What should be the role of orthopaedic surgeons in providing musculoskeletal care?

As orthopaedic surgeons, we pride ourselves in treating all disorders of the musculoskeletal system. We are trained to provide the full spectrum of nonoperative and operative treatments. As a result, we perceive our specialty as the most logical provider of musculoskeletal care. As individuals, however, we have important decisions to make about how we provide that care within our practices. Will we be the only providers of musculoskeletal care in our practices, or will we embrace other physician “partners”? And if we choose to “partner” with other physicians in providing musculoskeletal care, will we relinquish our claim to be the “quarterbacks” of musculoskeletal care?

Today’s realities

The reality of modern orthopaedic practice is that many of us specialize in discrete areas of musculoskeletal medicine. Some orthopaedists limit their practices to new patients who “need surgery.” As a result, orthopaedic surgeons may be failing to provide care to many patients with musculoskeletal disorders.

On the other hand, it may not be an efficient practice model for orthopaedic surgeons to provide “start-to-finish” care to all patients with musculoskeletal complaints. Many other physicians—including physiatrists, rheumatologists, and family practice physicians specializing in sports medicine—are also trained to provide musculoskeletal care. Other health care providers, such as podiatrists and chiropractors, and other surgical specialists, such as plastic surgeons and neurosurgeons, have scopes of practice that overlap with orthopaedics. These providers bring different skill sets and backgrounds to musculoskeletal health care, and may complement the care we provide as orthopaedic surgeons.

Will teamwork pay off?

“Partnering” with other musculoskeletal care providers in our practices has several benefits. In busy orthopaedic practices, many patients face long delays to see a doctor, which can increase patient dissatisfaction and complaints about care. A multidisciplinary practice may enable patients seeking nonoperative treatment to see other musculoskeletal specialists more quickly, while patients with urgent problems possibly requiring surgery may be triaged to see the orthopaedic surgeon sooner.

Just as a large practice may benefit from the subspecialization of its orthopaedic surgeons, the musculoskeletal institute may improve the patient care we provide as orthopaedists by matching patients who have self-limited musculoskeletal complaints with other physicians who can focus time and attention on these problems.

Multidisciplinary musculoskeletal care also has its drawbacks. Some patients may be unhappy about not seeing “the surgeon,” regardless of whether or not they need or would consider surgical treatment. Referring physicians may be unhappy if patients referred for an orthopaedic surgeon’s evaluation are seen by a different musculoskeletal care provider. We also risk partnering with providers who do not share our understanding of the entire musculoskeletal disease process and may deliver care that is below or inconsistent with our own standards. To this end, incorporating other providers into our practices should be accompanied by mentoring, participation in multidisciplinary conferences, and adherence to evidence-based practice guidelines.

For better or worse, multidisciplinary musculoskeletal care is “on the horizon,” and we’d like to hear your comments on the topic, which we will include in the next edition of AAOS Now. Please e-mail your comments to aaoscomm@aaos.org

Alan S. Hilibrand, MD, is vice chair of the AAOS Communications Cabinet.