Orthopedic care access is facing a slow-burning problem — one that doesn’t always show up in quarterly reports but is visible to patients trying to get in the door.
As CMS moves forward with a 2.5% reduction to the physician fee schedule, orthopedic surgeons warn the impact will extend far beyond margins, influencing who stays in practice, where care is delivered and how long patients wait for treatment.
R. Carter Cassidy, MD, chair of orthopedic surgery and sports medicine at Lexington, Ky.-based UK HealthCare, is already seeing how payment pressure intersects with workforce strain, administrative burden and an aging Medicare population that continues to demand care.
Why the physician fee cut hits orthopedics hard
Orthopedic surgery, particularly joint replacement, is heavily dependent on Medicare reimbursement, making even modest payment reductions difficult to absorb without operational tradeoffs.
“A lot of our patients are on Medicare, especially joint replacement patients,” Dr. Cassidy said. “With these cuts, physicians won’t be able to spend nearly as much time with people.”
Because practice costs, staffing, infrastructure and compliance do not decrease alongside reimbursement, surgeons are pushed to increase efficiency simply to maintain baseline operations.
“There’s a certain level of throughput you need just to pay staff and keep things running,” he said. “We really want to maintain the ability to see people and give them the time they deserve, but it becomes much tougher with these cuts.”
At the same time, administrative demands continue to grow. Preoperative optimization, insurance approvals and documentation requirements add hours of work that are often invisible in payment models.
“It feels like we’re doing more and more work, and it’s being recognized less and less,” Dr. Cassidy said.
Workforce pressure and the retirement tipping point
While reimbursement cuts affect all surgeons, Dr. Cassidy said the greatest impact may be on physicians nearing retirement, accelerating their exit from the workforce at a time when demand is rising.
“If you have to work a lot harder to do the same amount of work, people who are closer to retirement are going to leave,” he said. “They’re not going to want to deal with it.”
That attrition has immediate consequences for patient access — longer waits for consultations and extended delays between diagnosis and surgery.
“Fewer physicians means longer wait times to get in,” he said. “It means waiting longer in the office and waiting longer to actually have your joint replacement done.”
Even in systems with strong staffing, pressures are already surfacing.
“I’m already seeing patients having to wait much longer just to get in to see us,” Dr. Cassidy said. “People are putting things off longer than they should because they can’t find someone else to take care of them.”
Academic centers face unique recruitment challenges
Dr. Cassidy also flagged growing tension between financial incentives and the mission of academic medical centers.
Academic hospitals often care for higher-risk patients — complex cases that require additional resources and time but are increasingly disadvantaged under efficiency-driven reimbursement models.
“Larger academic institutions are often less efficient at delivering care because we take care of the sickest patients,” he said. “Those patients need more resources.”
In contrast, private practices and ASCs are better positioned for rapid turnover and higher volumes, dynamics that can influence where surgeons choose to practice, Dr. Cassidy added.
“It can put academic medical centers at a disadvantage when trying to recruit and retain the best surgeons,” he said, particularly when incentives favor speed over complexity.
Rural communities could bear the brunt
While access challenges persist across markets, Dr. Cassidy said rural patients are most vulnerable to the downstream effects of payment reductions.
“In rural areas, there are going to be fewer providers close to home,” he said. “Rural patients are really going to suffer; that’s what I worry about most.”
He witnesses firsthand ongoing consolidation in central Kentucky as small practices struggle to remain viable, a trend not limited to orthopedics.
“It’s becoming much harder to be a private practitioner or a small group,” he said.
The result is longer travel times for patients, reduced continuity of care and fewer opportunities for follow-up, all of which can affect outcomes.
“Some patients can’t drive two or three hours just for follow-up appointments,” he said. “Then they don’t get the same pre-op or post-op care, and complications become more likely.”
An aging population, rising demand
The timing of these pressures is particularly concerning, Dr. Cassidy said, given demographic trends. Patients are living longer, staying healthier and remaining active, even as their joints continue to wear out.
“We have people whose hearts and lungs are in great shape, but their joints still wear out just the same,” he said. “We’re going to have more Medicare-age patients who need orthopedic care.”
That reality raises a central question for the years ahead: who will be there to treat them?
“We’ll see how it plays out,” Dr. Cassidy said. “But I am concerned.”
What policymakers need to hear
After 20 years in practice, Dr. Cassidy sees a pattern repeating itself: physicians operating at the brink while hoping for late-stage policy fixes. His concern is less about short-term cuts and more about the long-term signal they send to the workforce.
“We want to incentivize the best and brightest people to take care of our population,” he said. “But as we continue to devalue what it means to take care of people, fewer people will want to do it.”
He remains proud of U.S. healthcare and its innovations, but believes the system hinges on maintaining a strong, motivated physician workforce.
