Projected Deficiencies in the United States Arthroplasty Workforce: State-Level Shortages of Orthopaedic Surgeons to 2038.

BACKGROUND: Previous studies have identified emerging deficiencies in the number of orthopaedic surgeons providing arthroplasty care in the United States (US). This study identified present and future geographic disparities in the supply and demand of orthopaedic surgeons across the US.

METHODS: This was a microsimulation of full-time equivalent (FTE) orthopaedic surgeons leveraging data from the Health Resource Service Administration. Supply was defined as the number of orthopaedic surgeons and demand was defined as the required number of orthopaedic surgeons under different scenarios. The more and fewer graduates scenarios were defined as 10% more and fewer orthopaedic surgery residency graduates, respectively. Adequacy was calculated as supply over demand. Regression modeling was used to analyze temporal trends from 2026 through 2038.

RESULTS: Under the status quo scenario, orthopaedic surgeon supply was projected to decrease by -1.7% to 2038 (P = 0.003). The greatest supply of orthopaedic surgeons was observed in the more graduates (+1.6%, P < 0.001) scenario. In contrast, the smallest supply of orthopaedic surgeons was observed in the fewer graduates (-5.7%, P < 0.001) scenario. The greatest demand for orthopaedic surgeons was observed in the improved access scenario (+8.5%, P < 0.001), which was driven by the race effect (+8.5%, P < 0.001). By 2038, the South (79.5%) was projected to have the lowest orthopaedic surgeon adequacy followed by the West (89.7%), Midwest (90.9%), and Northeast (102%) (P < 0.001). The non-metropolitan areas had lower orthopaedic surgeon adequacy compared with metropolitan areas by 2038 (48.8 versus 94.0%, P < 0.001). The states with the lowest orthopaedic surgeon adequacy were West Virginia (65.2%), Arkansas (65.7%), Alabama (66.7%), Florida (68.1%), and Mississippi (68.8%).

CONCLUSION: Deficiencies of orthopaedic surgeons were identified, especially in non-metropolitan areas, the South, and certain states like West Virginia and Arkansas. Future work is needed to increase the supply of orthopaedic surgeons in geographic areas with identified deficiencies.