Here are 10 orthopedic surgeons and industry members, representing several subspecialties, responding to the question: What do baby boomers mean for orthopedics today and tomorrow?
This is the first part of a three-part series discussing the impact of baby boomers on orthopedics. You may also be interested in viewing the second part where experts are asked: What can orthopedic surgeons do to meet the needs of baby boomers?
Christopher Browne, MD, Orthopedic Surgeon, Eastern Oklahoma Orthopedic Center, Tulsa.
With the increase in patient volume, practices and hospitals will need to become more efficient in service delivery. Having trained staff help patients through the whole process is one of the ways to increase efficiency. From initial examination to surgery and post-operation, the staff can guide the patient from the outset. Other ways include having additional providers (surgeons and PAs) to handle the increase, and by educating patients about their involvement and responsibilities for a successful outcome.
We have had an increase in the number of PAs in the last two years and are continually looking for surgeons interested in our market. We are investing in customer service training for our staff because we know that patients have choices and we want to give them an exceptional experience with us. In addition, we continually survey our patients about our service and fine tune our delivery based on their feedback.
Terrence Crowder, MD, Orthopedic Surgeon, Sonoran Spine Center, Phoenix.
The bad part about the baby boomer population increase is the decrease in reimbursement for clinical services. With Medicare reimbursing us less and less, it has changed the practice for a lot of physicians. Some physicians are limiting the number of Medicare patients they will see. They are still seeing a few Medicare patients per day, so it may take several weeks for a patient to see a particular orthopedic specialist. People are going to find it much harder to see physicians, and patients with better insurance could receive preferential treatment.
Additionally, physicians used to work into their 70s before retiring, and now specialists are retiring earlier. Orthopedic physicians are retiring at 55, which means there is 15 years less work from some individuals because they don’t want to deal with the hassles of the ever-changing healthcare system.
Douglas Garland, MD, Medical Director, MemorialCare Joint Replacement Center at Long Beach (Calif.).
Memorial. In addition to seniors, who for decades represented the majority of joint replacement surgeries, a growing number of 40- and 50-year-olds are now candidates for joint replacement procedures. In the past, younger individuals were often forced to wait until their mid-60s. Older joint replacement materials were not expected to last more than a decade or two, and many surgeons were reluctant to perform a second replacement when the first wore out. Today’s wear-resistant materials are lasting longer, allowing hip and knee replacements among the 45- to 64-year-olds, which have tripled in numbers compared to the last decade. Some centers report doing as many replacements in the under 65 age group as over 65 years.
MemorialCare Joint Replacement Center at Long Beach Memorial is geared to the active baby boomer. It takes individuals requiring hip and knee replacements through surgery and into rehabilitation, while promoting wellness and an active hospital stay. Individuals are often able to walk, with assistance, the same day of surgery, move independently in a day or two and leave the hospital in two to three days. They lead active lifestyles within two to three months, and a small number of young individuals may even qualify for outpatient joint replacements.
Some of the greatest advancements in orthopedic medicine have been in joint replacement procedures, particularly for the hips, knees and shoulders. Strides in replacing these joints are restoring individuals to greater mobility — with minimal morbidity. The surgeries are less invasive and advanced prostheses are more durable and longer lasting.
Guillem Gonzalez-Lomas, MD, Orthopedic Surgeon, New Jersey Medical School, New Brunswick.
Baby boomers are, comparatively, the most active generation ever. They have rewritten the age-activity equation. More 60-year-olds belong to Masters swim teams, triathlon clubs and trekking groups than ever with a determination to keep exercising. While exercise reliably potentiates cardiovascular health, it can also wear down the musculoskeletal system. Keeping these veteran machineries working is the challenge for the modern orthopedic practice.
There are a few approaches that may be helpful. One, although an old mantra, is: If it hurts, don’t do it. This may fall short of patient expectations, but educating the patients on the reality of the situation is paramount. Feel-good stories about older athletes who resumed training without limitations are motivational, but it should be emphasized to patients that such an outcome is the ‘best-case scenario’ result. More realistically, the surgeon can devise creative solutions with the patients’ input to keep them active. For example, in a runner with early osteoarthritis, recommending lower impact cross-training alternatives like swimming, biking or the elliptical machine to mix in with the running may keep them on the streets longer.
Additionally, practices need to work together with ancillary services like physical therapy to update operative and nonoperative rehabilitation protocols for older patients. For example, the benefits of some forms of exercise, like Tai Chi, on joints now have a clinical evidence basis.
Jeffrey Holmes, MD, Orthopedic Surgeon, El Camino Hospital Orthopedic Institute, Mountain View, Calif.
We expect Baby Boomers to redefine the patient experience, because they expect more than a “hospital” experience — more like the Ritz Carlton Hotel. We just built a whole orthopedic pavilion in a partnership with El Camino. It’s specifically designed to handle increased volume of joint replacements for this population because more of that is being demanded. It’s a multi-million dollar project to provide these patients with a place where they are comfortable from the beginning to the end of their care. These patients aren’t sick; they just have worn-out joints. We want to place them in a facility that resembles the Ritz Carlton Hotel instead of the plain and sterile hospital environments of the past.
Baby Boomers often won’t settle for just any orthopedic surgeon — they want an expert in their specific type of joint replacement or a specific surgical technique which has led to more specialization within our profession. But as physicians we still have to pay attention to cost-efficiency; healthcare reform is going to demand that physicians work not only better but in a less costly manner. That’s why our facility is designed to create maximum collaboration between everyone involved in the patient’s care.
As orthopedic surgeons, we understand what it takes to streamline care and get a patient back on their feet quickly. We’re proud of the fact that we were involved with El Camino Hospital every step of the way in designing a facility that is optimal for improved outcomes — and a better, more uniform experience for our patients. Someday, most patients will be handled this way — but right now, we’re one of the few places on the West Coast with this type of facility.
Kent Lerner, MD, Orthopedic Surgeon, Metropolitan Orthopaedics, North Arlington, N.J.
This group of patients tends to be more active and have higher demands. The income bracket among this population is a mixed bag, but a large portion is very successful. It’s a varied group, but there is a higher demand for orthopedic care and life expectancy is longer for them than their parents’ generation. You can’t draw any across-the-board generalizations, but there will be an increased number of people needing joint replacements and a lot of these people will want to maintain an active lifestyle. As surgeons, we can offer them joint-preserving solutions, such as partial replacement or resurfacing, for their conditions.
For minimally invasive techniques, you would have to start with arthroscopy. Twenty years ago, it was rare to see 50-year-olds getting ACL reconstruction, but now it’s not uncommon at all. This procedure could delay a knee replacement or prevent it. A biologic solution for the problem is preferable when possible, but the reattachment has to be individualized. There are some 60-year-olds who are running triathlons while others have several illnesses and can’t be too active. Both types of people might have the same condition, but their treatments would be different. The key here is patient selection; selecting the appropriate procedure for the particular patient makes a difference in the quality of the outcome.
Steve Neufeld, MD, Orthopedic Surgeon, The Orthopedic Foot & Ankle Center, Washington, D.C.
I don’t think there will be a huge influx of patients at once — I think there’s going to be a gradual increase in patient volume. There is time for practices to plan a global strategy to meet the needs of this population, which our practice is doing right now. We are trying to hire another physician, and we are in the middle of the interview process. We are also involved in teaching orthopedic residents, [and] hope this will also breed interest in our subspecialty.
We are increasing our ancillary services and midlevel providers, such as physician assistants, to fill in some of the gaps at our practice. The PAs, physical therapists and podiatrist we hire will help us maximize efficiency as more patients come into our practice as well as broaden the care we can provide to a patient and their family. Finally, we are investing in electronic medical records and technology such as electronic X-rays and ultrasound. This is our three-pronged approach to meet the future needs of our practice.
Patti O’Brien, Administrator, St. Vincent Medical Center’s Joint Replacement Institute, Los Angeles.
We see a lot of baby boomers in our practice and we’ve developed a program fit for their needs. A lot of the patients we see are athletes of any age, and we want to understand how to treat them as best we can. Baby boomers are internet savvy, and they’ve done research by the time they come to us. They have been on the Internet learning about joint replacement and they understand their options — they even know about the different implants our surgeons could use.
Baby boomers like to share their stories with our staff about where they are now and what they need in order to better their lives. We take that extra time out — especially if the patient needs surgery — to connect with the patient and schedule any further visits around their calendar. We may see patient volume increase around the holidays because people take time off then. We also schedule a lot of surgeries in the summer, around the baby boomers’ children’s vacation.
In the future, we expect to see an increase in patient volume because more people will become aware of the fact that they can receive treatment for arthritis at a younger age. A lot of people think they need to wait until they can’t walk any more to receive treatment, but that isn’t necessarily true. It’s important for them to come in for an examination because if they wait, the body could de-condition as they become less active.
Timothy Payne, MD, Orthopedic Surgeon, M and M Orthopedics, Lemont, Ill.
We know we are going to see more people with arthritis, which will become a bigger issue with the increasing age of the baby boomer population. As a result, we are looking at alternatives for treating arthritis, such as the BioniCare Knee System by VQ OrthoCare, a non-invasive and non-pharmaceutical treatment for osteoarthritis of the knee. Twenty years ago, patients might begin taking anti-inflammatory medication then receive cortisone injections before having total knee replacements. Now you do physical therapy, gait training, brace support activities, injections and then possibly unicompartmental knee replacements before total knee replacements. We even have robotic technology to help make these procedures more precise.
All of these treatment pathways are trying to maximize results. As we bring younger patients into our practice, we must make sure the technology stays current. We bring on new orthopedic surgeons recently out of training that have extensive experience in the new technology during their fellowship, because that really makes a difference. The key is to educate people when they have a choice about their treatment pathways instead of waiting until they are in a box and their only option is a total knee replacement.
Aarti Shetty, Senior Industry Analyst, Medical Devices, Frost & Sullivan Healthcare.
Baby boomers are aware of the treatment possibilities that are out there and they demand a certain level of care. They are definitely more likely to be aware of the different joint replacement options than the previous generation. This desire is driving device companies and physicians to introduce groundbreaking technology that addresses all aspects of orthopedics. In the past, when products weren’t so advanced, people would go in for a revision surgery 10-15 years after a big open replacement procedure. This isn’t convenient for a 40 year old who needs a joint replacement. People are trying hard to develop devices with longer life cycles and less wear.
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From the original source: Becker’s Orthopedic, Spine & Pain Management, written by Laura Miller.
What can orthopedic surgeons do to meet the needs of baby boomers?