toolbox

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Hey there all, hopefully some people in other corners of the country can weigh in and give the opinions that they've heard around the country. I'm here in ohio doing clinicals in the northeast, and I really wanted ortho before rotating through it. I've had lots of one on one contact with attendings, who have voiced concerns about the future of ortho. I have heard several discussions about the soon-to-decline reimbursements for total joint replacements. The rationale was focused around the cost of the equipment/new alloy technology. Basically they were saying that since insurance/medicare were paying more for the raw materials, the surgeon was going to take the hit in reimbursement to offset those rising costs. Another hot topic was the drying up of medicare, which ultimately (according to several) was going to happen, and when it does the primary care specialties are going to be considered the essentials in terms of reimbursement. They were saying that since the population as a whole will be skewed toward elderly range, that primary prevention will become the focus of the health dollar, and the days of "gate keeping" will once again reign supreme. What I gathered, was that the rationale was that since a primary care costs less there is less fat to trim. The docs were saying that their procedures along with other surgical procedures were going to become more severely discounted because 1) they can save more money by cutting big $$$ procedures 2) negotiating equipment costs is much more difficult than slashing physician reimbursement. Then there was the malpractice, which is a dead horse. Basically, I'm just curious as to what others are saying outside of ohio. Is this just some paranoia here, or has it metastasized elsewhere? Thanks all.
 

VentdependenT

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As long as humans are around on the planet they will at least need hips and knees replaced. Ortho ain't goen anywhere. In fact it'll explode as our population ages. I'm 28 and could already use a new knee.

As far as cost is concerned, its a hell of a lot cheaper to replace a guy's knee then it is to pay for disability and nursing care so he can perform his adl's. Insurance folks can't argue with that.

Its true that doc's don't make as much as they used to. That's why your ortho buddies are so pissed off. Shouldn't concern you. Be what you wanna be, go where you wanna go.
 

jakstat33

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Originally posted by toolbox
Hey there all, hopefully some people in other corners of the country can weigh in and give the opinions that they've heard around the country. I'm here in ohio doing clinicals in the northeast, and I really wanted ortho before rotating through it. I've had lots of one on one contact with attendings, who have voiced concerns about the future of ortho. I have heard several discussions about the soon-to-decline reimbursements for total joint replacements. The rationale was focused around the cost of the equipment/new alloy technology. Basically they were saying that since insurance/medicare were paying more for the raw materials, the surgeon was going to take the hit in reimbursement to offset those rising costs. Another hot topic was the drying up of medicare, which ultimately (according to several) was going to happen, and when it does the primary care specialties are going to be considered the essentials in terms of reimbursement. They were saying that since the population as a whole will be skewed toward elderly range, that primary prevention will become the focus of the health dollar, and the days of "gate keeping" will once again reign supreme. What I gathered, was that the rationale was that since a primary care costs less there is less fat to trim. The docs were saying that their procedures along with other surgical procedures were going to become more severely discounted because 1) they can save more money by cutting big $$$ procedures 2) negotiating equipment costs is much more difficult than slashing physician reimbursement. Then there was the malpractice, which is a dead horse. Basically, I'm just curious as to what others are saying outside of ohio. Is this just some paranoia here, or has it metastasized elsewhere? Thanks all.

relatively speaking, the future of ortho looks wonderful
 
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droliver

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Originally posted by jakstat33
relatively speaking, the future of ortho looks wonderful

There's a big difference between being "busy" & having a "wonderful" future and that's the discussion Toolbox was being introduced too. Orthopedics is staring at the same reality that General Surgery & its subspecialties (CTVS, Vascular, Plastic Surgery) got intoduced to about a decade ago. There's going to be a lot of business, but you'll be getting paid less then 50 cents on the dollar of what you were collecting previously while you're being squeezed on the practice expense & malpractice fronts. Increases in productivity only go so far before you start seeing substantiative cuts in you income. Orthopedics as a field was very organized with their negotiations and advocacy during the first era in capitated/managed care and were spared a good deal of the pain other specialties felt. It's kind of been the open secret among orthopedists that the joint & spine procedures are likely going to be savaged by reimbursement cuts the next go around.
 

Galaxian

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Almost every doctor will be earning less in the future, it doesn' t matter what you do, we're all gonna get screwed. It's still a great profession, and ask yourself...would you rather be a "gatekeeper," or an orthopod for the same amount of money?
 

toolbox

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Thanks for the replies! My post absolutely wasn't to insinuate that ortho is a "dying" specialty, I'm not that insane. I was merely wondering if this future cut in reimbursement is looming as major or minor trauma to the field, and will it be a primarily geographic or specialty wide problem. Being in a state that is in total degeneration of its healthcare system, I just wondered what the opinions of orthopods were in less problematic areas.
 

huktonfonix

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Already happening. Before 4-10 G was the norm for a TKA. Now in my state anyway I believe its around 1400-1800.
 
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