Challenges with insurance reimbursement and authorizations could be contributing to orthopedic surgeons leaving the field, according to Jonathan Koenig, MD.
Dr. Koenig is an orthopedic surgeon at Los Angeles Pediatric Orthopaedics. He recently spoke with Becker's about the factors leading surgeons to leave the field.
Editor's note: This response was lightly edited for clarity and length.
Q: What are some factors that may contribute to orthopedic surgeons leaving the field?
Dr. Jonathan Koenig: Orthopedic surgery still remains the best field in all of medicine For the most part, we’re helping hurt people, rather than sick people. We’re helping people maintain their mobility and independence. It’s incredibly rewarding to create relationships with patients and help them achieve their goals. I wouldn’t trade it for anything in the world.
The main factor contributing to surgeons leaving the field, however, has to be insurance. Reimbursement continues to decline despite rising costs of delivering care, or even just inflation. Red tape requiring authorization or referrals also makes it more and more complicated to take care of patients in an effective way. While reimbursement and red tape is troublesome, that’s not what bothers me the most. The worst is when these insurance issues hamper that amazing patient-physician relationship by making it increasingly difficult to provide care. It pits patients against their doctors when we can’t get care authorized and it harbors animosity when an insurance ultimately denies payment for care already authorized. This is further amplified by patients’ view that doctors bill and collect way more than the actual adjusted/allowed fee.
The only way doctors can continue to accept insurance is by selling to or partnering with hospitals, universities and larger organizations that can handle the red tape or negotiate higher/fairer reimbursements. I think within the next 10 years, pure private practice will not disappear but it will evolve into cash-only providers.