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Published 11/1/2011
Hazel Natividad, MA

How has orthopaedics evolved?

Every 2 years, the AAOS conducts the OPUS (Orthopaedic Practice in the United States) survey. This census of AAOS members, which was last conducted in 2010, provides a comprehensive look at the practice characteristics of orthopaedists in the United States. It not only reflects the orthopaedic workforce, but also shows how the orthopaedic specialty is evolving.

Distribution across the country
Surprisingly, several states with low populations had high surgeon densities (number of surgeons per 100,000 population). In rank order, Montana, Wyoming, Alaska, Vermont, and New Hampshire had the highest density of orthopaedic surgeons (11 or more per 100,000 population). These same states also ranked in the top five in terms of surgeon density in 2008. If it were a state, the District of Columbia would have beaten out New Hampshire for the fifth spot, with 11.84 surgeons per 100,000 population.

The converse, however, was not true. High population states such as California, New York, and Florida had density figures close to the national average of 7.80 surgeons per 100,000 population. The state with the lowest density of orthopaedic surgeons was West Virginia (5.88 per 100,000 population), followed by Michigan, Mississippi, Arkansas, and Texas (Table 1).

The average age of a practicing orthopaedist was 50.7 years in 2008, and 52.85 years in 2010. Most (96 percent) orthopaedists are male; women account for only 4 percent of the orthopaedic workforce. When the AAOS began tracking gender in 2000, women accounted for just 2.7 percent of board-certified practicing orthopaedic surgeons.

The AAOS began collecting data on race and ethnicity in 2004, and although Caucasians continue to be the majority (88 percent) of the orthopaedic workforce, the proportion of other races is increasing. Asian-Americans account for 5 percent of orthopaedic surgeons; Hispanic/Latino, African-American, multi-racial, Native American, and “other race/ethnicity” categories each account for less than 2 percent of the orthopaedic workforce (Fig. 1).

Although males outnumber females in the orthopaedic workforce within Caucasian and Hispanic groups, the opposite is true when looking at other minority groups. Among African-American and multi-racial groups, women outnumber men by more than two to one (Table 2).

Specialty orientation
The trend toward specialty orientation continued in 2010, as it has throughout the decade. In 2010, 48 percent of full-time orthopaedic surgeons identified themselves as specialists, compared to 44.3 percent of full-time orthopaedic surgeons who did the same in 2008. Similarly, 31 percent identified themselves as generalists with specialty interests in 2010, compared to 28.6 percent in 2008. Only the percentage of generalists has stayed fairly stable (18.9 percent in 2008 and 19.4 percent in 2010). (Percentages do not equal 100 percent because not all respondents answered the question.)

Part-time orthopaedists, on the other hand, remain overwhelmingly generalists (47.6 percent in 2008 and 53.1 percent in 2010). But the proportion of part-time specialists is increasing—from 23.5 percent in 2008 to 25.5 percent in 2010—as is the proportion of part-time generalists with a specialty interest (from 18.1 percent in 2008 to 21.1 percent in 2010).

As in 2008, the three most frequently cited areas of practice in 2010 were adult knee, arthroscopy, and sports medicine, while the most popular fellowship specialty areas were sports medicine, hand, and adult spine.

Practice settings
Members were asked to identify their practice setting. In both 2008 and 2010, the top four practice settings for full-time orthopaedists were the same, as follows:

  • private practice orthopaedic group
  • private practice solo
  • private practice multi-specialty group
  • academic practice with salary coming from an academic institution

The top four practice settings for part-time orthopaedists in 2010 were private practice solo, private practice orthopaedic group, other, and hospital/medical center.

Full-time orthopaedists reported working an average of 61 hours per week in both 2008 and 2010, with an average of 4 weeks of vacation per year. The average work week for part-time orthopaedists also remained the same at 24 hours per week.

Payer mix and procedures per month
The survey questions on payer mix changed slightly in 2010, combining health maintenance organizations, preferred provider organizations, and independent provider associations (HMO/PPO/IPA), which had been separate options in 2008. Medicare continues to be a primary payer, accounting for approximately one-fourth of payments to orthopaedic surgeons.

Although some analysts say that a fee-for-service payment schedule encourages procedure-oriented physicians, such as orthopaedic surgeons, to do more procedures to increase income, survey results show that a ceiling on the number of procedures a surgeon can perform during a single month may exist. Since 2004, full-time orthopaedic surgeons have reported performing an average of 31 to 33 procedures per month. In fact, the number of procedures per month performed by part-time orthopaedic surgeons decreased between 2008 and 2010, from 16 to 11.

The 2010 OPUS Report is available free to AAOS members and may be purchased by nonmembers. It can be downloaded from the AAOS website, at www.aaos.org/research

Be a part of the 2012 census
Next year (2012) will be another census year. The AAOS research department will have a census booth at the 2012 Annual Meeting in San Francisco. Stop by to find out more about previous results and about the 2012 census, which will be distributed in April.

The 2012 OPUS Census will be sent via email, fax, and hard copy to all AAOS members in the United States. When yours arrives, please take the time to respond. The better the response rate, the more accurate the data. Your participation will help ensure the data reflect the changes in the orthopaedic workforce and can provide valuable statistical support for advocacy and other efforts.

Hazel Natividad is manager, healthcare statistics and surveys, in the AAOS research department. She can be reached at natividad@aaos.org