Let’s fix orthopedics.
Deep down, I’m an optimist, fervently believing that we can elevate orthopedics to new heights. However, our beloved field is at a crossroads. For surgeons, hospitals, patients, and industry workers, the current trajectory isn’t promising.
This isn’t a moment for despair but for action. As we journey through the late-2020s, the old paradigms are fading, opening doors to innovation, efficiency, and a more impactful future in orthopedic care.
Below as a playbook of what I believe that we can do better together. Starting with what has changed, and then what you should do differently to help.
Here are 13 thoughts for improvement.
1/ A new customer pain point.
The manufacturers MUST realize this. Labor has become the bottleneck for customers. Not technology, not outcomes, not price, and not VACs.
Over the last few years, your hospital customers have been burdened with more steps, more procedures, more quality control, more reporting, more surgical instruments, more inventory, more HIPPA, more patient followup, and just more of everything. This complexity is killing the over-worked healthcare workers and the over-worked surgeons. One of our BoneChat members owns a hospital in Ohio and says, “We are now at the tipping point.”
What you should do –> Stop forcing new products (new implants, new guides, new imaging, new robots, etc) on your customers and start helping your customers with technologies and services that reduce their labor, reduce their time and reduce their costs. Win-win.
2/ Innovation by purchase
Today 100% of Innovation is coming from the Small Ortho sector. This was not the case when I worked at S+N, Sulzer and Wright. Today, the Big Orthos have given up on anything that smells like risk-taking to create innovation. The Big Orthos have shifted to an external R&D approach by acquiring other companies “once the innovation is safe enough” to acquire. The acquired startup company must de-risk the product or technology for the Big Ortho by checking many boxes (tech, IP, Reg approval, high rate of surgeon adoption, good margins, etc).while at the same time operating the company.
What you should do –> If you are in Small Ortho, take bigger risks, because you are effectively the R&D engine for the Big Orthos. If you are in Big Ortho, recognize that you cannot take risks, and support your Business Development teams to review and evaluate more startups faster.
3/ Clinical data is misdirection.
Everyone claims they need clinical data for products (surgeons, hospitals, VACs, FDA, etc.), yet it rarely influences product selection decisions. Clinical data has turned into a mere formality rather than a decision-making criterion. “Yes, we have clinical data for our ABC Product. What’s your next question?”
What you should do –> Continue with your pre-requisite clinical data collection (as a checkbox), but prioritize Economic Analysis to showcase cost savings for hospitals/ASCs and the healthcare system at large. Economic outcomes are now outweighing Clinical outcomes in importance.
4/ Access is the new barrier.
For Small Orthos, gaining access has become the primary challenge. The Big 7 Orthos (J&J MedTech, Medtronic Spine, S+N, Stryker, ZB, Arthrex, Glovasive) are fortifying their position by controlling access to healthcare providers, effectively marginalizing smaller competitors. They’ve intentionally engineered a ‘Confusopoly.’
What you should do –> Develop products and services that bypass the extensive contracts controlled by the Ortho Industrial Complex. Think revisions, oncology, AI, soft tissue procedures etc.
5/ The robot trojan horse.
Let’s be honest! Robots are primarily a strategy for Big Ortho to dictate implant selections within hospitals, occasionally serving as a marketing edge for hospitals against their rivals. Hospitals have been misled into integrating these complex robots into the OR, thereby diminishing their freedom in choosing implants. Although there’s evidence suggesting benefits like quicker recovery and better alignment, the high costs and complexities of these systems are still contentious. The bulky, refrigerator-sized robots of today aren’t the solution; the future lies in robots becoming increasingly smaller and eventually invisible and commonplace. Read – The shrinking… then disappearing robot in orthopedics.
What you should do –> Don’t get caught up in the allure of robots. Go back and review point #1.
6/ Sales: from jack-of-all-trades to specialist.
The role of sales within the orthopedic industry has evolved into a highly specialized function. Previously, sales reps were versatile, handling everything from product receipt to assisting in surgeries, acting as material managers, problem solvers, and key communicators. Now, the landscape has changed; reps often find themselves relegated to mere “box openers,” operating in a service-only capacity. This shift has led to reduced earnings as they maintain rather than expand their client base, focusing on service in hospitals that were initially secured by others.
What you should do –> If you’re a sales representative at a large, structured company, consider transitioning to a smaller, less rigid organization where you can take on a broader role with the potential for greater compensation.
7/ The emergence of Zombie companies
In the aftermath of the Zero Interest Rate Policy (ZIRP), a new breed of orthopedic companies has arisen – the Zombies. These entities either raised excessive capital or went public prematurely, resulting in perpetual unprofitability with no viable path to delivering returns to investors or shareholders. They neither grow nor collapse, stuck in a limbo of existence.
What you should do –> Take the time to assess your current position. Whether you’re on a W2 or 1099, familiarize yourself with your company’s financial health. It’s either on a path of growth, in decline, or stuck in Zombie status. If you find yourself in a Zombie company, it’s wise to seek opportunities with a company that’s expanding and thriving. Read to learn more about the characteristics of a Zombie company here – The Rise of Zombie Ortho Companies.
8/The futility of incrementalism
Incremental technology is NOT the answer for your company or our industry. Most innovation seen coming out of orthos these days is”incremental”. A new coating, a new expanding cage, a new instrument. Our industry has become a “fashion” industry, where companies must update the latest plate, cage, joint every year to stay relevant. This doesn’t work anymore.
What you should do –> Create a litmus test inside your company to test if you are really solving a clinical unmet need. And always go back and review point #1.
9/ The diminishing value of trade shows
The utility of major surgical conferences is waning, evidenced by reduced surgeon attendance, smaller exhibit spaces, diminished sales engagements, and fewer interactions between companies and surgeons. This shift is propelled by the move towards digital information platforms and the increasing demands on practitioners’ time. See The decline of NASS: Why device companies are abandoning big conferences.
What you should do –> Conduct a thorough return on investment (ROI) analysis for each trade show you attend. Then, adopt an innovative strategy for participating in smaller shows. Refer to Maximize your success at Medtech Conferences, Investor and Trade Shows.
10/ Real magic in streamlined personalization
Additive manufacturing has revolutionized orthopedic surgery by enabling the creation of personalized implants and single-use instruments, which are both innovative and appealing. However, the true innovation lies in the streamlined workflow from imaging to implantation, which optimizes every step for speed, accuracy, and efficiency, ultimately leading to better surgical outcomes.
What you should do –> Focus on optimizing your process from imaging to surgery to truly leverage the benefits of personalized orthopedics. Read It’s the System stupid ! Not the Implants.
11/ AI based decision making
Prepare for a transformative future where AI will fundamentally change how clinical decisions are made. Healthcare providers will leverage AI to ask these two critical areas
1/ Should I Treat? AI will revolutionize diagnosis and classification, providing clear guidance on whether treatment is necessary. By analyzing vast amounts of data, AI can offer insights into the progression of conditions, potentially identifying those that might resolve without intervention versus those requiring immediate action.
2/ How Should I Treat? AI unleashes its potential in treatment planning, transforming complex medical decisions into tailored, precise strategies. It leverages predictive analytics to suggest the most effective treatment options, considering patient-specific data to optimize outcomes, reduce risks, and personalize care.
The integration of AI with minimally invasive procedures is ushering in a new frontier in orthopedic care. AI tools provide surgeons with unprecedented precision, customizing surgical plans to individual patient anatomies and conditions. Alongside this, the rise in minimally invasive techniques is shortening recovery times and improving patient outcomes, marking a significant shift towards more effective, less invasive treatments. This synergy between AI and surgery is setting the stage for a more intelligent, patient-centric orthopedic practice.
What you should do –> First, “prompt engineering” is the new skill that everyone will have to learn this year to better use the new AI tools.every ortho person should learn prompt engineer skills to do your job better (play with these free tools – Grok, Claude, ChatGPT, Gemini). Secondly, every company should create an AI Product Manager role who works closely with logistics and operational people.
12/ Transforming sales in the tech era
The landscape of orthopedic sales is undergoing a significant shift from traditional implant sales to a technology-driven approach. Selling tech at scale requires a different skill set, involving new jargon, extended sales cycles, and specialized tools. The sales force, accustomed to the physical and tangible aspects of implant sales, must now integrate tech sales competency, adopting systems they’re not used to. This transformation is not just about selling new products but understanding and conveying their integration into healthcare systems differently.
What you should do –>
- For Independent Distributors or Sales Leaders: Lead the transformation within your sales organization. Shift from a generalist to a specialist model where your team is trained in the nuances of technology sales. They need to understand not only how to sell these products but how they fit into the larger ecosystem of healthcare, enhancing patient outcomes and operational efficiencies.
- For Implant Manufacturers: Support or demand the evolution of your sales teams into dedicated tech sales units. This involves investing in comprehensive training, adopting new sales methodologies, and possibly restructuring teams. Your sales force should be equipped with the knowledge to educate healthcare providers on how technology can lower costs, improve outcomes, and streamline hospital operations.
13/ Hospital need to diversify revenue streams
Hospitals traditionally rely on revenue from patient care services, including inpatient and outpatient treatments, surgeries, and diagnostic services. However, with the evolving healthcare landscape, including shifts in payer models, regulatory changes, and patient expectations, this model is becoming less sustainable. The pressure to reduce costs, manage reimbursements, and navigate payer negotiations has intensified. Meanwhile, ASCs have demonstrated agility by diversifying their income sources beyond direct patient care, tapping into areas like ancillary services, partnerships, and retail health. Hospitals, however, often lack the expertise or infrastructure to pivot quickly into these new revenue streams, which require different business models, marketing strategies, and operational know-how.
What you should do –> Recognize that hospitals must embrace ancillary services. Hospitals can look to incorporate services like imaging centers, physical therapy, wellness programs, or even pharmacies within their premises or through partnerships. These services can attract patients outside of traditional care scenarios, providing a steady revenue stream. Learning from ASCs, hospitals can focus on creating patient-centric service hubs that offer convenience and comprehensive care.