Published 8/1/2017
John Cherf, MD, MPH, MBA; Angela Buckley, MPA

Census Examines Orthopaedic Workforce Trends

The Orthopaedic Practice in the United States (OPUS) Survey, also known as the orthopaedic census, gathers demographics and practice data on U.S. orthopaedic surgeons. Conducted every 2 years by the AAOS research, quality, & scientific affairs department, the information collected helps ensure that AAOS members are accurately represented, Academy program and products evolve to reflect changes in membership, and the AAOS continues to address the professional needs and interests of its members.

The census provides a unique opportunity to examine trends in the practice of orthopaedic surgery. This article covers changes that have occurred in the orthopaedic workforce between 2008 and 2016.

Surgeon age
According to data gathered in the 2016 OPUS Survey, the average age of an orthopaedic surgeon in the United States is 56.48 years old. Although the average age has been continually increasing since 2008, it appears to be leveling off (Table 1). One explanation for the increase in the average age of orthopaedic surgeons is that many orthopaedic surgeons may have postponed retirement as a result of the economic recession in 2008.

Most full-time orthopaedists are between 40 and 59 years old, while most part-time orthopaedists are in their 60s or older (Fig. 1). These data suggest that many orthopaedic surgeons transition from full-time to part-time status prior to retiring.

Surgeon sex
For years, more than 90 percent of the orthopaedic workforce has been male (Table 2). The percentage of females has steadily increased, which is a promising trend toward diversity.

The 2016 OPUS Survey data show increases in the percentage of females among younger orthopaedic surgeon groups (Fig. 2). 

For years, most of the orthopaedic workforce has been Caucasian. Of the minority groups, Asian Americans lead the racial make-up of both male and female orthopaedic surgeons, followed by Hispanics and African Americans (Table 3). Orthopaedic surgeon recruitment in the next few years will likely focus on African American and Hispanic/Latino populations to ensure diversity within the field.

Degree of specialization
According to results of the 2016 OPUS Survey, most orthopaedists in the United States (58 percent) are specialists. Twenty-five percent define themselves as generalists with a specialty interest; only 17 percent report they are generalists.

Comparison of current OPUS data with reports from 2008 reveals an increase in the percentage of orthopaedists who define themselves as specialists and a decrease in the percentage of orthopaedists who define themselves generalists. This trend is consistent with the growing number of orthopaedic residents who pursue fellowship training. Breaking down the degree of specialization by age shows that the younger orthopaedists tend to be specialists while older orthopaedists tend to be generalists (Fig. 3).

Areas of focus
The census asks orthopaedists to identify both their primary specialty and other specialty areas. Since 2008, the top areas of focus have been the adult knee and arthroscopy.

Surgeon density
Wyoming has had the highest orthopaedic surgeon density (most surgeons per 100,000 people), followed by Montana, since 2008. Since 2010, Alabama has had the lowest orthopaedic surgeon density (least number of surgeons per 100,000 people), followed by Mississippi.

2018 will be a census year
The next census data gathering year will be 2018. Questionnaires will be sent to AAOS members via email, fax, or mail. As always, we seek a 100 percent response rate; orthopaedic surgeons are therefore encouraged to answer the survey as soon as they receive it during the first quarter of 2018.

The next article in this series will examine orthopaedic practice settings and productivity.

The full 2016 OPUS report is available to AAOS members at http://www.aaos.org/2016censusreport

AAOS log-in and password are required to view the report, which is also available for purchase.

John Cherf, MD, MPH, MBA, is the current practice and payment section leader of the Health Care Systems Committee, a member of the Council on Education, and a member of the AAOS Now editorial board. Angela Buckley, MPA, is a research analyst in healthcare statistics and surveys in the AAOS department of research, quality, & scientific affairs.

Editor's note: This article is the second in a series of articles that summarizes the results of the biennial orthopaedic census. The first article ("Orthopaedic Practice in the United States" AAOS Now, July 2017) covered key results of the 2016 census.

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