The orthopedic discipline faces major challenges and demonstrates symptoms of decline, according to an editorial by Augusto Sarmiento, MD, in Current Orthopaedic Practice.
Here are the major challenges Dr. Sarmiento identifies:
1. Economic profit: the evolution of medicine for some as a business rather than a purely altruistic profession has led to increased gaps in the quality of care between rich and poor countries. Improvements in technology are expensive and difficult for poor countries to afford.
2. Moral and ethical misconduct: Dr. Sarmiento highlights the recent action by the American Academy of Orthopaedic Surgeons to discontinue its Ethics Committee as a separate body and to include it as part of a multipurpose one.
3. Subspecialization: in many small communities, there are not enough patients who require subspecialized care, leaving a void for non-orthopedic practitioners to fill.
4. Orthopedic guidelines: Dr. Sarmiento claims that guidelines may not be completely scientific and evidence-based, as they are conclusions reached by a selected few identified experts who may have biases of their own. Guidelines also open practitioners up to litigation.
5. Education: the proposed reduction of the orthopedic residency to three years encourages further fragmentation and ultimately increases the cost of care, according to Dr. Sarmiento.
6. Research and publication: Dr. Sarmiento states that orthopedic surgeons must be vigilant when accepting industry support for research and education.
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