February 1998 Bulletin

You've got to know the territory

Data examine five most popular states for job seekers and all the others, too

Orthopaedic surgeons looking for their first practice or relocating to a new community weigh many factors such as the opportunities presented by the practice and compatibility with their physician-partners, as well as the culture and environment of the community that will affect their home life.

In today's competitive environment, orthopaedic surgeons should also know the "territory"-the number of orthopaedists in the state, the number of orthopaedists per 100,000 population and the managed care penetration.

The Academy's department of research and scientific affairs applied these factors to the five states where orthopaedic surgeons using the Academy's Placement Service said they would most prefer to practice.

North Carolina consistently leads the "preferred" list. In January, more than 36 percent of the orthopaedists wanted to locate in the state.

The Academy's department of research and scientific affairs analyzed the North Carolina marketplace and found that in 1996 there were 437 board-certified orthopaedic surgeons, a 27 percent increase from 1992, slightly higher than the national average of 25.54 percent. There were about 6 orthopaedic surgeons per 100,000 population, up from about 5 per 100,000 in 1992.

Orthopaedic surgeons in the state reported that almost 18 percent of the patients were in managed care plans in 1996, compared to the national average of 15.78 percent. In 1994, 12 percent of patients were in managed care and in 1992, 8 percent.

More than 31 percent of the orthopaedists wanted to locate in California, making it the second most "preferred" state. In 1996, California had the most orthopaedic surgeons in any state (1,968) and the smallest increase in orthopaedists of all the states since 1992-up 3 percent. It also had the highest penetration of managed care; 36.5 percent of orthopaedic patients were in managed care in 1996. That is more than double the national average and up almost 10 percentage points from 1992.

Oregon, which had the second smallest increase in orthopaedic surgeons in the 1992-1996 period-8.4 percent-has the second highest penetration of managed care-34.3 percent of patients.

In 1996, California had 6.21 orthopaedic surgeons per 100,000 people, down from 6.28 in 1992. It is one of only two states that had a decline in the density of orthopaedic surgeons to population. Although it was a minuscule 0.07 decline, it meant the state's population grew slightly faster than the number of orthopaedic surgeons increased. (Washington has a 0.05 percent decline in density of orthopaedic surgeons to population.)

California had the most practice opportunities available in the Placement Service-10 percent of the 520 listings-in early January.

Colorado was a close third on the "preferred" list; it was favored by more than 29 percent of orthopaedic surgeons. The two states often trade places on the list. Colorado had 289 board-certified orthopaedic surgeons in 1996, up 14 percent from 1992. There were about 7.7 orthopaedic surgeons to 100,000 population, only slightly higher than in 1992, meaning the increase in orthopaedists had kept pace with population growth.

More than one-third of orthopaedists' patients (34.3 percent) were in managed care plans. In 1992 almost 25 percent of patients had managed care plans.

Rounding out the five most preferred states are Florida and Virginia. The number of Virginia orthopaedic surgeons increased 18 percent to 434 in 1996 from 1992, while the percentage of managed care patients increased to almost 24 percent from about 14 percent in 1992. Virginia had about 6.5 orthopaedic surgeons per 100,000 population.

In 1992-1996 period, Florida had an almost 17 percent increase in orthopaedic surgeons to 875. In the same period, managed care patients increased to almost 25 percent from 15 percent. Florida had 6.1 orthopaedic surgeons per 100,000 population in 1996 vs. 5.6 in 1992.

You've got to know the territory if you want to make a successful relocation.

Preferred states
N. Carolina 36.36%
California 31.21
Colorado 29.85
Florida 29.58
Virginia 28.90
Maryland 26.05
Arizona 24.97
S. Carolina 24.97
New York 24.56
Pennsylvania 24.29
Connecticut 23.20
Georgia 22.12
Washington 20.49
New Jersey 20.08
Oregon 18.86
New Mexico 17.10
Massachusetts 16.15
Texas 16.01
Illinois 15.60
Rhode Island 14.93
Vermont 14.65
Dist Columbia 14.38
New Hampshire 13.70
Tennessee 13.57
Nevada 12.62
Delaware 12.62
Utah 11.80
Ohio 11.53
Idaho 11.40
Maine 11.26
Montana 10.45
Kentucky 9.50
Hawaii 9.23
Michigan 9.09
Indiana 8.96
Wyoming 8.14
Wisconsin 7.19
Missouri 7.06
Alabama 6.92
W. Virginia 6.24
Minnesota 5.43
Louisiana 4.75
Iowa 4.61
Mississippi 4.34
Kansas 4.21
Oklahoma 3.53
Arkansas 3.53
Nebraska 2.58
Alaska 2.31
N. Dakota 1.36
S. Dakota 1.22

Source: American Academy of Orthopaedic Surgeons, Placement Service

Orthopaedic surgeons and managed care penetration

Number of ortho. surgeons in 1996 Density ortho. surgeons per 100,000 pop. 1996 Mean pct. of patients in managed care 1996 Pct. change in ortho. Surgeons 1992-1996 Pct. change in patients in managed care 1992-1996
Alabama 218 5.1724.39% 25.29% 18.83%
Alaska 467.74 1.41 15.00213.33
Arizona 245 5.5634.63 18.36 41.75
Arkansas 132 5.2613.34 29.41 152.65
California 1,968 6.2136.50 3.09 37.42
Colorado 289 7.6934.30 14.23 38.36
Connecticut 266 8.1230.57 15.65 69.64
Delaware 46 6.4830.63 15.00 55.17
Dist. Columbia 55 10.1233.69 14.58 31.81
Florida 875 6.1124.56 16.98 58.55
Georgia 408 5.5823.34 27.90 113.35
Hawaii 685.74 20.54 25.93-5.08
Idaho 776.47 7.14 28.33158.70
Illinois 577 4.8825.45 20.96 79.35
Indiana 298 5.1219.46 24.69 47.54
Iowa 1445.12 15.96 10.7722.39
Kansas 1174.59 20.07 24.4727.92
Kentucky 191 4.9416.48 36.43 109.67
Louisiana 240 5.5418.14 23.71 75.95
Maine 856.92 12.51 10.39167.88
Maryland 373 7.3929.58 23.51 52.55
Massachusetts 436 7.1933.53 9.82 35.47
Michigan 378 3.9622.26 10.85 36.73
Minnesota 286 6.1429.55 22.75 12.44
Mississippi 104 3.877.55 22.35 107.99
Missouri 308 5.7626.23 21.74 43.65
Montana 82 9.326.88 32.26 297.69
Nebraska 95 5.7514.88 23.38 69.09
Nevada 835.18 25.97 50.9175.59
New Hamp. 93 8.0024.39 25.68 99.43
New Jersey 465 5.8625.19 8.64 139.45
New Mexico 95 5.5425.60 10.47 39.13
New York 1,016 5.6325.95 13.52 110.80
N. Carolina 437 6.0217.82 27.03 117.32
N. Dakota 36 5.599.74 28.57 84.82
Ohio 5705.15 23.84 13.5538.20
Oklahoma 155 4.7022.17 17.42 38.22
Oregon 2327.34 34.36 8.4152.37
Pennsylvania 714 5.9621.41 10.19 82.06
Rhode Island 80 8.0824.16 23.08 2.37
S. Carolina 199 5.3814.15 21.34 122.48
S. Dakota 46 6.288.00 53.33 107.25
Tenn. 3336.26 21.46 33.2029.75
Texas 9144.83 25.50 14.3981.37
Utah 1246.20 29.66 19.2313.16
Vermont 44 7.4716.26 12.82 79.27
Virginia 434 6.5523.91 17.93 72.01
Washington 396 7.2027.06 8.79 19.63
West Virginia 76 4.1610.00 26.67 216.46
Wisconsin 336 6.5723.43 20.43 40.55
Wyoming 38 7.892.31 72.73 -7.60
Nat. Average

25.54 15.78 51.79

Source: American Academy of Orthopaedic Surgeons, department of research and scientific affairs


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