Best method to deliver health care remains a work in progress
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The delivery of health care is in turmoil. Uncertainty about how to provide the health care patients desire at an affordable price has led to efforts to disrupt the status quo.
Global markers of population health, such as life expectancy, maternal mortality and access to care, are achieved at less than half the price in other industrialized nations as compared with the United States. According to CMS, national health expenditures increased to $4.1 trillion in 2020, which represents 19.7% of our gross domestic product. Despite ongoing rhetoric about value-based care providing reduced costs, there is little to no evidence the overall cost to the government and consumers has decreased, even in highly integrated systems.
Another sector of the economy
Health care in the United States, in many ways, has become the most impactful sector of the economy. Financial gains and rewards are pursued by every component involved in the delivery of care. This includes health care systems, hospitals, private insurance companies, pharmaceutical companies, pharmacy benefit managers, medical device companies, administrators and physicians. Margins of profit, not cost savings, are the prized outcome.
With all the negativity in health care news, a distorted perspective about our profession and professional lives as orthopedic surgeons may impact many decisions and efforts. We often give more value to negative facts instead of positive facts. This human tendency is preyed upon by many providers of health care news, whether it be newspapers, television or social media.
Burnout
The consequences of negativity surrounding health care may lead to an increasing sense of lack of control, dissatisfaction with our accomplishments, frustration with our work environment and fear of an unknown future in our chosen lifetime profession. The impact is reflected in the more than 30% of orthopedic surgeons and more than 50% of orthopedic residents who report burnout. It is difficult to believe, but orthopedic surgeons are reported to have the highest prevalence of death by suicide among all surgical specialties.
Burnout, depression, mental illness and suicide are not characteristics typically attributed to our specialty. These conditions were not caused by the COVID-19 pandemic, although it has increased the percentage of physicians who report these concerns.
With the average overall age of practicing orthopedic surgeons at 56.5 years, many are considering or have already elected to take early retirement to leave what they perceive as an increasingly toxic work environment. These decisions have furthered the discussion about the severe risk of a shortage of orthopedic surgeons to treat an aging and active population potentially placing added stress on those who continue to work.
Our role in health care
Despite the perceived chaos, negativity, frustration, burnout and decreased satisfaction, we need a paradigm shift in how we think of our role in the overall health care system and our contributions to orthopedics. As difficult as it may seem to take on additional responsibilities, we should provide leadership and insight on how we can improve musculoskeletal care for our patients. We need to find reward in service to our patients through thoughtful care, teaching the next generation of providers and developing a team approach to managing the myriad of conditions we see in a busy practice. Many of us are continually concerned about maintaining a work-life balance, as we should be, and many of us will struggle with these efforts throughout our professional lives. We are consistently drawn to our work responsibilities because we genuinely enjoy the opportunity to care for patients with musculoskeletal problems.
Health care is an incredibly complex, challenging, chaotic and unpredictable sector of our economy. The best method to deliver health care remains a work in progress. Despite all the available technology, the highest priority for most patients remains developing a respectful and trusting relationship with their physicians. In the overall health care system, orthopedic surgeons are blessed in many ways to be at the top of the desired attributes of medicine. We need to appreciate our position and help our peers do the same.
- References:
- www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NHE-Fact-Sheet.
- https://pubmed.ncbi.nlm.nih.gov/35171879/.
- Jennings JM, et al. J Am Acad Orthop Surg. 2022;doi:10.5435/JAAOS-D-21-00299.
- Travers V. Orthopaedics & Traumatology: Surgery & Research. 2020;doi.org/10.1016/j.otsr.2019.04.029.
- www.aaos.org/aaosnow/2019/sep/youraaos/youraaos01/.
- www.medscape.com/slideshow/2021-lifestyle-orthopedist-6013518#1.
- For more information:
- Anthony A. Romeo, MD, is the Chief Medical Editor of Orthopedics Today. He can be reached at Orthopedics Today, 6900 Grove Road, Thorofare, NJ 08086; email: orthopedics@healio.com.
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