The Coming Ortho Surgeon Shortage Is Serious

A new study from the Cleveland Clinic in Ohio has concluded that “based on historical trends in TJA volumes and active orthopaedic surgeons, the average TJA caseload per orthopaedic surgeon may need to double by 2050 to meet projected U.S. demand.”

This is a startling conclusion. And it raises a number of serious questions starting with the obvious—where are we going to get enough well-trained orthopedic surgeons to meet the coming demographically driven demand for musculoskeletal care in the coming years?

The study, “The Arthroplasty Surgeon Growth Indicator: A Tool for Monitoring Supply and Demand Trends in the Orthopaedic Surgeon Workforce from 2020 to 2050,” was published in the July 5, 2023 edition of The Journal of Bone and Joint Surgery.

Co-author Nicolas Piuzzi, M.D., Cleveland Clinic Adult Reconstruction Research director, told OTW, “There is an increasing demand for total joint arthroplasties (TJAs) in the U.S. and concerns exist about the potential shortage of orthopaedic surgeons to meet this demand.”

“Understanding the future trends and challenges in the orthopaedic workforce and the implications on patient care can help policymakers, healthcare institutions, and medical professionals make informed decisions and implement strategies to address the situation effectively.”

The researchers reviewed the National Inpatient Sample and Association of American Medical Colleges data, looking for individuals who underwent primary TJA and for active orthopedic surgeons (2010 to 2020), respectively. They used the arthroplasty-to-surgeon ratio, defined as the number of actual (or projected) annual total hip (THA) and/or knee (TKA) arthroplasties divided by the number of actual (or projected) orthopedic surgeons.

“The steps and challenges in developing the arthroplasty surgeon growth indicator (ASGI) involved the following,” stated Dr. Piuzzi to OTW.

• Data collection: Gathering accurate and comprehensive data on the number of TJAs performed annually and the number of active orthopaedic surgeons over time from reliable sources, such as the National Inpatient Sample and the Association of American Medical Colleges, was crucial for developing the indicator.
• Projection Modeling: Developing models to project future trends in TJA volumes and orthopaedic surgeon numbers required careful analysis and statistical techniques to ensure the accuracy and reliability of the predictions.”

The arthroplasty-to-surgeon caseload ratio for 2017 (n = 19,001) was:

• 1 total hip arthroplasties per surgeon
• 1 total knee arthroplasties per surgeon
• 2 total joint replacements per surgeon.

By 2050, the Cleveland Clinic research team projects that the number of total joint arthroplasties would rise to 1,219,852 hip cases and 1,037,474 knee cases.

Unfortunately, the number of orthopaedic surgeons, based on the Cleveland Clinic forecasts, would DECREASE 14% from 2020 to 2050 (18,834 to 16,189).

Those remaining orthopedic surgeons would now be responsible for:

• 4 total hip arthroplasties per surgeon
• 1 total knee arthroplasties per surgeon
• 4 total joint arthroplasties per surgeon

Aside from the stark prospect an overburdened healthcare system, it’s worth noting, first, that these projections are based on demographics—a validated reliable, steady, and long-term predictor of healthcare demand—and second, that 30 years is a long time. No doubt, surgical techniques and tools will have evolved considerably.

Follow the Evidence

“In a contemporary value-driven field, such as healthcare,” said Dr. Piuzzi to OTW, “the balance between supply and demand for services is crucial to ensuring increased access to care without compromising on quality. Adopting an evidence-based approach is essential to make informed decisions and implement effective strategies in managing surgeon supply and demand.”

“The main challenges in the future lie in the potential implementation of the Arthroplasty Surgeon Growth Indicator in real-world scenarios which will involve integrating it into healthcare systems and policy-making processes. Based on historical trends in TJA volumes and active orthopaedic surgeons, the average TJA caseload per orthopaedic surgeon may need to double by 2050 to meet projected U.S. demand.”

“Further studies are needed to identify solutions that meet the growing demand for TJA without compromising quality of care in value-driven healthcare models. Research may focus on validating and refining the Arthroplasty Surgeon Growth Indicator for future trends in TJA volumes and orthopaedic surgeon numbers, while considering regional variations, factors driving demand, and implementing effective strategies to enhance access to care while ensuring high-quality outcomes.”