Predictions about the FUTURE fororthopaedic surgeonsFrom the 3rd Annual Role of the Orthopaedic SurgeonStudy conducted by JBJS1Q. In the next 5 years, what do you think will change the most about your role as an orthopaedic surgeon?TOP TEN
Will rely less on insurance and transition moreto a fee for service model as insuranceregulations, hassles and decliningreimbursement will preclude continued.Ability to offer timely surgical interventionwithout mandates from insurance companieswill decrease.Worsening practice climate due to insuranceand government. Expect single-payergovernment insurance in near future.2More non-operative treatment due to tighterinsurance criteria.Arguing with insurance carriers over who getspaid for what.#10MOREINSURANCEHASSLES
3Less 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 ofhospital EHRs and to make my own job more efficient.See fewer patients due to EMR, more PAs NPs, and many more mistakes willoccur.Care will not be delivered by an orthopaedic surgeon like me in an office setting, butinstead will be done by a PA or NP. Surgery will be referred to hospital-basedOrthopedic Surgeons who are employed by the hospital system.#9MOREHEALTHCAREEXTENDERS
Income will go down, work will increase, andthere will be more separation of care into a twotier health care system.4Our salaries will continue to decline and ourhours will be regulated.Care for more patients for same compensation.Fewer resources for more patients.More work with less pay.#8WORKHARDER FORLESS $$
Pay for performance andreimbursement. This will directlyimpact device and product use andpatient outcomes is TBA.Continued erosion of reimbursement;more and more decisions made byadministrators.5Less reimbursement for more work.Would like to get reimbursementfrom the hospital system for call.Medical reimbursement anddecreased delivery of care.#7LOWERREIMBURSE-MENT
6Q. In the next 5 years, what do you think will change the most about your role as an orthopaedic surgeon?#6NOTHINGWILLCHANGE
7Intrusion by government and insurancecompanies on how we care for patients.More regulations that cause us to spend moretime on clerical work and administration thanactual orthopaedic care.Less ability to interact with patients due toincreased government intervention.Difficult to do job due to governmentinterference and bureaucracy.Ill be lucky to have a job. Government payer isgetting bigger and more unstable. Not a goodcombination. Overhead is increasing along withinflation and the cost of living. Patients cantafford co-pays. Unless you are a top tierboutique practice you cant survive.#5MORE GOV’TREGULATION
8My private practice group of 13 orthos willprobably have to sell and join a hospital tocontrol ever increasing overhead cost and to getbetter contracting rates.All orthopaedic surgeons will becomeemployees of hospitals, and the private practicemodel will tend to erode.Decreasing ability to remain in private practice.Private practice will be eliminated by the bighospitals and they will have a monopoly in eachmarket. EMR will drop efficiency whileremoving all autonomy.May become an employed physician.#4MORE WILLWORK FORHOSPITALS
I will have less autonomy and will have lessinfluence in making health care decisions withmy patients. Very sad.I will have less control over all aspects of mypractice and economic health.Loss of autonomy. Marginalization byadministrators, and non surgeons by grouppractice...smaller piece of the pie forreimbursement. Rationing of care from sickerpatients to protect individual physician stats.Fewer work hours.Less autonomy and more administratorcontrol.I fear that I will have less control over how Iwill be involved with the various decision-making processes regarding implants I can useand how I care for my patients. 9Less autonomy and more work as EMR isimplemented.#3LESSAUTONOMY
I am slowing down and limiting my practice. In 5years I plan to transition to an office practice andstop surgery.I am going to cut back the amount of hours Iwork. My pay will go down more than I cut back.Quality is much more important than quantityand it seems you cannot have both.10I will retire. The government will make thebiggest changes to our practice.I hope to retire...I dont like the changes in themedical world.Hope to slow down and work less hours.Decrease calls.#2RETIRE,WORK LESSOR DO LESSSURGERY
I will be required to do more administrativework and more documentation of requiredinformation in order to get reimbursed. Iexpect to be able to spend less time clinicallycaring for patients, and at the same time getreimbursed less for the work I do. If that is thetrend, then I think I will need to include mid-levels in my practice and therefore be more of asupervisor of them.11More administrative nonsense. Less take homesalary.More work less pay. More administrators toanswer to. Less satisfying role in world.Continued increases in paperwork and heavierburden of government assisted patients.More paperwork and less patient care.#1MORE ADMINWORK
1. More administrative duties2. Will retire/stop surgery3. Less autonomy4. Will become a hospital employee5. More government regulations6. Nothing7. Reimbursement (less and more)8. Work harder for less9. Role of healthcare extenders10. Insurance hasslesPredictions About Changing Roles ofOrthopaedic Surgeons12Q. In the next 5 years, what do you think will change the most about your role as an orthopaedic surgeon?
What We Learned from Orthopaedic Surgeons131. 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 purchaseprocess 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 morenurse practitioners, physical therapists, coding specialists, and hospitalists.5. Orthopaedic practices offer more than just diagnosis and treatment. Almost all offer X-ray services at theirpractice. Additionally, they offer online patient information, physical therapy and referral to other types ofsurgeons/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 12months. 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 preferredsource for information about medical devices/products.8. iPad® usage in orthopaedic practices has experienced double-digit growth; they are being used for morethan 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, thenumber one challenge listed is the abundance of administrative duties.
METHODOLOGY• An email survey was sent on Feb. 25, 2013, to 2,868 JBJS subscribers in the United States. A second broadcast wassent 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 Study14
Question and AnswersThank you! For more information on this study, pleasecontact: JBJS, Amber Howardahoward@jbjs.org • 781-433-123315