April 1998 Bulletin

ACROSS THE PRESIDENT'S DESK
Workforce solution: expand orthopaedics

Increasing the scope of activity may increase demand for orthopaedic surgeons

As I begin this year as your president, I look forward with enthusiasm to many of the opportunities before us. Being a generally optimistic individual, I want to focus in a positive way on what has been called the "work force problem in orthopaedics." With almost 20,000 orthopaedic surgeons practicing in this country, managed care models and the demand model recently described in The Journal of Bone and Joint Surgery by the RAND research organization say emphatically that there are too many orthopaedic surgeons and that this over-supply is going to continue for at least the next 20 to 30 years.

Some of the simple solutions that people have proposed, such as decreasing the number of residency positions or cutting back arbitrarily on the amount of work performed by practicing orthopaedists, either by decreasing the number of hours worked per week or forcing early retirement, will not have much of an impact or simply will create a void that will be filled by other providers of musculoskeletal care.

The RAND study has several shortcomings, but it shows clearly to me that one key element in the work force equation is the demand for reasonably priced orthopaedic services. Who is better educated and trained to provide musculoskeletal care than orthopaedic surgeons? I suggest that one effective way to address the work force problem is to actually expand the scope of what we are currently doing. There are several ways in which we can accomplish this objective:

Over this next year we are going to focus on these methods to incubate and promote the development of new ways to expand the scope of the practice of orthopaedics that will make that practice 25 years from now as different as the current practice of orthopaedics is from what it was 25 years ago. The combination of all these efforts should expand the scope of practice to such a degree that in 25 years there will be a demand for more, not fewer, orthopaedic surgeons.

I hope that you, the fellowship, will buy into this concept of expanding in a positive way those things that we, as the best educated and trained providers of musculoskeletal care, can and should do. If you have additional, positive suggestions about how we might apply our skills and experience to this task, I would love to hear from you.


James D. Heckman, MD
President


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