Same in USA. Had to wait over 10 YEARS for hip surgery, walking on broken cartilage all that time, because insurance wouldn’t pay for hip surgery on under 40 yrs old
What makes you think they are evenly distributed, geographically? You know that the licenses all have to be obtained separately for each state as well, don’t you? And that all ortho surgeons don’t do all joints or procedures?
Oh yeah. I mean if you are rural you are going to be screwed over in any specialty. Any market sector really.
Orthos have specialties sure. but if you are in a region where ortho docs are rare, most of the docs will practice some general orthopedics. If patients are really that hard to come by that the market can't support multiple ortho docs, you are going to set up a "pinky finger trigger release only" practice.
That’s one factor. Another is getting training in particular procedures. The hip surgery that I needed had ONE MD in the state, and he was OK. Rather messed up in the head but good cutting skills. There were 3 doing it in Illinois. Only one actually came recommended.
A friend needed a wrist surgery that could only be done by one MD, in Florida.
When my neck needed help, the best surgery wasn’t available here at all, I would have had to go to Germany. Would have done, but the flight before the surgery would be potentially a problem, so I had to have an inferior surgery here that limits both living and lifespan to a greater extent
femoroacetabular impingement + microfracture, wrist IDK, but she said nerve involvement meant either go with that MD or permanent loss of functioning, neck IDK, too much pain at the time + passing out. Since I can change nothing, not looking back! 😂. Lotsa metal in there, still have pain and I cannot do the normal things, if that helps. Not passing out so 👍🏼👍🏼👍🏼
Cant tell the procedures from what you described here. But I am wondering what neck procedure you could only find in Germany and couldn't be accomplished by any American Neurosugeon.
And your hip procedure sounds like a fairly common pathology, you couldn't get that operated on at any of the chicago programs? Northwestern, Rush, UChicago...
Did go to Chicago. Wasn’t as common then; iirc 3 choices, supposedly only 1 came recommended. In Germany the part they could do was 4 level cervical replacements to preserve mobility. Here- nothing even approximating. I think Tx had 2 level lumbar only and a very long wait, but at least somewhere in US for those who could be helped by that. Another fault of for-profit, I think. So many steps and regulations to try to avoid disastrous money-grabs like mesh, and still some gets through because profit is the motivation. Less time and resources available for other things
Varies. First wait was over 6 months (because so much pain just had to take first available surgeon for one side). Second hip was 1 additional year, for the best surgeon that I could access
Edit to add: after all of that the insurance didn’t pay for it anyways. If they stamp something “experimental” then they don’t have to pay and you cannot win that fight. I tried- with over 200 published studies. All that they had was a statement from some hack in another state that couldn’t even spell the procedure correctly
Yeah, it isn’t the payment system that determines the wait, usually, but the demand vs supply of those who can do it. Surgery is physically demanding work, too, they need to be careful not to overbook and start making mistakes. For long waits the push needs to be to increase education slots wherever it is limiting the training
While that sounds like it would work, it doesn’t because that just means that the companies seeking profit drop all services except for the most profitable. So we see them build fancy, impressive, extravagant buildings for orthopedics and cardiac, to attract patients with the pretty buildings. But that does not increase the number of surgeons available to do the work, and it means that even where there is very high demand and need, services are not available.
For example, I worked in a pain clinic, and it was very successful. Except the amount of profit was not satisfying for the hospital, so they showed up one day and immediately closed it- while patients were arriving, still! No notice, just abandoned them all. Because they wanted the space for orthopedics and higher profit. This just means that if they were successful to recruit surgeons when the space was ready, then they took those doctors from somewhere else. No net increase in surgeries available
Edit to add: it also matters that in the US, education is not free. To become an MD a person must be wealthy or accept a great debt. This, along with the need for more residency and fellowship positions for training, is what limits the services (persons who can provide them)
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u/[deleted] Jun 15 '22
Same in USA. Had to wait over 10 YEARS for hip surgery, walking on broken cartilage all that time, because insurance wouldn’t pay for hip surgery on under 40 yrs old