Desperately seeking orthopedists

The Willmar medical community has racked up some recent successes in bringing new doctors on board. They’re still struggling, however, to find more orthopedic surgeons – a specialty that continues to have high local demand but is short on supply.

It has been a source of ongoing disappointment and frustration, for the community as well as for ACMC and Rice Memorial Hospital. It’s not that the medical group and the hospital aren’t trying hard enough; they are. Unfortunately they’re up against a set of national trends that don’t work in their favor.

A workforce study by the American Academy of Orthopaedic Surgeons sheds some light on some of the things that have been happening within the profession. The study is a few years old; the data were collected three years ago during a survey of 24,000 orthopedic surgeons who are members of the academy. There’s no reason to think, however, that the picture has changed dramatically since 2006, and indeed the survey results help illuminate why it has become increasingly challenging for rural communities such as Willmar to recruit orthopedic surgeons.

One of the most significant trends: Since 2000 or thereabouts, orthopedic surgeons – especially younger surgeons – have become more likely to specialize. Only about one in four now practices general orthopedic surgery. Almost 40 percent are specialists, and 32 percent combine general orthopedic surgery with specialty surgery. Among those who are specialists, about 20 percent focus solely on hand surgery, and 18 percent specialize only in surgery on the spine.

Obviously there’s a need in rural Minnesota for orthopedists who can do hand and spine surgery. But for orthopedic surgeons whose practice is highly specialized, there probably isn’t enough patient volume in a rural area to financially sustain this type of service, hence they tend to be more concentrated in urban and suburban areas. Meanwhile, rural communities find themselves competing for a smaller supply of orthopedic surgeons who are generalists or who specialize in more than one procedure.

Another finding from the survey: Orthopedic surgeons overwhelmingly prefer to practice in single-specialty groups. Eighty-one percent of the surgeons in the survey were in private practice, and 60 percent of these were orthopedics-only group practices. Only 9 percent are in multi-specialty groups such as Willmar’s ACMC. It’s not clear why this is so, but it’s what the numbers are telling us.

The survey also found the orthopedic surgery workforce is getting older. Orthopedic surgeons under age 40 accounted for fewer than 15 percent of orthopods who were actively practicing in 2005-06.

A particularly interesting finding from the survey is a trend toward early retirement. The study notes:

There is a small, but significant, group of orthopaedic surgeons retiring from active practice earlier than the expected retirement age of 65 in the U.S. The reasons for this retirement are unknown without further study.

The survey queried orthopedic surgeons about their retirement plans and found that nearly 8 percent expected to fully retire within the next two years.

Essentially what we have is a workforce of orthopedic surgeons who are getting older, getting closer toward retirement, and being replaced by younger surgeons who are increasingly likely to specialize (although the AAOS report notes that the trend towards specialization appears to be stabilizing).

What does it mean for the local community? Orthopedic surgeons are out there, but given the overall issues with the workforce supply, the recruitment challenges are unlikely to ease any time soon. For many years Willmar enjoyed a strong, thriving orthopedic surgery program that had been built up by ACMC and Rice Hospital; in fact it was somewhat unusual among rural Minnesota communities. Patients and the community perhaps grew to expect this level of services would always be available, and we’re now having to adjust to the fact that it’s not. As orthopedic surgeons retire or move on, they’re becoming harder to replace. Although local providers know there’s a need and although they’re working on it, progress is unfortunately far slower than they’d like.

The whole situation underscores why the physician supply and the ability of local entities to recruit doctors is so important, and why it should matter to the rest of us. Without the physicians – and, we’d add, without other qualified personnel such as nurses and technologists – the service simply can’t exist.

Illustration courtesy of Fotosearch

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