Cecily O'Connor
RedwoodAge.com

As President Obama unravels a healthcare strategy, he can't ignore mounting surgeon shortages that could jeopardize aging boomers' access to quality care within a few years. 

A group of orthopaedic surgeons is warning that the number of patients requiring hip or knee replacement surgery is likely to soon outpace the number of surgeons who are able to perform those procedures. If the number of surgeons continues at the current rate, 46 percent of hip replacements and 72 percent of knee replacements won't be possible, according to a study by Dr. Thomas Fehring, an orthopaedic surgeon at OrthCarolina Hip and Knee Center in Charlotte, NC. Inadequate reimbursement rates for surgeons may be partly to blame.

"I was somewhat shocked at the shortfall that we predicted," Dr. Fehring said. "This is life-changing surgery, offering patients the chance to be mobile, and a very high percentage of patients may not be able to receive it."

Dr. Fehring's study was one of two presented on age-related threats at a recent annual meeting of the American Academy of Orthopaedic Surgeons. A second study by Dr. Steven Kurtz found that a major reason for rising joint replacement demand is the increase in younger patients. 

The shortage is concerning, especially because similar losses have been predicted in other areas of medicine. Nurses and cardiothoracic surgeons, among other specialties, are in increasingly high demand as boomer healthcare needs increase across the board.

That's So Hip
Projections show that more than 50 percent of patients requirement hip replacements will be under 65 by 2011. The knee replacement population will reach that threshold by 2016. For primary knee replacement, adults age 45 to 54 make up the fastest-growing group of patients.

They'll collectively will need 994,104 procedures performed by 2030, rocketing up from just 59,077 in 2006. Currently, more than 400,000 primary total hip and knee replacements are performed annually in the US.

The procedures replace the patient's natural joint with an artificial one, made of a combination of plastic, metal and ceramic. Most adults undergo surgery to relieve them from pain and stiffness that limit normal activities such as walking and bending.

"Joint replacement is generally thought of as a procedure for older people, over 65," said Dr. Kurtz, corporate vice president and office director at Exponent, an engineering and scientific consulting firm in Philadelphia. "Our projections show that younger people make up a big piece of the pie, and that is only going to increase if historical trends continue."

Surgery timing also is critical to the healing process. Typically, patients with "worse joint function before surgery do not do as well" after the procedure, said Dr. James Slover, an orthopaedic surgeon at New York University Hospital for Joint Diseases.  

'Epidemic Proportions'
Generally speaking, Hispanic and African-American patients tend to have poorer joint function before undergoing hip or knee replacement surgery, according to Dr. Slover. In addition, female patients have less preoperative joint function than male patients across all ethnic groups.

Even so, there needs to be enough orthopaedic surgeons around who can help patients get appropriate care and treatment.

Both Drs. Kurtz and Fehring said they believe the key to reducing the shortage is for policymakers to reconsider the rates at which total joint replacements are reimbursed.

The reimbursement rates have consistently gone down over the years, even as the costs of providing health care have gone up. Groups representing nurses and cardiothoracic surgeons, emphasize that it's hard to recruit and retain professionals who are either reluctant to undergo years of training, or put off by the stress that comes with the job.  

In the meantime, Dr. Kurtz said the possibility of new technologies offers the orthopaedic field a bright light.

"Hopefully, we will have some new tools in the future to help address this problem, which could be of epidemic proportions."