Expanding and modernizing training programs, as well as engaging potential surgeons earlier in their education are crucial to improving the spine and orthopedic surgeon pipeline.
The number of orthopedic surgeons has steadily declined over the past few years. In 2021, there were 16,260 orthopedic surgeons in the U.S., but that number dropped to 14,100 in 2025, according to data from the Bureau of Labor Statistics.
This is not just a problem for the present day. According to the Health Resources and Services Administration, orthopedic surgery is facing a 12% shortage by 2038.
Recruitment is just one piece of the puzzle. Continuing to invest into surgeons, creating flexible practice models and reducing administrative burdens are key to retention.
Two leaders recently connected with Becker’s to share how the pipeline of orthopedic and spine surgeons can be improved to reduce and eliminate potential shortages in the future.
Note: Responses were lightly edited for clarity and length.
Question: How can the orthopedic and spine surgeon pipelines be changed meaningfully to improve recruitment and retention?
Amit Jain, MD. Spine Surgeon and Vice President, Care Transformation of Johns Hopkins Medicine (Baltimore): To meaningfully improve recruitment and retention in orthopedic and spine surgery, we must shift from a traditional high-attrition pipeline to a sustainable professional lifecycle through three structural changes:
- Earlier Exposure: Integrate musculoskeletal education and formal mentorship into pre-clinical medical school years, rather than relying on late-stage third year and fourth-year electives.
- Modernized Training: Transition toward competency-based advancement using surgical simulation and virtual reality. Shifting training culture from pure endurance to sustainable performance reduces early-career burnout.
- Flexible Practice Models: Retain mid-career talent by introducing flexible scheduling, staggered call systems and robust operational support, such as AI-driven documentation and care transformation models, to mitigate the administrative friction driving surgeons away from active practice.
We must treat recruitment and retention as a continuous investment in a surgeon’s professional longevity.
Lori Pagan. CEO of Orthopaedics NorthEast (Fort Wayne, Ind.): The orthopedic and spine workforce shortage is not simply a recruitment challenge; it is a pipeline challenge that begins years before a surgeon enters practice. Meaningful improvement requires action across training, practice design and long-term career sustainability.
First, residency and fellowship programs must expand training capacity in high-demand subspecialties, particularly spine, hand, sports medicine and adult reconstruction.
Second, practices and health systems must engage trainees earlier. Medical students and residents increasingly evaluate organizations based on culture, mentorship, autonomy and quality of life rather than compensation alone. Structured mentorship programs, early exposure to private practice and longitudinal relationships with residents and fellows can create stronger recruitment pipelines and improve long-term retention.
Third, the industry must address surgeon burnout. Today’s surgeons are entering practice with unprecedented administrative burdens, including prior authorization requirements, documentation demands and increasing regulatory complexity. Organizations that invest in advanced practice providers, AI-assisted documentation, optimized workflows and physician leadership development create environments in which surgeons can focus on patient care rather than on bureaucracy.
Finally, orthopedic groups must continue investing in physician leadership and governance. Surgeons are more likely to remain with organizations where they have meaningful input into strategic decisions, compensation design, quality initiatives and operational improvements. A culture of transparency, physician engagement, and shared accountability is often a stronger retention tool than compensation alone.
The organizations that will be most successful over the next decade are those that view recruitment and retention as a continuum — building relationships early, supporting surgeons throughout their careers, reducing unnecessary administrative burdens, and creating practice environments where physicians can thrive professionally and personally.
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.
