Orthopedics is under growing strains, ranging from AI disruptions and workforce shortages to reimbursement pressures and prior authorization delays.
Below, seven industry leaders single out the most urgent issue they believe threatens patient access, practice sustainability and the future of musculoskeletal care.
Question: What is one issue in orthopedics that deserves more attention right now?
Editor’s note: These responses have been lightly edited for clarity and length.
Gregory Berlet, MD. Retired Orthopedic Surgeon and Co-Founder of Orthopedic Foot & Ankle Center (Columbus, Ohio): AI is coming fast and being widely employed before it has been refined. AI slop is going to be a big problem. Patients are being guided by an AI agent that generates unrealistic expectations and creates confusion. The surgeon will have to find a way to get ahead of the conversation, but this will be challenging.
AI billing agents are communicating with each other (from the practice and from the insurance companies). The result will be a drive to oversimplification, delay and inaccurate reimbursement.
Lee Grossman, CEO of the Orthopaedic Research and Education Foundation (Rosemont, Ill.): The greatest issue that deserves more attention in orthopedics and all of MSK is the lack of research funding. MSK has the greatest burden of disease in healthcare and yet receives among the least amount of research funding of any disease condition.
The underlying impact of this disparity is having profound negative effects on our nation’s healthcare. This situation has been exacerbated this year as a result of the massive research funding cuts and disruption that our healthcare and research communities are experiencing.
To that end, and to address this critical moment, OREF partnered with the American Academy of Orthopaedic Surgeons and the Orthopaedic Research Society to hold a Research Summit last month to bring all the stakeholders (orthopaedic societies, industry and patient advocacy organizations) together to develop a unified plan to bring awareness to this situation and move forward to increase MSK research funding. We all agreed that our nation’s healthcare will not improve until and unless MSK research becomes a priority.
Elizabeth Matzkin, MD. Chief of the Women’s Sports Medicine Program at Brigham and Women’s Hospital and Assistant Professor of Orthopedic Surgery at Harvard Medical School (Boston): Prior authorization is interfering with timely, evidence-based musculoskeletal care. Delays in orthopedic surgery after conservative care has failed can result in progressive conditions, downstream costs or more complex surgery.
PA systems rely on algorithms that do not account for clinical judgement and the administrative burden and time wasted by staff and physicians for peer-to-peer calls. Appeals divert time away from patient care. We need to continue to advocate for timely, expert, compassionate and shared care for our patients.
Brandon Ortega, MD. Orthopedic Spine Surgeon at Long Beach (Calif.) Lakewood Orthopedic Institute: The biggest issue in orthopedics today isn’t a lack of clinical innovation; it’s the systematic erosion of the independent practice model. We are currently trapped between “reimbursement deflation,” driven by the latest CMS efficiency adjustments, and an unprecedented spike in the cost of doing business.
Spine surgery is one of the few fields where our revenue per unit of work is trending downward, while our overhead is skyrocketing. Between 2025 and 2026, we’ve seen staffing costs and implant pricing continue to climb, yet the 2026 Physician Fee Schedule has once again cut the very procedural RVUs that sustain a specialized practice.
Even more concerning is the shift in how we spend our time. We aren’t just fighting human medical directors anymore; we are fighting AI-driven “denial engines” that use natural language processing to flag and reject complex claims before a human even sees them. Independent practices don’t have the administrative scale of a massive hospital system to absorb these delays.
When you combine these “stealth cuts” with the administrative burden of prior authorizations, you force surgeons into employment models. This consolidation doesn’t actually lower costs; it just devalues the surgeon’s autonomy and limits the personalized, high-efficiency care that only an independent practice can provide. We need to stop pretending that surgery can just “get more efficient” to offset these cuts. We have reached the ceiling of operational efficiency; what remains is a direct assault on the viability of the private surgeon and the autonomy of our clinical decisions.
Michael Stauff, MD. Chair of Orthopedics and Medical Director of Spine Health at UMass Chan Medical School (Worcester, Mass.): The ripple effects of preauthorization for elective procedures, including delays in patient care. The use of preauthorization to control the type of surgery performed using haphazardly created criteria. The impact on the amount of back-office work required to move a patient to surgery, expanding the administrative burden. A peer-to-peer process that is not truly a peer-to-peer process.
Jerry Tillinger, CEO of Evolve Orthopedic Partners (Latham, N.Y.): At an operational level, the biggest challenge facing orthopedic surgery practices is the scarcity of high-quality, full-time anesthesia providers. Every market has a different dynamic, but too many orthopedic surgery ASCs are being forced to use travelers for both CRNA and MD-anesthesia needs. This raises costs significantly and is inherently lower quality because those providers are not consistent members of the care team.
Higher-acuity patients, quality program management and value-care programs all require consistent participation by the surgeons, anesthesia and management teams to be successful. Every member of that team needs the ongoing education and facility integration that only permanent team members can achieve.
If we want to be ready for the future state of orthopedic surgery care, we need to be investing more resources into training programs for both MDs and CRNAs to support the continuing push to migrate cases from high-cost hospitals to lower-cost ASCs.
Joseph Zuckerman, MD. Chair of Orthopedic Surgery at NYU Langone Health (New York City): The number of medical students applying to orthopedics from allopathic and osteopathic medical schools keeps increasing. The number of available positions increases at a far more modest rate. This means that each year, more and more students, even well-qualified students, will not match. Given the need for musculoskeletal care in this country, should we be addressing this with a more structured and strategic approach?
