Top 10 List of predictions about the changing role of the orthopaedic surgeon.

1. Predictions about the FUTURE for
orthopaedic surgeons
From the 3rd Annual Role of the Orthopaedic Surgeon
Study conducted by JBJS
1Q. In the next 5 years, what do you think will change the most about your role as an orthopaedic surgeon?
TOP TEN

2. Will rely less on insurance and transition more
to a fee for service model as insurance
regulations, hassles and declining
reimbursement will preclude continued.
Ability to offer timely surgical intervention
without mandates from insurance companies
will decrease.
Worsening practice climate due to insurance
and government. Expect single-payer
government insurance in near future.
2
More non-operative treatment due to tighter
insurance criteria.
Arguing with insurance carriers over who gets
paid for what.
#10MORE
INSURANCE
HASSLES

3. 3
Less primary, front line orthopaedics, which will be done by PAs and non-
operative MDs.
Will need help from NP or PA to keep up with complexity and time demands of
hospital EHRs and to make my own job more efficient.
See fewer patients due to EMR, more PA's NP's, and many more mistakes will
occur.
Care will not be delivered by an orthopaedic surgeon like me in an office setting, but
instead will be done by a PA or NP. Surgery will be referred to hospital-based
Orthopedic Surgeons who are employed by the hospital system.
#9MORE
HEALTHCARE
EXTENDERS

4. Income will go down, work will increase, and
there will be more separation of care into a two
tier health care system.
4
Our salaries will continue to decline and our
hours will be regulated.
Care for more patients for same compensation.
Fewer resources for more patients.
More work with less pay.
#8WORK
HARDER FOR
LESS $$

5. Pay for performance and
reimbursement. This will directly
impact device and product use and
patient outcomes is TBA.
Continued erosion of reimbursement;
more and more decisions made by
administrators.
5
Less reimbursement for more work.
Would like to get reimbursement
from the hospital system for call.
Medical reimbursement and
decreased delivery of care.#7LOWER
REIMBURSE-
MENT

6. 6Q. In the next 5 years, what do you think will change the most about your role as an orthopaedic surgeon?
#6NOTHING
WILL
CHANGE

7. 7
Intrusion by government and insurance
companies on how we care for patients.
More regulations that cause us to spend more
time on clerical work and administration than
actual orthopaedic care.
Less ability to interact with patients due to
increased government intervention.
Difficult to do job due to government
interference and bureaucracy.
I'll be lucky to have a job. Government payer is
getting bigger and more unstable. Not a good
combination. Overhead is increasing along with
inflation and the cost of living. Patients can't
afford co-pays. Unless you are a top tier
boutique practice you can't survive.
#5MORE GOV’T
REGULATION

8. 8
My private practice group of 13 orthos will
probably have to sell and join a hospital to
control ever increasing overhead cost and to get
better contracting rates.
All orthopaedic surgeons will become
employees of hospitals, and the private practice
model will tend to erode.
Decreasing ability to remain in private practice.
Private practice will be eliminated by the big
hospitals and they will have a monopoly in each
market. EMR will drop efficiency while
removing all autonomy.
May become an employed physician.
#4MORE WILL
WORK FOR
HOSPITALS

9. I will have less autonomy and will have less
influence in making health care decisions with
my patients. Very sad.
I will have less control over all aspects of my
practice and economic health.
Loss of autonomy. Marginalization by
administrators, and non surgeons by group
practice...smaller piece of the pie for
reimbursement. Rationing of care from sicker
patients to protect individual physician stats.
Fewer work hours.
Less autonomy and more administrator
control.
I fear that I will have less control over how I
will be involved with the various decision-
making processes regarding implants I can use
and how I care for my patients. 9
Less autonomy and more work as EMR is
implemented.
#3LESS
AUTONOMY

10. I am slowing down and limiting my practice. In 5
years I plan to transition to an office practice and
stop surgery.
I am going to cut back the amount of hours I
work. My pay will go down more than I cut back.
Quality is much more important than quantity
and it seems you cannot have both.
10
I will retire. The government will make the
biggest changes to our practice.
I hope to retire...I don't like the changes in the
medical world.
Hope to slow down and work less hours.
Decrease calls.
#2RETIRE,
WORK LESS
OR DO LESS
SURGERY

11. I will be required to do more administrative
work and more documentation of required
information in order to get reimbursed. I
expect to be able to spend less time clinically
caring for patients, and at the same time get
reimbursed less for the work I do. If that is the
trend, then I think I will need to include mid-
levels in my practice and therefore be more of a
supervisor of them.
11
More administrative nonsense. Less take home
salary.
More work less pay. More administrators to
answer to. Less satisfying role in world.
Continued increases in paperwork and heavier
burden of government assisted patients.
More paperwork and less patient care.
#1MORE ADMIN
WORK

12. 1. More administrative duties
2. Will retire/stop surgery
3. Less autonomy
4. Will become a hospital employee
5. More government regulations
6. Nothing
7. Reimbursement (less and more)
8. Work harder for less
9. Role of healthcare extenders
10. Insurance hassles
Predictions About Changing Roles of
Orthopaedic Surgeons
12Q. In the next 5 years, what do you think will change the most about your role as an orthopaedic surgeon?

13. What We Learned from Orthopaedic Surgeons
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1. Hospital takeovers of orthopaedic practices are growing (19% to 28%).
2. Despite this growth of hospital-owned practices, orthopaedic surgeons are just as involved in the purchase
process for medical devices/products.
3. Orthopaedic surgeons are involved in all phases of the purchase process for orthopaedic products/devices.
4. Physician assistants are on the rise in orthopaedic practices. Orthopaedic practices are also hiring more
nurse practitioners, physical therapists, coding specialists, and hospitalists.
5. Orthopaedic practices offer more than just diagnosis and treatment. Almost all offer X-ray services at their
practice. Additionally, they offer online patient information, physical therapy and referral to other types of
surgeons/physicians. Just under half say they offer MRI imaging.
6. An array of medical devices/products are being considered by orthopaedic surgeons over the next 12
months. In many cases, the supplier is not yet set in stone.
7. Orthopaedic surgeons rely heavily on orthopaedic journals and consider them the number one preferred
source for information about medical devices/products.
8. iPad® usage in orthopaedic practices has experienced double-digit growth; they are being used for more
than just email.
9. Orthopaedic surgeons are involved in coding procedures and diagnoses.
10. Many challenges lie ahead for orthopaedic surgeons, some as a result of hospital buy-outs. However, the
number one challenge listed is the abundance of administrative duties.

14. METHODOLOGY
• An email survey was sent on Feb. 25, 2013, to 2,868 JBJS subscribers in the United States. A second broadcast was
sent on Feb. 28 to non-responders.
• The survey was sent from The Journal of Bone & Joint Surgery.
RESPONSE
• 469 orthopaedic surgeons responded to the survey, representing a response rate of 16%.
• At a 95% confidence level, results are projected at a + or – 4.5% margin of error.
• Results in this study include only those respondents who self-identified as orthopaedic surgeons.
How We Did the Study
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15. Question and Answers
Thank you! For more information on this study, please
contact: JBJS, Amber Howard
ahoward@jbjs.org • 781-433-1233
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