As demand for musculoskeletal care accelerates, orthopedic programs are under pressure to train more specialists, use data effectively and deliver higher-value care.
Joseph Zuckerman, MD, chair of orthopedic surgery at NYU Langone Health in New York City, has led one of the nation’s largest and most influential programs through these shifts — and says the challenges are only growing.
“The big picture is that there’s more and more need for musculoskeletal specialists because, as the population ages, these problems become more common,” Dr. Zuckerman said. “It’s impossible for orthopedic surgeons to see every patient with a musculoskeletal issue.”
He noted that many patients are first seen by nonorthopedic clinicians such as rheumatologists, physiatrists or primary care sports medicine physicians. Meeting this growing demand, he said, requires a broader workforce and expanded training across specialties.
“At NYU, we think we’re doing our part because it’s the largest orthopedic residency program in the country — 14 residents per year,” he said. “We’re considering increasing it to 16 because we can train people at a high level. We also train fellows in seven specialties, including a primary care sports medicine fellowship.”
He added that musculoskeletal education should begin well before residency.
“Orthopedics usually doesn’t have much input in medical school training,” Dr. Zuckerman said. “That needs to change. The same is true for primary care specialties. They should be exposed to more musculoskeletal education and experience.”
NYU’s scale allows the department to make an impact nationally, with graduates entering practice across the country and new sites opening throughout the New York region.
“We’re mirroring the growth of NYU Langone Health,” he said. “When NYU Langone expands into Brooklyn or Nassau or Suffolk, we’re putting more orthopedic surgeons out there.”
For him, preparing the next generation of surgeons goes beyond technical training.
“Orthopedic surgeons today need to appreciate, first and foremost, the outcomes of what we do,” he said. “Surgeon-based outcomes are different from patient-based outcomes. I may look at an X-ray of someone who had a shoulder replacement and think it looks perfect, but if that patient can’t do what they expected to do, that’s a problem.”
Understanding patient expectations — and the cost of care — is just as important.
“Everything we do under the heading of ‘better’ generally costs more money,” he said. “Robotic knee and hip replacements are technological triumphs, but we haven’t yet answered whether they’re worth the additional expense.”
NYU Langone has taken a data-driven approach to those questions.
“We decided back in 2007 that everything had to be data driven — no more anecdotes,” Dr. Zuckerman said. “When we converted to the Epic system, we built dashboards that show, in real time, exactly what’s going on for every faculty member — how many cases they do, what their outcomes are. It’s updated daily.”
Those dashboards provide visibility across the health system.
“If you asked me what cases were done at our Suffolk County campus today, it would take me two minutes to find out,” he said.
That transparency, paired with a strong culture of accountability, has made NYU Langone a national leader in quality.
When it comes to new tools, Dr. Zuckerman said evidence must lead the way.
“Right now, technology is mostly market driven,” he said. “It’s driven by manufacturers producing the technology. Patients come into my office all the time asking whether I do robotic shoulder or knee replacements because they’ve been told — or assume — it’s better. It might be. It might not. We don’t know yet.”
He believes the future of orthopedics depends on aligning innovation with outcomes data.
“If the data show a technology truly improves outcomes, then full speed ahead,” he said. “If it doesn’t, we need to hit the brakes. We have to prove new tools actually add value.”
For Dr. Zuckerman, that balance between data, technology and patient outcomes will define the next era of orthopedic surgery.
“Technology, orthopedic care, outcomes and value,” he said. “That’s the four-legged stool we have to focus on.”
