The Orthopaedic Care You May or May Not Choose
When we compare private pay orthopaedics to publicly available or managed care orthopaedics, there's a huge difference.
Public and managed care orthopaedics in the United States have risen to such a good level that most people arriving in an emergency room, having a sports trauma or suffering from arthritis, will get a pretty good level of care. With the arrival of AI and targeted information programs like Open Evidence, every doctor in the country can be reasonably up to date on what the latest, greatest treatments are. And every patient can be reasonably informed as well.
The problem is that in public and managed orthopaedics, there is such an overwhelming drive to lower costs that the newest care is often not available, provided, reimbursed, or even permitted. Every time a patient enters a managed care program (such as Kaiser, or many of the others), they are choosing to have their care managed to the lowest possible cost, with reasonable efficiency as the key standard. When balancing efficiency with the best possible treatment, the patients’ and providers’ goals are not always aligned.
It is even worse in single-payer systems where, by definition, all doctors work for the government (the single payer). We all have seen how well that works out. And now, especially, sweeping cuts to every federal program in order to meet some arbitrary economic goal bring additional cost-cutting pressure.
In private care, the incentives and motivations are very different. The opportunity exists to see a problem, work with the patient, and help them see their problem as an opportunity to become, as we like to say, “fitter, faster, and stronger than they've been in years.” Fix the problem with the latest and greatest tools, implants, and robotic technologies—then engage with a patient in the post-operative rehabilitation program. This means helping them find the best trainer and work with the best physical therapist to achieve a new level of fitness. This symbiotic relationship with a patient lasts a lifetime. It’s a stark contrast with the managed care doctor, who is incentivized to adopt a “one-and-done approach: find your problem, fix the problem, and never see you again.
Developing the doctor/patient relationship in the private medical space fosters trust, a key element in healing. Many of the orthopaedic injuries we see do not require surgery; they can be treated with appropriate guidance, physical therapy and/or—in this new anabolic era of sports medicine—injections of PRP, lubrication, and growth factors. Now more than ever, it’s important to know that your doctor has your best interests in mind and is unconstrained in implementing them.
A doctor who can treat patients at one stage of injury and see them through their problem—then design a program that will enhance both their health span and lifespan—is also a boon to their family and friends. Investing in such care leads to a roster of happy patients, who grow with the doctor over a lifetime.
Not all doctors choose to work with this mindset. Some focus only on the non-surgical aspects of orthopaedics, specializing in injections of the latest therapies. Other doctors prefer to simply rely on surgery, schedule a follow-up, and let that be the end of it.
My own biases are clear. They center on biologic therapies to repair, regenerate, and replace damaged tissues; on avoiding surgery whenever possible, and using robots when surgery is necessary, to improve precision of partial and total joint replacements; and on helping my patients stay healthy.
My bias also includes developing relationships with my patients, and caring for them over the course of a lifetime. This approach is time-intensive, expensive, and not fit for everyone. But it’s very satisfying for me.
And so, ask yourself what type of relationship you want, and ask your physician what type of program they like (or are permitted to) engage in. Then and only then, choose your care.
While having such a conversation may seem strange to people who see a doctor only when they're sick or injured, it’s becoming more common. The fact is that we are living in an age where we have the tools to improve people's healthspan and lifespan at the same time. This involves using the most current knowledge of genetics, diet, fitness, surgical procedures, and recovery tools, combined to create an optimal care program. The challenge, of course, is figuring out how to make such a program cost-effective for both the patient and society.
This last part tempers the idealism of the dream, and asks the medical community to figure out how to do the maximum number of things for the patient with the minimum number of things to the patient, in the most expedient way possible. The ultimate goal, as always, is to find affordable treatments that will not just extend our lifetimes, but help make each of us fitter, faster, and stronger.
