April 1998 Bulletin
ACROSS THE PRESIDENT'S DESK
Increasing the scope of activity may increase
demand for orthopaedic surgeons
Workforce solution: expand orthopaedics
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:
- The Academy will continue to work through the Patient Access
to Specialty Care Coalition in Washington to ensure that our patients
continue to have wide-open and direct access to our services without
going through intermediary steps or being sidetracked to the care
of a nonorthopaedist.
- The Academy is going to explore attractive alternative forms
of orthopaedic practice to provide options for those fellows who
wish to leave a surgical practice. As the size of the surgical
aspects of our practice decreases, we have more time to spend
in the office with our patients and, more importantly, more time
to expand the actual scope of what we do there. A Board of Directors
task force is exploring the expansion of the scope of orthopaedic
practice, which we hope will not, in any way, compromise our commitment
to the practice of orthopaedic surgery but will provide an enhancement
to the quality of office practice for both the orthopaedic surgeon
and his or her patients.
- We are going to explore the creation of a shared interest
group within the Academy to include all those fellows who wish
to explore new and alternative pathways for the delivery of musculoskeletal
- We will work in collaboration with orthopaedic industry through
our newly created Corporate Advisory Council and with the FDA
through our device forum to bring new safe and effective orthopaedic
technologies to the marketplace in a timely manner.
- We will work through our International Committee to explore
further opportunities to deliver high-quality orthopaedic care
to underserved areas of the world.
- Through the newly created task force on volunteerism, we will
look for ways to enhance, in a meaningful way, the delivery of
high-quality musculoskeletal care to underserved populations here
- And finally, through our Council on Research we are going
to re-double our commitment to support both clinical and basic
research. As we move into this era of biological solutions to
biological problems, who knows what new advances are just around
the corner? Each new advance will create another opportunity to
serve our patients and grow the practice of orthopaedic surgery.
However, we will see such advances only if we continue to allocate
a certain proportion of our time, energy and resources to both
basic and applied research
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
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