Access to orthopaedic care is uneven. Some patients receive timely treatment, while others wait too long or never receive surgery at all. Race, insurance status, and geography influence who gets care and how well they recover. These disparities are deeply embedded in the healthcare system, raising important questions. Are you responsible for addressing them, or are they too deeply rooted for you to change?
The reality of unequal access to orthopaedic care
If you treat patients with osteoarthritis, you know how life-changing joint replacement can be. However, Black patients are significantly less likely to undergo hip or knee arthroplasty than white patients, even though both groups experience arthritis at similar rates. When Black patients do receive surgery, they have longer hospital stays, more complications, and higher readmission rates. Some of these differences stem from gaps in follow-up care, while others are linked to provider bias in treatment decisions.
Insurance status adds another layer to the problem. In a national study of orthopaedic offices, all surveyed practices offered quick appointments for children with private insurance. For children with Medicaid, only 2% received the same scheduling priority. Adults with public insurance face similar delays, particularly for elective procedures like joint arthroplasty.
Geography also plays a major role. High-volume surgical centers, which often have the best outcomes, are concentrated in urban areas. Rural patients must travel long distances to access specialized care, which is not always feasible. Even if they manage to reach a major hospital, they may struggle to return for follow-ups due to cost, work, obligations, or lack of transportation.
Action Step: If you work in a high-volume surgical center, consider developing partnerships with smaller hospitals in rural areas. Remote consultations and mobile surgical units can extend access to specialized orthopaedic care for patients in underserved communities.
Surgeon demographics influence patient trust and outcomes
Your relationship with your patients affects their willingness to seek care. When patients see providers who look like them or share their cultural background, they are more likely to feel comfortable and adhere to treatment plans. Orthopaedic surgery, however, is one of the least diverse specialties in medicine. White men make up most of the workforce, while Black, Hispanic, and female surgeons remain underrepresented. Increasing diversity in the field may help improve patient trust and engagement.
Bias in treatment decisions is also a concern. Research shows that Black and Hispanic patients receive less pain management for fractures than white patients, even when they report the same pain levels. These disparities suggest that unconscious bias influences clinical decision-making. If you and your colleagues participate in structured bias training, you can help reduce disparities in surgical recommendations and post-operative care.
Action Step: Encourage your hospital or practice to implement regular bias training sessions. Research has shown that structured education on implicit bias can improve awareness and reduce disparities in treatment decisions.
Systemic barriers make equity difficult to achieve
Even if you are committed to equitable care, systemic barriers can limit what you can do in your practice. Insurance reimbursement policies discourage many private orthopaedic offices from accepting Medicaid patients, reducing access for lower-income populations. When patients struggle to find a surgeon who will accept their insurance, they experience delays in diagnosis and treatment, leading to worse outcomes.
Socioeconomic factors also affect your patients’ ability to receive care. Many lack reliable transportation, time off from work, or caregiver support at home. Language barriers and health literacy gaps can make it difficult for patients to understand their treatment options and post-surgical care plans. If you do not address these factors, disparities in recovery rates and complications will persist.
If you believe in the ethical principles of beneficence and justice, these disparities should concern you. However, good intentions alone are not enough. Systemic problems demand structural solutions, and those solutions require collaboration among healthcare professionals, hospitals, and policymakers.
Action Step: If your practice or hospital sees a high percentage of Medicaid patients, advocate for better reimbursement policies at the state and federal level. Financial incentives for orthopaedic providers who accept publicly insured patients could improve access to care.
Strategies for improving equity in orthopaedic care
If you want to help close these gaps, you need both policy changes and practice-level interventions.
Insurance reform
Push for Medicaid expansion and improved reimbursement models to make it easier for private orthopaedic practices to accept publicly insured patients. Hospitals that serve vulnerable communities may need additional funding to support equitable care.
Workforce diversity
Encourage underrepresented students to enter orthopaedic surgery by participating in mentorship programs. Residency programs should prioritize diversity in recruitment and offer support for medical students from underrepresented backgrounds.
Technology in patient care
Expand the use of telemedicine for pre-surgical evaluations and post-operative follow-ups. Remote monitoring tools can help catch complications early, reducing the need for in-person visits for rural and low-income patients.
Community engagement
Partner with local organizations to educate patients about orthopaedic conditions and their treatment options. Outreach programs tailored to cultural and socioeconomic barriers can improve trust between you and your patients.
Bias training and standardized treatment plans
Participate in structured training on unconscious bias to improve equity in clinical decision-making. Standardized treatment guidelines can also help ensure that all patients receive consistent recommendations for pain management and surgical intervention.
Related: The Importance of Standardization in Orthopaedic Procedures
Moving forward requires action at multiple levels
If you want to reduce disparities in orthopaedic care, you cannot do it alone. Surgeons, hospitals, policymakers, and insurers must work together to address systemic barriers. Changes in reimbursement policies, diversity initiatives, and technological advancements can help level the playing field for patients. The goal is a healthcare system where access to high-quality orthopaedic care does not depend on race, gender, income, or geography. These challenges are complex, but meaningful progress is possible when you take action.
Sources
Disparities in Access to Musculoskeletal Care: Narrowing the Gap
Grand Rounds: Understanding Health Disparities in Orthopaedic Surgery: An Epidemiological Approach
Lessons Learned About Addressing Health Disparities in Total Joint Arthroplasty
New Data on Orthopedic Care Disparities Mirrors Lack of Provider Diversity.
Patient Disparities and Provider Diversity in Orthopaedic Surgery: A Complex Relationship
