The orthopedic workforce shortage is widening — but not everywhere. While major cities like New York, Boston and Philadelphia remain well-staffed, less populated regions are struggling to attract and retain surgeons.
That imbalance, said William Levine, MD, Frank Stinchfield chairman of orthopedic surgery at New York city-based Columbia University and orthopedic surgeon-in-chief at New York-Presbyterian/Columbia, is reshaping how training programs and health systems think about preparing the next generation of orthopedic leaders.
Dr. Levine said smaller communities need general orthopedic surgeons who can handle a range of procedures — from carpal tunnel release to joint replacement — because many patients can’t realistically travel to major centers of excellence.
He believes residency programs should identify candidates early who are inclined toward smaller or underserved markets and support them with guaranteed employment pathways. That, he said, could alleviate some of the anxiety that often surrounds the transition from fellowship to practice.
“There’s really two pathways,” he said. “There’s no shortage of orthopedics in major cities, but there’s more of a shortage in the less-populated areas. For patients in those areas, that’s a real concern.”
Training beyond technique
For Dr. Levine, however, the pipeline challenge is inseparable from surgical education itself. Training programs, he said, must go beyond technique to teach critical thinking, adaptability and judgment.
“Surgical education is the lifeline of what we do,” he said. “If you think of it only as the transfer of technique-related steps — ‘I’m going to teach you how to do a total knee from A through Z’ — then you’re failing miserably as a surgical educator.”
He emphasized that 95% of what he performs today wasn’t part of his formal training. The lasting value of residency and fellowship, he said, lies in learning how to make decisions and solve problems when operations don’t unfold as expected. The best educators, in his view, train surgeons to think rather than to replicate.
Balancing innovation with fundamentals
That philosophy also shapes how he approaches innovation. Orthopedics has seen rapid advancement in robotics, AI and digital technologies, but Dr. Levine believes discernment is just as important as adoption.
“You have to decide which bandwagons you’re going to get on and which ones are just flashes in the pan,” he said. “It’s OK to be in the middle of the curve, but you probably don’t want to be the laggard.”
AI, he noted, has already proven its staying power. At Columbia, his team uses an AI-enabled scribe to streamline documentation, allowing surgeons to focus more on patients. He described it as a meaningful step toward restoring the human connection in care.
“AI is not hype,” he said. “It’s already changing medicine.”
Robotics, he added, continues to evolve but must be implemented responsibly. He pointed to Zimmer Biomet’s decision to pause the rollout of its shoulder robot as a model of professional restraint. He also warned against allowing technology to erode fundamental surgical skills.
“You can’t have residents and fellows leaving training not knowing how to do handheld cuts,” he said. “When the robot’s down, you can’t cancel the case.”
Dr. Levine often reminds trainees that creative thinking — not gadgets — is what defines great surgeons. He likens it to the television character MacGyver, who could defuse a bomb with little more than a pen.
“You might not have all the gadgets and gizmos you have at Columbia in a smaller operating room or a developing country,” he said. “You’ve got to move forward. You have to use your brain, not just your brawn.”
Leading through pressure and change
Outside the OR, he is candid about the financial and policy pressures facing academic medicine. Shrinking margins, reduced reimbursement and declining federal support have affected even top-tier institutions.
Still, he approaches those challenges with focus and transparency. Rather than dwell on what’s beyond his control, he concentrates on leading his department and supporting his team.
“I need my full attention and energy on the things that I can control,” he said.
Optimism for the next generation
What gives him the most optimism, he said, are the people entering the field. Each year, hundreds of students apply to Columbia’s orthopedic residency program, and their credentials and commitment inspire confidence in the future.
“We have the hardest working, most talented, and committed group” he said. “When I look at their accomplishments, it’s remarkable and empowering.”
Despite financial strain and administrative complexity, Dr. Levine remains grounded in purpose.
“The ability to be an orthopedic surgeon — to impact a patient’s quality of life — is actually the highest of all subspecialties in medicine,” he said. “That’s not going to change.”
In his own practice, he finds renewed satisfaction in spending more time with patients and ensuring they understand their care plans.
“My goal is that they leave without one unanswered question,” he said. “Our ability to allay fears and concerns, if we just spend the time to do so, is really powerful.”
For Dr. Levine, that human connection — the trust between surgeon and patient — is what keeps orthopedics meaningful, no matter how much technology or policy evolves.
“We’re blessed to do what we do,” he said. “And that’s what keeps me optimistic about the future.”
