As orthopedics sees a decline in the number of physicians in the specialty, surgeons say practices will have to adapt to stay afloat.
The number of orthopedic surgeons has seen a steady decline since 2021, according to the most recent data from the U.S. Bureau of Labor Statistics. In 2025, the number of orthopedic surgeons, not including pediatrics, was 14,100. That’s down from 16,260 in 2021.
Physicians discuss what this trend means for orthopedics’ future,
Editor’s note: Responses are lightly edited.
Question: If this shortage continues on its current trajectory, what will it mean for your practice in five years?
Frank Aluisio, MD. EmergeOrtho (Greensboro, N.C.): The projected shortage in the number of practicing orthopedic surgeons is alarming. In a time where the population of those over 60 is expanding rapidly and demand for orthopedic services is concomitantly growing rapidly, we cannot afford to have such a decline in the number of surgeons available to provide these services. This will cause undue stress on the existing providers and most likely increase burnout rates, leading to earlier retirements and even further decreases in our workforce.
Without regulatory and reimbursement reform it will already be extremely difficult for practices to survive financially. If the workforce shrinks further, practices will have to limit available services and unfortunately this will negatively affect access to care. Services with low profit margins will have to be limited or eliminated with an emphasis placed on services that will keep the practice financially viable.
Practices will also have to adapt to the way in which care is provided. There will be a much heavier reliance on mid-level providers to perform in-office services to allow surgeons to address the projected higher volume of operative cases. Practices will also have to implement new revenue strategies such as alternative payment programs and direct to employer models to improve revenue and decrease the physician and practice burdens (prior authorization, denials) inherent in working with current insurance companies.
Even with these changes, it will be difficult to provide our current level of service with a smaller workforce unless we see significant improvements in reimbursement, regulatory reform and insurance reform, which will make it easier for physicians to practice and focus on what is most important — patient care.
Cory Calendine, MD. Bone and Joint Institute of Tennessee (Franklin): Basic economics would predict that as surgeon supply falls and surgical volume climbs, reimbursement should rise to meet demand. It won’t because Medicare sets the price, but not the market.
So we will get the shortage without adjustment. And the problem is bigger than we tend to think. Per 2021 AAMC data, roughly 60% of orthopedic surgeons (more than 11,000 of us) will reach age 65 by 2031.
That changes three things fast. Efficiency stops being a luxury and becomes a requirement of the system. Access, especially in non-metro areas, becomes the central equity issue. And the training pipeline can’t refill that fast, so the access problem extends well beyond 2031.
In summary: more demand, fewer of us and access will suffer even as efficiency benchmarks become mandatory.
Christian Pean, MD. Duke University School of Medicine (Durham, N.C.): If the shortage continues on its current trajectory, the path forward has to be empowering surgeons to spend more time operating and less time on administrative work. Shrinking reimbursements compound the problem — they squeeze practices at exactly the moment when demand is accelerating and the workforce is contracting.
I also anticipate the transition to accountable care to accelerate. Episode-based and population-based models like TEAM and ACCESS reward the kind of coordinated, team-based delivery that a shrinking workforce will require to keep pace.
In five years, AI will need to take on a much larger role across the administrative layer and the downstream care continuum: intake, documentation, patient education, PROM collection, post-acute coordination. That is the only realistic way to protect surgical capacity and keep access from collapsing.
Lisa Cannada, MD. University of North Carolina (Charlotte): Recent Bureau of Labor Statistics data reflecting a steady decline in the number of orthopedic surgeons since 2021 — from approximately 16,260 to 14,100 in 2025 — and projections of a workforce shortfall by 2036 as demand rises by up to 13% while supply contracts warrant careful, subspecialty-specific interpretation before drawing broad conclusions. From the vantage point of an orthopedic trauma surgeon practicing within a major metropolitan medical center, the data as presented does not reflect the reality of our subspecialty. Orthopedic trauma has maintained a robust pipeline through fellowship training, with approximately 100 fellowship-trained trauma surgeons finishing fellowship annually. That throughput, concentrated largely in high-volume urban and level I trauma centers, has far sustained workforce adequacy within the subspecialty at institutions where the patient volume and infrastructure justify and attract that talent and actually the graduating fellows may feel more concerned about finding their desired job.
The more substantive concern is one of geographic and subspecialty maldistribution rather than an aggregate shortage at the national level. Rural and underserved regions, which lack the large institutional infrastructure, referral networks, and academic affiliation that draw fellowship-trained surgeons, are likely bearing a disproportionate share of workforce allocation. The data presented should prompt targeted policy and program responses aimed at access gaps — incentivizing placement in underserved areas, supporting rural trauma and orthopedic coverage models, and evaluating what orthopedic subspecialties may benefit from pipeline expansion — rather than broad alarm applied uniformly across orthopedic surgery.
Philip Louie, MD. Virginia Mason Franciscan Health (Seattle): There are important considerations on three separate levels.
1. Individually. As the surgeon, I should not be the bottle neck for MSK care. Triage, workup, and follow-up will be heavily redistributed to APPs, physiatrists, PT and AI-enabled pathways.
2. As a hospital system. The systems that build real hub-and-spoke models with virtual consultation and reproducible clean handoffs will own the regions that rural patients can no longer reach.
3. As an entire field and industry. Enabling technologies have to do more than the current OR tools. They need to integrate upstream with MSK care, advance our personalized understanding of risk and surgical indications, improve intraoperative safety and efficacy, and capture meaningful subjective and objective outcomes on the back end. These tools need to impact the entire episode of care.
Kevin Plancher, MD. Plancher Orthopedics: If the orthopedic surgeon shortage continues, healthcare will drift toward an employed model increasingly driven by administrators and constrained reimbursement rather than the art and science of compassionate patient care. More patients will face long waits and be directed toward midlevel providers to reduce costs. As patients lose direct relationships with experienced orthopedic surgeons, there would be a profound loss to our profession.
Sean Tabaie, MD. Nationwide Children’s Hospital (Columbus, Ohio): The data from the Bureau of Labor Statistics is concerning but frankly not surprising to those of us who have been watching workforce trends in orthopedics closely. We have been aware of this trajectory for some time, and it is one of the reasons workforce development and pipeline issues are such a priority at the Academy level.
If this shortage continues on its current trajectory, the implications for practice over the next five years are significant and multilayered. On the clinical side, we will see increased demand placed on each surgeon in the workforce, meaning longer wait times for patients, greater pressure on those of us in practice, and real risk of burnout accelerating the very shortage we are trying to address. It becomes a self reinforcing cycle that is difficult to reverse once it gains momentum.
From a practice standpoint, we will also face intensifying competition for qualified support staff, advanced practice providers, and surgical time, all of which drive up overhead and compress margins at a time when reimbursement pressures are already acute.
Perhaps most importantly, underserved and rural communities will feel this most acutely. Orthopedic care is not elective for a patient with a hip fracture or a child with scoliosis. Access to care becomes a genuine public health issue when the workforce cannot meet demand.
This is exactly why mentorship and pipeline investment at the residency and medical student level are so critical right now. We need to be intentional about recruiting the next generation of orthopedic surgeons and supporting them once they are in training. The decisions we make in the next few years will shape what the specialty looks like a decade from now.
Vijay Yanamadala, MD. Hartford (Conn.) Healthcare: The BLS data tracks orthopedic surgeons specifically, but the shortage is felt acutely across all of spine care — neurosurgeons and orthopedic surgeons share this patient population, and the downstream effects on access, wait times, and case mix will look the same regardless of which residency a surgeon completed.
Here is what I expect over the next five years if the trajectory holds:
First, wait times for elective spine surgery will lengthen significantly, particularly in mid-sized and rural markets where there is no slack in the system today. Patients already travel two to three hours for consultation in some regions. That will become the norm rather than the exception, and high-volume systems will consolidate spine care into regional centers of excellence. This is largely good for outcomes — the volume-outcome relationship in complex spine is well established — but it will create real equity problems for patients without the means or mobility to travel.
Second, the shortage will force a long-overdue reckoning with how much surgical capacity we actually need. The U.S. performs spine surgery at rates several times higher than peer countries with comparable outcomes. Roughly half the spine consultations I see today could have been resolved earlier and more effectively in a conservative pathway. If we have fewer surgeons, we will be forced to do what we should have been doing all along — reserving the operating room for patients who truly need it, and routing the rest to evidence-based conservative care. That is not a loss. That is a correction.
Third, AI will absorb a meaningful share of the work that currently consumes surgeon time but does not require a surgeon’s hands. Triage, imaging review, pre-operative planning, documentation, post-operative monitoring are tasks where AI is already outperforming the status quo. Combined with scope expansion for advanced practice providers in pre- and post-operative care, I expect a single surgeon to be effectively two to three times as productive as today, not because we are working harder, but because we are finally offloading the work that was never the highest use of our training.
For my own practice at Hartford HealthCare, the shortage reinforces what we have been building toward: a model where conservative care is the default, surgery is the exception, and technology amplifies the surgeon rather than replacing the relationship with the patient. The best back surgery is still no surgery, and a workforce shortage may finally make our healthcare system act like it believes that.
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