Census data provides a peek at the profession, practices

Not many people live in Montana or Wyoming—by population, they rank 44th and 50th among all U.S. states—but they are well-served with orthopaedic surgeons. Both states have more than 10 orthopaedic surgeons per 100,000 population. In contrast, Texas, the 2nd most populous state, has fewer than 6 orthopaedic surgeons per 100,000 population.

That’s just one of the tidbits of information you’ll find in the 2008 Orthopaedic Practice in the United States (OPUS) report. The report, which is based on the biennial census of AAOS members conducted by the Academy’s research department, is now available online, and is free to members and residents.

The demographic and orthopaedic practice-related information collected through the census is especially useful in ensuring that Academy programs and products are designed to address AAOS members’ professional needs and interests.

Basic demographics
The AAOS has surveyed members every other year since 1985 to update surgeon and practice information in the Academy’s database. Information in this article is based on the most recent census, completed by just over 37 percent of the 25,464 orthopaedists surveyed.

Overall, the United States had 7.18 orthopaedists per 100,000 population. Joining Wyoming and Montana as high-density states (more than 10 orthopaedic surgeons per 100,000 population) are Alaska, the District of Columbia, and Vermont. At the other end of the scale, West Virginia, Mississippi, and Arkansas—like Texas—have fewer than 6 orthopaedists per 100,000 population (Fig. 1).

The average age of practicing orthopaedists is 50.7 years. This is younger than the average age reported in the 2006 census (51.4 years old), and more in line with previous census data. The state with the “oldest” orthopaedists is New Mexico, with a mean age of 53.0 years; the state with the “youngest” orthopaedists is Nevada, with a mean age of 48.1 years.

Overall, 4.3 percent of orthopaedists are female. Based on gender information in the AAOS database, California has the most female practitioners and Delaware has none.

Practice characteristics
The most popular practice setting is a private orthopaedic group; 44 percent of respondents practice in that setting. More than one in five orthopaedists (21 percent) practice in a private solo setting (Fig. 2).

About one in four orthopaedic surgeons (24 percent) practice general orthopaedic surgery; this is down slightly from 2006, when 28 percent responded that they practice general orthopaedics. The number who say they are generalists with a specialty interest is also down from 2006, from 32.2 percent to 30 percent. Less than half (46 percent) report practicing as a specialist (Fig. 3), up from 39.2 percent in 2006.

Slightly more than one in ten surgeons (11 percent) in the orthopaedic workforce is currently working part-time. A larger proportion of part-time orthopaedists can be found in the general orthopaedist group compared to generalists with a specialty interest and specialists (Fig. 4).

Nearly all (98 percent) of respondents offer X-ray services in their office and less than half (46 percent) offer physical or occupational therapy. On average, orthopaedists offer 2.6 additional services in their offices.

Clinical focus
As in previous years, the three most frequently cited areas of practice are adult knee, arthroscopy, and sports medicine. One out of three surgeons indicates these as a focus area.

Sports medicine is the leading fellowship area, followed by hand and adult spine.

Overall, orthopaedists perform an average of 32.2 procedures per month, with full-time orthopaedists reporting an average of 33 procedures per month and part-time orthopaedists performing an average of 16.7 procedures per month.

Where the time goes
Full-time orthopaedists spend most of their time (85 percent) in clinical care activities. Administrative activities occupy an additional 7 percent of professional time, followed by teaching at 5 percent (Fig. 5).

Overall, full-time orthopaedists reported taking an average of 4.1 weeks vacation, 8.9 days away from practice for continuing medical education activities, and 8.1 days away for professional meetings.

Orthopaedists who are female or younger than age 40 tend to take less time for vacation (slightly more than 3 weeks a year).

Special focus: Trauma
The 2008 census also included specific questions on trauma call. Approximately two thirds (68 percent) of respondents take trauma call associated with an emergency department at their hospital. About 4 in 10 (39 percent) of those who do take trauma call are compensated for their time.

Younger surgeons are more likely to take trauma call; more than four out of five orthopaedists younger than age 50 reported taking call, compared to one in three orthopaedists in the 60–69 age group.

Only about one in four orthopaedists in solo practice takes trauma call, compared to three out of four orthopaedists who work in a hospital or medical center.

Get ready for the 2010 census
Find out more during the 2010 Annual Meeting in New Orleans. Visit staff from the AAOS department of research and scientific affairs at the Orthopaedic Census Booth in Academy Row. Get a jump start on the campaign to gather the latest data from orthopaedic surgeons for the census year 2010!

Links to the 2008 Orthopaedic Practice in the United States (OPUS) data can be found in the online version of this article, available at www.aaosnow.org; member log-in is required to access gross collection and net income information.

Hazel Natividad, MA, is a research analyst in the AAOS department of research and scientific affairs. She can be reached at natividad@aaos.org

Heidi Schmalz is manager, survey research, in the AAOS department of research and scientific affairs. She can be reached at schmalz@aaos.org