Today's News

Sunday, February 25, 1996

Oversupply of orthopaedists likely in next century

Corporate practice offers surgeons chance to compete with large care organizations

Although seeing into the future of practice under managed care remains as problematic as ever, orthopaedic surgeons should prepare for an oversupply of surgeons and get ready to join with their colleagues in large corporate practice groups.

Those were some of the insights from experts at Saturday's symposium "Riding the Tidal Wave of Change: Strategies for Survival and Success in Today's Evolving Healthcare Marketplace."

Forecasting the supply of and demand for orthopaedic surgeons in the next 20 years is a difficult business, said Bernard A. Rineberg, MD, New Brunswick, N.J. But most indications of the future of the orthopaedic "work force" point toward an oversupply.

"The bottom line is tension," he said. "The market forces indicate that we'll need fewer orthopaedic surgeons, but this could produce unmet needs (for surgical services) that might be taken up by other practitioners."

Already, practitioners in a variety of areas - including rheumatologists, general surgeons, primary care physicians, pediatricians, plastic surgeons, neurosurgeons, chiropractors and podiatrists - are "moving into our areas," he said.

Dr. Rineberg outlined a number of potential problems associated with an oversupply of orthopaedic surgeons. Most obviously, some simply might not find jobs. Already, residents are having difficulty finding positions in the locations they desire, he said.

Other complications of an oversupply include "retreading," in which specialists are forced to turn to primary care; more limited surgical experience; the possibility of specious treatments, or "things surgeons wouldn't do if they were really busy"; territorial competition with other practitioners; and decreased fees, Dr. Rineberg said.

To cope with the health care marketplace of the present and future, orthopaedic surgeons should consider entering into large practices functioning as corporations, said David R. Mauerhan, MD, Charlotte, N.C. With the "industrialization" of medicine, the "cottage trade" of small practices is quickly losing ground to larger integrated care organizations.

Driving this transformation are the "four Cs of health care market reform," Dr. Mauerhan said: cost, control, consolidation and competition. As care organizations consolidate in order to save costs, individual surgeons or small groups are disadvantaged because they don't have the time or manpower to devote to managing the business of medicine.

Other symposium participants included Michael H. Graham, MD, Portland, Ore.; Thomas J. Grogan, MD, Santa Monica, Calif.; and Michael D. Henderson, MD, Lincolnshire, Ill.