Editor’s note: This article is the first of a four-part series that examines trends in orthopaedic practice in the United States. The first three articles of the series focus on results from the 2018 AAOS Census Survey, and the final article includes data collected by the 2017 American Association of Orthopaedic Executives Benchmarking Survey of Orthopaedic Practices. The second part, which will address trends in the data reported, will be featured in the September issue of AAOS Now.

The AAOS research, quality, and scientific affairs department gathers demographic and practice data on orthopaedic surgeons through the Orthopaedic Practice in the United States (OPUS) Survey, also known as the Census Survey. The most recent data from the biennial report come from the 2018 Census Survey, the 17th in the series, which had a response rate of 23.3 percent based on the most recent orthopaedic physician census of 30,141 members.

The information collected in the surveys helps ensure that AAOS members are accurately represented, that Academy programs and products evolve to reflect changes in membership, and that AAOS continues to address the professional needs and interests of its members.

Surgeon density

Surgeon density was computed with 2017 U.S. Census figures and 2018 orthopaedic surgeon counts per state. The 2018 density of orthopaedic surgeons in the United States was 9.25 per 100,000 population, or a population of 10,810 per orthopaedic surgeon. Montana, Vermont, Wyoming, Alaska, and South Dakota had the highest surgeon density, with more than 13 orthopaedic surgeons per 100,000 people (i.e., a population of 7,692 or fewer per orthopaedic surgeon). Mississippi, Texas, Nevada, Arkansas, and Oklahoma had the lowest surgeon density at eight or fewer orthopaedic surgeons per 100,000 people (i.e., population of 12,500 or more per orthopaedic surgeon).

The surgeon density map (Fig. 1) illustrates the density of orthopaedists by state.

Age and sex

The average age of an orthopaedic surgeon is 56.5 years. Most (92.2 percent) of the orthopaedic workforce is male, and 5.8 percent is female (2.0 percent did not indicate their sex) (Fig. 2). Fig. 3 illustrates average ages by state.

Fig. 4 shows the racial/ethnic breakdown among orthopaedic surgeons. The majority of the orthopaedic workforce is white. Asian Americans comprise the largest minority group, followed by Hispanic/Latino, then other, black, and Native American.

Practice setting

Members were asked to identify their practice settings (Fig. 5). The most common practice setting is private practice-group (36 percent), followed by hospital/medical center (17 percent), academic practice-salaried by academic institution (14 percent), private practice-solo (12 percent), private practice-multispecialty (9 percent), and academic practice-private practice (4 percent). Locum tenens, the military, health maintenance organizations, public institutions, and other practice settings account for the remaining 9 percent.

Degree of specialization

More than half (60 percent) of the orthopaedists who responded to the survey identify as specialists (Fig. 6), whereas 25 percent are generalists with a specialty interest. The remaining 15 percent identify as generalists.

Areas of focus

The 2018 Census Survey asked orthopaedists to identify their specialty areas. The top seven areas of focus are sports medicine, total joint, hand, adult spine, trauma, foot/ankle, and pediatric orthopaedics.

The full 2018 OPUS report is available to AAOS members at www.aaos.org/aaoscensus. AAOS members must log in to read the report. It is also available for purchase by non-AAOS members.

John Cherf, MD, MPH, MBA, is the 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.