How ‘Political’ Are Orthopedic Surgeons?

How political is your “average” hip and knee surgeon?

And, to what extent do they take advantage of opportunities to help craft governmental policies that influence their work, as well as the lives of patients?

A team from Rothman Orthopaedic Institute at Thomas Jefferson University, Maine Medical Partners, OrthoCarolina, and the American Association of Hip and Knee Surgeons (AAHKS) launched an effort to find answers to these questions.

Their research, “Health Policy Views and Political Advocacy of Arthroplasty Surgeons: A Survey of the American Association of Hip and Knee Surgeons Members,” was published in the August 2023 edition of The Journal of Arthroplasty.

The OR and the Boardroom

Co-author P. Maxwell Courtney, M.D., division chief of adult reconstruction at the Rothman Orthopaedic Institute-Thomas Jefferson University explained to OTW, “We have been facing substantial headwinds in trying to preserve access for our joint replacement patients over the past few years. Hip and knee replacements are one of the most successful operations we perform in medicine and provide great value to our patients. With many recent policy changes, we as surgeons cannot just focus on patient care anymore and need to be advocates educating the public and our elected officials on the issues we face.”

The researchers distributed a 22-question email survey on multiple occasions to all 3,638 U.S. members of AAHKS who were in practice or training in 2022, ultimately obtaining 311 responses.

The survey was divided into three parts:

1. Demographics—membership level, political affiliation, surgical experience, and practice setting
2. Policy views including perceptions of contemporary policy issues, mispriced procedure codes, awareness of recent changes to the fee schedule for arthroplasty procedures, and experience with bundled payment systems.
3. Advocacy participation including political donations, current advocacy efforts, and barriers to participation.

The team found that 18% of respondents had begun practicing within the last 5 years and 38% had more than 20 years of practice.

Their political affiliations were:

1. Republicans (40%),
2. Independents (37%), and
3. Democrats (21%).

The top concerns were:

1. preserving physician reimbursement and equitable fee schedule representation (95%),
2. the burden of prior authorization (53%),
3. the impact of Center of Medicare and Medicaid Services regulations (39%), and
4. medical liability and tort reform (39%).

The top benefits from participating as advocates for their profession were:

1. maintaining appropriate physician reimbursement (44%) and
2. advocating for patients (37%)

And what do most orthopedic surgeons want? Survey says: (81%) more time on pre-surgery optimization now than 10 years ago.

What was the most common impediment to advocacy participation? Lack of time (77%).

“This study showed that many AAHKS members are informed and actively engaged in the political process,” stated Dr. Courtney to OTW.

“Regardless of personal political party affiliation, we continue to advocate for non-partisan causes. Although inflation is up 20% in the last four years, Medicare reimbursements for total joint replacements have dropped substantially. Insurance companies often require a prior authorization process to approve a test or a procedure, burdening our clinical staff, requiring more time on the phone for the physicians, and causing frustration in the delay of care for our patients.”

“Medical liability continues to be an issue in several states, with us in Pennsylvania fighting ‘venue shopping,’ where a plaintiff’s attorney can file a lawsuit in a more litigious county anywhere in the state, not just where the surgeon practices. We hope our study can prompt other subspecialty societies to continue to engage its members to take an active role in the political process to advocate for their patients.”