For the past few decades Orthopedic Surgery has been the "jewel" of medicine. The technological advances in Sports Med, Microsurgery, Spine surgery, Joint Replacement, and Trauma Care have been astonishing and well documented. All of that being said, the looming problem in the US and around the world is higher and growing demand and not enough providers to keep up. That is the Musculoskeletal Time Bomb. According to Steven M. Kurtz, PhD, and Kevin L. Ong, PhD by 2030, the demand for primary total hip arthroplasty (THA) is
estimated to grow annually from 209,000 to 572,000 and the demand for
primary total knee arthroplasty (TKA) is projected to grow from 450,000
to 3.48 million procedures. The American Academy of Orthopedic Surgery estimates that the demand for joint replacement will double in ten years and that Total Knee replacement demand will grow by 674% and Total Hip replacement demand will go up by 174% by 2030.
Two often overlooked factoids are that new surgeons have different lifestyle expectations i.e. they want to work less and spend more time doing other things, in practical terms they want to do fewer cases. The second factoid is the trend for older surgeons to retire early. These two trends come at an inopportune time.
How to increase the supply of qualified Orthopedic surgeons to meet the increased demand is going to demand we, as a society, look at new models for educating surgeons. It will not be easy. I anticipate one approach will be to further expand the role of mid-level providers to do more of the office work which will allow the surgeon to spend more time in the OR, but that creates its own problems. Most patients want to meet their surgeon before they go to the operating room, and who can blame them?
As our population ages it is expected to drive the demand for Orthopedics up by at least 50% over the next twenty years or so. The combination of longer expected life spans, the obesity epidemic, and the progress of the population bubble representing the baby boomers combine into what has been called the perfect storm of unmet expectations for MS care. Demand for specific procedures like total joints will be even higher if Kurtz and Ong are to be believed.
There are a lot of places to look for numbers on population growth but in very rough terms the Medicare population in the US is projected to increase from around 47 million in 2010 to 80 million in 2030. Social security numbers indicate that the worker/beneficiary ratio will shrink from 3.4 to 2.3. The potential instability is hard to overlook.
There may be no clean answer to this dilemma. Normally supply and demand tend to balance out. The exception to that is areas where exceptional knowledge and skill are required.
ReplyDeleteThe only solution with a likelihood for success is the preloading of the system that produces the Orthopedic surgeons. This is highly unlikely since there is no mechanism in existing health care mechanisms in the US to make this happen. Over seas, there are mechanisms for this to happen. It may be that I will need to get my total hip replacement in Sweden in 2035.
Robotics will probably contribute significantly, although insufficiently to meet all the increased demand.
ReplyDeleteRobotics can do a great deal to improve what is called "efficiency" of physician utilization. Today, most physicians resist the concept of efficiency that robotics can bring. To them it is more like being pushed out of medicine by a machine than a tool to allow great increases in capacity as well as great increases in quality of outcomes. The coldness of robots and great advances that Artificial Intelligence can bring to technically complex surgeries can easily allow a physician to triple their throughput. It is not hard for me to imagine even 20 times what is done today.
ReplyDeleteWhen a physician fully embraces this concept, there is a paradigm shift in the role of the orthopedic surgeon. Of course, they will always require technically trained minds to understand and advance the techniques of the various surgeries. But the core of the work becomes managing the technicians that operate the robot and being the human interface for all the “machine work” that is done in the “machine shop.”
This role of manager and human interface is very different from the focus of todays orthopedic surgeon. Of course, today, all good physicians have what used to be called great bedside manners. I prefer to call this the human touch for the robot doing it’s work in the machine shop. This concept embraces fully the concept of high touch, high technology. It is a strange concept that the efficiencies of machines, production lines and specialization of work will improve the outcomes as well as improve the satisfaction of the physician. Will the patients be as fully satisfied when their hips are replaced on “Ford’s Assembly Line?” Why not? Satisfaction is dependent on the physician/manager being the high touch as much as the technical proficiency of the robots in the operating room.
To be an effective change agent to this new way of orthopedic surgery a very different kind of physician is needed. They must not only be masters of complex technical work in the operating room and the soft delicate work of working with the people needing the surgery. These change agents must be “Pioneers in spirit.” In addition, the work itself demands the Integrator personality as well. This is fundamentally different from the persona that all physicians have today. Today, the successful orthopedic surgeon is better characterized as a Guardian and Driver. The new physician will be a Pioneer and Integrator. The change needed in the kind of person that this new way of doing medicine cannot be overstated. In fact, it is doubtful that those who have these rare combinations of personality Pioneer-Integrator will be drawn to medicine. The normal path for those personalities in the past has been entrepreneur.