Virtually every orthopedic service line leader in the country is planning for more patient volume. What only a handful of them have fully planned is how they will manage those volumes. It's becoming increasingly clear that the demand for joint replacement keeps climbing, while the supply of surgeons to perform it is projected to shrink, particularly as CMS continues cutting surgeon reimbursement for joint replacements. A federal analysis published in Orthopedics and covered by Healio highlighted the growing projected shortage of orthopedic surgeons by 2037. Importantly, both analyses argued that this is “not beyond our influence,” and we agree. For our hospital and clinician partners, the most durable lever isn't recruiting more staff; it's redesigning how the care team's time is spent across the episode of care.
A Widening Gap Between Demand And Supply
Drawing on the Health Resources and Services Administration's (HRSA) Health Workforce Simulation Model, the federal analysis projects that the supply of orthopedic surgeons will fall from 31,980 in 2025 to 30,620 in 2037–a 4.3% decline–while demand rises from 33,690 to 35,850 over the same period, a 6.4% increase. The practical result is that surgeon adequacy (the percentage of supply versus demand) slips from 94.9% to 85.4%.
A separate HRSA workforce projection reached a similar conclusion: orthopedic surgery is on track for roughly a 12% shortage by 2038, as reported by Becker's Spine Review. These are not distant challenges; Becker's notes the trend is already visible in Bureau of Labor Statistics data showing a decline in practicing orthopedic surgeons since 2021.
On the demand side, the pressure is even sharper for arthroplasty specifically. The AAOS has projected that, to keep pace with need through 2050, orthopedic surgeons will need to roughly double their total joint arthroplasty (THA/TKA) caseload, or the field will need to add surgeons at about 10% every five years. Average primary TJA caseload per active surgeon was projected to rise from 65.2 procedures in 2017 toward 139.4 by 2050. Put simply: fewer surgeons are being asked to carry substantially more episodes.
Why The Shortage Is A Care Model Problem
It is tempting to read a workforce projection as strictly a recruitment and pipeline challenge. While expanding residencies, growing fellowships, and retaining aging surgeons a few years longer are all valid approaches, they have their own challenges. Training a new orthopedic surgeon takes well over a decade, and the demand curve is steeper and nearer than the supply curve can shift. That mismatch is precisely why the Healio commentary framed the shortage as influenceable rather than inevitable: the leverage available in the next few years lives in how care is delivered, not only in how many surgeons are hired.
Most of a surgical episode does not happen in the operating room. It happens in the weeks of preparation before surgery and the 90 days of recovery after. This is the window where readiness, education, monitoring, and follow-up determine outcomes and cost. Historically, that window has been staffed by nurses, navigators, and physical therapists making phone calls, fielding inbound questions, and manually chasing down patient-reported outcome measures (PROMs). Every one of those minutes is a scarce, clinical resource. As the workforce tightens, the episode's manual overhead is the first thing to break.
Extending The Care Team Beyond The Four Walls
This is the core of what the Force Therapeutics platform is built to do: extend the care team across the full episode of care–pre-op through recovery–without requiring partners to add headcount or brick-and-mortar settings. With Force, condition- and procedure-specific care plans guide patients through their surgical journey with video-based education and structured milestones, so that routine questions are answered before they become inbound phone calls. Remote monitoring surfaces the patients who need a human touch and lets the rest progress on a proven pathway. The effect is not to replace the care team but to concentrate its scarce hours on the patients and moments that most need them.
The ongoing site-of-service shift makes this even more urgent. As joint replacement continues migrating to hospital outpatient departments (HOPDs) and ambulatory surgery centers (ASCs), care teams are managing more of the episode outside the walls of a traditional inpatient setting. Leaner settings simply cannot absorb the same manual coordination load. A digital care management layer that accompanies the patient across inpatient, outpatient, and ASC settings is a reliable mechanism for holding quality steady while volume climbs and staffing stays flat.
Capacity And Quality Are Linked Challenges
There is a temptation to treat capacity and quality as competing priorities by assuming that doing more with less means accepting more variation. But value-based bundles do not allow that trade. Under programs such as the Transforming Episode Accountability Model (TEAM) and the Comprehensive Care for Joint Replacement Expanded (CJR-X) Model, partners are held accountable for cost and quality across the episode, including for PROMs. A staffing shortage that quietly erodes PROMs compliance or lengthens recovery follow-up isn't only a capacity issue; it is a reimbursement and quality measure risk.
That is why we treat automated PROMs collection as inseparable from workforce strategy. When outcome capture runs automatically rather than through manual outreach, compliance holds up even as caseloads rise. Our real-world evidence, including a 22,000-patient THA/TKA analysis, points to the same conclusion: engaging patients digitally across the episode can satisfy quality reporting, registry requirements, and certifications from The Joint Commission or for Centers of Excellence while absorbing volume that would otherwise require more staff.
How Orthopedic Programs Should Prepare
If your service line is forecasting volume growth, the workforce projections should reframe your long-term planning conversations. The binding constraint over the next several years is unlikely to be operating room time or implant supply; it is the clinical labor available to manage everything around the procedure. Three questions are worth putting to your team now: How many hours does your staff spend each week on manual pre-op prep, education, answering questions over the phone, and PROMs chasing that could be automated? Where would a surgeon or nurse retirement or exit leave the biggest coverage gap across the episode? And are your outcome reporting workflows resilient enough to hold compliance if caseloads rise 10% or 20% without added staff?
The organizations that fare best will be the ones that redesign the episode so their existing care teams can reach more patients, more consistently, with less manual burden.
To learn more about how leading institutions are extending their care teams to meet rising demand without adding staff, reach out to the Force team:
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