives in ways never possible before now. Minimally invasive surgeries, motion preserving and restoring surgeries, and the use of biologics combined with better knowledge and robotic and AI technologies all enhance the treatments, and thus options, for our patients. It is a wonderful time for people to be able to heal and get on with their lives.