Orthopaedic manpower: an overview

What constitutes orthopaedic practice and how many orthopaedic surgeons are desirable for a given population has been discussed since the specialty was founded. The American Academy of Orthopaedic Surgeons began addressing this issue in January 1937. Extensive studies were done in the early 1970s with sponsorship from the American Academy of Orthopaedic Surgeons, the American College of Surgeons, the American Surgical Association, and the Division of Manpower Intelligence of the Department of Health Education and Welfare. These studies involved questionnaire surveys, Delphi panel modeling, and direct observation in a three-day time and motion study of a statistical sample of 150 practices. At the conclusion of these studies, it was observed that orthopaedics was largely a male specialty, practitioners preferred the surgical aspect of their practices to their office practices, that there was no type of practice that was more efficient than another, that the more orthopaedic surgeons there were in a population the more operative procedures were being done, and the character of the practice changes with the ratio of orthopaedist to population drops below 1 to 15,000. After 30 years involvement in health manpower issues the author concludes that there is no substitute for developing a solid database and analyzing trends, that the predictions have been remarkably accurate and although honorable men and women may disagree on the interpretation of data, few will argue that there is a limit on the number of orthopaedic procedures that can be justified in the diagnosis and treatment of a population. The essence of professionalism is self regulation and doing first and foremost what is in the best interest of the patient and society whether there necessitates an increase or a decrease in the number of orthopaedic surgeons being trained or practicing in a given population.