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Published 11/1/2015

September Struck Chords with Readers

Setting AAOS NOW Straight

The letter about compensation for orthopaedic surgeons from Dempsey Springfield, MD, in the September 2015 issue indicated that orthopaedic surgeons make 10 times the median income of an American household, which is $52,000. I want to know whether anyone ever accounted for overhead and practice expenses?

I practice in California as a general orthopedic surgeon with a focus on joint arthroplasty. Reimbursements are declining, overhead continues to spiral upwards, and, if it were not for MICRA, I would be unable to afford my malpractice insurance. I have calculated my hourly salary after deducting overhead but prior to taxes, and it is a shocking $25 per hour. My physician assistant, whom I employ to help me, earns $42 per hour, works 8 hours a day, 5 days a week, and does not take call.

Statistics can be manipulated to draw any conclusion, but orthopaedists should speak up and be honest with each other and with our patients to correct the misconceptions that are flying around about how rich doctors are. Most people are unaware that private practice orthopaedic surgeons do have a significant burden with overhead, and that we have to pay for all benefits (health insurance, retirement plans) that most employees take for granted.

When patients have asked me about my income, I honestly discuss the issue. I find that they are very understanding and sympathetic, because they see that doctors are their advocates and want to help them. They, in turn, are quite appreciative of how hard we work on their behalf.

I hope my colleagues will speak up on this issue (and if someone is truly making more than $500,000 per year after paying overhead but before paying taxes, please let me know, because I would love to learn from that person).
Rina Jain, MD, FRCSC
San Diego

The September 2015 issue of AAOS Now contains an article concerning a surgeon's scorecard from ProPublica ("Surgeons Get Graded: Your Report Card Is Online"). My understanding is this is generated from computer data of surgeons providing services for Medicare. I have several comments concerning the rating. Obviously, these are raw data and do not take into consideration the complexity of the surgery involved or the preoperative comorbidity factors of the patients. The obvious criticism of any rating system like this is the fact this rewards surgeons that do minor surgical cases on extremely healthy patients and punishes physicians doing more complex surgery on patients with comorbidities.

Another criticism of this rating is that it does not list what the complications were. One could assume most of these readmissions have nothing to do with the actual spine surgery, but more to do with complications such as a urinary tract infection or respiratory problems.
Kenneth A. Pettine, MD
Johnstown, Colo.

I certainly appreciated the article on the physician score card. I had already seen my ProPublica score before the article came out and was somewhat dismayed. My scores were somewhat higher than those surgeons whose many misadventures and/or problems I routinely see. I agree that the score card was a first step, but more importantly agree with the call to action that we should be stimulated to move to our own reporting and safety mechanisms. The excluded databases of Medicaid and private payers should become available as the ACA processes and meaningful use become more prevalent. There are a tremendous number of papers published out of the Kaiser system secondary to their long running database that I find educational and enlightening.

Having performed more than 100 revisions every year I have been in practice (26 years), I am considering limiting my revision access because the reimbursement is poor, the headaches are increasing, and the number of "Joint Centers" at small hospitals churning out less-than-ideal results is becoming overwhelming.

I see access becoming quite limited as financial pressures and outcome reporting becomes more prevalent, and this will also include the revision traumatologist, revision spine surgeons, and even those doing revision sports medicine.

I commend you on a timely and well-presented article. I am working to address this on a regional level, but it is very difficult to get any traction. Thank you for making this development front and center. As always, I truly enjoy the AAOS Now publication and always read it cover to cover. Please keep up the excellent work.
Dennis M Brown, MD
Dayton, Ohio

Setting Now Straight
If you want to set AAOS Now straight, send your letters to the Editor, AAOS Now, 9400 West Higgins Rd., Rosemont, Ill. 60018; fax them to 847-823-8033; or email them to aaoscomm@aaos.org