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.