August 2001 Bulletin

Practice survey tells all about what you do

The biennial survey of orthopaedic surgeons, conducted by the AAOS Department of Research, provides a detailed profile of orthopaedic surgeons and their practices. The Orthopaedic Physician Census questionnaire was sent to 20,431 active orthopaedic surgeons. A total of 13,835 were completed and returned by the cut-off date, for an overall response rate of 70 percent. The following information was extracted from Orthopaedic Practice in the U.S. 2000-2001.

Who are you and how do you compare with other AAOS members?

You’re 49 years old (median age). Fifteen percent of the AAOS membership is under age 40 and 33 percent are ages 40 to 49. The average age of orthopaedic surgeons has increased steadily from age 47 in 1990 to 49 in 2000.

You’re a male. Women account for only 2.7 percent of orthopaedic surgeons in full-time or part-time orthopaedic practice.

Most likely you’re in full-time clinical practice along with 85 percent of the AAOS members. Only 2.5 percent of members are in full-time non-surgical practice. About 12 percent are in part-time clinical practice of orthopaedic surgery. Within this group, on average, about 60 percent of the time is devoted to clinical practice; 11 percent to teaching; 9 percent to administration; and 7 percent to research.

Chances are you’re among the 83 percent of orthopaedic surgeons in private practice. About 63 percent of AAOS members are in group practice and 24 percent in solo practice. Thirteen percent are in a multispecialty group.

Almost 70 percent of orthopaedic surgeons with a teaching appointment work in a clinical setting. During the last decade, a small but steady 9 percent to 10 percent were full-time medical school or hospital appointments with no patient load. The proportion of part-time academic positions has declined significantly from 13 percent in 1990 to 8 percent in 2000.

More than one-third of orthopaedic surgeons (37.4 percent) designate themselves as a "general orthopaedic surgeon with a specialty interest." Almost 32 percent consider themselves "general orthopaedic surgeons" and approximately 30 percent consider themselves "specialists within orthopaedic surgery."

If you’re in the under 40 age group, you may be among the 78 percent of members who consider themselves either as specialists or general orthopaedic surgeons with a specialty interest. This compares with 76 percent in the 40-49 age group and 59 percent among members ages 50 and older.

Nationally, there was one orthopaedic surgeon for 13,210 people in the U.S. in 2000. That’s up sharply from one orthopaedist per 16,863 people in 1998.

Almost half of your patients are in the 19 to 64 age category and about one-fourth of your patients are 65 and older. The slight, nonsignificant differences in the age groups since 1990 are most likely a reflection of the aging population.

The knee remains, by far, the most treated anatomical area. About 25 percent of cases treated involve the knee–about the same amount as in 1990. The number of cases involving the elbow/ shoulder increased to 16.5 percent in 2000 from 12 percent in 1990. Spine cases at almost 15 percent in 2000 were down from 18 percent in 1990.

The number of hip cases declined from 15.4 percent in 1990 to 12.8 percent 2000 and foot cases declined from 12 percent in 1990 to 10 percent in 2000.

Here’s some data to check your office practice workload with what other orthopaedists said in the survey:

The survey data also shows the experience of other orthopaedists in their surgical practice.

During a typical week an orthopaedic surgeon in full-time clinical practice sees 23 new patients, provides 72 follow-up office visits and delivers 12 hospital visits and six emergency visits. On average, a new patient usually has to wait about 11 days for a routine initial office appointment.

About 29 percent of your patients come from referrals from non-orthopaedic surgeons. Referrals from your former patients account for 21 percent of patients, while self-referrals account for 15 percent of patients.

On average, you’re the first or initial contact physician for 29 percent of new problem visits for musculoskeletal conditions or complaints.

Not surprisingly, you probably have patients from managed care sources, which is the experience of 87 percent of orthopaedists. Eighty percent of orthopaedic surgeons have managed care, discounted fee-for-service patients, while about one-third have managed care capitation patients.

In the last year, 25.5 percent of orthopaedic surgeons were deselected or voluntarily dropped from managed care plans with which they were contacted. Only 12.6 percent were denied contracts by managed care plans to which they applied.

If you fit the "average" profile, you spend 57 hours a week in full-time practice, of which 50 hours or 89 percent of the time is spent on patient care.

The time spent on patient care include:

Other hours spent on professional activities include 1.4 hours on medical teaching or training, 0.6 hours on research and 4.3 hours on administrative activities.

Are you contemplating fully retiring from or ending orthopaedic practice within the next five years? Almost one-quarter (24.4 percent) of the orthopaedists said "yes" and 75.6 percent, "no." That’s an average. Here’s a breakdown by age of those who said "yes":

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