orthopedic surgeon saturation?

[maybeortho]

I've read a lot of stuff about how there is a surplus in the number of orthopedic surgeons in America, which would clearly be bad for a prospective ortho in the future. However, I've also read that the need for orthos will be great in the future. What do you guys think? Will orthos be in demand or supersaturated in 10-20 years?

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[cdql]

I think they'll be in great demand. There was an article in the NYTimes last week about how the baby boomer generation is the first one to really embrace exercise. And in doing so, a lot of those people suffer from hip, knee, ankle, etc... problems.

I think there'll be plenty of business out there.

 

[ny skindoc]

I think they'll be in great demand. There was an article in the NYTimes last week about how the baby boomer generation is the first one to really embrace exercise. And in doing so, a lot of those people suffer from hip, knee, ankle, etc... problems.

I think there'll be plenty of business out there.

I agree I think is is a real growth specialty nationally.Especially if one would practice in smaller cities or geographic areas which are poorly served they will kept be very busy.

 

[cdql]

http://www.nytimes.com/2006/04/16/sports/16boomers.html?incamp=article_popular_3

Here was the article I was talking about!

That being said, it doesn't necessarily mean that ortho will be a gold mine. It merely means new ortho docs will have plenty of opportunities to find work!

e.g. (from the article above) Dr. Thomas Schmalzried, a Los Angeles-area orthopedic surgeon who specializes in hip and knee replacement, said: "The majority of patients getting total knee and hip replacements are Medicare patients. And no one is getting rich from Medicare payments."

I guess I understand why some of the older docs around here always suggest choosing a specialty based on what you actually like. Payment, work opportunities, etc... etc... are always cyclical and unpredictable. Sometimes they increase, sometimes they decrease, and if you choose a field based on what the current work conditions are like now, you may find yourself very disappointed later on!

 

[dawg44]

http://www.nytimes.com/2006/04/16/sports/16boomers.html?incamp=article_popular_3

Here was the article I was talking about!

That being said, it doesn't necessarily mean that ortho will be a gold mine. It merely means new ortho docs will have plenty of opportunities to find work!

e.g. (from the article above) Dr. Thomas Schmalzried, a Los Angeles-area orthopedic surgeon who specializes in hip and knee replacement, said: "The majority of patients getting total knee and hip replacements are Medicare patients. And no one is getting rich from Medicare payments."

I guess I understand why some of the older docs around here always suggest choosing a specialty based on what you actually like. Payment, work opportunities, etc... etc... are always cyclical and unpredictable. Sometimes they increase, sometimes they decrease, and if you choose a field based on what the current work conditions are like now, you may find yourself very disappointed later on!

Yeah but if there is a huge shortage nationwide, you don't have to take medicare and stay as busy as you want to.

 

[dawg44]

The crunch is already starting the avg starting salary for an orthopod has went up 80,000 dollars in just the last 4 years. Whether or not reimbursement goes down hospitals are going to find ways to get ortho done in their hospitals. They make so much on facility fee's its in there interest compensate orthopods through other means (call, reimbursing for self pays, directorships) otherwise they will lose one of the biggest money makers in a hospital. Or risk losing high paying outpatients to orthopods privately owned MRI, PT and surgery centers if they don't play. Our profession did a wise thing by limiting spots and with the old balance budget freeze the government is unlikely to come up with new money to meet the need for more residents. Its a rosy picture for orthopods in the future as much as any part of medicine.

 

[Avery0106]

http://www.nytimes.com/2006/04/16/sports/16boomers.html?incamp=article_popular_3

Here was the article I was talking about!

That being said, it doesn't necessarily mean that ortho will be a gold mine. It merely means new ortho docs will have plenty of opportunities to find work!

e.g. (from the article above) Dr. Thomas Schmalzried, a Los Angeles-area orthopedic surgeon who specializes in hip and knee replacement, said: "The majority of patients getting total knee and hip replacements are Medicare patients. And no one is getting rich from Medicare payments."

I guess I understand why some of the older docs around here always suggest choosing a specialty based on what you actually like. Payment, work opportunities, etc... etc... are always cyclical and unpredictable. Sometimes they increase, sometimes they decrease, and if you choose a field based on what the current work conditions are like now, you may find yourself very disappointed later on!

Interesting point regarding Medicare patients and hip replacements. Thanks.

 

[doclm]

I think they'll be in great demand. There was an article in the NYTimes last week about how the baby boomer generation is the first one to really embrace exercise. And in doing so, a lot of those people suffer from hip, knee, ankle, ect... problems.

I think there'll be plenty of business out there.

I totally agree with this.

 

[MossPoh]

This is just a question from a premed interested in pod stuff....... Does the increase amount of cases lead to shottier work? I understand that many docs won't do more than they can handle but it seems that there have to be a few that want to capitalize on the huge amount of cases and try to bust through as many surgeries as possible.

 

[sscooterguy]

This is just a question from a premed interested in pod stuff....... Does the increase amount of cases lead to shottier work? I understand that many docs won't do more than they can handle but it seems that there have to be a few that want to capitalize on the huge amount of cases and try to bust through as many surgeries as possible.

Although there is an increase in cases AND a concurrent decrease in reimbursement, this has not translated into shoddier work from what I've seen. I asked my chair this very question. He told me that people have gotten better as well as more efficient, so hip and knee replacements are not nearly as long, complications have decreased, and they are doing a better job BECAUSE not despite of the high volume.

sscooterguy

 

[MossPoh]

Well that is comforting to know! I have noticed how fast recoveries are now. My gma just got her second hip replacement and the first one she was in the bed for nearly a month before really getting up...second time it was a little less than two weeks. This was for a 94 yearold woman. I am really amazed to see how fast surgeries have evolved from the day when an athlete tore an ACL and was doomed to now when they can come back fairly quickly with minimal problems....well some of them.

 

[Playmakur42]

I am really amazed to see how fast surgeries have evolved from the day when an athlete tore an ACL and was doomed to now when they can come back fairly quickly with minimal problems....well some of them.

I tore my ACL playing football in 1999 and got an ACL reconstruction using my hamstring tissue. My knee is rock solid. However, my hamstring is now weak and the subsequent weakness has resulted in lower back pain. My surgeon promised me my hamstring would recover totally. Not the case! Should have gotten the cadavers ACL!

Do they still use the hamstring for ACL reconstruction?

 

[RxnMan]

I tore my ACL playing football in 1999 and got an ACL reconstruction using my hamstring tissue. My knee is rock solid. However, my hamstring is now weak and the subsequent weakness has resulted in lower back pain. My surgeon promised me my hamstring would recover totally. Not the case! Should have gotten the cadavers ACL!

Do they still use the hamstring for ACL reconstruction?

The orthopods I've talked to use the middle third of the patellar tendon (w/accompanying sections of patella and tibial tuberosity). The bone on bone contact heals better than using just tendon, and the patellar tendon fills in over time.

 

[Playmakur42]

The orthopods I've talked to use the middle third of the patellar tendon (w/accompanying sections of patella and tibial tuberosity). The bone on bone contact heals better than using just tendon, and the patellar tendon fills in over time.

The surgeon recommended that, however, I had patellar tendonitis at the time. (From heavy weightlifting combined with constant running) So, he said hamstring works just as good. Just like the patella fills in, supposedly the hamstring would too.

 

[SOUNDMAN]

I tore my ACL playing football in 1999 and got an ACL reconstruction using my hamstring tissue. My knee is rock solid. However, my hamstring is now weak and the subsequent weakness has resulted in lower back pain. My surgeon promised me my hamstring would recover totally. Not the case! Should have gotten the cadavers ACL!

Do they still use the hamstring for ACL reconstruction?

We are using Bone-tendon-bone allograft from cadavers. Approximately 90% of the time. We don't use the patellar tendon autograft anymore, since there is an increased risk of fractured patella with it. Hamstrings may never recover as indicated above, and you have a small 1:2000000 risk or so with the cadaveric allograft.

All of them have the risks/side effects, you just get to choose which one you want.

 

[Playmakur42]

All of them have the risks/side effects, you just get to choose which one you want.

At the time, the belief was that a cadaver reconstruction is not as strong as living tissue from the patient because it was foreign. Since I had 2 years of college ball, and a reasonable shot of continuing on playing after college, the surgeon recommended the hamstring.

Is that still the belief that the cadaver reconstruction doesn't become as strong as the patellar/hamstring reconstructions?

 

[SOUNDMAN]

Well a lot of things are really changing right now regarding ACL reconstruction. My doc just got back from the AAOSM meeting and they are drilling a lot of the tunnels from the inside now, so you have just the arthroscopic portals. Pretty sweet technology they were demonstrating.

In my experience with patients the BTB allograft from cadavers are doing very well. I have seen some hamstrings stretch out a little bit, but whether that was fixation versus graft, probably remains to be seen.

At the time (your reconstruction) hamstrings were definitely the thing most people seemed to be doing. Perhaps now your doc would point you in a different direction. Sometimes it seems so cyclical, I woundn't be surprised if we come back to patellar BTB autograft is back "in". It is the essentially the gold standard, although nothing will replace your native ACL as you well know.

 

[Playmakur42]

Sounds like a pretty subjective decision - it seems like all 3 are decent options. Thanks for the replies.