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AAOS Now

Published 11/1/2013
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TaCarra Moore, MPH; Hazel Oreluk, MA

Orthopaedic Practice in the United States

OPUS trends show evolution of orthopaedic workforce

Every 2 years, the AAOS surveys members to track the numbers and practice patterns of orthopaedic surgeons. The results are summarized in Orthopaedic Practice in the United States (OPUS). The information collected helps ensure that AAOS members are accurately represented, that Academy program and products evolve to reflect changes in membership, and that the AAOS continues to address the professional needs and interests of its members.

Among the data tracked by the OPUS survey are the following:

  • demographic information such as the gender and race of surgeons
  • orthopaedic practice-related information, including practice setting and degree of specialization
  • procedure information, such as the number and type of procedures performed

Using OPUS data from 2000 to 2012, the Academy’s research department recently conducted a historical analysis to determine changes in membership and trends in the American orthopaedic workforce. Information in this article is based on respondents from the following membership categories:

  • candidate members
  • applicants for fellowship
  • active fellows
  • nonmember practitioners
  • emeritus fellows who indicated an active work status (full-time or part-time) at the time of the survey

Gender
The number of female orthopaedic surgeons has increased over the past 12 years; however, most of the orthopaedic workforce is male. In 2000, women accounted for just 2.7 percent of the orthopaedic workforce. By 2012, that percentage had nearly doubled to 5.1 percent (
Fig. 1).

Race/ethnicity
Starting in 2004, members participating in the survey were asked to select the category that best described their race/ethnicity, based on the following categories:

  • African American
  • Asian American
  • Caucasian
  • Hispanic/Latino
  • Multiracial
  • Native American
  • Other

Although minority representation is increasing, the majority of the orthopaedic workforce remains Caucasian, accounting for 88.1 percent of orthopaedic surgeons in 2012. Asian Americans continue to be the largest minority group, increasing from 3.9 percent in 2000 to 5.8 percent in 2012.

The proportion of orthopaedic surgeons who identified themselves as African American, Hispanic/Latino, Multiracial, Native American, or “other” has increased slightly during the past decade, from 4.8 percent in 2000 to 6 percent in 2012. However, surgeons in these racial and ethnic groups remain underrepresented, with each group accounting for less than 2 percent of the orthopaedic workforce (Fig. 2).

Practice setting
Beginning in 2004, members were asked to identify their practice setting. The most popular practice setting continues to be private practice/orthopaedic group, followed by academic practice (
Table 1). The least common practice remains locum tenens.

The percentage of orthopaedists practicing in a hospital/medical center is steadily increasing and has more than doubled since the question about practice setting was first asked (from 4 percent in 2004 to 9.1 percent in 2012). It will be interesting to see how this trend evolves when the 2014 survey is conducted.

Degree of specialization
The AAOS member census asks members to identify their degree of specialization based on the following categories: generalists, generalists with a specialty interest, and specialists (
Fig. 3). From 2000 to 2008, the trend toward increased specialization rose steadily; from 30.9 percent who identified themselves as specialists in 2000 to 45.7 percent in 2008.

After 2008, the trend from generalists to specialists stabilized, and specialists now account for 46.6 percent of the orthopaedic workforce. Similarly, the proportion of orthopaedic surgeons identifying themselves as generalists with a specialty interest seems to have stabilized at approximately 30 percent of the orthopaedic workforce. Likewise, the proportion of orthopaedic surgeons identifying themselves as generalists, after trending down from 2000 to 2010, has stabilized at about 23 percent of the orthopaedic workforce.

Areas of focus
Even generalist surgeons may focus on particular areas of orthopaedics within their practices. The OPUS survey asks members to identify their specialty areas in orthopaedics, based on the following selections:

  • adult hip
  • adult knee
  • adult spine
  • arthroscopy
  • disability/legal orthopaedics
  • foot & ankle
  • hand
  • nonoperative practice (introduced in 2008)
  • orthopaedic oncology
  • pediatric orthopaedics
  • pediatric spine
  • rehabilitation, prosthetics/orthotics
  • shoulder & elbow
  • sports medicine
  • total joint (introduced in 2006)
  • trauma

Until 2008, nearly half of all respondents indicated a focus on adult knee. In 2010 and 2012, however, arthroscopy was the most popular focus area, followed by adult knee and sports medicine.

The percentage of members electing “disability/legal orthopaedics” as an area of focus has dropped considerably over the years, from a high of 12.2 percent in 2004 to just 2.8 percent in 2012. Fewer than 1 percent of respondents indicated “orthopaedic oncology” as an area of focus in both 2010 and 2012.

Procedures performed monthly
Starting in 2004, members were asked to estimate the number of surgical procedures they performed in a typical month. Full-time orthopaedists performed an average of 31 to 33 procedures per month. Part-time orthopaedists perform approximately 10 procedures per month.

It’s almost time!
The 2012 OPUS report is available free to AAOS members and may be purchased by nonmembers. AAOS members can access the full report from the AAOS website (log-in required). Nonmembers can purchase a downloadable copy online through the AAOS store. Questions about previous census reports should be directed to
oracle@aaos.org

The 2014 census questionnaire will be sent to AAOS members via email, fax, or postal service after the 2014 Annual Meeting. Over the years, the number of respondents has decreased—a trend the AAOS hopes will be reversed in 2014. Providing information about your practice patterns is key to enabling the AAOS to meet its mission to serve you. The data only you can provide will help the AAOS monitor orthopaedic trends, provide information, and support advocacy, research, and public relations efforts.

TaCarra Moore, MPH, is a health services research analyst and Hazel Oreluk, MA, is manager, healthcare statistics and surveys, in the AAOS department of research and scientific affairs.

Additional Information
2012 OPUS report:
http://www.aaos.org/research/orthocensus/census.asp (member login required)