Orthopedic surgeons will face many challenges over the next year as the economy continues to struggle and healthcare reform constantly changes. However, here are eight reasons why orthopedic surgeons should be optimistic about the future.
1. Increased physician input in healthcare legislation. The introduction of healthcare reform over the past several months has opened up opportunities for physicians to be at the forefront of creating the country's healthcare policies. The decisions made by Congress and other facets of the government will impact all surgeons by increasing patient volume, setting reimbursement rates and transparency in industry relationships. While surgeons haven't always been involved in these decisions, the nature of this legislation calls for more surgeon involvement. "In the future, there's probably going to be more of a trend toward physician input to the healthcare reform movement," says Greg Lervick, MD, an orthopedic surgeon at Twin Cities Orthopedics in Edina, Minn. He says physicians and hospitals will need to work together in order to solve the problems presented by the healthcare reform legislation.
"Physicians have the expertise in streamlining good care," he says. "The other thing is that doctors and surgeons can really innovate in terms of cost controlling." For orthopedic surgeons, this means knowing what products are the most cost-effective while still providing the highest quality of care for the patient. The government will look to the medical professionals on the best methods for implementing efficient cost-savings processes, he says.
2. More patients mean increased job security. Due to the influx in the number of patients able to receive medical attention under healthcare reform in addition to the population of older adults increasing, orthopedic surgeons are going to be in high demand over the next several years. "There have been a series of studies over the past couple of years that indicate there is going to be a huge need for joint replacement surgery and this is going to be unmet by the number of ," says James J. Purtill, MD, an orthopedic surgeon at Rothman Institute in Philadelphia. "There is a fantastic amount of job security and orthopedic services are going to be needed in the foreseeable future. There's always going to be plenty of work to do."
3. Technology is trending toward minimally invasive techniques. An improvement in orthopedic technology has allowed for nearly all subspecialties to include minimally invasive procedures. In some areas, such as knee arthroscopy, the procedures are fairly common, while in others, such as spine surgery, the minimally invasive procedures are still relatively new. The trend toward minimally invasive surgery is a positive change for orthopedic surgeons because they are able to provide better outcomes for their patients, if the surgeries are done properly. "By doing spine surgeries through smaller incisions, there is less damage to the muscle and tissues," says Stefan Prada, MD, a spine surgeon with Laser Spine Institute in Tampa, Fla. He performs minimally invasive endoscopic spine surgery on his patients. "When you do smaller incisions, there has been shown to be less bleeding, less risk for infection postoperatively and quicker recovery time."
There have also been a several advances in joint replacement surgery which have been able to increase the longevity of the implant, reduce the risks of surgery and improve patient outcomes, says Dr. Purtill. Advancements in orthopedic and spine technology allow surgeons to provide better care for their patients than in the past. Surgeons can also take the lead in developing new technologies in several surgical areas, especially biologics, to improve the future of orthopedics.
4. Biologics provides new opportunities. Biological treatment solutions is where orthopedic surgery is headed, says Dr. Lervick, and many orthopedic surgeons are learning and developing biologic techniques. Treating patients with growth factors, gene therapy tissue healing, stem cell treatment and platelet-rich plasma injections are all at the cutting-edge of biologics in orthopedic surgery. "The question is whether we can push much further without biologic intervention," says Dr. Lervick. "In my lifetime, biologics is the area that's going to change the most." While many of the biologic treatments are still experimental, efforts are being made to conduct the clinical trials that prove or disprove them as viable methods for treatment. "PRP is one thing that is very fun to talk about and dream that it might make a big difference, but we need more scientific studies to show us that it is useful," says Dr. Lervick. "We need to find the right thing to help our patients."
5. Improved relationships between hospitals and surgeons. Changes from healthcare reform, including the public release of hospital data, will improve the relationship between hospitals and orthopedic surgeons. "I see hospitals and orthopedic surgeons having common goals," says Dr. Purtill. "As physician and hospital rating systems become more popular on the internet and more important for patients as they chose hospitals and orthopedic surgeons, I think surgeons and hospitals are going to work together to achieve common goals." The two entities will work to decrease morbidities, improve outcomes and ensure a continuum of care for the patients. Patients will take note of these efforts and choose to see the orthopedic surgeons and hospitals with the best ratings, he says, which means hospitals are going to associate with physicians who have good ratings and vice versa.
Dr. Prada sees more hospitals relying on employed orthopedic surgeons to grow the outpatient departments. "Outpatient orthopedic surgery is one of the biggest income generators for the hospitals," he says. "The hospitals gain a great deal by assuring a volume they desire based on having their employed surgeons." The recent trends for orthopedic surgeons right out of residency has been toward hospital employment and the hospital may offer increasing employment opportunities.
6. Better quality of life for surgeons. Orthopedic residencies now require an 80 hour work week, which means they see less cases during their residencies, says Dr. Prada. "These doctors are used to less hours as residents, so many are looking for a better lifestyle with a trade off of less income," he says. Orthopedic surgeons are now working for fewer hours than they used to, which means more time for the surgeons to spend with their families or on other activities.
This past year, orthopedic and spine surgeons were among the highest paid physicians and surgeons. Some of this income is generated during the many houses these surgeons have to spend working on call during the evenings and weekends, says Dr. Prada. While hospitalists can admit many physicians' patients to the hospital, they cannot treat orthopedic and spine conditions, which means there will be a continued demand for orthopedic surgeons on-call.
7. Orthopedic surgery residencies are competitive. Students finishing medical school and applying for residencies are finding that orthopedic residencies are difficult to secure, which means that only top students are able to enter into the subspecialty. "It's very hard to become an orthopedist," says Dr. Purtill. "We have an enormous group of very talented medical students who are interested in performing the residencies. It's difficult to be chosen for an orthopedic residency, which means we often get talented and incredibly smart people. For us experienced surgeons, it's really exciting to be able to train these young minds." Dr. Purtill is the director of the residency program at Jefferson Hospital in Philadelphia and he says the program regularly chooses six residents from 600 applicants.
8. Orthopedic surgeons are still able to produce great results. Despite the worries associated with the changing healthcare environment, many orthopedic surgeons are still able to form a good patient-physician relationship and provide good results for patients, says Dr. Lervick. Especially in metropolitan areas, if there is competition for physician services, providers that produce good results and provide a positive patient experience will continue to have the edge. "The good thing that I see — that we sometimes lose sight of as providers — is that people still want to find doctors that do a good job, doctors who they can trust," says Dr. Lervick. "You can still build that patient-provider relationship even in the current economic state. By and large, you can be a good doctor and make the right choices and treatment options for your patients."
Read other coverage on orthopedic and spine trends:
- The Year Ahead: 9 Biggest Issues for Orthopedic Surgeons in 2011
- Spine Surgery in 2011 and Beyond: 7 Points About the Future of Spine Surgery
- 11 Biggest Trends for Sports Medicine in 2011
1. Increased physician input in healthcare legislation. The introduction of healthcare reform over the past several months has opened up opportunities for physicians to be at the forefront of creating the country's healthcare policies. The decisions made by Congress and other facets of the government will impact all surgeons by increasing patient volume, setting reimbursement rates and transparency in industry relationships. While surgeons haven't always been involved in these decisions, the nature of this legislation calls for more surgeon involvement. "In the future, there's probably going to be more of a trend toward physician input to the healthcare reform movement," says Greg Lervick, MD, an orthopedic surgeon at Twin Cities Orthopedics in Edina, Minn. He says physicians and hospitals will need to work together in order to solve the problems presented by the healthcare reform legislation.
"Physicians have the expertise in streamlining good care," he says. "The other thing is that doctors and surgeons can really innovate in terms of cost controlling." For orthopedic surgeons, this means knowing what products are the most cost-effective while still providing the highest quality of care for the patient. The government will look to the medical professionals on the best methods for implementing efficient cost-savings processes, he says.
2. More patients mean increased job security. Due to the influx in the number of patients able to receive medical attention under healthcare reform in addition to the population of older adults increasing, orthopedic surgeons are going to be in high demand over the next several years. "There have been a series of studies over the past couple of years that indicate there is going to be a huge need for joint replacement surgery and this is going to be unmet by the number of ," says James J. Purtill, MD, an orthopedic surgeon at Rothman Institute in Philadelphia. "There is a fantastic amount of job security and orthopedic services are going to be needed in the foreseeable future. There's always going to be plenty of work to do."
3. Technology is trending toward minimally invasive techniques. An improvement in orthopedic technology has allowed for nearly all subspecialties to include minimally invasive procedures. In some areas, such as knee arthroscopy, the procedures are fairly common, while in others, such as spine surgery, the minimally invasive procedures are still relatively new. The trend toward minimally invasive surgery is a positive change for orthopedic surgeons because they are able to provide better outcomes for their patients, if the surgeries are done properly. "By doing spine surgeries through smaller incisions, there is less damage to the muscle and tissues," says Stefan Prada, MD, a spine surgeon with Laser Spine Institute in Tampa, Fla. He performs minimally invasive endoscopic spine surgery on his patients. "When you do smaller incisions, there has been shown to be less bleeding, less risk for infection postoperatively and quicker recovery time."
There have also been a several advances in joint replacement surgery which have been able to increase the longevity of the implant, reduce the risks of surgery and improve patient outcomes, says Dr. Purtill. Advancements in orthopedic and spine technology allow surgeons to provide better care for their patients than in the past. Surgeons can also take the lead in developing new technologies in several surgical areas, especially biologics, to improve the future of orthopedics.
4. Biologics provides new opportunities. Biological treatment solutions is where orthopedic surgery is headed, says Dr. Lervick, and many orthopedic surgeons are learning and developing biologic techniques. Treating patients with growth factors, gene therapy tissue healing, stem cell treatment and platelet-rich plasma injections are all at the cutting-edge of biologics in orthopedic surgery. "The question is whether we can push much further without biologic intervention," says Dr. Lervick. "In my lifetime, biologics is the area that's going to change the most." While many of the biologic treatments are still experimental, efforts are being made to conduct the clinical trials that prove or disprove them as viable methods for treatment. "PRP is one thing that is very fun to talk about and dream that it might make a big difference, but we need more scientific studies to show us that it is useful," says Dr. Lervick. "We need to find the right thing to help our patients."
5. Improved relationships between hospitals and surgeons. Changes from healthcare reform, including the public release of hospital data, will improve the relationship between hospitals and orthopedic surgeons. "I see hospitals and orthopedic surgeons having common goals," says Dr. Purtill. "As physician and hospital rating systems become more popular on the internet and more important for patients as they chose hospitals and orthopedic surgeons, I think surgeons and hospitals are going to work together to achieve common goals." The two entities will work to decrease morbidities, improve outcomes and ensure a continuum of care for the patients. Patients will take note of these efforts and choose to see the orthopedic surgeons and hospitals with the best ratings, he says, which means hospitals are going to associate with physicians who have good ratings and vice versa.
Dr. Prada sees more hospitals relying on employed orthopedic surgeons to grow the outpatient departments. "Outpatient orthopedic surgery is one of the biggest income generators for the hospitals," he says. "The hospitals gain a great deal by assuring a volume they desire based on having their employed surgeons." The recent trends for orthopedic surgeons right out of residency has been toward hospital employment and the hospital may offer increasing employment opportunities.
6. Better quality of life for surgeons. Orthopedic residencies now require an 80 hour work week, which means they see less cases during their residencies, says Dr. Prada. "These doctors are used to less hours as residents, so many are looking for a better lifestyle with a trade off of less income," he says. Orthopedic surgeons are now working for fewer hours than they used to, which means more time for the surgeons to spend with their families or on other activities.
This past year, orthopedic and spine surgeons were among the highest paid physicians and surgeons. Some of this income is generated during the many houses these surgeons have to spend working on call during the evenings and weekends, says Dr. Prada. While hospitalists can admit many physicians' patients to the hospital, they cannot treat orthopedic and spine conditions, which means there will be a continued demand for orthopedic surgeons on-call.
7. Orthopedic surgery residencies are competitive. Students finishing medical school and applying for residencies are finding that orthopedic residencies are difficult to secure, which means that only top students are able to enter into the subspecialty. "It's very hard to become an orthopedist," says Dr. Purtill. "We have an enormous group of very talented medical students who are interested in performing the residencies. It's difficult to be chosen for an orthopedic residency, which means we often get talented and incredibly smart people. For us experienced surgeons, it's really exciting to be able to train these young minds." Dr. Purtill is the director of the residency program at Jefferson Hospital in Philadelphia and he says the program regularly chooses six residents from 600 applicants.
8. Orthopedic surgeons are still able to produce great results. Despite the worries associated with the changing healthcare environment, many orthopedic surgeons are still able to form a good patient-physician relationship and provide good results for patients, says Dr. Lervick. Especially in metropolitan areas, if there is competition for physician services, providers that produce good results and provide a positive patient experience will continue to have the edge. "The good thing that I see — that we sometimes lose sight of as providers — is that people still want to find doctors that do a good job, doctors who they can trust," says Dr. Lervick. "You can still build that patient-provider relationship even in the current economic state. By and large, you can be a good doctor and make the right choices and treatment options for your patients."
Read other coverage on orthopedic and spine trends:
- The Year Ahead: 9 Biggest Issues for Orthopedic Surgeons in 2011
- Spine Surgery in 2011 and Beyond: 7 Points About the Future of Spine Surgery
- 11 Biggest Trends for Sports Medicine in 2011