By Phillip Miller, VP at Merritt Hawkins
According to the Centers for Disease Control and Prevention (CDC), the number of hip replacements among people 45 and over increased from 138,700 to 310,800 over the opening decade of this century, while the rate of these procedures increased from 142 per 100,000 people to 257 per 100,000.
These numbers tell you all you need to know regarding why demand for orthopedic surgeons is rising. Population aging is driving the need for a wide range of specialists who treat conditions common to older citizens, including orthopedic surgeons. The Association of American Medical Colleges (AAMC) projects a shortage up of to 122,000 physicians by 2032. Of these, up to 55,000 will be primary care physicians, while an even larger number (up to 67,000) will be specialists. The AAMC projects a shortage of up to 23,000 surgeons.
The supply of orthopedic surgeons is limited due to the relatively small number who complete residency each year – a number that is inhibited by the 1997 cap Congress placed on funding for physician graduate medical education (GME). Supply also will be increasingly limited by retirements in the specialty. Close to 60% of orthopedic surgeons in active practice are 55 years old or older, and a “retirement cliff” in the specialty is looming. As a result, the Health Resources and Services Administration (HRSA) projects a shortage of 5,080 orthopedic surgeons by 2025.
Given the current limited supply of orthopedic surgeons and the strong demand, hospitals, medical groups and others seeking physicians in this special should consider incorporating a variety of best practices to enhance their recruiting success. Some of these are reviewed below. More Sub-specialization A first factor to consider is that it is becoming increasingly difficult to recruit orthopedic surgeons because candidates are becoming more and more specific on the style of practice they are seeking and more committed to practicing in the specific geographic location they prefer. Many orthopedic surgeons are electing to complete fellowships such as Sports Medicine and wish to focus their practice exclusively on their subspecialty in (typically) a suburban location. Prior to this trend, most candidates often would complete their general orthopedic surgery training and then specialize through experience rather than a fellowship. Many of these physicians would be willing to practice general orthopedics with a subspecialty emphasis. Today, they wish to concentrate exclusively on their subspecialty, and not all opportunities can offer this option. Offer a Competitive Practice Environment It is important to structure the practice opportunity to be as attractive as possible. Not all candidates are seeking the same thing, but in general a positive practice opportunity for many orthopedic surgeons might include an existing practice in which a physician is about to retire, so that the new physician will have an established referral network and patient base. Many orthopedic surgeons would prefer to join a private group in which they can receive ancillary revenue from an ambulatory surgery center (ASC). Like other physicians, orthopedic surgeons prefer a controllable lifestyle, and a call schedule of 1:4 or better is preferred by most. Few candidates are seeking a solo practice. They prefer to have at least four or five colleagues for call and for comradery. ORS trauma call is a major negative for many candidates, particularly if they are focusing on a subspecialty. For example, a foot and ankle orthopedic surgeon usually does not want to have to be called into the ED for a fractured hip on an 80 year old. The compensation must be competitive, with the majority of candidates seeking a potential of $750,000 annually, and often considerably more if they are fellowship trained in total joints, spine, surgery, etc. The other reality is that location makes a significant difference to today’s candidates. Because there are a lot of options in a competitive market, and because orthopedic surgeons earn high incomes regardless of location, it may be difficult to attract candidates to traditionally challenging locations with just a high income potential. It therefore is important to make all other aspects of the practice as positive as possible.