The consolidation reshaping orthopedic surgery isn’t slowing subspecialization — it’s accelerating it. As solo and small-group practices disappear, surgeons gain partners who can absorb more specialized cases, reducing pressure to remain a generalist.
Increased specialization could lead to improved patient outcomes, reduced costs and deeper expertise for surgeons.
Five physicians weighed in on the future of orthopedic subspecialization and whether a more focused field can stay a unified one.
Ask Orthopedic Surgeons is a weekly series of questions posed to orthopedic surgeons and leaders around the country about clinical, business and policy issues affecting orthopedic care. Becker’s invites all orthopedic surgeons and specialists to respond.
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Note: Responses were lightly edited for clarity and length.
Question: Where do you think orthopedic subspecialization is headed?
Harpreet Bawa, MD. Orthopedic Surgeon of DISC Thousand Oaks (Calif.): Orthopedic surgery will continue to move toward greater specialization. As the depth and volume of research within each subspecialty expands, physicians are simply more knowledgeable within their focused areas than they were a generation ago. Most orthopedic practices operate on volume, and there’s a direct relationship between the number of cases a surgeon performs and their proficiency — that reality naturally pushes surgeons to concentrate their practice.
This benefits more than just technical proficiency. Higher volume and focused expertise translate into better patient outcomes and meaningful cost reductions through shorter surgical times, optimal pre- and post-procedure management, and optimal handling of surgical complications when they arise.
At the same time, we are seeing less fragmentation. The independent private practice model has shrunk considerably, and consolidation has accelerated. Solo and small-group practices are increasingly rare, which means most surgeons now have partners who can take on the more specialized cases. That structure reduces the need for any one surgeon to be a generalist and reinforces the trend toward focused, high-volume expertise.
Brandon Haghverdian, MD. Orthopedic foot and ankle surgeon of Hoag Orthopedic Institute (Irvine, Calif.): Orthopedic surgery, much like other surgical specialties, continues to become increasingly subspecialized, with many surgeons narrowing their scope of practice to a particular body part or group of conditions. This can be beneficial, as greater case volume and focused experience allow surgeons to develop more refined techniques and deeper expertise in managing complex conditions. I expect this trend to continue, particularly in larger practices and metropolitan areas where patient volume can support narrower areas of expertise, while smaller communities will continue to rely on surgeons with broader scopes of practice.
Frank Liporace, MD. Senior Vice President, Musculoskeletal Service Line of RWJBarnabas Health, Northern Regions (West Orange, N.J.): As the field of orthopedics has evolved and technology has improved, we’ve seen the growth of subspecialties, each with their own specific knowledge base. I see orthopedic subspecialization as leading to further fragmentation but also consolidation based on need, patient demographics and available technologies, such as the growth of robotic navigation technology. The subspecialty of traumaplasty is one area where we have seen this occur.
Elizabeth Matzkin, MD. Orthopedic Surgeon and Chief of Women’s Sports Medicine of Brigham and Women’s Hospital (Boston): We will continue to specialize, but we must remain collaborative to represent and advocate for the entire field of orthopedic surgery. We are stronger together.
Leo Spector, MD. Orthopedic Spine Surgeon and CEO of OrthoCarolina (Charlotte, N.C.): I think orthopedic subspecialization is moving toward more intentional concentration of scope, not fragmentation, and there is a strong clinical rationale for that shift. Much of orthopedic care is repeatable and process-driven. When care can be standardized, teams become more efficient and outcomes improve. Hip and knee replacement surgery is a clear example of how standardized care pathways can create efficiencies while improving results.
I see this trend leading to centers of excellence built around specific service lines. That is central to how we are approaching our ASC strategy at OrthoCarolina. A team focused exclusively on orthopedic surgery is positioned to perform orthopedic surgery better, benefiting patients, physicians and payers. That is why we are prioritizing single-specialty orthopedic ASCs over multispecialty centers. Dedicated centers allow us to align facilities, teams and processes around the clinical realities of orthopedic care rather than trying to fit everything under one roof with inconsistent infrastructure.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
