Published 3/8/2024
Rebecca Araujo

Physician-Led Orthopaedic Hospitals Score Higher on Quality Rankings

An analysis of the top 200 orthopaedic hospitals in the United States found that physician-led orthopaedic hospitals performed better than hospitals without physician leadership.

The findings were presented at the AAOS 2024 Annual Meeting by Patrick Allan Massey, MD, orthopaedic surgeon specializing in sports medicine at Shriners Children’s Shreveport.

“Physician-run hospitals have significantly higher quality scores than non–physician-run hospitals, as well as higher scores in overall management and productivity,” the authors wrote. For this study, “The main objective was to determine if physician-led orthopaedic hospitals were ranked better than hospitals led by a non-physician.”

Assessing rankings
Hospital rankings were based on U.S. News and World Report (USNWR) rankings for top hospitals for orthopaedics, including overall calculated score generated by USNWR for each hospital. As the authors noted, “Orthopaedic hospitals were ranked based on the analysis of various data, including patient survival, volume of patients, overall patient experience, staffing, and availability of advanced technologies. Additionally, specific scores analyzing the quality of procedures applicable to orthopaedics were recorded.” Applicable procedures were hip fracture surgery, back surgery, hip replacement, and knee replacement. Additional scores for hip-fracture procedures analyzed overall survival, readmission prevention, and patient experience. Scores were on a scale of 1 to 5, with 1 being poor, 2 being below average, 3 being average, 4 being above average, and 5 being excellent or high performance.

The current chief executive officer (CEO) or president of each hospital system was noted, along with any educational degrees held. Degree data were collected from either the hospital website or via LinkedIn. Hospitals were grouped according to whether the CEO was a physician (MD).

Overall, physician-led hospitals tended to rank higher than non–physician-led hospitals (P = 0.02), with an average ranking of 85.6 versus 108.0, respectively. Average scores for physician-led hospitals were also higher, at 53.9 compared with 50.0 for non–physician-led hospitals (P = 0.01).

Individual scores
Assessment of individual scores showed that hospitals with physician leadership demonstrated greater scores for back surgery and patient experience (P = 0.021 and 0.029, respectively). There were no differences in scores for hip-fracture surgery, hip replacement, knee replacement, 30-day survival, or readmission between groups.

Regression analysis was performed to evaluate associations between CEO/president degrees and hospital rating. Hospitals with leaders who had either an MD or both an MD and an MBA demonstrated greater hospital scores (P = 0.025 and 0.011, respectively). No significant difference was found in scores between hospitals with a CEO/president with any of the following degrees: MBA only, RN, MHSA, MHA, and PhD.

Overall, the authors reported, “This finding aligns with recent research conducted on physician-led hospital systems worldwide. For instance, a study of 370 German hospitals discovered that physician-led hospitals had lower in-hospital mortality rates in pneumonia patients and a higher level of patient satisfaction. Similarly, a recent investigation of physician leadership during the COVID-19 pandemic found that physician-led hospitals had higher patient-satisfaction ratings and utilization rates.”

The impact of physician leadership may be due to a benefit from having an “expert leader,” the authors suggested. “Having domain experts appears more credible to its employees, as well as outside the workplace,” they wrote. This benefit could potentially lead to higher employee satisfaction and retention.

Paper 375 will be presented during Practice Management/Rehabilitation II, 1:30 p.m. on Thursday in South, Esplanade Ballroom 153.

Dr. Massey’s coauthors of “Physician Led Orthopaedic Hospitals Outperform Non-Physician Led Orthopaedic Hospitals: An Analysis of the Top 200 Orthopaedic Hospitals” are Collyn C. O’Quin and K. Samer Shamieh, MD.

Rebecca Araujo is the managing editor of AAOS Now. She can be reached at raraujo@aaos.org.


  1. Kaiser F, Schmid A, Schlüchtermann J: Physician-leaders and hospital performance revisited. Soc Sci Med 2020;249:112831.
  2. Belasen A, Belasen A, Feng Z: The physician CEO advantage and hospital performance during the COVID-19 pandemic: capacity utilization and patient satisfaction. J Health Organ Manag 2023;10.1108/JHOM-04-2022-0126.