By Thomas K. Fehring, MD
Background
Total joint arthroplasty is one of the most successful procedures in the history of surgery. Demand for this procedure is expected to double in the next ten years in the United States, primarily driven by the aging of the baby-boomer generation and the obesity epidemic. Coincident with this increased demand is a decreased interest in adult reconstructive careers on the part of graduating orthopaedic residents. Additionally, the retirement of many high-volume joint replacement surgeons is predicted, further threatening access to this procedure as we enter a decade of peak demand.
The purpose of this study was to determine the arthroplasty workforce that will be available in 2016. By calculating the current workforce and the number of retiring arthroplasty surgeons, we hoped to determine if the number of orthopaedic surgeons entering the supply chain would be able to meet the growing demand for joint replacement.
Methods
To calculate the workforce in 2016, we made use of survey and research data from the American Academy of Orthopaedic Surgeons (AAOS)1,2. In order to calculate the demand for total joint arthroplasty, we made use of projection data from a published article on this subject3. These data were used to determine the anticipated demand for total knee and hip replacement in the year 2016. This information was then used to create an economic supply-and-demand model for arthroplasty in 2016.
Results
In 2006, a total of 1612 AAOS fellows were registered as hip and knee specialists, while 5973 were registered as generalists with a hip or knee focus. Between 2008 and 2016, 400 hip and knee specialists and 1584 generalists will enter the workforce, while 963 specialists and 3568 generalists will retire, leaving a workforce of 5038 in 2016 (a decrease of 34%). Currently, hip and knee specialists perform 110 hip and 107 knee arthroplasties per year, while generalists perform twenty-nine hip and forty-four knee arthroplasties per year. Demand projections for the year 2016 are 427,500 total hip arthroplasties and 1,046,000 total knee arthroplasties. In 2016, the workforce, working at current rates, will perform only 231,071 total hip arthroplasties and 287,759 total knee arthroplasties—a shortfall of 46% and 72%, respectively.
Conclusions
In this economic model, we predict a supply-side crisis that severely threatens access for our arthritic patients. Governmental agencies, health-care economists, and our patients need to understand that in the near future, the arthroplasty workforce will be unable to meet the arthroplasty needs of a growing arthritic population. Immediate steps to stimulate the supply side of this model must be taken to rectify this situation.