I’ve been to a lot of Orthopaedic conferences this year. I’m always thrilled to see the talks on physician burnout and moral injury amongst Orthopaedic Surgeons. Every year I hear about another Orthopaedic Surgeon committing suicide, and every day I see my colleagues vacillate between job satisfaction (when they’re feeling appreciated and get to focus on their Orthopaedic work) and frustration (generally when confronting the realities of the non-Orthopaedic aspects of their practice, like business management, corporate buyouts, patient surveys, and the threat of medical malpractice).
LOSS OF AUTONOMY
I go to these talks hoping that a speaker will address the issues: Orthopaedic surgeons have steadily lost autonomy in their practices, which is where they spend a major portion of their time. Only 12% of Orthopaedic Surgeons are in solo private practice nationwide, as of the 2018 AAOS OPUS report, less than half of the 25% who were in 2006. I suspect that the rise of private equity, need for merging of small groups for leverage, and the pandemic has further depressed the number of solo private practices.
When Orthopaedic Surgeons are employed, a large degree of autonomy is lost. Often, the employer hires and assigns staff, decides on the electronic medical record, establishes the length of time assigned to each patient, and may even determine approved implants. Some physicians are willing to accept these restrictions in exchange for the security of a steady flow patients and therefore paychecks. For many of us, however, this lack of autonomy leads to a constant state of frustration.
PHYSICIAN BURNOUT
The focus of physician burnout at many of these conferences is to get physicians to change their reaction to a broken system: meditation, yoga, healthy diet, avoidance of harmful coping mechanisms such as self-harm and alcohol, and my personal favorite, “finding a mentor.”
While there are many for whom this may improve the day to day, many of us also already engage in these habits, and yet we’re left with healthy coping skills in a very broken system.
I would love to see conferences have a second talk, the leadership response to the root causes of physician burnout.
NEW PATHS TO FINANCIAL FREEDOM
My own opinion is that financial freedom is a path to burnout avoidance. By being able to design our own practices in the way we want by unburdening our clinical practices from being our sole source of income, we can practice more ethical Orthopaedics.
A good source of ancillary income is a proven path towards financial freedom. While some generally more senior partners are able to make significant income from clinical ancillaries such as surgicenters, for most junior partners, this is not enough to bridge the gap that declining reimbursements are causing.
Legal expert witness work remains a highly paid source of income for Orthopaedic Surgeons, and complements our clinical practices well. The physical examinations and legal determinations are very familiar and require little extra training for the legal portion of reports. Our team at OrthoLegal are specialized in introducing Orthopaedic Surgeons to legal work, and we provide ample staff to assist with the non-Orthopaedic work. A high-volume medicolegal practice can easily double a surgeon’s income. My own hope is that I’ll see more of my colleagues living where they want to and working a practice that provides fulfillment, not burnout and exhaustion.
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