Orthopedic surgery spends a great deal of time worrying about its future workforce. Will there be enough surgeons? How will programs recruit talent? Can the specialty keep pace with growing patient demand?
For Amiethab Aiyer, MD, division chief of foot and ankle surgery at Baltimore-based Johns Hopkins University, those conversations often overlook a more fundamental question. How do future orthopedic surgeons find the specialty in the first place?
The realization did not come from a workforce study or national report. It emerged through years of conversations with medical students. Early in his career, Dr. Aiyer found himself advising students at the University of Miami, where he saw firsthand the difficulties for aspiring orthopedic surgeons to find mentorship, understand the application process and gain meaningful exposure to the specialty.
As word spread, students from other institutions began reaching out. Then came friends of those students. Before long, he was hearing many of the same questions from students across the country. The pattern was impossible to ignore.
“There was a lot of heterogeneity of access,” Dr. Aiyer told Becker’s. “Access to information, access to opportunities, access to experiences and ultimately access to understanding how to get from being a medical student to becoming a competitive applicant.”
The issue was not interest. Students wanted to learn about orthopedics. The issue was access.
Not every medical school had a strong orthopedic department. Not every student had a mentor. Not every aspiring surgeon knew how to navigate one of medicine’s most competitive specialties.
Support for aspiring orthopedic surgeons exists in many forms. Organizations such as the American Academy of Orthopaedic Surgeons, American Orthopaedic Association, Perry Initiative, Ruth Jackson Orthopaedic Society, J. Robert Gladden Orthopaedic Society and numerous specialty societies all provide mentorship and educational resources.
The challenge, Dr. Aiyer said, is that students often do not know where to start. Information exists, but it is scattered across institutions, organizations and personal networks that can be difficult to navigate without guidance.
That realization ultimately led Dr. Aiyer to co-found OrthoMentor, a platform that began on Instagram and evolved into webinars, educational resources and advising efforts reaching students nationwide.
But he views OrthoMentor as a response to a larger problem, not the solution itself. The real challenge, he said, is whether orthopedic surgeons are willing to make themselves accessible.
Part of problem, Dr. Aiyer believes, is that successful physicians naturally become further removed from the experience of being a student.
“The further out you are, it can be harder to remember what it was like going through this process,” he said. Medical students are often navigating one of medicine’s most competitive specialties while making career-defining decisions with limited information. The anxiety, uncertainty and self-doubt that accompany those decisions can be easy to forget after years in practice. For Dr. Aiyer, effective mentorship starts with remembering what that felt like.
The work that doesn’t generate RVUs
Mentorship is one of the most universally praised activities in medicine. It is also one of the least rewarded.
Faculty members are measured on clinical productivity, research output, administrative leadership and financial performance. Spending an hour advising a medical student does not generate revenue. It does not improve clinic volume. It does not appear on a productivity dashboard.
“It’s hard to spend that extra time talking to another student, another resident or another fellow,” Dr. Aiyer said. “It doesn’t yield another [relative value unit]. It doesn’t yield another dollar of revenue.”
Yet he believes those conversations may be among the most important investments the profession can make.The irony, he said, is that nearly every orthopedic surgeon can point to a mentor who influenced their career.
Yet the system often leaves little protected time or formal incentive for physicians to provide that same guidance to the next generation. Preparing future surgeons requires the very thing healthcare leaders are increasingly short on: time.
Every orthopedic surgeon can trace their career back to someone who answered a question, offered advice or opened a door at a critical moment. The challenge is that healthcare increasingly rewards measurable productivity while some of the specialty’s most important work remains difficult to measure.
“How do we prepare the next generation of surgeons who are looking to be mentored and nurtured?” Dr. Aiyer said.
Why mentorship is not the same as encouragement
For Dr. Aiyer, mentorship is often misunderstood. Many people assume it means supporting every student’s interest in orthopedics. He sees the responsibility differently.
Sometimes mentorship means helping a student pursue orthopedics. Other times it means helping them recognize that another path may be a better fit.
Dr. Aiyer believes mentors have an obligation to provide honest guidance, even when the conversation is uncomfortable.
“We have to be able to have difficult conversations,” he said. Those conversations require honesty. Students need feedback about their strengths, weaknesses and readiness. They need guidance about how to improve. They need people willing to tell them what they need to hear rather than what they want to hear.
Too often, Dr. Aiyer believes, medicine struggles with that balance.
“We have to be better as a whole about giving feedback,” he said. “Not just honest feedback, but constructively critical feedback.” The goal is not to discourage students. The goal is to help them make informed decisions.
In that sense, mentorship resembles patient care more than many people realize. Surgeons guide patients through difficult choices every day. Dr. Aiyer believes mentors have a similar obligation to students.
Why access matters more than ever
The irony, Dr. Aiyer said, is that students today have access to more information than any generation before them. What they often lack, he said, is context. When OrthoMentor launched, social media was viewed skeptically by many in academic medicine. Dr. Aiyer saw it differently. Students were already there.
“If I had to start from scratch, I would still pay attention to where people are consuming information,” he said. The platform’s growth accelerated during COVID-19, when traditional networking opportunities disappeared and students increasingly relied on virtual resources to learn about programs and connect with mentors.
But technology alone cannot solve the problem. Information is valuable. Relationships are transformative. “The more we can all make ourselves accessible, the easier it is for folks to feel they have individuals they can rely upon,” Dr. Aiyer said.
The next frontier
Dr. Aiyer believes mentorship is entering another period of change. AI is already influencing how students gather information, prepare applications and seek advice. Future generations may rely on tools that barely existed a few years ago.
That does not concern him. If anything, he sees it as a reminder that mentorship models cannot remain static. “Just because OrthoMentor has been great and maybe one of the first ones doesn’t mean it’s the only one,” he said. “Things are changing. AI is coming into play. What’s the next iteration of it?”
The specific technology matters less than the principle. The profession has to continue finding new ways to reach students wherever they are. OrthoMentor was one attempt. The next solution may look entirely different.
The future of orthopedics
For all the discussion about workforce shortages, residency positions and recruitment, Dr. Aiyer believes the profession’s future may ultimately depend on something much simpler.
Availability. Not every student needs another webinar. Not every student needs another social media post. Many simply need someone willing to answer a question, offer perspective or help them understand what comes next.
Mentorship does not generate RVUs. It does not appear in financial reports. Yet it remains one of the few investments that directly shapes who will be caring for patients decades from now.
The students are already there. The question is whether orthopedics will make time to reach them.
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.
